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. 2002 May 25;324(7348):1275.

Academic medicine

Academic medicine is still hospital based

Campbell Murdoch 1
PMCID: PMC1123225  PMID: 12028988

Editor—Stewart in his editorial on academic medicine displayed a total lack of recognition that academic medicine includes general practice and other disciplines not included in “teaching hospitals.”1 The largest group of consultants in the NHS work in general practice, not anaesthesia, and maybe Stewart wondered how many general practice trainees were contemplating an academic career.

As someone who started an academic career in 1976 and is about to re-enter the fray, let me offer a different reason why academic medicine is so unpopular. Academic medicine is still dominated by the aristocratic hospital minorities such as internal medicine and surgery, which play such a small part in the modern practice of medicine. Perhaps it is because they have so much time to spare that they can spend their time administering. To become a professor of medicine or surgery now you have to be young, impossibly specialised to the point of non-functionality in any clinical reality zone, and skilled either in the treatment of rats and cats or in plagiarising other people's research through meta-analysis. You then progress to deanship and the task of creating academics in your own image.

The hospital is now an obsolete concept, and most of the departments on which academic medicine is based are as outdated as orders of the garter, the bath, or the chamber(pot). What we need is for academic medicine to provide generic training in the education of students and postgraduates for the cream of those who have shown themselves worthy by surviving in the real world for a few years. The creation of a such a community of scholars is an urgent task and needs to be well funded. If I were in the British government I would not leave the task in the hands of universities because they would be the last people to know what I am talking about.

References

BMJ. 2002 May 25;324(7348):1275.

Clinical academic recruitment begins in clinical departments

M W Lim 1

Editor—Recent publications have highlighted the problems faced by established and aspiring clinical academics.1-1–1-3 But the role of clinical departments in nurturing or frustrating academic ambitions in specialist registrars, who form a major source for clinical academic recruitment, was not really mentioned.

Clinical academic training usually requires external funding for the salary and project costs of full time research.1-3 But competition for such funding is intense. To have a fair chance of success, time and effort need to be invested in background research, networking, organisation, pilot studies, drafting and revisions of funding applications, and other preparations.

Research time for trainees, in the form of study leave or research days, is not high on the priority list of clinical departments in university hospitals or district general hospitals. They are already struggling with the opposing demands of improving both clinical training and service and guard their manpower allocations jealously. The reduction in clinical time due to changes to working patterns in the new deal (and the forthcoming European working time directive) only exacerbates the situation.

The perception that research training is an unnecessary drain of scarce manpower is reinforced by the finding that most clinical fellows intend to return to clinical practice after fulfilling their interests or aims.1-1 Trainees wanting to do research are sometimes asked to do it in their spare time even though research training should be counted in the total hours worked. Many research related activities cannot be fit to whatever time off is available. Trainees may also be told that taking time to do research compromises their own or other colleagues' clinical training, although other non-clinical activities such as rota administration or teaching, do not similarly detract from anyone's clinical training. Yet others are told that requests for research time cannot be supported on a “value for leave” basis, unless research potential has first been established.

The clinical academic career is difficult enough without this additional layer of frustration. The disincentive is especially powerful since it affects some of the most important years in terms of preparation for entry into an academic career. Whatever time is lost cannot be easily made up within the ordained period and pace of specialist training. Therefore, this approach cannot be optimal for clinical academic recruitment.

Improved clinical academic training structures and clinical academic working patterns do increase the incentives. But they do not actually address the problem of pre-entry obstruction. A two pronged approach of addressing the manpower concerns of clinical departments and improving support for aspiring clinical academics, should complement the measures outlined in the publications.

Footnotes

  MWL's research projects and grant applications are supported by the anaesthetic departments of Kettering and Northampton General Hospitals.

References

  • 1-1.Stewart PM. Academic medicine: a faltering engine. BMJ. 2002;324:437–438. doi: 10.1136/bmj.324.7335.437. . (23 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.MacDonald R. Survey shows serious shortage of medical academics in the UK. BMJ. 2002;324:446. doi: 10.1136/bmj.324.7335.446. . (23 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-3. Robinson F. What can you expect from a career in academic medicine? Hospital Doctor 2002;21 Feb:38-9.
BMJ. 2002 May 25;324(7348):1275.

Academy of Medical Sciences responds

Mark Walport 1, Mary Manning 1

Editor—The Academy of Medical Sciences agrees with the diagnoses of the threats to academic medicine made by Stewart in his editorial.2-1 After its formation in 1998 the academy set up a working party under the chairmanship of Professor John Savill to examine academic medical careers. The party's main recommendation was the establishment of a tenure track career pathway for outstanding trainee academics.

Since the publication of the Savill report in April 2000 the Department of Health, the Medical Research Council, and several medical research charities have committed funds to establish a cohort of new fellowships for clinician scientists and a national committee to monitor these and award a new tranche of academic national training numbers (NTN(A)).2-2 The PPP Foundation has established a series of earmarked fellowships to help develop capacity in disciplines that are particularly threatened, including surgery, radiology, and anaesthesia. More funding is urgently needed.

Mentoring is a key element of career development and has often been a haphazard process in the past. The academy has set up a mentoring scheme to provide independent support and advice to young clinician scientists.

The academy's most recent report has focused on the needs of non-clinical scientists on short term contracts in medical research and highlights the problems of job insecurity, lack of adequate career structures or careers advice, lack of recognition and status, and the problems of remuneration. Failure of employers and funders to tackle these issues may hinder the modernisation of the research infrastructure on which the future development of the medical science base in the United Kingdom depends. Increasingly, the best research is produced by teams rather than by exceptional individuals working largely on their own.

The priority of the NHS is to provide the best possible medical services to the population of the United Kingdom. The support and nurturing of academic medicine must be a key element in attaining this goal. Medical education and training depends on first class teachers and researchers. The practice of evidence based medicine is a goal for everyone who looks after patients. We know, however, very little about many of the most important diseases, and only new research can provide many of the answers.

The academy will continue to play an important part in promoting academic medicine. At its most recent council meeting it agreed to set up a working party to examine impediments to medical research. It also undertook to examine ways of setting up entry level fellowship schemes to encourage bright young doctors to explore research for a year during their early postgraduate years.

References

  • 2-1.Stewart PM. Academic medicine: a faltering engine. BMJ. 2002;324:437–438. doi: 10.1136/bmj.324.7335.437. . (23 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-2.Academy of Medical Sciences. The tenure-track clinician scientist: a new career pathway to promote recruitment into clinical academic medicine—the report of an Academy of Medical Sciences working party chaired by Professor John Savill. London: AMS; 2000. [Google Scholar]

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