Integrating research into clinical training through academic pathways.

Whilst the structured and integrated academic pathways appeal to many, it is a competitive selection process and not all will be successful. Furthermore some students/trainees wish to maintain a degree of flexibility or are simply not 100% decided upon an academic pathway, with the option to have a research interest within an NHS consultant job more of an attractive option.

Trainees may go through the typical training pathway of foundation, core and specialty training posts, with opportunities for formal research experience along the way.

Research experience is an integral part of training, as highlighted by the CST and ST interview process – part of the CV station at ST3 interviews (which attributes 20% of overall mark) awards bonus points for postgraduate qualifications, peer-reviewed publications, national/international presentations and awards (which can be achieved through conference prize sessions) – the following marking proforma pays evidence to this – here.

The critical appraisal interview station will be much easier to perform well if you are regularly involved in reviewing research studies.

As such all trainees need experience in high quality research, and NESTAC hope to provide these opportunities, especially as this may inspire trainees to pursue further research within their career.

Nonetheless if you wish to excel in a research career, it is generally considered nearly essential to enter a period of formal research to achieve an MD/PhD, as this provides invaluable expertise (running a trial/lab skills) and knowledge (developing a niche specialist interest), development of organizational/team-working skills, experience in grant/fellowship writing, and ultimately the dedicated time to commit to an in depth research project, with the potential for much greater future research prospects as a result.

Pursuing formal research in mainstream training can be done in one of 2 ways:

1. “Out of training” formal research – Following F2 or CT2, rather than moving on to CT1/ST3 respectively.
2. Out of programme research (OOPR) – There is the potential to take time out of speciality training (i.e. ST3-8) via “Out of programme for research” (OOPR) arrangements to undertake an MD or PhD, which are usually 2 and 3 year periods respectively. We believe the optimal time for this would be following ST4/ST5; at this stage you will have most likely decided upon the surgical subspecialty you wish to pursue, and as such can tailor the research project towardsa specific area of interest, with the most appropriate supervisors and institutional involvement. At this stage you will have developed a competent level of surgical skills which will allow you to pick up these basics quicker once you return to full time training. Taking OOPR later on (ST7/8) potentially leads to de-skilling immediately prior to taking up a consultant job when ideally you should be on top of your game.

Applying for a project can be done generally in one of two ways:

1. Advertised projects where the study topic/supervisor is often pre-determined thus limiting any project personalisation, however these opportunities are often fully funded through research fellowships/charity involvement (e.g. MRC/Wellcome/CRUK), and therefore represent an ideal chance to step straight into a set-up project with less concerns regarding money for general costs/consumables/salary and generally the benefit of committing full time (with usually an unbanded salary) to the project. Applications are typically through a competitive interview process, thus re-emphasising the need to optimise your CV during early years training to increase chances of success. Keep an eye out on university websites for such opportunities; alternatively the Newcastle Joint Research Office may be able to guide you.
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2. DIY with the assistance of a consultant supervisor/NESTAC mentor – herein you contact a potential supervisor who might have a project idea and established connections to achieve both a salary (often by taking up a research fellow post and covering an on call rota +/- limited elective duties) and consumables (from a “research pot”/established research fund). Typically the first 6 months is spent generating pilot data, prior to using this data to apply for a fellowship e.g. from RCSEng (salary funded + small amount of consumables for 1yr →MD) or to a charity such as MRC/Wellcome/CRUK (typically 2yrs salary with higher consumable funding →PhD), both of which allow you to commit full time in the second +/- third year to complete your project. Research supervisors will have more detailed information on these and other funding sources, with local charities also possibly providing consumable support.