The Kennedy Institute of Rheumatology Division and 1 Eric Bywaters Centre, Faculty of Medicine, Imperial College London, London and 2 Department of Rheumatology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Correspondence to: A. P. Cope, The Kennedy Institute of Rheumatology Division, Faculty of Medicine, Imperial College, 1, Aspenlea Road, Hammersmith, London W6 8LH, UK. E-mail: andrew.cope{at}imperial.ac.uk
The rise and fall of academic medicine is now a widely recognized problem [13]. While the Academic Careers SubCommittee of the Modernising Medical Careers (MMC) and UK Clinical Research Collaboration (UKCRC) in consultation with the Academy of Medical Royal Colleges are making valiant attempts at resurrecting an academic track [46], many clinical trainees around the UK are struggling to find ways to integrate a period of research into their clinical training programme. We endorse the idea that defined academic career paths should be structured and evolve early (perhaps as early as in medical school), but at the very least have their foundations placed firmly during the basic specialist training period, with flexibility built in. We also favour the idea that all trainees should undertake a period of research, not as a means of obtaining a consultant post but as an integral part of training. Research training should provide a rich and rewarding period of learning with respect to critical thinking, reviewing and interpreting the literature, experimental design, data interpretation and communication. Above all, a period of research should enable rheumatologists to obtain a deeper understanding of the clinical field, and should not be restricted to academics.
Although many rheumatology trainees are curious to explore clinically relevant biological questions, they may see significant obstacles standing in their way. What should they study? Where should they do it? How do they find the most appropriate supervisor? How should the research be funded? These and other questions formed the basis of a one-day symposium for rheumatology clinical trainees entitled Planning your research training, held at the Kennedy Institute of Rheumatology, Imperial College London, on 16 November 2004. This editorial seeks to crystallize some of the key learning points that arose from the discussions.
It was suggested that I need to do some research should enter consciousness before or soon after starting a specialist registrar training scheme. Over the course of the symposium several crucial checkpoints were defined, spreading across an imaginary 18-month time-line. The first of these relates to the choice of project. Trainees were advised to consider the three Rs. Is the project Right for me? Is the project Relevant? Is the project Realistic? The right and relevant project will offer better prospects for trainees to continue their research theme or to apply a particular research technique after completion of training. For example, for those planning a largely clinical rather than academic career, generating a gene mutant mouse may be a stimulating experience at the time but may be of less practical value once the rheumatologist returns to clinical practice. In contrast, the development of novel disease assessment skills may be a greater asset in the clinical setting. Due consideration of right and relevant should help trainees to define a niche and develop a career in a particular field in the longer term. This is good for self-esteem.
At this early stage it is also important for the trainee to consider what he or she is likely to enjoy in practical terms, and in particular to define whether they wish to work with patients, to study biological material or work full-time at the bench in a basic science laboratory. Indeed, the lifestyle and day-to-day activities will differ considerably depending on the nature of the project. To facilitate this decision-making process, a period of wide exploration and consultation is strongly recommended, during which time the trainee is encouraged to visit as many research units as possible. Ideally this should not just be those that are locally convenient.
Another key checkpoint involves a process of matching up. In other words, there needs to be a good fit between the project itself, the broader field of research, the institution and the supervisor. As both institutional and personal websites have become more sophisticated and informative, this checkpoint is much easier to negotiate. But trainees should address head-on the crucial and fundamental question of whether a prospective supervisor is really the most appropriate. Good supervision is an acquired skill, requiring both time and dedication [7]. Specifically, trainees would be well advised to navigate the appropriate pages on PubMedline, find out how many students the supervisor has supervised, identify what these students published during their research training and where they are now. This information, together with a visit to the department, may provide greater insight into whether the environment is appropriate and whether the infrastructure is in place. A visit may also provide an opportunity to meet existing students and research fellows in the host laboratory or department. Some units have postgraduate tutors or directors of postgraduate studies who will provide useful additional information about research training and higher degrees. At the same time, the trainee can establish what clinical activities may be feasible during the period of research training to maintain clinical skills, and, if necessary, identify a clinical mentor if the project supervisor is a basic scientist. During the course of the symposium it was generally agreed that good clinical research fellows are always in demand. Accordingly, prospective fellows can afford to be ambitious.
The third checkpoint revolves around getting funded and preparing an application, for which at least 9 months should be allocated [8]. First and foremost, the application should be relevant to the funding body. It should address an important and interesting clinical or biological question, formulated around a clear hypothesis. Any answer to the biological question posed must necessarily add to existing knowledge; more of the same is no good. A useful guide, shown in Fig. 1, illustrates in simple terms how the impact of an application may be dictated, at least in part, by the novelty of the experimental approach as well as the research problem. For example, it is perfectly valid to address an old research problem (e.g. what is the cause of RA?) using novel experimental techniques, provided the approach is hypothesis-driven and not just hypothesis-generating. It is also perfectly acceptable to use tried and tested methodologies to unravel a new research problem. But beware of the overambitious project that adapts new, untested techniques to explore a new research question, as this can be a high risk. Funding councils stress that applications should emphasize the training potential of a research programme. Unlike project grants, where the emphasis for peer review is on the science, assessment of research fellowships will give consideration to the 3 P's: the Project, the Person and the Place. All three are important. Thus, a strong candidate with a good project may be less competitive if the institution or supervisor is not appropriate.
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Recent audits suggest that rheumatologists have a pretty good track record in research. Based on 28 consultant/senior lecturer appointments from across the North West Thames region from 19972004, 10 rheumatologists had an MD degree while eight had successfully acquired PhDs (D. Isenberg, personal communication). From this cohort, all senior lecturers had higher degrees but nine out of 10 had a PhD. How do we fare with other specialties? The Wellcome Trust database for current entry level Research Training Fellows, Intermediate Training Fellows and Senior Clinical Fellows indicates that 4, 10 and 5%, respectively, are rheumatologists. This too seems encouraging. Finally, a frequently asked question is Should I do an MD or PhD? The answer depends to some extent on the topic of research and the time frame; this topic has been discussed previously in these pages [9]. Few universities, let alone supervisors, would recommend submitting a PhD thesis after just 2 years work. From a purely training perspective, the type of degree may be less important, so long as quality supervision and local infrastructure are in place.
In conclusion, this one-day symposium identified a number of useful learning points that might be helpful to those considering their research training. These are summarized in Table 1. On a more philosophical note, we suggest that all trainees heed the words of the 19th-century American essayist, poet and philosopher Ralph Waldo Emerson, who wrote do not go where the path may lead, go instead where there is no path and leave a trail.
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References
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