More research time prescribed

July 25, 1997

Academic medics are valued by the NHS, says Rex Richards, but seem ill served to compete in research

Medical research, a vital component of the health care of the country, is directed mainly by clinical academics, whose other duties include teaching undergraduates and postgraduate training.

Our task force found that people's main reason for entry into a clinical academic career is the desire to do research.

Some of our most able doctors are prepared to accept that training in academic medicine will take longer than conventional training, be more uncertain and probably be less well-paid. There will also be fewer career posts along the way to enjoying research that could eventually lead to better patient care. However, we found overwhelming evidence that the pressures of service and the pursuit of clinical research at internationally competitive levels are difficult paths to reconcile. Clinical academics are normally expected to provide clinical service for the National Health Service for more than half their time over a year. The NHS has always looked to clinical academics in the main teaching hospitals to lead service developments.

The remaining time for clinical academics is, in principle, available for teaching, research and associated administration. But different trends in the NHS and in the universities combine to intensify the difficulty of combining these roles properly. We have found that under pressure (academic doctors routinely work 50 to 60 hours a week) research is the first activity to suffer. We believe that this must be a major factor in explaining the results of the recent research assessment exercise in which many of our medical and dental schools did not score particularly highly when compared with international institutions - where, in many of the schools, academic doctors are able to devote as much as 75 per cent of their time to research.

The high RAE scores achieved by the postgraduate medical institutes suggest that where the conditions are right our doctors can compete with the best in the world.

In view of this, our report makes recommendations that should go some way towards protecting and even increasing research time in the medical schools here.

We have also found that the terms of service of clinical academics often fall short of those for NHS doctors, and that administrative accidents sometimes lead to loss of accreditation time and possibly salary increments. We suggested that these anomalies be removed. The situation is particularly serious for academic general practitioners where improvements are essential if the policies of the General Medical Council are to be implemented.

In our review of the various types of medical courses designed to appeal to aspiring doctors who may wish to follow academic medicine, we suggested that variety is a good thing and that the courses should be monitored carefully for some years to find the most cost-effective schemes. Young clinical academics' training takes longer than that for NHS specialist registrars because about three years is needed for the main research training, of which usually only one year is taken into account in the training programme.

But the accelerated training programmes now in place for the certificate of completion of specialist training (CCST) have tempted some royal colleges, worried about the risk of falling standards, to impose very rigid requirements for time spent on training and procedures completed.

Although we appreciate the difficulty of finding secure systems, we have urged the royal colleges to examine carefully the possibility of measuring competence as well as the passage of time, so that those who are fast learners, as academics sometimes are, can save time in their training.

We have observed the complexity of the management and organisation required for clinical academic staff employed by, or dependent upon, universities and NHS Trusts. Academics can see themselves as serving a number of masters, some of whom are in direct competition with one another, and some of whom have quite different primary objectives from those of the university.

Sir Rex Richards, chancellor of Exeter University, chaired an independent task force established by the Committee of Vice Chancellors and Principals.

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