2. To note this report about the GMC s position on integrated academic pathways (paragraphs 13-19).

Transcription

1 2 February 2011 Postgraduate Board 8 To note Update on GMC Position for Integrated Academic Pathways Issue 1. A summary of the present position for integrated academic pathways and some of the ongoing issues for monitoring and enhancement through the proposed Quality Improvement Framework. Recommendation 2. To note this report about the GMC s position on integrated academic pathways (paragraphs 13-19). Further information 3. If you require further information about this paper, please contact us by gmc@gmc-uk.org or tel

2 Background 4. Integrated academic pathways are training programmes that combine specialty training to Certificate of Completion of Training (CCT) with research training (usually to PhD doctorate of philosophy) and experience, enabling the successful doctors to pursue a career in research or combine clinical practice with research. Academic doctors are seen as crucial to the future of British healthcare because they are so closely involved with teaching and training future generations of doctors, as well as carrying out medical research that will benefit future patients. Academic integrated pathways to CCT were and are seen as an important contribution to building a workforce to establish the UK as a leader in health research. 5. Doctors who want to pursue a career in research, or combine clinical practice with research, need to gain both the necessary clinical and academic qualifications in the course of their training. In the mid 2000s, the UK Clinical Research Collaboration and Modernising Medical Careers established dedicated training pathways for clinical academics. 6. These innovative training pathways were set out in the report Medically and dentally qualified academic staff: Recommendations for training the researchers and educators of the future (2005), and implemented from Clinical academics make up five to ten per cent of the medical workforce (Medical Schools Council 2009); most are university employees but in addition to academic activities, they have honorary contracts with the NHS and spend part of their week as practising doctors. 8. Essentially, the first opportunity for research arises in the Foundation Programme where medical students can apply to enter a two year Academic Foundation programme in which academic experience is offered either in an integrated manner or as a four month block in year 2 to explore an interest in academia (rather than do in-depth research). 9. Following Foundation, doctors can apply to an integrated academic pathway and so undertake an academic clinical fellowship in conjunction with specialist training to a CCT. 25% of time is devoted to research with the aim of generating a research proposal to secure funding for a PhD (doctorate of philosophy) or MD (medical doctorate), usually after specialty training (ST) year 3. After completing the PhD the trainee would return to clinical training at ST4 as a clinical lecturer for post-doctoral research and completion of clinical training, aiming to progress into a senior academic role thereafter. 10. Academic clinical fellows are allocated an academic national training number (NTN(A)), the A part of which can be dropped at any point should the trainee wish to leave academic training. 2

3 11. This is a diagrammatic representation of the post-2007 opportunities: 12. We felt it would be useful for the Board to receive information about these pathways and to understand the GMC s role in quality assurance of them: in adopting the Quality Framework (QF), we undertook to quality assure these pathways through post and programme approval, surveys, curriculum and assessment system approval, and visits. Please note this paper does not address other research opportunities such as out of programme research. Discussion 13. Professor Collins report Foundation for Excellence (2010) identified the academic programme as a strength, noting the support for it from the Medical Schools Council and the National Institute for Health Research. It also noted the very positive feedback from Foundation doctors. The recently published Scottish Foundation Programme Report (2010) has confirmed that there should be no change at the moment to the Scottish Foundation Programme. 14. The Tooke report (2008) unequivocally supported the academic pathways but called for more flexibility in access and transfer between an academic and a clinical career. Numbers of trainees accessing the integrated pathways have increased significantly over the last few years but are unlikely to fully compensate for the number of experienced academics due to retire in the next decade. 15. More recently, since uncoupling of single run-through programmes into core programmes then higher specialty programmes, the assumption of a run-through to CCT has become more challenging for deaneries and Royal Colleges. In England, there is a perceived mismatch between the allocation of Academic Clinical Fellowship (ACF) posts with specialties by the National Institute for Health Research (NIHR) and the workforce/selection processes. There also issues that the types of specialties being chosen for ACFs are not necessarily where there is a demand for specialist consultants. This is not for the GMC to take action but to be aware that we will need to consider the approval process in light of any changes in approach to integrated programmes. The deans and Royal Colleges will be discussing these issues with NIHR. 3

4 QA activity 16. PMETB committed its full support for these pathways and the development of academic medicine; these pathways have been separately approved and monitored through the Quality Framework since The GMC adopted the Quality Framework and has therefore continued this commitment. 17. The pathway approval is basically on an ad personam basis and the trainees are considered as being in run-through programmes as the NTN (A) is in place until they achieve a CCT. The Academic Clinical Fellowships (ACFs) and clinical lectureships (CLs) are considered and approved against the postgraduate standards for training (each country has a slightly different approach or position in terms of delivery). Every visit to a deanery has included interviews and verification of the quality of the academic integrated pathways; the national trainee survey asks specific questions of such trainees and the trainee data in the annual deanery report also seeks to identify this particular cohort in each deanery. The GMC also ask that Royal Colleges include consideration of the academic routes in their annual specialty reports, although not all specialties have a specific integrated pathway route. 18. Overall the pathways work well; there are however challenges in achieving integration from the trainee s perspective. This is exemplified in the annual review of competence progression (ARCP) process; the ideal would be a joint ARCP and at the very least, close cooperation between the academic supervisor and the clinical supervisor/s. Many but not all trainees experience a quite separate set of processes; the Academy of Medical Royal Colleges working with the deaneries is exploring the potential for an academic portfolio for such trainees to support integration. Trainees report variable support and the emphasis on the coherent education of the trainee varies, mostly depending upon the local supervisors, ranging from excellent to poor, in one or both of these factors. 19. The GMC continues to quality assure the integrated academic pathways from start to finish through the mechanisms of the Quality Framework (in future, the Quality Improvement Framework); there is leadership from a lead dean for academic routes - Professor Michael Bannon - as well as clear responsibility for quality management of the complete pathways to CCT by the postgraduate deaneries. The GMC liaises closely with key bodies such as the National Institute for Health Research (NIHR) in England and has a representative on their Advisory Group. The Academy of Medical Sciences is a key UK partner in the development of academic opportunities in medicine. Recommendation: To note this report about the GMC s position on integrated academic pathways. Resource implications 20. No additional resource to that already allocated. 4

5 Equality 21. Women in academia and medicine have been the subject of several reports. The Deech Report (Department of Health (England), 2009) states: a. Academic medicine also reveals some concerning statistics. In 2007, one in five medical schools had no female professor at all, and only two of the 32 medical schools had a female head. In total, 23.6% of clinical academics are women, whereas women represent 28% of the senior hospital workforce and 36% of general practice providers. b. Indeed, within the international context the UK is amongst the countries with the worst representation of women at senior academic level (13% of full clinical professors in the UK are women, compared with 20% in Finland and Portugal). 22. This aspect of academic medicine is one that the GMC can contribute indirectly to through support of the academic routes and assuring the quality of the training. Communications 23. The approval data for integrated academic pathways are published on GMC Connect with all other approval data. This paper will be published on the GMC website. 5