Academic medicine

Medical academics are trained as medical practitioners and scientists. They conduct original scientific research, teach medical students and medical graduates, and provide patient care. Senior clinical academics can also take on administrative responsibilities for universities and the health service. Some become deans or even vice chancellors or chief executives.

Why might a medical student choose a career in academic medicine? Does the intellectual stimulation of an academic environment outweigh the disadvantages of longer training, harder work, and probably less financial reward? For many, the answer is yes. The challenge to develop medical science and shape the teaching of the future has appeal.

Career opportunities

Some clinical academics are employed by NHS trusts and others by universities. Indeed the Academy of Medical Sciences states that clinical academics have responsibilities to “their university and their NHS hospital trust, combining ‘service delivery with research, teaching and or administration.”^w1 Jobs vary in terms of the proportion of clinical and academic responsibility, and a few include no direct clinical work. Posts are available in a wide range of specialties, including general practice.

The number of clinical academics has fallen by 27% in the past seven years to below 3000 in the United Kingdom in 2006, many of them at the later end of their careers. This is despite an increase in the number of medical students and doctors in training.^w2 The government and medical organisations want to reverse this trend. So now may be a good time to consider academic medicine. This is particularly so for women, who currently hold just 11% of clinical academic posts at professorial level, and there is determination to improve this.^w3

Planning ahead

There are several equally valid routes towards a clinical academic career. In general medical academics start their career at medical school, through an academic foundation programme, or through academic specialist training (^{figure 1}). A doctorate, typically a doctor of philosophy degree (PhD) is now a prerequisite for a career as a clinical academic. Most doctors complete this either early in their training or during their higher specialist training.

Walport integrated academic training pathway for researchers. Reproduced with permission from the UK Clinical Research Collaboration (www.ukcrc.org)

Before and at medical school

UK medical schools offer a range of programmes to cater for medical students with diverse backgrounds who seek a route into academic medicine. The important step is to undertake an additional scholarly component to supplement your medical degree. These additional studies demonstrate your interest and expertise in science and whether you have the necessary aptitude.

Examples of such experience include undertaking an intercalated bachelor of science (BSc) or medical science degree (BMedSci); enrolling in a bachelor of medicine (MB)-PhD course; completing a first degree in a relevant science with or without a research masters degree or PhD before enrolling for graduate entry medicine; or undertaking a research degree after completion of an MB. Each of these pathways has advantages and disadvantages. Financial or domestic considerations will often influence the choice for an academically inclined medical student.

Few MB-PhD programmes exist in the UK. The Cambridge programme, which accepts transfers from other medical schools, is a good example. It enables students to intercalate three years of research with clinical training, totaling 5.5-6 years on top of the preclinical years by combining clinical studies for the MB and bachelor of surgery (BChir) with research that leads to a PhD. The course includes weekly supervision during the research to ensure that students maintain clinical skills.^w4

Academic foundation programmes

Academic foundation programmes offer a combination of clinical experience and at least four months in an academic environment but are few in number. Posts are advertised before the main bulk of foundation programmes so consider early in the penultimate year of your MB whether this is a route that you want to pursue.

At this stage, consider the academic component in terms of the wider philosophy of foundation training, which is to help with “generic competencies.” The quality of academic input into your training is more important than the specialism, and you should choose on the basis of whether the programme and the location suit you.

Specialist training

Postgraduate research training is designed to be flexible and to offer different pathways for different doctors in different medical specialties. The main route is through an academic clinical fellowship. A quarter of the three years of the fellowship is for research. It provides a clinical and academic training environment to help you secure funding for a PhD or doctor of medicine degree (MD), a competitive training fellowship, usually after the third year of specialty training.^{w5 w6}

Academic clinical fellowships are also open to doctors who have a PhD to prepare postdoctoral research applications. Junior doctors who are eligible to apply for specialist training and doctors who are already in specialist training posts are eligible to apply.

After completing an academic clinical fellowship and a training fellowship leading to a higher degree you return to clinical training while you apply for a clinical lecturer post if you are committed to the academic pathway. New clinical lecturer posts are designed for doctors with a PhD-MD or equivalent, who have had specialist clinical training. Clinical lectureships last for four years, and you should schedule full time clinical training to allow you to complete specialty training within this four year period.

After training doctors often apply for a clinician scientist award or a senior clinical lectureship, sometimes known as an associate clinical professorship.

Choosing a research topic

For your PhD research you may chose to do experimental work with animals or humans or to work in biomedical sciences, such as molecular genetics, immunology, or neurosciences. Alternatively you may chose to conduct your research in social or behavioural medicine, in disciplines such as medical ethics, primary care, public health, psychiatry, or psychology. Medical education or service delivery are other possibilities. Research is tough, and unless you have a real passion for your subject your stamina may not hold out.

Points to watch out for

Grasp early opportunities to take part in research, however humble your role. Academics are usually only too happy to find students who are prepared to help with the labour of their research projects and to reward this with on the job training in research methods and the inclusion of your name in a publication if your contribution has been enough. Treasure and record these on your CV: evidence of early interest in research can be invaluable in getting you to the next stage of your career.

Later you need to develop assertiveness without becoming pushy so that you avoid being overlooked and receive due credit for your teaching and research. Careers in medicine are always competitive, particularly in academic medicine. But be wary of overcompeting: academia encourages a healthy balance of cooperation and competition—“coopetition” is now the key to success.

It can be difficult to serve two masters. The Medical Academic Staff Committee of the BMA says that academic trainees must have a clear understanding of their entitlements and their responsibilities to the academic and clinical employer.

Dual supervision for your research is different from having two masters. If you are to succeed as an academic clinician you must be capable of synthesising from multiple sources. This means that it is an asset to have supervisors with different experience and different viewpoints. You have the responsibility to collate the advice that you are given and work out how to use it.

Help and advice

The existence of several different pathways makes it difficult for the novice to plan a career in academic medicine. To determine the best way to gain the necessary clinical and research qualifications seek advice from academic clinicians who you know at the medical school or hospital and from the postgraduate deaneries, most of which employ careers advisers.

To find out about an academic foundation post consult your medical school and postgraduate deanery. Further advice from the UK Foundation Programme Office is imminent (http://saftuk.org). For academic foundation doctors the Society of Academic Foundation Trainees offers valuable support (www.foundationprogramme.nhs.uk).

Doctors engaged on an academic clinical fellowship or a doctoral training programme are allocated supervisors. But good mentoring has no substitute, and anyone contemplating a career as a clinical academic should find a mentor as early as possible in their career. The Academy of Medical Sciences has developed a mentoring scheme for clinician-scientists who have support from a funded fellowship and have already achieved a PhD or MD.^w7

Clinical academic training abroad

In the United States and some European countries medical training is modular, and a three or four year residency leads to a registerable qualification to practise. Academic physicians can hold fellowships in research or clinical work relatively interchangeably. Often research training is also done as an undergraduate in the United States, and several MD-PhD programmes make it possible to intercalate a PhD.

Academic status in North America and elsewhere is categorised by whether a senior post is “tenure track” or “non-tenure track.” The difference lies in the job security because tenure posts mean that the position is permanent. The grades progress instructor, assistant professor, associate professor, and, finally, professor.

Although it is no longer a tacit requirement for academic success in the UK to award yourself a BTA, a “been to America” suffix, think long and hard about the value of a year or so spent abroad in the course of your training—it can be extremely helpful to broaden your experience.

Conclusion

Academic careers can offer huge personal rewards—not financial—but a sense of contributing to the future of medicine as well as contributing to clinical care. Opportunities exist in all specialties, and the variety of routes of entry and current shortage of clinical academics means that there has never been a better time to consider academic medicine as a career.

But academic medicine isn’t for everyone. Students should find out during their medical degrees whether they have the qualities needed. If you are interested, try it and see; but don’t be afraid to recognise that it may not be for you.

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

1. Royal College of Physicians Clinical Academic Medicine; the way forward. Report from the forum on academic medicine. London 2004. http://www.rcplondon.ac.uk/pubs/books/clinacad/ClinAcadMed.pdf
2. Clinical Academic Staffing Levels in UK Medical and Dental Schools A report by the Medical Schools Council (previously the Council of Heads of Medical Schools May 2007
3. British Medical Association Women in Academic Medicine BMA London 2008 http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFwamreport08/$FILE/wamreport08.pdf
4. University of Cambridge http://www.cam.ac.uk/admissions/undergraduate/courses/medicine/outline.html
5. UK Clinical Research Collaboration and Departments of Health for England and Wales http://www.academicmedicine.ac.uk/uploads/A-pocket-guide.pdf
6. Kingston O, Behjati S. Academic medicine. BMJ Career Focus 2008 May 14; http://careers.bmj.com/careers/advice/view-article.html?id=2942
7. Academy of Medical Sciences http://www.acmedsci.ac.uk/index.php?pid=55

      

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