Big fall in medical teachers

Universities may be forced to squeeze the number of medical school places they can offer unless they can train more academic clinicians, a conference heard this week.

Medical academics attending the Developing Academic Medicine conference held by the British Medical Association in London debated a strategy to halt the decline in numbers of academic clinicians. The latest figures from the Council of Heads of Medical Schools show a significant decline in UK clinical academic staffing levels from 3,549 in 2000 to 3,113 in 2004.

The biggest drop has been among clinical lecturers, with the total last year at 494, down from 594 in 2003. This contrasts starkly with a 40 per cent rise in the number of medical students between 2000 and 2004.

Peter Dangerfield, deputy head of the BMA's medical academic staff committee (MASC), said: "We may reach the stage where we have to curb the number of medical undergraduate courses. There are plenty of scientific staff but they don't have the same clinical training as doctors and this is crucial. If academics are lacking, then National Health Service staff might have to step in - this isn't their role."

David Gordon, dean of the faculty of medicine at Manchester University, said: "The fall in numbers of clinical academics is a threat, but the sector has been efficient at dealing with difficult circumstances in the past and we will find a way of coping as long as the support needed is forthcoming."

The Walport report, published in March, drew attention to the falling numbers of clinical academic staff and made recommendations defining clearer training pathways aimed at removing obstacles to clinical research.

Many of the recent changes in the NHS have placed emphasis upon meeting patient-led targets rather than facilitating the education and training of medics.

In June, the Department of Health took action in response to the Walport report by introducing 250 new clinical fellowships and lectureships for people in the early stages of their careers, and an additional 100 for mid-career clinicians. Geraint Rees, a member of the MASC, said: "The academic fellowship scheme outlined in the Walport report provides a structured, two-phase scheme for junior clinicians entering academia that incorporates clinical competencies and structured academic training."

But Dr Rees said that funding mechanisms such as the research assessment exercise failed to recognise the contribution of medical academics not only to research but also to teaching and patient care. Pressure put on academics to publish papers on high-impact basic science rather than clinical research acted as a disincentive to entering medical-led research, he said.

"The RAE is a blunt instrument and can fail to recognise both the importance of clinically led research and the multiple commitments of medical academics to patient care, teaching and research," Dr Rees said.

The BMA launched an initiative at this week's conference, announcing 25 clinical academic "role models", profiling those who had successfully split their time between the demands of the clinic and academia. One of the role models, Fritz Muhlschlegel, complements his research role at Kent University with duties as a consultant at the Kent Hospitals Trust Clinical Microbiology Service. "We need more cross-talk between research and the clinic to encourage a culture of translational development," he said.

Role models: Clinical academics get to Practise what they preach

Irwin Nazareth finds that most research ideas stem from experiences with patients and interactions with fellow clinicians.

Dr Nazareth, director of the Medical Research Council-General Practice Research Framework at University College London, has been translating findings from primary care research into benefits for patients in general practice since 1990.

"Working between academia and clinical practice overcomes the frustration of having something published in a journal but not seeing this implemented in practice," he said.

"I think it would be difficult to do academic research divorced from medicine itself. For me, practice helps me identify the main question that I use to formulate my research."

Dr Nazareth trained in India and in 1984 moved to the UK, where he qualified as a GP before meeting with success in his research. He first published a paper on the back of his senior house officer post in psychiatry and later moved into primary care academic research.

He now takes a leading role in developing primary care research infrastructures across the UK while working two days a week from his practice in North London.

It is never too late to enter academia, but Dr Nazareth feels that clinicians should sample academic research before specialising in one field.

"Clinicians need to take the opportunity to explore different areas earlier and to pursue original research ideas," he added.

"There is also a need to encourage clinicians to research in novel areas that are unrelated to agendas such as those set by the national service frameworks."

Sarah Fidler , senior lecturer in HIV and genitourinary medicine at Imperial College London and clinician at St Mary's Hospital, often finds that research and practice are two sides of the same coin in the field of HIV/Aids.

Dr Fidler said: "The research I do in academic medicine provides the evidence to support the clinical work.

"My involvement with HIV is more than just the provision of a service. I put patients into trials and test different strategies for using the drugs we currently have available."

Dr Fidler completed her BSc in immunology during the late 1980s, a couple of years after HIV became a major health issue, and she decided to steer her career in the direction of research while keeping her hand in with clinical work.

She gained an MRC training fellowship to undertake a PhD in HIV immunology at Imperial and then went on to a postgraduate clinical specialist registrar/academic lecturer post (part time) at Imperial before taking up her current post.

Dr Fidler would like to see a system that offers more substantial rewards to young clinicians considering entering academia.

"If it is possible to negotiate, then a clinical academic post is hugely rewarding and, in my opinion, far more challenging and stimulating than a purely clinical role," she said.