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.

Widening access to the specialised foundation programme

The specialised foundation programme, previously known as the academic foundation programme, is an alternate foundation training pathway for doctors that are interested in research, medical education and leadership. The programme is highly competitive, with competition ratios rising to 1:5 in some units of application. A series of courses is held each year out of goodwill to assist students with the application process, but little has been published with respect to evidence-based approaches to both the application process and interviews. This article provides a series of frameworks to simplify the challenges posed by the application process and the academic, personal and clinical interviews.

The Case for Junior Doctor Academic Internships: A Narrative Review of the Published Literature

INTRODUCTION

There is a growing concern with the dwindling academic workforce especially in medicine. Academic internships refer to a hybrid internship during which an intern spends a period of time (typically 3-6 months) in academic/research endeavours. These may serve as initial research experience for junior doctors. However, the merits of this programme have not been assessed to date.

METHODS

Studies on integrated academic internships by junior doctors (ie, interns) were included in the present review. The identified articles were grouped into themes. For each article, the methodological approach (and subsequent implemented methods) was noted. The articles were also critically appraised for methodological soundness (both at the study-level, and the outcome-level).

RESULTS

A total of 1621 publication titles were identified and screened, of which 8 publications were included in the final review. The major themes of the identified publications are: overview of the academic internship programme, evaluation of a programme's experience and outcomes, and other miscellaneous publications.

DISCUSSION

The studies to date have only reported on "soft outcomes", but overall, interns and supervisors alike appear to be satisfied with the programme. Whether the programme increases the likelihood of future academic careers is difficult to establish at this juncture. The academic internship posts appear to be competitive, which reflect their popularity among graduating medical students.

Mind the (support) gap: supporting academic trainees through peer networks

Academic Foundation Programme (AFP) trainees face challenges in making the most of the research opportunities available to them. Improved support for trainees throughout the AFP may result in improved outcomes and increase retention of clinical academic trainees. Peer support may address some of the challenges faced by AFP trainees at this early stage of their careers. A Plan-Do-Study-Act (PDSA) approach was used to design and implement a peer support programme for AFP trainees in paediatrics. Feedback from recent AFP graduates was used to identify challenges and possible solutions, which were then incorporated into the programme. Trainee views informed the format of the support offered, especially the role of trainee coordinator and importance of regular meetings. The PDSA approach facilitated constant re-evaluation of the programme, which continued to evolve over several years. Peer support is highly valued by AFP trainees, who use the network to obtain information, as well as concrete assistance, and emotional support from their peers. Such networks are not self-perpetuating, and a significant commitment is required from fellow trainees to ensure the success of the network.