The doctors' fairy godmother

George Radda looks at the evolving financial relationship between the Medical Research Council and academia

The Medical Research Council plays a crucial role in advancing clinical practice in the United Kingdom. At the cutting edge of clinical research, it supports some 150 clinical trials to evaluate screening and treatment methods and other medical interventions. It funds and develops all aspects of clinical research alone and through partnerships with the health departments, industry and charities to fulfil its mission to advance knowledge in science to improve human health.

But another crucial part of the MRC's mission is to maintain the flow of excellent new minds trained to keep up the momentum. To this end the MRC provides a comprehensive portfolio of personal award schemes for every stage of clinical and non-clinical research careers.

It fosters research and researchers at the formative stages by funding the country's best graduates and postgraduates through their early research training so that they might contribute to advances that benefit patients. Such benefits are either direct through breakthroughs in clinical practice or via advances in medical knowledge which ultimately inform the clinician.

Later, the MRC funds researchers either through three-year or five-year grants held in universities or directly through its units and institutes. Close contact with the Department of Health ensures that clinical priorities are kept firmly in the frame.

The council's clinical training fellowships provide PhD training for clinical practitioners. It is a tremendous task for trainee doctors in hospitals or general practice to combine research with their already demanding work with patients, but the MRC believes doctors should be given access to careers in academia because their clinical experience is so valuable in research. Competition for the awards is fierce: more than 250 applications were received for the 50 or so awards last year.

Of the Pounds 34 million commit-ment to new personal awards made last year the split between studentships and clinical/non-clinical fellowships was about equal. Of the fellowships just over three-fifths were clinical and more than 40 per cent of these were clinical training fellowships.

Young hospital doctors with research interests face new challenges following the Government's implementation of the recommendations of the Calman report on clinical training. For many, the proposals will reduce the period dedicated to higher specialist training during their clinical training. The MRC has been looking at how its clinical fellowship schemes fit in with the new specialist registrar grade established under the Calman recommendations - to give those in the early stages of a clinical career the opportunity to pursue research interests in parallel with their training without falling behind those on the NHS track.

The awards schemes are constantly reviewed and developed with an emphasis on research career development in recent years. Examples of such developments last year are the extension of clinician scientist research fellowships, which offer a year working in industry. The senior research leave award scheme has been expanded to release researchers from administrative clinical duties to focus full-time on research. Outstanding senior research scientists who are programme grant-holders with an established international reputation for scientific excellence are able to devote themselves exclusively to research through MRC clinical and non-clinical readership and professorship schemes.

The MRC recognises the growing acceptance that research workers can no longer expect to rely solely on their skills at the research bench to secure their careers. Industry and indeed the demand on research team leaders call for more general abilities in the art and science of managing people and resources.

On these grounds it is reasonable that transferable skills such as those in written and spoken communication and time management should become part of the training given to our young researchers on their way to a doctorate. The MRC is looking into formalising the inclusion of such training into its schemes.

The net for contributors to clinical and other medical research has been cast wider in recent years to include nurses and other professions allied to medicine. The MRC has earmarked money for junior research fellowships for them. It has also set up a joint scheme of special training fellowships with the Royal College of Surgeons.

In primary care - general practice and other health care in the home and in the community - the MRC is working to redress a shortfall in research compared to that for hospitals. An MRC review of primary care research will report later this year.

The universities are also finding it more and more difficult to support the long-term, multi-discipline research. Last year the MRC awarded more than 1,500 grants and most of our training and career awards were in universities. It also awarded infrastructure grants worth Pounds 2 million. Most of the MRC units - research groups based around the proven intellectual leaders in their fields - are based in universities. The financial environment has led to fierce competition between units and institutes. Every five years these organisations have to demonstrate that their funding cannot be more efficiently deployed elsewhere.

Industry is making a much-needed contribution to the fund-ing of clinical research through collaborations with the MRC. These partnerships are giving researchers the extra experience of research in academia as well as in commercial organisations and a feel for the dynamics of collaboration between the two.

Last year, as part of a drive to extend career development initiatives, the MRC approved plans to enable its research staff to be seconded to industry and other organisations that use research findings.

It is a significant result of the MRC's emphasis on the need to collaborate that about 40 per cent of its clinical trials are co-funded and well over half of its partners are from industry.

The MRC funds promising and established excellent researchers to nurture their ideas from their formative stages through to their establishment as the star achievers in the academic firmament. It also develops initiatives to ensure its researchers are prepared to meet the demands of a modern research career. Their work with our support continues to feed new technologies, better practices and other advances into clinical practice that bring benefits to patients and the public health.

George Radda is chief executive of the Medical Research Council.

ROUTE FINDING

There are four MRC-funded routes by which clinicians can enter research: * the three-year long clinical training fellowship for doctors up to specialist registrar level

* the clinician scientist fellowship for specialist registrars with a PhD that lasts four years and includes the opportunity to spend a year working overseas or in UK industry

* the clinical senior fellowship that lasts five years - renewable in competition for a further five years - and is open to specialist registrars and consultants

* the clinician research professorship which is available to consultants or clinical professors with MRC programme grant support and an established international reputation for excellent research