Endorsed by more than 40 journals and prominent organisations, the International Campaign to Revitalise Academic Medicine (ICRAM) aims to give a new lease of life to academic medicine. Timothy Underwood explains what it is and how you can get involved

A career in academic medicine is the last thing on your mind at the beginning of freshers' week, and so it should be. In fact, many people have not got a clue what academic medicine is, let alone how to get into it. But if you were to stop and think for a minute about medical school education and the training that you will receive throughout your career, it might become apparent how important academic medicine actually is.

From the biochemistry lecture hall with diagrams of the DNA double helix to the professor of surgery's seemingly impossible to answer questions, academic medicine and those within it have traditionally been the educators of the next generation of doctors—you.

Not only are these educators providing first class clinical care for their patients, but they are also discovering the next generation of chemotherapeutic agents or doing a multi-centre randomised controlled trial. The triple thread of clinical care, teaching, and research is what defines academic medicine. Although it is true that many doctors are great teachers and others do first class research, it is the synergy between the three pillars of academic medicine that makes it special.

A career in academic medicine can be exciting, enjoyable, rewarding, and may be the only time in your life when you genuinely know more than anyone else about your subject. All is not well with academic medicine and problems exist across the globe, however. In fact, if academic medicine was a patient it would be quickly admitted to intensive care. Although not quite at the end of its life, academic medicine is in need of immediate resuscitation.

In an attempt to start this process the International Campaign to Revitalise Academic Medicine (ICRAM) has begun. Initially a collaboration between the BMJ Publishing Group and the Lancet in November 2003, ICRAM has since gained the support of more than 40 international medical journals and a number of prominent organisations.¹

The central force within ICRAM is a working party of 20 individuals, selected from 80 international applicants under the leadership of Peter Tugwell from Canada. We are charged with delivering meaningful options for change in academic medicine worldwide. Represented in the working party is a diverse mixture of age, career stage, country, sex, and background. Included in the working party are two student representatives. In June 2004, the working party of ICRAM held a three day retreat to develop the strategy and structure of the campaign. Nearly 100 key stakeholders including patients, senior academics, society leaders, and policy makers contributed to a one day meeting in London during this retreat. As a result, the working party has formed task groups to tackle the areas of academic medicine that we feel need attention. Our initial focus is to develop links with as many interested parties as possible. We believe that a campaign of this nature must be inclusive and representative of the diverse views of academic medicine around the world.³

As the current generation of learners and the next generation of doctors, medical students are ideally placed to tell us what we do right, but more importantly what we do wrong and how to fix it. Hopefully, we already know some of the problems—for instance, has anyone told you before what academic medicine is, and how to best place yourself for a career as an academic? How many junior doctors do you hear extolling the virtues of academic medicine to their peers or to their students? Instead, academics all too often appear as isolated odd characters, who grow to resemble their mice more than their patients. As a profession we have been slow to recognise our failings and even slower to take up the task of sorting them out. Is any right minded graduate going to take up a career that is perceived as time consuming, poorly paid, and uninspiring? Great people have been lost to academic medicine for too long.

Academic medicine may be in crisis but there are those of us who still believe that it offers the chance to make a real difference for patients and represents the most exciting career in medicine.

This is where we need your help. We have the chance to create a profession that is responsive to the needs of society, a profession that values its stakeholders equally and rewards success appropriately, a profession, unlike any other in medicine, where a concept can be taken from the laboratory to the bedside in an environment of rigorous accountability and support.

A number of advisory groups are being set up to help the working party answer the many questions that we will face and to provide opinions on the solutions that we come to. The student advisory group is already off the ground and we are actively recruiting members. If you would like to be part of the group please email: sachisiva@aol.com We look forward to hearing from you.

I very much enjoyed reading your theme issue on global academic medicine, and agree with you regarding the importance of it.

I have been involved in setting up a new elective scheme in global health for medical students. I originally piloted this elective in Tanzania during 2002 as a medical student with the International Health and Medical Education Centre (IHMEC) at University College London. It has been an highly successful project that is expanding rapidly at UCL and other medical schools.

The objectives of the Global Health Elective relate closely to overcoming the some of the challenges in academic medicine set out in the article by Clark and Tugwell in BMJ 7469. It seeks to highlight issues of global health to future doctors, through peer-led medical education in the developed and developing world during the traditional elective period of their final year. Structured education in aspects of global health take place before the elective period, to prepare students for the elective period. The actual elective then takes place overseas, with students travelling either from developed to developing countries or vice versa. Travelling medical students then consolidate the knowledge they have acquired during an elective based around a host medical school. The elective comprises formal education within the host medical school's own curriculum as well as a strong emphasis on peer-led education between medical students, in both hospital and community-based environments. Students also perform original research in project form, on an issue of global health. North-South research partnerships are created and students are able to follow these through after qualification and in their future careers.

My experience of this scheme so far is that it is encouraging future doctors to practise medicine in globally responsible way. Increasing numbers of young doctors plan to work abroad, and has been a successful way of maximising the experiences they have. The North-South divide is perhaps more easily crossed by medical students than senior doctors in established careers, and this has fostered strong and sustainable links to base academic partnerships.

I am currently involved in writing an article for the student BMJ about this new elective scheme. I wonder if you would also be interested in publishing anything relating to this successful advance in global academic medicine?

Many thanks for your time,

Yours sincerely,

Sarah Finer
(SHO in Medicine, Newham General Hospital)

EDITOR- It is not surprising that most of the students are unaware of the phenomenon of Academic medicine today. In this age of multiplicative technological advancement internet and alike resources have become primary source for seeking knowledge. The time old relationship of a student and an academician as a mentor no longer exists. In this scenario it is not possibble for students of today to envision themselves as becoming academicians of tomorrow. This situation, as one would like to think, not only exists in developed part of the world but also in the developing part¹. In countries like Pakistan and India where internet access is fast becoming cheap information gathering and analysis has become a practice of desktop clicks.

It cannot be denied that a good academician is the primary prerequisite for producing high quality students. Students who can serve as good doctors in the society. In order to reintroduce the concept of academic medicine the job has to be made more colourful and should be integrateds with the new advances in technology so that students find their interaction with academicians useful and are able to idealize them.

References

1. Inamdar SC, Rotti SB. Computer use among medical students in institutions in southern India. Natl Med J India 2004;17(1):8-10.

During my training as a medical student, I had the opportunity to be taught by amazing physicians and researchers. It is mainly due to my involvement in research throughout my medical training that I decided to pursue a career in Academic medicine.

But even then, as I progress through my training, I realize that it is far from easy. In Quebec, Canada we now have strict restrictions as to who will be permitted to pursue sub-specialty training. In order to be admitted to a sub-specialty training, one now needs to confirm that one of the teaching universities of the province will guarantee them a position after completion of their subspecialty training. Given that there is a scarcity of positions currently available in academic centers in our province, this has made the access to academic medicine very difficult.

In order to circumvent these difficulties and to improve their chances of being offered academic positions, medical residents are now having to find diversified and inventive ways to boost their candidacy. Some will seek to pursue a MD/MBA program in medical school. Others will pursue a master's of Phd degree during their specialty training. Or even try to obtain a master's in education...

The Royal College of Physicians and Surgeons of Canada has now put forward an initiative to encourage young trainees to pursue a career in academic medicine and research. The Clinician Investigator Program requires that the specialty trainee complete a minimum of 2 years of research training in or outside the context of a master's or PhD degree. This new program provides the traineed with a new certification that will hopefully improve their chances of obtaining a position in academia. The main problems with this great initiative is 1) it is not publicised and students / residents are not directly encouraged to consider it 2) there is no financial support from our governement for the 2 years of research required by the program 3) there are very few grants available for financial support during these two years which means overall that many residents find it impossible to pursue the program and this for financial reasons.

Hence, despite new initiatives to encourage residents to pursue an academic career in medicine, there are many deterrents to doing so.

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