Strengthening the clinical academic pathway: a systematic review of interventions to support clinical academic careers for doctors and dentists

Barriers to Clinical Academic Surgical Training and Career Development in the United Kingdom: A Review from the National Institute for Health and Care Research (NIHR) Advanced Surgical Technology Incubator (ASTI) Group

Clinical academics play a vital role in advancing medical research, knowledge and treatments within the National Health System (NHS), but this career's sustainability is at risk due to barriers to accessing and pursuing research opportunities throughout a surgeon's training and career. Despite the diversification of surgical training with integrated opportunities, challenges such as limited training opportunities, lack of protected research time, and financial constraints persist. This paper from the National Institute for Health and Care Research (NIHR) Advanced Surgical Technology Incubator (ASTI) group highlights these issues, addressing the competitiveness of academic pathways, workload balance, mentorship importance, and the need for standardised assessments. It highlights the need for greater accountability from healthcare employers and academic institutions. Additionally, the paper focuses on increasing diversity and inclusion in clinical academia, addressing systemic discrimination, and changing the NHS culture. This paper calls for collective efforts from the medical profession, government, and institutions to address these issues.

How can we promote academic GP careers? A qualitative framework analysis of factors affecting the development of the academic GP workforce

OBJECTIVES

General practice continues to be an under-represented career choice among medical school graduates, and the retention of the general practitioner (GP) workforce remains challenging. Academic general practice (AGP) is vital to the development of the evidence base for general practice and the education of the next generation of doctors and GPs. Academic careers and portfolio careers in general practice are seen as a means of increasing retention of GPs in the profession. However, AGP remains largely invisible to many and the number of AGPs is declining. There is no clear understanding of the reasons for this. The aim of this study was to explore factors that inhibit and promote AGP careers.

DESIGN

Secondary framework analysis of data from two qualitative studies.

PARTICIPANTS, SETTING AND MEASURES

41 GPs, GP trainees and Academic GPs (25 females and 16 males) across Scotland. Analysis of the data employed a framework based on Feldman and Ng's model of the factors influencing career mobility, embeddedness and success in order to explore the barriers and enablers to GPs developing academic careers that exist at multiple levels from the personal to the structural.

RESULTS

GPs encountered barriers to entering AGP at multiple levels. Lack of clarity and visibility of training pathways, including the lack of clear routes into academia at multiple career stages, were significant barriers, as were the effects of taking on academic work on overstretched practices, and relative job insecurity and lower pay in academic careers.

CONCLUSION

The findings of this research demonstrate that unless the structural issues affecting the profession more generally are addressed, significant barriers to pursuing AGP careers will remain.

Students' and educators' perceptions of clinical academic pathways in the UK: a qualitative study

OBJECTIVES

This study aimed to understand the experiences and perceptions of medical students and medical educators regarding barriers and facilitators for pursuing clinical academic pathways.

DESIGN

A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was used for data analysis. Theoretical and snowball sampling approaches were applied for participant recruitment.

SETTING

University of Manchester and NHS Trusts in the Greater Manchester region.

PARTICIPANTS

The sample of this study was composed of 43 participants, including medical and dental students, clinical academics, clinicians and stakeholders.

RESULTS

Three themes were identified: Theme 1: Knowledge of the CA pathway; Theme 2: The costs linked to pursuing a clinical academic pathway; Theme 3: Exposure to and time for research.

CONCLUSIONS

While institutions offer opportunities for research experience, there is a need for extended and more tailored opportunities and information, and the overall cost of training for students reduces the attractiveness of the clinical academic pathway.

Gender, race and ethnicity biases experienced by hospital physicians: an umbrella review to explore emerging biases in the evidence base

OBJECTIVES

To examine the authorship and content of systematic reviews (SRs) of biases experienced by medical professionals through a gender lens.

DESIGN

Review of SRs.

DATA SOURCES

We searched PubMed, Embase, PsycINFO and CINAHL from inception. Searches were conducted in May 2022 and updated in October 2023.

ELIGIBILITY CRITERIA

Reviews of studies reporting biases experienced by hospital physicians at any stage of their careers and in any country. Reviews were included if they used systematic methods to search the literature and synthesise the data. Non-English language publications were excluded.

DATA EXTRACTION AND SYNTHESIS

The main theme of each eligible review was identified through qualitative thematic analysis. We used NamSor to determine the first/last authors' gender and computed the proportion of female authors for each review theme.

RESULTS

56 articles were included in the review. These covered 12 themes related to gender, race and ethnicity bias experienced by physicians at any stage of their careers. The overall proportion of female authors was 70% for first authors and 51% for last authors. However, the gender of authors by theme varied widely. Female authors dominated reviews of research on discrimination and motherhood, while male authors dominated reviews on burnout, mental health and earnings. Only six reviews were identified that included race and ethnicity; 9 out of the 12 first and last authors were female.

CONCLUSIONS

Understanding the potential for a gendered evidence base on biases experienced by hospital physicians is important. Our findings highlight apparent differences in the issues being prioritised internationally by male and female authors, and a lack of evidence on interventions to tackle biases. Going forward, a more collaborative and comprehensive framework is required to develop an evidence base that is fit for purpose. By providing a point of reference, the present study can help this future development.

PROSPERO REGISTRATION NUMBER

CRD42021259409; Pre-results.

Transitioning between clinical and academic practice from the perspectives of clinical academic trainees, academic training programme directors and academic supervisors: a mixed methods study

BACKGROUND

The career pathway of clinical academics in the UK is challenging. To pursue academic endeavors, trainees often undertake approved time 'Out of Programme for Research' (OOPR), a standalone research fellow post or join an 'Integrated Academic Training' pathway. Time out of training may impact their clinical skills, confidence and competency. The aim of this qualitative study was to explore the challenges associated with returning to clinical training after prolonged leave for academic trainees.

METHODS

Stakeholders were clinical academic trainees and supervisors within the Yorkshire and Humber region of England, and training programme academic leads from universities across England. Qualitative data-analyses of verbatim recorded data from three focus groups and 12 individual telephone interviews were conducted within an a priori framework.

RESULTS

Returning to a high-stress environment with a perceived lack of specialty-level advocacy and support, feeling isolated from peers, struggling to balance competing demands, meet clinical and academic expectations and managing clinical deskilling in a trainee's return to clinical training were common experiences described by stakeholders. There was a lack of recognition from academic leads, however, on the impact of such challenges on the trainees' subsequent ability to successfully integrate their clinical and academic careers. Various solutions were identified by stakeholders to overcome such barriers, including a normalised, phased, individualised supported return to work and capacity building for supervisors.

CONCLUSIONS

There is an apparent disconnect between the clinical and academic world, with clinical academic trainees stuck between the two, being pulled by each, feeling like they are not quite meeting the expectations of either. Time away from training for trainees on OOPR is often longer than for other reasons for time out of programme (typically 3-4 years if completing a doctoral degree). Given the importance of clinical academics in bridging clinical research and practice, and the concerns recently raised about the rate of attrition of clinician scientists within the NHS, it is of the utmost importance that clinical academic trainees are supported throughout all stages of their careers.

Perspectives on Academic Training in Clinical Oncology in the United Kingdom: A National Cross-Sectional Analysis

AIMS

There are longstanding concerns relating to clinical academic training pipelines, with evidence for multiple barriers and enablers to clinical academic career progression. We sought to assess the extent to which these and other factors apply to academic training in clinical oncology in the United Kingdom.

MATERIALS AND METHODS

A cross-sectional survey was undertaken using a bespoke, pre-piloted online electronic questionnaire that was distributed to clinical oncology specialty trainees and consultants who had at any point between January 2013-January 2024 commenced an academic post whilst in training. Collated information included demographic data, location and stage of training, research experience and ambitions, research skill confidence and academic career progression.

RESULTS

Seventy eligible responses were included, representing 84% (n = 16/19) of UK training deaneries. Thirty-seven (53%) of the respondents had obtained their certificate of completion of training (CCT) whilst 11% (n = 8/70) and 40% (n = 28/70) were at specialty trainee level and respectively pre- or within-/post-doctoral studies. Of 34 post-CCT respondents, 58% (n = 20) had ongoing research commitments but this reached 30% of their overall activity for just 30% (n = 10). Barriers to academic progression included clinical training requirements, post availability and limited mentorship. Most (60%; n = 35/58) undertook doctoral studies in their final two training years. A majority of respondents lacked confidence in radiation oncology (RO) skills relevant to their career ambitions, with 60%, 40% and 30%, respectively, confident in RO clinical research outcome evaluation, in vitro radiation analyses and using RO animal models.

CONCLUSION

These data provide a granular, long-term analysis of academic clinical oncology training at a national level; identifying poor progression to research independence underlined by limited confidence in RO research skills and multiple barriers to academic career progression. These data provide areas in which policy makers, research funders and training programmes can focus to improve academic training in clinical oncology.

Forensic mental health: envisioning a more empirical future

Forensic mental health services provide crucial interventions for society. Such services provide care for people with mental disorders who commit violent and other serious crimes, and they have a key role in the protection of the public. To achieve these goals, these services are necessarily expensive, but they have been criticised for a high-cost, low-volume approach, for lacking consistent standards of care, and for neglecting human rights and other ethical considerations. A key concern is an insufficient evidence base to justify common practices, such as restricting leave from hospital and detaining patients for long periods. There is also insufficient quality evidence for core interventions, including psychological therapies, pharmacotherapy, and seclusion and restraint. The causes for this evidence deficit are complex but include insufficient investment in research infrastructure and fragmentation and isolationism of services, both nationally and internationally. In this Personal View, we highlight some of the major gaps in the forensic mental health evidence base and the challenges in addressing these gaps. We suggest solutions with implications at clinical, societal, and public health policy levels.

Barriers and facilitators to establishing a clinical academic career in clinical education research in the UK: A focus group study

In a rapidly changing healthcare environment, we need a robust evidence base to inform effective education and training. This study aimed to examine factors perceived to determine career progression in clinical education research in the UK. Six online focus groups were conducted, with 35 participants from a range of medical, dental, nursing, and allied health professions who identified as aspiring or early career clinical education researchers. Transcripts underwent thematic analysis. Two themes and associated subthemes were constructed to illustrate perceived factors impacting on career development: (1) A cultural challenge from clinical norms. Challenges included differences between the epistemological assumptions of biomedical and clinical research, and the underlying philosophy of education research, which is more closely aligned with the knowledge generation of the social sciences. This led to difficulty communicating the impact of education research to patient care. There were also blurred boundaries between education delivery and research, with the latter lacking a clearly defined group identity. (2) Structures, systems and relationships for career progression. Practical considerations included time and funding (or lack thereof), the opportunity to undertake formal training, networking and role models. This research highlights a number of systemic barriers and facilitators to careers in clinical education research and offers targets of intervention to enable a sustainable academic workforce in clinical education research.

Is there a sufficient supply of clinical academics for UK medical schools? A retrospective cohort study

OBJECTIVES

Clinical academics lead research to deliver medical advancements while also teaching in medical schools to maintain high-quality medical services. The objective of this project was to determine if there is a sufficient supply of clinical academics for UK medical schools.

DESIGN

Retrospective cohort study.

SETTING

Data were extracted from the UK Medical Education Database and the General Medical Council (GMC) annual National Trainee Survey between 2012 and 2022.

PARTICIPANTS

1769 registered UK doctors with academic training and a certificate of completion of training.

MAIN OUTCOME MEASURE

The percentage of doctors with clinical and academic training who ended up as incumbent clinical academics at UK medical schools.

RESULTS

Approximately 50% of doctors with clinical and academic training were matched as incumbent clinical academics at UK medical schools. There was a low annual rate of incumbent clinical academics leaving their post.

CONCLUSION

Either clinical academic trainees do not find jobs at medical schools, or they do not want the jobs that are available. These results are indicative but not conclusive as generalisation is compromised by inconsistent disclosure of data by medical schools. We discuss variables which may contribute to the loss of clinical academics and explore the health economic case for clinical academic incentive packages to improve return on training investment.

Exploring the Impact of Equity, Diversity, and Inclusion Initiatives Within a Canadian Nursing Program: A Pilot Study

Interventions that aim to address equity, diversity, and inclusion (EDI) within the health professions often strive to promote the retention, recruitment, and success of individuals from historically underrepresented groups, who often belong to the same groups experiencing underservicing in health care. A pilot study aimed to examine the impact of ongoing EDI initiatives at Dalhousie University in Nova Scotia, Canada by exploring sense of belonging and curricular inclusion/representation from the perspectives of enrolled students. Intersectionality Theory was operationalized by way of considering the relational and contextual nature of marginalization. Results showed differences in perceptions of impacted sense of belonging and curricular inclusion/representation of diverse groups between respondents in the underrepresented subgroup as compared to their overrepresented counterparts. Differences in underrepresented and overrepresented subgroups' perceptions of impacted sense of belonging and curricular inclusion/representation suggest a need for further research to better understand the impact of EDI interventions on nursing students.

Experiences of the clinical academic pathway: a qualitative study in Greater Manchester to improve the opportunities of minoritised clinical academics

OBJECTIVES

The aim of this study was to explore the barriers and facilitators faced by clinical academics (CAs) in the Greater Manchester region, with particular attention to the experiences of minoritised groups.

DESIGN

A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was applied to identify key themes.

SETTING

University of Manchester and National Health Service Trusts in the Greater Manchester region.

PARTICIPANTS

The sample of this study was composed of 43 participants, including CAs, senior stakeholders, clinicians and medical and dental students.

RESULTS

Six themes were identified. CAs face several barriers and facilitators, some of which-(1) funding insecurity and (2) high workload between the clinic and academia-are common to all the CAs. Other barriers, including (3) discrimination that translates into struggles with self-worth and feeling of not belonging, (4) being or being perceived as foreign and (5) unequal distribution of care duties, particularly affect people from minoritised groups. In contrast, (6) mentorship was commonly identified as one of the most important facilitators.

CONCLUSIONS

Cultural and structural interventions are needed, such as introducing financial support for early career CAs and intercalating healthcare students to promote wider social and cultural change and increase the feelings of belonging and representation across the entire CA pipeline.

Experience of an NIHR Clinical Lectureship (medical/dental) and the determining factors for a clinical academic career post lectureship: a mixed-method evaluation

OBJECTIVES

The objective of this study is to investigate early-to-late postdoctoral clinical academic progression and the experiences of NIHR Clinical Lectureship (CL) fellows, considering enablers and barriers to success, and identifying the factors associated with immediate progression to a clinical academic role following completion of the award.

SETTING

Datasets of CL awardees across the UK.

PARTICIPANTS

For semistructured interviews, n=40 CL awardees that had finished their award within the previous 5 years. For quantitative analysis, n=1226 completed or currently active CL awardees.

OUTCOME MEASURES

The responses from the semistructured interviews to the defined questions on experiences during the award, postaward progression, and enablers and barriers to academic progression. Other primary outcome measures were quantitative data on first destinations postaward, demographic data, and whether an awardee had previously held an NIHR Academic Clinical Fellowship (ACF) or was a recipient of the Academy of Medical Sciences (AMS) Starter Grant.

RESULTS

CL awardees identified numerous benefits to the award, with the majority achieving their aims. Most awardees progressed to a clinical academic role; however, some returned to a clinical only position, citing concerns around the time pressure associated with balancing clinical and academic responsibilities, and the competition to attain further postdoctoral awards. The region of the award partnership, year of award end and success in applying for an AMS Starter Grant were associated with progression to a clinical academic role. Gender, holding an ACF and having a craft or non-craft specialty had no independent statistical association with clinical academic progression.

CONCLUSIONS

The CL is a valued element of the Integrated Academic Pathway. By addressing issues around later postdoctoral progression opportunities, responding to challenges experienced by CLs, and by understanding the factors identified in this study associated with clinical academic progression, it should be possible to increase the proportion of CLs that become fully independent clinical academic research leaders.

PARTICIPANTS

1226 NIHR CLs active or completed on the award between 2006 and 2020.

Using Evidence-Based Medicine to Support Clinical Decision-Making in RMS

The foundations of evidence-based practice are the triad of patient values and preferences, healthcare professional experience, and best available evidence, used together to inform clinical decision-making. Within the field of rhabdomyosarcoma, collaborative groups such as the European Paediatric Soft Tissue Sarcoma Group (EpSSG) have worked to develop evidence to support this process. We have explored many of the key research developments within this review, including patient and public involvement, decision-making research, research into areas other than drug development, core outcome sets, reporting and dissemination of research, evidence synthesis, guideline development and clinical decision rules, research of research methodologies, and supporting research in RMS.