Traditionally, clinical research fellowships are occupied by junior trainees and are used as a stepping stone not only to an academic career but more commonly to the higher specialist training scheme. In the United Kingdom, clinical academic medicine is having difficulties in recruitment, especially to senior posts, and in academic surgery several professorial chairs remain vacant because of a shortage of suitable candidates.1
Analysis of research papers presented at surgical meetings over the past 20 years has shown a considerable reduction in the number of randomised clinical trials and a corresponding increase in the number of basic scientific projects.2 Surgical research has recently been criticised for its poor quality and lack of evidence based “patient oriented research that matters.”3 Training in research methods is important for surgeons conducting research, and a previous survey showed that this view is shared by consultant surgeons.4 However, little is known about the surgical trainees in research fellowships or about their career aspirations.
The Calman report, Hospital Doctors: Training for the Future, recommended in 1993 that postgraduate training should be shorter and more structured, with research—and presumably research fellowships—being undertaken during the period of higher specialist training.5
We examined the views of research fellows towards research and investigated whether the recommendations of the Calman report on research and surgical training had been adhered to.
Methods and results
In 1999, we asked all 53 professors of general surgery in the 24 academic departments of surgery in the United Kingdom for the names of their research fellows; 48 responded. An anonymous postal questionnaire survey was then sent to the 123 fellows identified; non-responders received a second distribution. The response rate was 74% (91/123). The table shows the training undertaken by surgical research fellows and their attitudes towards research.
In total, 64% (58/91; 95% confidence interval 53% to 74%) of the research fellows were experienced senior house officers before carrying out their research; 32% (29/91; 22% to 42%) were specialist registrars during their period of higher specialist training. In all, 66% (60/91; 55% to 76%) were in their 30s or older. Surgical research has traditionally incorporated clinical studies into the surgical management of disease and the development and evaluation of surgical techniques. A total of 18% (16/91; 10% to 27%) of fellows were working on purely clinically oriented research, compared with 43% (39/91; 33% to 54%) for laboratory based projects and 38% (35/91; 28% to 49%) for studies comprising both elements.
During their research, 77% (70/91; 67% to 85%) of the respondents were required to undertake clinical duties including on-call rotas, outpatient clinics, and minor procedure lists and to assist in theatre, as well as teaching. Their duties varied but were often tied to their funding, for which major grant awarding bodies, hospital trusts, and private industry each provided one third.
Comment
Most surgical fellows are undertaking research before obtaining their specialist registrar posts and for the sole purpose of career advancement; the research is more commonly laboratory based than clinical. The appropriateness of the timing of the research in a surgeon's career, the reason for doing it, and the nature of the research undertaken is questionable, particularly in view of the current debate on the quality of surgical research.
Two thirds of research fellowships are being undertaken before higher specialist training, against the recommendations of the Calman report. Owing to the lack of comparative data from the “pre-Calman” era, we are unable to identify whether or not this represents a continuing trend or a change.
Our results reflect the motivation of the fellows in undertaking research. The high percentage of respondents having career advancement as their only aim may be related to the competition involved in obtaining a specialist registrar post, and presumably research enhances their curriculum vitae.
Table.
Training of surgical research fellows and their attitudes towards research. Results are numbers (percentages)
| Respondents (n=91) | Respondents (n=91) | |||
|---|---|---|---|---|
| Sex | Working towards a higher degree? | |||
| Male | 76 (84) | MS/MSx/ChM | 13 (14) | |
| Female | 15 (16) | MD | 60 (66) | |
| Age (years) | phD | 14 (15) | ||
| 25-29 | 31 (34) | Undecided | 1 (1) | |
| 30-34 | 49 (54) | No | 3 (3) | |
| 35-39 | 10 (11) | Clinical commitment? | ||
| >40 | 1 (1) | Yes | 70 (77) | |
| Postgraduate qualification | No | 21 (23) | ||
| FRCS | 77 (85) | Principal source of funding* | ||
| MRCS or AFRCS | 10 (11) | Internal (NHS trust) | 30 (33) | |
| Other | 4 (4) | External: | ||
| Post prior to research | Grant awarding institution/trust | 31 (34) | ||
| Junior house officer | 1 (1) | Private industry hospital | 27 (30) | |
| Senior house officer | 58 (64) | Pharmaceutical company | 5 (5) | |
| Specialist registrar | 29 (32) | Preferred duration of research | ||
| Consultant | 2 (2) | 6-9 months | 3 (3) | |
| Other | 1 (1) | 12-18 months | 43 (47) | |
| Nature of research project | ⩾2 years | 35 (38) | ||
| Solely laboratory based | 39 (43) | No preference | 10 (11) | |
| Solely clinically oriented | 16 (18) | Reasons for doing research | ||
| Both | 35 (38) | Career advancement only | 54 (59) | |
| Other | 1 (1) | Pursuit of medical or scientific knowledge | 6 (7) | |
| Duration of research | Both | 31 (34) | ||
| 12-18 months | 19 (21) | Interested in a career in academic surgery? | ||
| 2 years | 63 (69) | Yes | 38 (42) | |
| ⩾3 years | 9 (10) | No | 24 (26) | |
| Undecided | 29 (32) |
Some respondents listed more than one source of principal funding.
Acknowledgments
We thank all the academic professors of surgery and research fellows who participated in the study, Professor Primrose for the name list of professors in the academic departments, and Mr Jim Paul and Dr Keith Vass for their statistical advice.
Footnotes
Funding: None.
Competing interests: None declared.
References
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