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Developing a career in academic paediatrics
SYMPOSIUM: RESEARCH
Developing a career in academic paediatrics
whether we are primarily employed by the health service or by an academic institution such as a university. Having determined that, the question for trainees and senior doctors alike is not whether to be academic or not, but rather how much time devoted to academic activity is to be included in a job plan or career. For trainees in particular, it is worth spending some time early in the training pathway thinking about how research will play a role in your future career. A good research project which will lead to a doctoral degree generally takes at least a year to initiate, and will require funding, possibly obtaining pilot data prior to a grant application, and planning from the local training committee to arrange training rotas and account for gaps caused by trainees taking time out of programme. A request to the local paediatric school for time out for research is more likely to be successful if accompanied by a timely request with a well thought through project, required funding and an appropriate supervisor. It is never too early to discuss this with your programme director e they are generally averse to sudden surprises. See Box 1.
Andrew R Gennery
Abstract Many trainees think about research towards the end of clinical training, but at that stage, it may be too late to get the most from the limited opportunities that remain. Ideally, trainees should consider research early in their career. For some, a career in academic paediatrics may be attractive, in which case following the clinical academic pathway as outlined by the National Institutes of Health Research may be appropriate. For others, research may be part of a wider clinical training. This article discusses a variety of research opportunities available to trainees, and offers advice on a career in academic paediatrics.
Keywords academic clinical fellow; academic clinical lecturer; academic foundation programme; academy of medical sciences; clinical academic; clinician scientist; national institutes of health research; PhD
Opportunities to improve your CV Ask consultants e are there projects you can do with them:
Introduction
C C
To sit, alone or with a student or a supervisor, discussing newly emerging data is one of the most thrilling moments in an academic career e to have acquired knowledge that is unique to you, until it is shared, confirming (or sometimes refuting) a carefully considered hypothesis. Alone in the world, only you have this newly discovered knowledge. The thrill of the discovery after a long chase is difficult to beat. It is one of the ultimate rewards awaiting a clinical academic. An academic has an opportunity to treat an entire cohort of patients or a complete patient population rather than just the patient in front of them, as a result of the development of care guidelines adopted into NICE guidelines, or introduction of a new therapy. Actually, I dislike the terms ‘clinical academic’ or ‘academic paediatrician’ because they confer the concept that a small but elite subset of us are more cerebrally endowed than the rest, whose function is to run an ever expanding service with ever diminishing financial, temporal and human resources, whilst the elite sit in ivory towers, devolved from the real world and pontificate on obscurities. The reality is that the majority of us have excelled at school, spent at least 5 years in undergraduate medical education, gained further professional exams and in many cases a postgraduate degree or certificate e and we are all to a greater or lesser extent ‘academic’. The difference is in the amount of time allocated to our job plan or timetable for academic activities, and related to this,
C C
Box 1
It is also worth thinking about when will be a good time to conduct research, early on in your training pathway. If you wish to be a tertiary specialist in a narrow specialty, where specialty training is competitive, training jobs are few, and successful candidates generally apply when they are completing doctoral studies, you will need to be thinking about an MD or PhD early in your training e 6 months before a grid application deadline is too late.
General principles A number of features are required to be successful in academic paediatrics: Intellectual curiosity An identified question Dedicated time Good mentorship Appropriate environment Patient and public participation Serendipity Intellectual curiosity It may seem obvious, but unless you are curious about the subject that interests you, you are unlikely to ask questions that will develop into a project. Questions can be from a wide variety of approaches e an observation of a gap in patient care e be that in initial recognition of a diagnosis (or lack of recognition), in patient assessment or diagnostic test or pathway or in treatment
Andrew R Gennery MD DCH DipMedSci FRCPCH MRCP, Professor of Paediatric Immunology and Haematopoietic Stem Cell Therapies, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK and Paediatric Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, UK. Conflicts of interest: none declared.
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Case reports Audits e to present or publish Literature review Small clinical series
1
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
SYMPOSIUM: RESEARCH
approach and outcome. At the most basic level, research may start with a question that leads to an audit of an aspect of patient care, which in turn identifies a deficit. This may result in a tightening of established processes, but may raise more fundamental questions about the process and lead to a search for what is already known about a topic e a review of the literature is always a good way to identify what is already understood about a particular issue and to identify gaps in knowledge. Well conducted, a literature review may even lead to a publication as an up to date review on the topic of interest. At a more fundamental level, the question may ask about the disease process itself, for instance, the cause at a molecular or genetic level, or the natural history of the disease. These questions may lead to a more basic scientific investigation, rather than a clinical-based project.
time (weeks or months) are more productive than half days taken here and there e at worst try and insist on complete days for research, rather than several half days (valuable time will be consumed by clinical over-run and by spending time trying to recall where you were in the research plan). All clinicians involved in research will recognise the competing tension between academic and clinical time, but it is important to value academic time as much a priority as clinical time. Supervision and mentorship This is an extremely important requirement of becoming and remaining a successful researcher e even senior academics benefit from mentors. Supervision will occur at different levels during a project. Your main supervisor will likely have conceived the project and helped to gain funding. Scheduled regular monthly meetings (at least) should be held to assess the overall progress and direction of the project e more frequent meetings may be required if the student is having difficulties. The Principle Investigator is the ‘go to’ person for discussions about results and the direction of the project. However, if the pipette is broken, or chemicals need ordering, the laboratory technician or post-doctoral scientist will be of much more practical help e it is worth nurturing a good relationship with the technician e they are often the most experienced person in the laboratory and will understand how to navigate the quirks of the institutions’ technical bureaucracy! For trainees, remember that there are mentors to fulfil different roles e including general career advice, as well as focussed advice on the research topic itself. A good mentor should be approachable, and inspiring. Mentorship is different to supervision, and implies an interest in the personal development and future direction of the trainee, rather than specific advice on a particular project. Supervision will occur at different levels during a project.
An identified question Again, it may seem obvious, but good research starts with a good question. It is relatively easy to generate data, but in order to interpret it in a meaningful way, it is important to make sure that you have understood what the research question was asking. It is worth spending time on this, and understanding the background to the topic of interest in order to identify gaps in knowledge. The National Institutes of Health Research fund schemes such as the Academic Clinical Fellowships, precisely to give trainees time to explore a topic of interest, generate pilot data and construct a fellowship application. Do not be afraid to approach senior colleagues or experts to ask for advice and to ask questions e it is surprising how often in medicine we do things because they have always been done that way, rather than because of an evidence base. Dedicated time You are more likely to be successful in your research if you have dedicated time to fulfil it. For those who are in a postgraduate study programme, protected research time is likely to be built-in, but it is difficult to protect it entirely. For doctors whose research is clinically focussed, it may be that clinical time is included in the programme e for instance taking measurements or samples, or assessing patients in clinic. For trainees on a doctoral programme, it is likely that some of the time spent doing the research will be asked to count towards clinical training, and many trainees will continue to cover out of hours rotas whilst doing research, partly to maintain clinical competencies and also to supplement income. The difficulties arise when clinical emergencies arise, with sick patients, absent colleagues or gaps in rotas or ward cover. Most of us are clinicians and find it difficult to walk away from these clinical situations. Sometimes it is completely unavoidable and we just have to cover the gap, but hospital services are very good at ‘using’ colleagues on research programmes to ‘fill in’ for emergencies. Remember that the body funding your research is expecting outputs when you have completed your studies, and emergency shifts that you have covered do not count, and cannot be listed on your curriculum vitae. This is one period in your career when it is permissible to make yourself unavailable e preferably in a different building or out of telephone contact. Well conducted research needs dedicated time and focus. For those studying or conducting research part time, this difficulty can be magnified e blocks of research
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Environment Successful research needs to be performed in an appropriate environment. Are you surrounded by people who can advise on practical aspects of the project, and help you ‘troubleshoot’? Is there an appropriate academic nurturing surrounding e are you being adequately supervised and mentored, but also academically challenged and exposed to new or different opinions or ideas? Do you have access to the necessary tools or equipment to perform your research? Do you have access to library resources? Does the institution have a track record of supervising research projects and trainees. Clinical academics are more likely to flourish in an environment that provides a wide range of support, and should not be working in isolation. Patient and public participation It is important that clinical research has an intention to benefit patients and the wider society. Many grant-giving bodies encourage researchers to approach patient groups or organisations to help in formulating research questions, or even designing materials such as consent forms and patient information forms. Good research questions should also address important problems, and it is helpful if clinicians and patients can agree on what are important topics in the field.
2
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
SYMPOSIUM: RESEARCH
Serendipity Research should not rely on luck, but it is true that many discoveries or breakthroughs are serendipitous, rather than part of a carefully formulated research protocol. The secret to success is not so much to rely on luck, but rather be open-minded about unusual results and enthusiastically take emerging opportunities. The successful researcher should never stop asking questions or lose their curiosity.
Should I choose a UK MD or PhD? MD
PhD
2 years full time study Clinical or laboratory based Often less structured supervision Less favoured by Research Council funding bodies Less recognised internationally e few equivalent degrees
3 years full time study Clinical or laboratory based More structured supervision More favoured by Research Council funding bodies International recognition e similar to other PhD degrees from abroad Less favoured by universities for Favoured by universities for senior academic positions senior academic positions Unlikely to secure a Clinician/ More likely to secure a Clinician/ scientist position scientist position
Research training A postgraduate certificate or higher degree, gives the trainee some exposure to training in research. This can cover many areas, including how to use the library and conduct a literature review, how to write a scientific manuscript, how to plan and write up experimental work, learning practical laboratory or clinical skills, and how to present work in poster or oral format. A common question however addresses that of statistical method e should I go on a statistics course? I suspect this question is asked so frequently because most of us hold some fear of statistics e how to use them and how to interpret them. [The interested reader should certainly avail themselves of the article by Foard in this month’s edition of P&CH]. To my mind, it is helpful to take a basic course, and most universities will provide this. The reason for doing this is that we all should have a basic understanding of statistics, possibly for our research project, but certainly when reading and interpreting data from published manuscripts. However, statistics are a tool, like flow cytometry, gel electrophoresis or sequencing e it is helpful to know the basics generally, the detail of a particular test or tests for your specific project, but if you really need advice e consult the expertise of a statistician (and early on in a project, rather than at the end). You may tinker with your car as a pastime, but if you need serious advice, you ask a mechanic. In the same way, you may be conversant with a particular test to analyse your data, but do ask for professional advice from a statistician if you need it.
Table 1
data at local, national or international conferences and even publish their results. Student selected components during the undergraduate medical course are also opportunities to get involved in research projects that might result in academic outputs. An intercalated degree is a good opportunity to be involved in a longer project, which may also result in a presentation or publication as well as an additional qualification. Following qualification, the next step on the clinical academic pathway is the Academic Foundation Programme. Programmes vary from region to region around the United Kingdom in the amount of dedicated time that is provided, but trainees will often have the opportunity to be involved in a project or to complete a piece of academic writing. The Academic Clinical Fellowship gives trainees an opportunity to formulate ideas for a higher degree, usually a PhD, and to focus on a paediatric subspecialty. The posts are generally for 3 years, with 25% of time dedicated to research. The split of clinical to academic time is not fixed, and different specialties or trainees may have different requirements but it is important that the research time is available in substantial blocks and not fragmented. During this time, pilot data are often collated and a detailed research proposal formulated to submit to the research council for a fellowship application. The grant application is one of the most difficult aspects to achieve. A well written application takes time to construct, and may require pilot data. The nature of the degree (MD or PhD e see Table 1), may direct the application to a particular institution, such as a research council, charity, pharmaceutical or industry grant. Which direction an applicant
Full-time academia The paediatric trainee who aspires to a predominantly academic rather than clinical job should consider the role of research early their career, and will likely wish to follow the clinical academic pathway envisioned by the Academy of Medical Sciences (Figure 1). These trainees may get involved in research as medical students and take the opportunity to get involved in summer vacationships where they may experience a small research project, which might lead to opportunities to present
Figure 1 The integrated clinical academic career pathway.
PAEDIATRICS AND CHILD HEALTH xxx:xxx
3
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
SYMPOSIUM: RESEARCH
on-line e which will enable them to participate in clinical research happening within their hospital. It is possible to step in and out of the clinical academic pathway to the point of a doctoral fellowship e and so it is feasible to do a PhD and then move on to an Academic Clinical Lecturer position, without having been involved in the prior steps. However, it is essential to think as early as possible about doing an MD or PhD, in order to maximise chances of finding a supervisor, constructing a project, gaining funding and obtaining time out of programme for research e 12 months is really the minimum time required for this. After completing a doctoral degree (and the same advice about writing up the thesis before you re-start in full time clinical medicine applies!!!), the trainee will be committed to subspecialty training, but within this programme there may be limited protected time to perform small research projects, write manuscripts and have opportunities to present data. On successful application for a consultant position, it may be possible to negotiate 1 or 2 units of Programmed Activity for research e consultants involved with this may be involved in helping run clinical trials as stand alone projects or as a partner in a wider consortia. Protecting this time can be very difficult, but is important, as failure to demonstrate academic outputs may result in withdrawal of the funding. It is worth giving some thought about your ideal career destination early on in training. Possible models are: Full time NHS consultant collaborating with multi-centre research as a local principal investigator e up to date Good Clinical Practice certificate will be required Full time NHS consultant but having one or two academic sessions within the job plan enabling collaborative research, but also leading single centre projects and trials Formal academic position as senior lecturer, reader or chair with a university contract and usually having half clinical work and half research time, although more research time may be negotiated
choses may depend on the nature of the project and the ultimate destination of the trainee. Research Council grants from the Medical Research Council, Wellcome Trust or National iInstitute for Health Research are more prestigious than other funding and will be looked upon more favorably by universities when considering appointments for senior academic positions, but are extremely competitive, and prospective candidates may be required to attend for interview. Grants from other sources are also competitive however. Ultimately, money in the bank from (almost) any source is to be welcomed, and generally covers salary plus employer costs, consumable costs for laboratory work, and may cover university fees, some costs for conferences, and travel if required for the project. A successful application will take weeks or months to write, go through many drafts, including revision by senior colleagues and will require input from the hosting institution regarding costing. A successful candidate will spend at least 2 years in an MD project and 3 years in a PhD project, gaining research experience and collecting data for the thesis and for presentation and publication. I cannot emphasise enough how important it is to write the thesis as the candidate progresses e time management and personal organisation is critical. The introduction is the literature review, which can be written without any laboratory experience, and is best done at the beginning of the project e it can be modified when the project is complete, if necessary. References to the literature should be stored contemporaneously rather than trying to remember them a year or two later, and are best managed with a reference manager. Methods should be written as the candidate progresses, and results chapters can be composed as potential manuscripts. It is very difficult to write a thesis upon returning to full time clinical work, and I recommend as a minimum that the first thesis draft is complete before returning to clinical service e ideally the thesis will be submitted by that stage. An Academic Clinical Lectureship can only be applied for upon submission of the PhD thesis (another incentive for timely submission), but gives a longer period of time for the trainee to develop their post-doctoral research ideas as they become an independent Principal Investigator, as well as completing their sub-specialty clinical training. Usually the post will be for four years full time equivalent, with 50% of time dedicated to research. Ideally during this period they will have an opportunity to co-supervise PhD or Masters students and begin to successfully acquire grant money to help fund their projects. During this time, trainees may move to laboratories outside their institution, often abroad, to gain more experience. At the end of this period they will have enough high quality publications and pilot data to submit an application for an intermediate fellowship, as they become a Senior lecturer and an independent researcher.
Conclusion Academic medicine, and particularly academic paediatrics is currently struggling in the UK as a discipline, with falling numbers of doctors involved in research or holding academic positions. Given the importance of evidence-based medicine in maintaining good clinical practice and best outcomes for our patients, it is critical that academic paediatrics is encouraged. It is not easy to combine academic and clinical training, but trainees should be encouraged to question, to develop ideas and to seek a mentor to encourage them in academic paediatrics. A FURTHER READING Academy of Medical Sciences: https://acmedsci.ac.uk. Association of Medical Research Charities: https://www.amrc.org.uk. Medical Research Council: https://mrc.ukri.org. National Institute of Health Research: https://www.nihr.ac.uk. UK Foundation Programme Academic Compendium: http://www. foundationprogramme.nhs.uk/sites/default/files/2018-08/ Academic%20Compendium0.pdf. Wellcome Trust: https://wellcome.ac.uk.
Academia in the National Health Service For some doctors, either the opportunities outlined above were not available, or they realise somewhat later in their training that they wish to have dedicated research time within their career. It is possible to maintain an interest in academic medicine however, by getting involved in research happening within the paediatric department. It is my belief that all doctors should obtain the certificate of Good Clinical Practice e courses are available
PAEDIATRICS AND CHILD HEALTH xxx:xxx
4
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
Developing a career in academic paediatrics
whether we are primarily employed by the health service or by an academic institution such as a university. Having determined that, the question for trainees and senior doctors alike is not whether to be academic or not, but rather how much time devoted to academic activity is to be included in a job plan or career. For trainees in particular, it is worth spending some time early in the training pathway thinking about how research will play a role in your future career. A good research project which will lead to a doctoral degree generally takes at least a year to initiate, and will require funding, possibly obtaining pilot data prior to a grant application, and planning from the local training committee to arrange training rotas and account for gaps caused by trainees taking time out of programme. A request to the local paediatric school for time out for research is more likely to be successful if accompanied by a timely request with a well thought through project, required funding and an appropriate supervisor. It is never too early to discuss this with your programme director e they are generally averse to sudden surprises. See Box 1.
Andrew R Gennery
Abstract Many trainees think about research towards the end of clinical training, but at that stage, it may be too late to get the most from the limited opportunities that remain. Ideally, trainees should consider research early in their career. For some, a career in academic paediatrics may be attractive, in which case following the clinical academic pathway as outlined by the National Institutes of Health Research may be appropriate. For others, research may be part of a wider clinical training. This article discusses a variety of research opportunities available to trainees, and offers advice on a career in academic paediatrics.
Keywords academic clinical fellow; academic clinical lecturer; academic foundation programme; academy of medical sciences; clinical academic; clinician scientist; national institutes of health research; PhD
Opportunities to improve your CV Ask consultants e are there projects you can do with them:
Introduction
C C
To sit, alone or with a student or a supervisor, discussing newly emerging data is one of the most thrilling moments in an academic career e to have acquired knowledge that is unique to you, until it is shared, confirming (or sometimes refuting) a carefully considered hypothesis. Alone in the world, only you have this newly discovered knowledge. The thrill of the discovery after a long chase is difficult to beat. It is one of the ultimate rewards awaiting a clinical academic. An academic has an opportunity to treat an entire cohort of patients or a complete patient population rather than just the patient in front of them, as a result of the development of care guidelines adopted into NICE guidelines, or introduction of a new therapy. Actually, I dislike the terms ‘clinical academic’ or ‘academic paediatrician’ because they confer the concept that a small but elite subset of us are more cerebrally endowed than the rest, whose function is to run an ever expanding service with ever diminishing financial, temporal and human resources, whilst the elite sit in ivory towers, devolved from the real world and pontificate on obscurities. The reality is that the majority of us have excelled at school, spent at least 5 years in undergraduate medical education, gained further professional exams and in many cases a postgraduate degree or certificate e and we are all to a greater or lesser extent ‘academic’. The difference is in the amount of time allocated to our job plan or timetable for academic activities, and related to this,
C C
Box 1
It is also worth thinking about when will be a good time to conduct research, early on in your training pathway. If you wish to be a tertiary specialist in a narrow specialty, where specialty training is competitive, training jobs are few, and successful candidates generally apply when they are completing doctoral studies, you will need to be thinking about an MD or PhD early in your training e 6 months before a grid application deadline is too late.
General principles A number of features are required to be successful in academic paediatrics: Intellectual curiosity An identified question Dedicated time Good mentorship Appropriate environment Patient and public participation Serendipity Intellectual curiosity It may seem obvious, but unless you are curious about the subject that interests you, you are unlikely to ask questions that will develop into a project. Questions can be from a wide variety of approaches e an observation of a gap in patient care e be that in initial recognition of a diagnosis (or lack of recognition), in patient assessment or diagnostic test or pathway or in treatment
Andrew R Gennery MD DCH DipMedSci FRCPCH MRCP, Professor of Paediatric Immunology and Haematopoietic Stem Cell Therapies, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK and Paediatric Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, UK. Conflicts of interest: none declared.
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Case reports Audits e to present or publish Literature review Small clinical series
1
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
SYMPOSIUM: RESEARCH
approach and outcome. At the most basic level, research may start with a question that leads to an audit of an aspect of patient care, which in turn identifies a deficit. This may result in a tightening of established processes, but may raise more fundamental questions about the process and lead to a search for what is already known about a topic e a review of the literature is always a good way to identify what is already understood about a particular issue and to identify gaps in knowledge. Well conducted, a literature review may even lead to a publication as an up to date review on the topic of interest. At a more fundamental level, the question may ask about the disease process itself, for instance, the cause at a molecular or genetic level, or the natural history of the disease. These questions may lead to a more basic scientific investigation, rather than a clinical-based project.
time (weeks or months) are more productive than half days taken here and there e at worst try and insist on complete days for research, rather than several half days (valuable time will be consumed by clinical over-run and by spending time trying to recall where you were in the research plan). All clinicians involved in research will recognise the competing tension between academic and clinical time, but it is important to value academic time as much a priority as clinical time. Supervision and mentorship This is an extremely important requirement of becoming and remaining a successful researcher e even senior academics benefit from mentors. Supervision will occur at different levels during a project. Your main supervisor will likely have conceived the project and helped to gain funding. Scheduled regular monthly meetings (at least) should be held to assess the overall progress and direction of the project e more frequent meetings may be required if the student is having difficulties. The Principle Investigator is the ‘go to’ person for discussions about results and the direction of the project. However, if the pipette is broken, or chemicals need ordering, the laboratory technician or post-doctoral scientist will be of much more practical help e it is worth nurturing a good relationship with the technician e they are often the most experienced person in the laboratory and will understand how to navigate the quirks of the institutions’ technical bureaucracy! For trainees, remember that there are mentors to fulfil different roles e including general career advice, as well as focussed advice on the research topic itself. A good mentor should be approachable, and inspiring. Mentorship is different to supervision, and implies an interest in the personal development and future direction of the trainee, rather than specific advice on a particular project. Supervision will occur at different levels during a project.
An identified question Again, it may seem obvious, but good research starts with a good question. It is relatively easy to generate data, but in order to interpret it in a meaningful way, it is important to make sure that you have understood what the research question was asking. It is worth spending time on this, and understanding the background to the topic of interest in order to identify gaps in knowledge. The National Institutes of Health Research fund schemes such as the Academic Clinical Fellowships, precisely to give trainees time to explore a topic of interest, generate pilot data and construct a fellowship application. Do not be afraid to approach senior colleagues or experts to ask for advice and to ask questions e it is surprising how often in medicine we do things because they have always been done that way, rather than because of an evidence base. Dedicated time You are more likely to be successful in your research if you have dedicated time to fulfil it. For those who are in a postgraduate study programme, protected research time is likely to be built-in, but it is difficult to protect it entirely. For doctors whose research is clinically focussed, it may be that clinical time is included in the programme e for instance taking measurements or samples, or assessing patients in clinic. For trainees on a doctoral programme, it is likely that some of the time spent doing the research will be asked to count towards clinical training, and many trainees will continue to cover out of hours rotas whilst doing research, partly to maintain clinical competencies and also to supplement income. The difficulties arise when clinical emergencies arise, with sick patients, absent colleagues or gaps in rotas or ward cover. Most of us are clinicians and find it difficult to walk away from these clinical situations. Sometimes it is completely unavoidable and we just have to cover the gap, but hospital services are very good at ‘using’ colleagues on research programmes to ‘fill in’ for emergencies. Remember that the body funding your research is expecting outputs when you have completed your studies, and emergency shifts that you have covered do not count, and cannot be listed on your curriculum vitae. This is one period in your career when it is permissible to make yourself unavailable e preferably in a different building or out of telephone contact. Well conducted research needs dedicated time and focus. For those studying or conducting research part time, this difficulty can be magnified e blocks of research
PAEDIATRICS AND CHILD HEALTH xxx:xxx
Environment Successful research needs to be performed in an appropriate environment. Are you surrounded by people who can advise on practical aspects of the project, and help you ‘troubleshoot’? Is there an appropriate academic nurturing surrounding e are you being adequately supervised and mentored, but also academically challenged and exposed to new or different opinions or ideas? Do you have access to the necessary tools or equipment to perform your research? Do you have access to library resources? Does the institution have a track record of supervising research projects and trainees. Clinical academics are more likely to flourish in an environment that provides a wide range of support, and should not be working in isolation. Patient and public participation It is important that clinical research has an intention to benefit patients and the wider society. Many grant-giving bodies encourage researchers to approach patient groups or organisations to help in formulating research questions, or even designing materials such as consent forms and patient information forms. Good research questions should also address important problems, and it is helpful if clinicians and patients can agree on what are important topics in the field.
2
Ó 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007
SYMPOSIUM: RESEARCH
Serendipity Research should not rely on luck, but it is true that many discoveries or breakthroughs are serendipitous, rather than part of a carefully formulated research protocol. The secret to success is not so much to rely on luck, but rather be open-minded about unusual results and enthusiastically take emerging opportunities. The successful researcher should never stop asking questions or lose their curiosity.
Should I choose a UK MD or PhD? MD
PhD
2 years full time study Clinical or laboratory based Often less structured supervision Less favoured by Research Council funding bodies Less recognised internationally e few equivalent degrees
3 years full time study Clinical or laboratory based More structured supervision More favoured by Research Council funding bodies International recognition e similar to other PhD degrees from abroad Less favoured by universities for Favoured by universities for senior academic positions senior academic positions Unlikely to secure a Clinician/ More likely to secure a Clinician/ scientist position scientist position
Research training A postgraduate certificate or higher degree, gives the trainee some exposure to training in research. This can cover many areas, including how to use the library and conduct a literature review, how to write a scientific manuscript, how to plan and write up experimental work, learning practical laboratory or clinical skills, and how to present work in poster or oral format. A common question however addresses that of statistical method e should I go on a statistics course? I suspect this question is asked so frequently because most of us hold some fear of statistics e how to use them and how to interpret them. [The interested reader should certainly avail themselves of the article by Foard in this month’s edition of P&CH]. To my mind, it is helpful to take a basic course, and most universities will provide this. The reason for doing this is that we all should have a basic understanding of statistics, possibly for our research project, but certainly when reading and interpreting data from published manuscripts. However, statistics are a tool, like flow cytometry, gel electrophoresis or sequencing e it is helpful to know the basics generally, the detail of a particular test or tests for your specific project, but if you really need advice e consult the expertise of a statistician (and early on in a project, rather than at the end). You may tinker with your car as a pastime, but if you need serious advice, you ask a mechanic. In the same way, you may be conversant with a particular test to analyse your data, but do ask for professional advice from a statistician if you need it.
Table 1
data at local, national or international conferences and even publish their results. Student selected components during the undergraduate medical course are also opportunities to get involved in research projects that might result in academic outputs. An intercalated degree is a good opportunity to be involved in a longer project, which may also result in a presentation or publication as well as an additional qualification. Following qualification, the next step on the clinical academic pathway is the Academic Foundation Programme. Programmes vary from region to region around the United Kingdom in the amount of dedicated time that is provided, but trainees will often have the opportunity to be involved in a project or to complete a piece of academic writing. The Academic Clinical Fellowship gives trainees an opportunity to formulate ideas for a higher degree, usually a PhD, and to focus on a paediatric subspecialty. The posts are generally for 3 years, with 25% of time dedicated to research. The split of clinical to academic time is not fixed, and different specialties or trainees may have different requirements but it is important that the research time is available in substantial blocks and not fragmented. During this time, pilot data are often collated and a detailed research proposal formulated to submit to the research council for a fellowship application. The grant application is one of the most difficult aspects to achieve. A well written application takes time to construct, and may require pilot data. The nature of the degree (MD or PhD e see Table 1), may direct the application to a particular institution, such as a research council, charity, pharmaceutical or industry grant. Which direction an applicant
Full-time academia The paediatric trainee who aspires to a predominantly academic rather than clinical job should consider the role of research early their career, and will likely wish to follow the clinical academic pathway envisioned by the Academy of Medical Sciences (Figure 1). These trainees may get involved in research as medical students and take the opportunity to get involved in summer vacationships where they may experience a small research project, which might lead to opportunities to present
Figure 1 The integrated clinical academic career pathway.
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SYMPOSIUM: RESEARCH
on-line e which will enable them to participate in clinical research happening within their hospital. It is possible to step in and out of the clinical academic pathway to the point of a doctoral fellowship e and so it is feasible to do a PhD and then move on to an Academic Clinical Lecturer position, without having been involved in the prior steps. However, it is essential to think as early as possible about doing an MD or PhD, in order to maximise chances of finding a supervisor, constructing a project, gaining funding and obtaining time out of programme for research e 12 months is really the minimum time required for this. After completing a doctoral degree (and the same advice about writing up the thesis before you re-start in full time clinical medicine applies!!!), the trainee will be committed to subspecialty training, but within this programme there may be limited protected time to perform small research projects, write manuscripts and have opportunities to present data. On successful application for a consultant position, it may be possible to negotiate 1 or 2 units of Programmed Activity for research e consultants involved with this may be involved in helping run clinical trials as stand alone projects or as a partner in a wider consortia. Protecting this time can be very difficult, but is important, as failure to demonstrate academic outputs may result in withdrawal of the funding. It is worth giving some thought about your ideal career destination early on in training. Possible models are: Full time NHS consultant collaborating with multi-centre research as a local principal investigator e up to date Good Clinical Practice certificate will be required Full time NHS consultant but having one or two academic sessions within the job plan enabling collaborative research, but also leading single centre projects and trials Formal academic position as senior lecturer, reader or chair with a university contract and usually having half clinical work and half research time, although more research time may be negotiated
choses may depend on the nature of the project and the ultimate destination of the trainee. Research Council grants from the Medical Research Council, Wellcome Trust or National iInstitute for Health Research are more prestigious than other funding and will be looked upon more favorably by universities when considering appointments for senior academic positions, but are extremely competitive, and prospective candidates may be required to attend for interview. Grants from other sources are also competitive however. Ultimately, money in the bank from (almost) any source is to be welcomed, and generally covers salary plus employer costs, consumable costs for laboratory work, and may cover university fees, some costs for conferences, and travel if required for the project. A successful application will take weeks or months to write, go through many drafts, including revision by senior colleagues and will require input from the hosting institution regarding costing. A successful candidate will spend at least 2 years in an MD project and 3 years in a PhD project, gaining research experience and collecting data for the thesis and for presentation and publication. I cannot emphasise enough how important it is to write the thesis as the candidate progresses e time management and personal organisation is critical. The introduction is the literature review, which can be written without any laboratory experience, and is best done at the beginning of the project e it can be modified when the project is complete, if necessary. References to the literature should be stored contemporaneously rather than trying to remember them a year or two later, and are best managed with a reference manager. Methods should be written as the candidate progresses, and results chapters can be composed as potential manuscripts. It is very difficult to write a thesis upon returning to full time clinical work, and I recommend as a minimum that the first thesis draft is complete before returning to clinical service e ideally the thesis will be submitted by that stage. An Academic Clinical Lectureship can only be applied for upon submission of the PhD thesis (another incentive for timely submission), but gives a longer period of time for the trainee to develop their post-doctoral research ideas as they become an independent Principal Investigator, as well as completing their sub-specialty clinical training. Usually the post will be for four years full time equivalent, with 50% of time dedicated to research. Ideally during this period they will have an opportunity to co-supervise PhD or Masters students and begin to successfully acquire grant money to help fund their projects. During this time, trainees may move to laboratories outside their institution, often abroad, to gain more experience. At the end of this period they will have enough high quality publications and pilot data to submit an application for an intermediate fellowship, as they become a Senior lecturer and an independent researcher.
Conclusion Academic medicine, and particularly academic paediatrics is currently struggling in the UK as a discipline, with falling numbers of doctors involved in research or holding academic positions. Given the importance of evidence-based medicine in maintaining good clinical practice and best outcomes for our patients, it is critical that academic paediatrics is encouraged. It is not easy to combine academic and clinical training, but trainees should be encouraged to question, to develop ideas and to seek a mentor to encourage them in academic paediatrics. A FURTHER READING Academy of Medical Sciences: https://acmedsci.ac.uk. Association of Medical Research Charities: https://www.amrc.org.uk. Medical Research Council: https://mrc.ukri.org. National Institute of Health Research: https://www.nihr.ac.uk. UK Foundation Programme Academic Compendium: http://www. foundationprogramme.nhs.uk/sites/default/files/2018-08/ Academic%20Compendium0.pdf. Wellcome Trust: https://wellcome.ac.uk.
Academia in the National Health Service For some doctors, either the opportunities outlined above were not available, or they realise somewhat later in their training that they wish to have dedicated research time within their career. It is possible to maintain an interest in academic medicine however, by getting involved in research happening within the paediatric department. It is my belief that all doctors should obtain the certificate of Good Clinical Practice e courses are available
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Please cite this article as: Gennery AR, Developing a career in academic paediatrics, Paediatrics and Child Health, https://doi.org/10.1016/ j.paed.2019.11.007