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THE term “academic medicine” can conjure up nostalgic images of white coats, eccentric professors and dingy hospital research departments.
While these images may relate to a bygone era, the central tenets of clinical academia remain unchanged.
Today clinical academics typically have conjoint university and health service appointments, and assume a blend of clinical, teaching, research and leadership roles. Numerous models exist, reflecting differences in emphasis and employment arrangements.
As a consequence of an ageing and increasingly part-time academic workforce, the number of full-time equivalent clinicians who are active in research and education is in relative decline. At the same time, trainee numbers have expanded with the resulting mismatch of supply and demand for clinical academics becoming increasingly problematic.
It’s for this reason that numerous organisations, including medical schools, colleges and peak bodies, have turned their attention to recruitment and retention strategies for academic clinicians. The focus on these efforts has been reinforced by the release of the McKeon Strategic Review of Health and Medical Research.
The problem doesn’t appear to be a lack of appeal among trainees. About 50% of Australian medical graduates are keen to become involved in research and more than three-quarters express an interest in teaching. Record numbers of graduate-entry medical students hold higher degrees, with 8% having a master or PhD qualification.
That this interest is not being converted into an academic workforce indicates significant barriers. These include a lack of distinct career paths, absence of mentoring opportunities, pressure to complete specialty training, demands of clinical practice, poor job security and pay inequity.
An accessible career pathway that trainees can enter and exit at various stages along the medical education continuum should be a priority. While an integrated path that spans different specialties is unlikely, increasing the flexibility for junior doctors to build their research or teaching experience during their prevocational and vocational years is a crucial first step.
International experience is available to inform the development of a clinical academic pathway in Australia. One example is the academic stream of the UK’s Foundation Programme, which allows prevocational doctors to complete an extended academic term that provides opportunities to develop research, teaching and clinical leadership skills. This program has been popular among trainees, and a recent evaluation showed it has strong support.
Australian equivalents are in their infancy. Although college training programs increasingly reward research experience, there are few health service positions that provide funding for education and research activities alongside service delivery.
Melbourne Health has recently implemented a hospital medical officer quality improvement position with similar posts in other hospitals. Many large teaching hospitals now have medical education registrar positions, allowing vocational trainees to further develop their skills in teaching, and there are isolated examples of registrar-level positions that include a funded research component, such as the Australian General Practice Training academic registrar initiative.
Opportunities for junior doctors to further develop research, teaching and leadership skills are crucial to maintain early academic interest through to advanced specialty training, where the pursuit of a higher degree is generally more accessible and acceptable.
Structures are also needed to support emerging clinician academics who have completed specialty training, including positions and departments that provide conditions and entitlements commensurate with those of full-time clinicians. At all stages, role modelling and mentoring are critical.
The AMA recently released a model for this type of articulated clinical academic training pathway, following similar suggestions from other organisations. Among these proposals is a call for greater integration between universities, health services and funding partners.
With the impending introduction of activity-based funding for teaching, training and research, the case for establishing more explicit clinical academic career pathways is compelling. Not only will this enhance education and research outcomes, it is in the firm interests of high-quality clinical care.
Dr Will Milford is a senior obstetrics and gynaecology registrar at the Mater Women’s Hospital, Brisbane, and chair of the AMA Council of Doctors-in-Training. Dr Rob Mitchell is an emergency registrar at Townsville Hospital and a director of Cor Mentes Health Consulting.
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I think the real problem is the selection of medical students.
We are increasingly concerned with intellect mixed with great communications skills. This does not necessarily match all people who wish to do research.
we need to focus on the entry level. If it is determined that there are certainly attributes required in a medical researcher, then we should be identifying them in candidates for medical courses.
It would be useful to have opportunities for experienced clinicians wanting to reduce their clinical time as they start to approach retirement to take part in relevant research, including opportunities to set up trials etc. I have made approaches to scientific /medical research colleagues but received little more than a polite hearing. This may be because they spend their time under pressure to publish or appply for competitive grants etc, but I think there is also a culture of thinking pure clinicians are outsiders not to be seriously engaged with.
It is our professional responsibilty to support medical research.
Although many students express an interest in academic medicine, this is followed through by only a few. The reasons are complex and I think Will and Rob have covered well the importance of a clear career pathway (generally missing) and renumeration (in most states, albeit with some exceptions, academics get paid less than clinicians). Other barriers include (i) after, or in addition to vocational training the required extra work to become a productive medical academic for the same or less pay weeds out many, (ii) a perception that academia means forgoing clinical work (although this is true to an extent, academic life can help one to maintain clincial longevity), and (iii) huge difficulties obtaining medical research funding for those considering a research career. I dont have the solutions for these problems.
Another common mistake, I think, is to separate academics from clinical units- Academics need to be firmly embedded in clinical units and accountable to them. We need to do our best to make sure our work is highly relevant to the clinicians around us, and that they are true partners in the academic endeavor to improve patient care through the acumuation of high quality evidence and through teaching that is based on evidence and critical analysis. No easy task, especially when academic work needs a quiet space and time to think.