Entering academic medicine

Modernising Medical Careers, published 8 years ago,3 established academic training pathways that run alongside standard clinical training. Walport/National Institute for Health Research (NIHR) Academic Clinical Fellowships (ACFs), for example, run alongside early specialty training and provide 9 months of protected research time over 3 years while gaining the same competencies as full-time clinicians.

Paediatrics is one of the few specialties with entry at Specialty Training year 1 (ST1) level, and the potential to pursue basic or clinical sciences across diverse areas, the early start and flexibility are key attractions. Another strength is separation of clinical service and academic commitments, allowing dedicated time to develop research skills. Successful trainees find a topic that excites them, and a supervisor with a track record in nurturing junior scientists.

Academic trainees really value their individual programmes,2 particularly educational modules (often as part of a formal MSc program) and regular academic meetings that build a sense of community, a challenge for junior academics working across disparate hospitals.

Maintaining momentum

After 3 years, ACFs decide whether to revert to clinical training or continue as academics by applying for PhD funding. The protected research time, and the opportunity to generate preliminary data, give ACFs a competitive advantage in research fellowship competitions.

Post PhD, a next step is an Academic Clinical Lectureship (ACL) post: 4 years alongside clinical training, with 50% research time. Trainees usually alternate 6–12 month blocks of clinical or academic work. ACL posts can only be awarded to those with a higher degree, and suffer from unpredictability about timing and location of their availability. Moreover, since trainees may only be at level 2 training and ACLs are supposed to bridge to Certificate of Completion of Training (CCT), they may come too early in paediatric training. The Wellcome Trust and the NIHR have developed early postdoctoral awards to support academic trainees post-PhD, but integration of these within the paediatric clinical training requires flexibility and recognition by deaneries that trainees need protected research time throughout training.

Despite the clear Modernising Medical Careers (MMC) diagram of academic career paths, it is apparent among our peers that many enter, exit and enter again at different stages. Our recent academic trainee survey demonstrated that half started their PhD after Level 1 training, but others entered right up to the end of Level 3. Such flexibility was a key tenet in the Walport report, but is often lost when translated into Deanery-speak about rotations and academic schedule.

We believe that there should be a national academic training board, to support trainees with such difficulties and to promote flexible entry points into official programmes, encourage PhD applications and facilitate regional mobility if required to improve research.

Supporting academic trainees

Academic trainees need support to flourish, and good mentorship is essential. The Academy of Medical Sciences took a lead on this with a national mentoring scheme, and there are some effective local set-ups, but we need more mentors and schemes for junior clinical academics. Increased awareness of the academic training pathways is also important, and it is still surprising how many senior consultants appear unfamiliar with the integrated academic and clinical components.

Early planning and dialogue is vital to coordinate training with recognition of the unique needs of different academic trainees in different specialties. Furthermore, reduced clinical time makes some academic trainees less confident in their clinical abilities (despite gaining official competence!) so they may need extra support. Based on the results of a survey of 48 academic trainees nationally,2 we make several recommendations for how to best support trainees within academic programmes (box 1).

Future challenges

Academic paediatrics is clearly becoming a viable training pathway with many positives, but challenges remain (table 1). The length of training, while inevitably longer if leading to expertise in laboratory and clinic, needs constant and individual review, with more proactive consideration of dual counting. If academic options are valued, why don't we count research time as ‘In programme’ experience? Length of training is a particular problem for women, for whom research is unlikely to be the only out of programme experience, and whose part-time working on return needs further recognition. The Athena Swan charter recognises the importance of retaining women in science and the drive from academic institutions to become accredited is likely to have a positive impact on flexible working patterns for all.4

Overall, academic paediatrics offers an exciting, fulfilling career and there is a large cohort of enthusiastic trainees coming through. Flexibility and strong networks will be vital in nurturing these trainees and cultivating the future leaders whom this specialty needs.