Academia: the view from below

A national career structure is needed for medical academics

The problems of training and recruitment of academic medical staff have been the subject of a recent independent working party report1 and several editorials.2 3 All suggest long term changes in the academic career structure, but they fail to address the real life problems of “partially trained” junior doctors currently employed in academic posts. This editorial reflects the views of just such a group of academic trainees engaged in research at the Institute of Child Health and Great Ormond Street Hospital, London, UK. The current uncertainties in academic training have led many of us to question our future in academic medicine, and we suggest that a more structured and consistent approach to the academic career ladder would improve academic recruitment.

Our decisions to embark on academic training were made for a variety of reasons: some aimed to improve career prospects, others relished the intellectual challenge of being at the forefront of research, but only a few felt the compelling “inner force” described by Sir Rex Richards.1 All of us, however, are faced with an academic career structure in disarray; this compares unfavourably with conventional clinical training, which is now both clearly defined and relatively short following the implementation of the Calman report. A further disincentive is the lack of matching of junior and senior academic posts in some specialities, where the number of trainees bears no relation to the number of senior positions available. Our uncertainties have been exacerbated by difficulties in obtaining appropriate and consistent advice from our colleges and deaneries.

Currently there is no uniformity, either within specialities or within regions,in the training and research components of, or entry qualifications for, research fellow and lecturer posts. The lecturer is often regarded as an extra ward registrar, with or without a research project: as someone to teach the medical students; organise exams and courses; and undertake any other additional clinical duties required. Lecturers often have little time for research and no formal training, supervision, or assessment. Many research fellows are in a similar position, particularly those with short term funding. Although their projects are for a higher degree, these may be poorly thought out and ill supervised.

Minimum standards should be established for research fellow and lecturer posts, and these posts should be accredited and monitored. Those with a serious interest in an academic career need a higher degree, either an MD or PhD. This can be undertaken at any stage of specialist training, but it is vital that the time spent as a research fellow is dedicated to research and that any clinical work is purely supernumerary and done at the discretion of the trainee and his or her research supervisor. Furthermore, as academic posts are not evenly distributed between specialities, those considering an academic training need to be given realistic career advice. Otherwise, they may be left with no alternative but to take up positions which have little relevance to their chosen speciality when they complete specialist training. Research fellow posts leading to an MD or PhD are clearly inappropriate for those who merely want a taste of research. A well structured and supervised one year degree, such as an MSc, should be available for this group.

The aim of a lecturer post should be to train the senior lecturers of the future—individuals with the skills to oversee research and training programmes. To develop these skills in parallel with a clinical training, lecturers must have a higher degree at the time of appointment and have protected research time which is not compromised by covering for clinical colleagues. Fundamental to this is an explicit job plan defined by the supervising consultant, the postgraduate dean, and the NHS trust, with a clear delineation of protected research and clinical time. Accrediting lecturers only for their clinical commitments and not their research time greatly lengthens their training and may deter those who take a career break. Measures of competence, as well as simply time spent in post, should be incorporated in the assessment for the certificate of completion of specialist training. One further limitation of the Calman scheme of specialist training for the academic trainee is that it reduces national mobility, which may be critical in smaller specialities. We therefore support a national career structure for academics.

The diverse specialities in clinical medicine have created a relatively uniform and clearly defined career structure under the Calman scheme. If academic medicine in Britain is to continue to attract enough high calibre trainees it needs to offer comparable training programmes with a clearly defined academic career structure.