The clinician-scientist track: an approach addressing Australia's need for a pathway to train its future clinical academic workforce

Challenges for trainee physician-scientists during their PhD candidature: a cross-sectional study

BACKGROUND

Physician-scientists are important drivers of research, in both knowledge acquisition and research translation. In Australia, many newly qualified physicians and advanced physician trainees enrol in PhD studies, with a view to training as physician-scientists. However, data on perceived challenges and ways to support them are limited.

METHODS

This single-centre study surveyed trainee physician-scientists undertaking PhD studies within the Monash University Department of Medicine in 2020. Following discussions with PhD students and a qualitative written questionnaire, trainee physician-scientists were invited to complete a quantitative survey that aimed to identify current and future career challenges and determine the type of enrichment and support mechanisms they value most and would most likely use.

RESULTS

From 45 eligible participants, 25 responses were received (76% female). Participants identified multiple substantial challenges (median of 6) during their candidature relating to their project, changes in roles and their personal lives. They also envisaged future challenges post-PhD in establishing themselves as an independent investigator, further changes in their identity and their personal lives. Of potential support mechanisms during their candidature, a mentoring program was the most favoured, with an online discussion forum being the least popular.

CONCLUSIONS

Trainee physician-scientists report multiple challenges during their PhD candidature and envisage significant challenges in establishing their research independence after PhD completion. They valued several potential support mechanisms, particularly a mentoring program. Australian universities and their associated academic health services should consider establishing programs to support trainee physician-scientists.

The bumpy ride to a medical PhD degree: a qualitative study on factors influencing motivation

INTRODUCTION

In parallel with a tremendous increase in medical PhD enrolments, concerns have risen about PhD candidates' poor well-being, increasing attrition rates for PhD programmes, and, eventually, a decline in clinician-scientists. According to the Self-Determination Theory, autonomous motivation is strongly linked to positive aspects of well-being and other positive outcomes such as study completion and success. In this way, motivation has a pivotal role in successful completion of medical doctoral programmes. In this study we explored factors affecting motivation during the PhD journey and aimed to contribute to engaging doctoral education environments, and, eventually, a sustainable clinician-scientist workforce.

METHODS

This constructivist qualitative interview study was conducted among ten medical PhD candidates in the final phase of their PhD. We used timeline assisted interviews to identify meaningful experiences throughout their PhD journey. Thematic analyses as an iterative process resulted in overarching themes.

RESULTS

We identified six themes influencing autonomous and controlled motivation along the challenging PhD journey: (1) Initial motivation to start a PhD matters; (2) Autonomy as a matter of the right dose at the right time; (3) PhD as proof of competence and/or learning trajectory?; (4) It takes two to tango; (5) Peers can make or break your PhD; (6) Strategies to stay or get back on track.

CONCLUSION

This study revealed factors that contribute positively and/or negatively to autonomous and controlled motivation. Some factors impacted motivation differently depending on the PhD phase and individual strategies. Additionally, some factors could coincide and change from positive to negative and vice versa, showing that a successful journey cannot simply be reduced to an absence of negative experiences.

"Walking on both sides of the fence": A qualitative exploration of the challenges and opportunities facing emergent clinician-scientists in child health

RATIONALE, AIMS, AND OBJECTIVES

While paediatric clinician-scientists are ideally positioned to generate clinically relevant research and translate research evidence into practice, they face challenges in this dual role. The authors sought to explore the unique contributions, opportunities, and challenges of paediatric clinician-scientists, including issues related to training and ongoing support needs to ensure their success.

METHOD

The authors used a qualitative descriptive approach with thematic analysis to explore the experiences of clinician-scientist stakeholders in child health (n = 39). Semi-structured interviews (60 min) were conducted virtually and recorded. Thematic analysis was conducted according to the phases outlined by Braun and Clarke (2006).

RESULTS

The analysis resulted in the creation of three themes: (1) "Walking on both sides of the fence": unique positioning of clinician-scientists for advancing clinical practice and research; (2) the clinician-scientist: a specialized role with significant challenges; and (3) beyond the basics of clinical and research training programmes: essential skill sets and knowledge for future clinician-scientists.

CONCLUSIONS

While clinician-scientists can make unique contributions to the advancement of evidence-based practice, they face significant barriers straddling their dual roles including divergent institutional cultures in healthcare and academia and a lack of infrastructure to effectively support clinician-scientist positions. Training programmes can play an important role in mentoring and supporting early-career clinician-scientists.

A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science

Objective

This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science.

Methods

Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords.

Results

Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05).

Conclusion

This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.

Motivation, self-efficacy, perception, curiosity, and barriers toward medical research among undergraduates in China

Medical research is important to scientific progress and medical education. Institutions worldwide have sought to increase student involvement in research such as clinician-scientists training programs, while little is known about how medical undergraduates perceive research. A cross-sectional study was conducted in Chongqing Medical University, Chongqing, China, with first-fourth year undergraduates. An online, anonymous, and self-rating 5-point Likert questionnaire was conducted to investigate medical undergraduates' demographic characteristics and assess motivation, self-efficacy, perception, curiosity, and barriers regarding medical research. Content validity was checked with experts and face validity was checked for clarity and understanding of the questionnaire. The Cronbach's alpha coefficient of the questions ranged from 0.813 to 0.879. A total of 3273 medical undergraduates were surveyed, and 86.62% (2835) participants (male 962, female 1873) were identified as effective. Males scored higher than females on self-efficacy (p < 0.001), perception (p = 0.017), and curiosity (p < 0.001), and lower on barriers (p < 0.001). The second year students are at the peak of their perception (p = 0.006) and lowest barrier scores (p = 0.003). Students with scientific research experience scored higher in motivation (p = 0.002), self-efficacy (p < 0.001), perception (p < 0.001), and curiosity (p < 0.001). Lack of proper mentoring opportunity (86.2%) and knowledge (84.5%) were the main barriers in conducting research. Even though they have a positive perspective, only a few undergraduates enrolled in research. Medical universities should encourage faculties to supervise and guide undergraduates' projects, and provide feasible solutions for students to learn scientific knowledge and skills. It is vital to build a research-oriented environment and academic atmosphere.

A global view of the aspiring physician-scientist

Physician-scientists have epitomized the blending of deep, rigorous impactful curiosity with broad attention to human health for centuries. While we aspire to prepare all physicians with an appreciation for these skills, those who apply them to push the understanding of the boundaries of human physiology and disease, to advance treatments, and to increase our knowledge base in the arena of human health can fulfill an essential space for our society, economies, and overall well-being. Working arm in arm with basic and translational scientists as well as expert clinicians, as peers in both groups, this career additionally serves as a bridge to facilitate the pace and direction of research that ultimately impacts health. Globally, there are remarkable similarities in challenges in this career path, and in the approaches employed to overcome them. Herein, we review how different countries train physician-scientists and suggest strategies to further bolster this career path.

Curricula, Teaching Methods, and Success Metrics of Clinician-Scientist Training Programs: A Scoping Review

PURPOSE

To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models.

METHOD

The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics.

RESULTS

From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment).

CONCLUSIONS

Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.

Publication in the Australian medical student journal is associated with future academic success: a matched-cohort study

BACKGROUND

Medical student journals (MSJs) help to introduce the fundamentals of academic research and publication to future doctors. It has recently been shown that MSJs can influence doctors' future academic and professional success, however these findings have not been replicated in an Australian cohort. The aim of this study was to examine the association between publication in the Australian Medical Student Journal (AMSJ) and markers of a student's future academic trajectory, including future publication, attainment of higher academic degree or entry into specialist training.

METHODS

Articles authored by medical students in the AMSJ from 2010 to 2015 were retrospectively identified. A list of these student authors was made, with university- and year- matched control students randomly selected from university graduation databases. For all students, data related to academic success were obtained from multiple sources including PubMed®, Google, university databases and author affiliation information from publications. A multivariable conditional logistic regression model was used to assess correlation between variables. The primary outcome measure was the number of postgraduate PubMed®-indexed publications. Secondary outcome measures included attainment of higher degree or faculty position. Clinical speciality was also recorded.

RESULTS

Fifty-five AMSJ authors (14 case reports, 17 original research, 21 review articles) from 14 Australian universities were included. Publication in the AMSJ was associated with future PubMed® indexed publications (OR 3.43, 95% CI 1.74-6.77, P < 0.001) and higher degree attainment (OR 4.05, 95% CI 1.99-8.22, P = 0.0001). AMSJ authors were also significantly more likely to enter into surgical training (OR 2.53, 95% CI 1.10-5.84, P = 0.029). A multivariable conditional logistic regression model demonstrated that publication in the AMSJ was predictive of future PubMed indexed publication, independent of higher degree or faculty position attainment (OR 2.56, CI 1.22-5.39, P = 0.01).

CONCLUSION

We have shown that publication in a MSJ is associated with markers of academic success in an Australian cohort. PubMed®-indexed publications, attainment of a Masters degree, and entry in to surgical training were all significantly correlated to AMSJ publication. A conditional logistic regression model demonstrated that medical student publication in the AMSJ influences the number of future PubMed®-indexed publications, independent of major academic confounding variables.

An impact review of a Western Australian research translation program

The translation gap between knowledge production and implementation into clinical practice and policy is an ongoing challenge facing researchers, funders, clinicians and policy makers globally. Research generated close to practice and in collaboration with end users is an approach that is recognised as an effective strategy to facilitate an improvement in the relevance and use of health research as well as building research capacity amongst end users. The Research Translation Projects (RTP) program funded by the Western Australian (WA) Department of Health facilitates clinical and academic collaboration through competitive funding of short-term research projects. Its aim is to improve healthcare practice while also finding efficiencies that can be delivered to the WA health system. A mixed methods approach was adopted to evaluate the research impact of the RTP program, at completion of the two-year funding period, across a range of impact domains through the adaptation and application of the Canadian Academy of Health Sciences’ (CAHS) framework for research impact. In addition, further analysis was undertaken to address specific objectives of the RTP program more closely, in particular research capacity building and collaboration and health system Inefficiencies targeted by the program. Social network analysis was applied to assess the extent and growth of collaboration across WA health organisations over time. Results indicated that the ‘bottom up’ approach to research translation has triggered modest, yet positive outcomes across impact domains including advancing knowledge, collaboration and capacity building as well as contributing to changes in policy and practice. Additionally, the projects identified opportunities by which inefficiencies in the health system can be addressed. Further work is required to better understand the pathways by which short-term outcomes can be translated into more long-term impacts and the mechanisms that trigger this process.

Establishing CREATE: lessons learned in setting up a training environment for early-career researchers in respiratory medicine

BACKGROUND

The purpose of the National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis (CRE-PF) is to improve and extend the lives of patients living with pulmonary fibrosis through the development of a comprehensive and integrated program of basic and clinical research and education across Australia. A key objective of the CRE-PF was establishment of a unique national training scheme, CREATE, for early-career researchers (ECRs) in respiratory research. CREATE ECRs are broadly drawn from two main fields of researchers: clinicians and scientists, where clinicians tend to be involved in part-time translational research and scientists are involved in broad scientific research including laboratory or genetic research, health economics or population research.

METHODS

We describe the CREATE Program which, with limited budget and the assistance of key organisations, has provided funding opportunities (scholarships, fellowships, prizes, travel and collaboration grants), professional development (mentoring program, symposia, presentation opportunities and on-line training) and fostered a connected, supportive research community for respiratory ECRs.

RESULTS

The CREATE program has successfully fostered the development of the supported researchers, contributing substantially to the future of pulmonary fibrosis research in Australia. During the life of the program the CRE-PF has offered 10 PhD scholarships and five postdoctoral fellowships, awarded 13 travel grants and three grants to promote collaboration between ECRs from different institutes. A mentoring program has been established and CREATE Symposia have been held in association with key meetings. During COVID-19 restrictions, a series of virtual research meetings has offered 12 CREATE ECRs from seven universities the opportunity to present their research to a national audience. CREATE research-related achievements are impressive, including over 80 first-author publications by ECRs, and many conference presentations. Contributions to the research community, measured by committee membership, is also strong.

CONCLUSIONS

In spite of a very limited budget, wide geographic distribution of participants and the multi-disciplinary nature of the cohort, we have succeeded in providing a unique, supportive academic development environment for CREATE ECRs. Lessons learned in the process of developing this program include the importance of leveraging funding, being flexible, building networks and seeking and responding to ECR input.

The experiences, attitudes and understanding of research amongst medical students at an Australian medical school

BACKGROUND

Research engagement plays an integral role in developing clinicians that practice effective, evidence-based medicine. Research participation by clinicians, however, is declining. Given the link between research during medical school and future research output, promotion of medical student research is one avenue by which this shortage can be addressed. Student research attitudes and participation in Australia are not well-documented in the literature. This study therefore aims to investigate research practices, motivators, and barriers amongst Australian medical students in order to determine whether there is a need for further integration of research within Australian medical school curriculums.

METHODS

A cross-sectional study design was used to explore research experience and attitudes, as well as the enablers and barriers to research amongst students enrolled in all years of the five-year medical course at Monash University. A questionnaire was created by combining questions from several surveys on medical student research and comprised Likert scales, multiple choice options and free-text responses assessing research experience, attitudes, motivators, and barriers.

RESULTS

Seven hundred and four respondents (69.4% female; survey response rate 36.7%) reported variable research experience and interest. Less than half of the cohort (n = 296; 44.9%) had contributed to a research project. Increasing employability for specialty training programs was the primary motivating factor (n = 345; 51.9%) for pursuing research, with only 20.5% (n = 136) citing an interest in academia as a motivator. Time constraints (n = 460; 65.3%) and uncertainty surrounding how to find research opportunities (n = 449; 63.8%) were the most common barriers to research.

CONCLUSIONS

Medical students at Monash University are interested in but have limited experience with research. Students are, however, primarily motivated by the prospect of increasing employability for specialist training; medical schools should therefore focus on encouraging intrinsic motivation for pursuing research. Greater integration of research education and opportunities within medical school curricula may also be required to provide students with the skills necessary to both pursue research and practice evidence-based medicine.

Sustainable Clinical Academic Training Pathways: A framework for implementation in Oman

Clinical academics—medical doctors with additional training in basic science or clinical research— play a pivotal role in translating biomedical research into practical bedside applications. However, international studies suggest that the proportion of clinical academics relative to the medical workforce is dwindling worldwide. Although efforts to reverse this trend are ongoing in many countries, there is little perceptible dialogue concerning these issues in Oman. This article explores the current status of clinical academic training pathways worldwide, concluding with a framework for the implementation of a dual-degree medical-research training programme in Oman in order to stimulate and develop a sustainable national clinical academic workforce.