A novel foundation-year-two post in academic medicine

Abstract

A decline in the number of doctors pursuing careers in academic medicine poses a risk to medical research and training in the UK. This is happening at a time of major changes to postgraduate training, with the introduction of the Foundation Programme for newly qualified medical graduates in August 2005 and further changes to basic and higher specialist training expected thereafter.1,2 This paper describes an innovative training programme in academic medicine for foundation-year-two (F2) trainees. The 12-month programme provides training and practice in research, audit and medical undergraduate teaching in addition to traditional clinical training in medicine. Although in part dependent on the local infrastructure, it has key components that can be adapted by any academic unit in the UK. The impending changes to postgraduate medical training were driven by several reports highlighting the lack of formal training and career progression for senior house officers (SHOs).3-5 Although some of the changes have yet to be fully confirmed, training is likely to become shorter, more intensive and competency based. All newly qualified UK graduates will enter a two-year foundation that equips them with the skills to enter higher specialist training.6 These reforms offer new opportunities to address the growing reluctance of middle-grade junior doctors to take an academic career path.7 The Academy of Medical Sciences has pointed to lack of infrastructure, inadequate funding and the complexity of legal and ethical governance frameworks as reasons for a declining base8 together with the personal academic disincentives of insufficient flexibility, prolonged insecurity and lack of career structure.9 A British Medical Association (BMA) report indicates that, of specialist registrars working towards a postgraduate research degree, two-thirds are doing so primarily for reasons of career progression and only 17% because of an interest in research. It is possible that some of those who begin with career motives have their interest ignited and switch to academic medicine; consequently, the Academy argued for preservation of key appointments at specialist registrar grades along with new opportunities for senior SHOs at the completion of their general professional training.9 The National Health Service, as the main provider of UK healthcare, depends on a healthy research environment.11 In addition to research, medical academics provide leadership in healthcare delivery and teaching.13 Teaching is becoming increasingly important as medical undergraduate numbers rise. The two-year foundation programme provides an opportunity to develop innovative F2 posts in academic medicine. The Leicestershire, Northamptonshire and Rutland Deanery has funded two pilot posts, which started in August 2004 for one year, with further programmes planned for August 2005. Trainees are based in the Academic Medical Unit at the Leicester Royal Infirmary and the Department of Cardiovascular Sciences at the University of Leicester. The basic 40-hour week is split equally between clinical medicine and academic pursuits. In addition, trainees participate in emergency out-of-hours work on a rota identical to that of their SHO colleagues. The specific aims of this programme are: To achieve all competencies in the Foundation Programme in preparation for higher specialist training To provide exposure to academic medicine, clinical science and evidence-based clinical practice as a foundation for a career in academic medicine To provide training and practice in bedside and tutorial-based undergraduate teaching To provide continuing professional development, including preparation for successful completion of part I of the MRCP examination Effectively, these posts offer a 'taster' of academic medicine—ideal for trainees who contemplate embarking on a clinical research training fellowship as a prelude to academic study as well as for those who are unsure whether they should commit themselves to such a career. Whatever the level of commitment, the trainee will get comprehensive clinical training in an academic environment. Importantly, he or she will be excluded from the Research Assessment Exercise, so this period can be specifically dedicated to training. The educational supervisors, the trainees and the postgraduate deanery will all contribute to the continuous assessment and evaluation of these posts.