Blending clinical and academic activities can be very rewarding. Academic surgery offers the chance to participate in the broader scientific community, develop a field of expertise and make contributions to the leading edge of patient care.
The integrated academic training (IAT) pathway outlined below is for those trainees wishing to become independent researchers. However, research is valuable for all surgical trainees and there are ample opportunities to gain experience outside of the IAT.
The integrated academic training pathway
In 2005, the Joint Academic Careers Subcommittee of the UK Clinical Research Collaboration (UKCRC) and Modernising Medical Careers (MMC) published the ‘Walport' report, recommending an integrated academic training pathway that combined research and education with a clinical career.
The image below shows the current integrated academic training pathway for plastic surgery. The stars mark the points where the BAPRAS Research Committee recommends a higher research degree is best undertaken. In general, this is either before commencing core training or following the award of a national training number.
Academic Foundation Programme
The academic foundation programme offers newly qualified doctors the chance to gain experience in a broad range of education and research topics. The two-year programme varies greatly between regions. In some the academic component is a discrete block and in others it runs concurrently with clinical training. Completing an AFP is not a prerequisite for gaining an academic clinical fellowship (ACF). Visit the Foundation Programme website.
Academic Clinical Fellowships
Academic Clinical Fellowships follow the Foundation Programme and last a maximum of three years. During this period of core surgical training a specialty interest and research area is identified. There is a time allocation of 25% for research activity. Ideally a project proposal is assembled during this time and external funding sought for a doctorate.
Higher research degree
The degree of choice for the IAT pathway is a PhD. It is recognised internationally and provides formal research training that sets the trainee on the path to becoming an independent researcher.
Those outside of the IAT can still choose to pursue a higher degree. The website Postgraduate Search has a comprehensive listing of MSc courses.
Out of Training Research Experience
Undertaking a higher degree will necessitate a period of out-of-training time. Although there are diplomas and some Masters degrees that can be followed as distance learning or part time activities, formal research training within a Masters or Doctorate programme will require full time commitment.
The present competitive selection for appointment to higher specialist training at ST3 is based on a number of criteria of which research is just one of many. Credit is certainly given for a one-year research Masters degree but little extra credit is awarded for PhD, MD or ChM degrees. The extra investment in time to complete such degrees does not guarantee ST3 selection. Those aspiring to become academic surgeons must appreciate that they will need to train and become fully competent in the two separate fields of surgery and science. Achievements in the latter may not have a positive value in surgical promotion.
The best time to undertake a PhD is either early, (intercalated with undergraduate studies or before or after the foundation programme), or after a higher specialist training number has been secured. During core training the major focus should be on acquiring clinical competencies and gaining a National Training Number. Interrupting this progression by embarking on doctoral research carries the risk of reaching a career ‘dead end’ if a training number is not subsequently secured.
The present training structure points towards there being a benefit to most trainees of a one year Masters degree. Perhaps 10% of trainees should do a PhD, at the times advised, not as a means of advancing a surgical career, but as a formal research training to work closely with scientists from other disciplines and develop an academic career. The lesson of history is that only a small committed minority of consultant surgeons will continue to be research-science-active, although we are entering an era where most will admit patients to clinical trials.
For those aspiring to become surgeon scientists a PhD is recommended rather than an MD as this is internationally recognised and carries greater weight amongst the scientific community.
Clinical Lectureships (CL)
NIHR Clinical Lectureships are appointed after admission to higher specialist training and generally after graduation from a PhD programme. There may need to be a period of dedicated clinical training between completing a doctorate and applying for a clinical lectureship. Such posts enable trainees to split their time. Fifty percent is spent on clinical training and 50% on research or educational development at a postdoctoral level. The lectureship has a maximum duration of four years or until the certificate of completion of training is achieved. Clinical lectureships are not awarded to a specialty but to a University that will then generate its internal mechanism for selection of candidates and specialty areas to support.
Exit from training
Substantive academic surgery posts remain few and far between in plastic surgery in the UK. In fact the majority of academic plastic surgeons hold honorary or single session academic positions and future appointments at professional level are likely to be based on personal achievements rather than continuation of established posts.
Ideally a joint appointment would be developed between an NHS Trust and a university research department. This would provide support and infrastructure required to be competitive for grant applications and to make the transition to setting up a research group comprising basic scientists and trainee surgeon-scientists.
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