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Editor,—Should anyone decide to scrap secondary school education, one effect would be to make it near impossible for anyone to go to university. To axe clinical lecturer posts, as discussed in the alarming January 1997 editorial in the journal,1 would be an equally insane act, and would at a stroke virtually abolish recruitment into academic medicine.
The problem is that it is near impossible to get clinical lecturers to perform world class research (a) early in their research careers and (b) while needing to continue with clinical training. The situation is bizarre: it is like expecting an 11 year old to play cricket for England. The poor child needs to get further experience in the sport, as well as needing to continue with a general education. The solution is quite simply to forget about 11 year olds as being eligible for the national team, and to concentrate on their further development. By agreement with the Higher Education Funding Council for England (HEFCE), who make the rules, clinical lecturers should be excluded from the quinquennial research assessment exercise.
In commenting on the Archives editorial, an editorial in the Lancet has summed up the situation as ‘a research culture that asks too much’.2 Radical alternatives have been proposed, but are unlikely to work. One option, for which there is considerable pressure, is to make clinical lecturers wholly supernumerary to the clinical service, for approximately three years—sufficient time for a PhD. They would be engaged 100% of the time on research, and would have to spend additional years undergoing clinical training. However such an arrangement would require aspiring academics to take a very large salary drop, hardly a practical way to tackle the existing combined difficulties of recruiting into paediatrics and into academic medicine. Another option would be for NHS trusts to take over the funding of HEFCE funded clinical lecturer posts, but this seems little more than a pipe dream given the existing difficulties of getting NHS trusts to fund ordinary training grade posts.
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