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Clinical academic training: a lost opportunity

A review of Medical Training Application Service and Modernising Medical Careers

June 2007

• Executive summary
• Summary of recommendations
• Context
• Prelude to MTAS
• Design and operation of MTAS
• Shortlising and interview
• Interview problems
• Round 1b
• The future of MTAS
• The future of MMC
• List of abbreviations

Executive summary
1. This document provides background information about the problems associated with application and appointment to ACF posts in 2007 as well as more general comments about academic training pathways. It makes recommendations, both with regard to the ACF posts and the arrangements for academic training alongside MMC in the future, following a period of consultation with academic members of the BMA.

2. The BMA MASC has long been voicing concerns about the declining numbers of clinical academics. The UK workforce is below 3000, having fallen by 27% in the past seven years. In addition, a lack of new recruits has resulted in an ageing population with over 57% of clinical academics aged 46 or over [1] . The introduction of a clear academic training path and dedicated posts for clinical teachers and researchers of the future is welcomed [2] however the numbers of academic training posts that have been announced are unlikely to bridge the gap of nearly a decade of decline. Given the significantly increased numbers of medical students, the greater emphasis in the NHS on research and development and the value to the UK economy of investment from research and development, more academic training posts and senior lectureships must be made available.

3. We have played an active role in all elements of the establishment of an academic training pathway – from contributing to the development of the pathway, to assisting with decisions on the allocation of posts to host institutions, providing advice to academic applicants, alerting decision makers to the problems with the ACF application process, and suggesting solutions to the ACF application process in 2007. The disastrous experience of application to ACFs in 2007 must not be repeated if the aim of recruiting a new generation of clinical academics is to come to fruition.

4. We also note that introduction of more structured and streamlined training envisaged by MMC might come at the expense of flexibility – that is the ability of trainees to move between clinical and academic training and the ability of trainees to undertake periods of research during their progress toward gaining a CCT. We would be very concerned if a reduction in flexibility resulted in reduced opportunities for all trainees to undertake periods of research, whether they aspire to pursue a career in clinical academia or not; or if reduced flexibility limited the ability of academic trainees to gain clinical competencies whilst pursuing an academic career.

5. Medical academic activities underpin clinical decision making in the NHS and attract significant investment to the UK. Moreover, a basic principle of higher specialty training [3] is that doctors should understand research methodology and should be encouraged to undertake research. Deaneries must therefore support continued access to opportunities to undertake out of programme experience during training within the NHS and abroad. Failure to do so is likely to badly affect clinical research in the NHS.

6. Further recommendations are made to ensure that the establishment of academic training through MMC does not result in disparities between academic trainees and their NHS colleagues.

Summary of recommendations
We make the following recommendations

7. From 2008, advertising of ACF posts should be conducted in a separate round outwith the main clinical training MTAS process. The risk of attracting large numbers of speculative applicants) is no more significant than the 2007 process where 1/3 all applicants ticked ‘prefer academic; while the benefits in terms of central provision of program information, job descriptions and tailored academic application forms are very significant. While advertising of ACFs must be separate from the main clinical round, recruitment will necessarily continue to be via a joint academic and clinical assessment. It is absolutely imperative that unsuccessful candidates retain the ability to access clinical posts with no detriment as is currently the case. Consideration must be given as to how clinical colleagues are to be made aware of academic training programmes and their input into the process.

8. This new process should be based on a revised application and objective scoring system, focusing on objective competencies that are relevant to clinical and academic training. The basis for such a system lies in the MTAS Review Group approved objective scoring system for ACF posts, and existing experience from the current round can be used to modify this system appropriately (and perhaps locally and/or on a specialty-specific basis, as appropriate) for any future recruitment process.

9. Consideration should be given to either formally placing responsibility on NCCRCD for collating and disseminating specific descriptions of individual ACF programs and posts, or creating a new body (e.g. a UKCRC ‘Academic Training Network’). This body could be specifically tasked with promoting a central collection of material, easily accessible by trainees, that outlines not just the general scope of UK academic training but the specific posts and programs available, with appropriate contact details. Adequate funds to support the NCCRCD, postgraduate deanery’s clinical training committees to provide this information and the UKCRUK ‘training Network’, must be made available for these activities from central government.

10. We also recommend

a. ‘disaggregation’ of specialty-specific ACF posts associated with common stem clinical training (e.g. in the medical specialties), with separate application and shortlisting for each specialty-specific ACF (though joint interviewing with clinical colleagues remains desirable)

b. the ability to advertise and recruit ACFs at multiple ST levels (subject to local clinical training programme approval)

c. transparent publication of competition ratios for all ACF posts

11. Given the benefits to the NHS of trainees understanding research methodology and undertaking periods of research, out of programme experience should be vigorously supported by Deaneries and clinicians, and promoted widely to able doctors, especially but not only in relation to those interested in academic careers.

12. The established practice in many Deaneries, specialty training committees and clinical training interview panels of routinely including clinical academic representatives should be formalised. This practice appears to have been lost in the 2007 recruitment process.

13. Work must be undertaken to address the pecuniary disadvantages that accrue during clinical academic training and to maintain parity with the NHS on pay and conditions, including loss or denigration of entitlements on transfer into or out of the NHS. Development of the key contractual principles that should apply to NHS and University contracts for academic trainees should be undertaken with the key stakeholders, including the BMA.

14. Workforce planning must be undertaken in relation to the clinical academic workforce to ensure that the future numbers accord with maintaining the clinical academic workforce at 6%, rising to staffing levels in 2000 or 8-10% of the consultant workforce. This modelling must take into account the latest figures on clinical academic staffing from the Medical Schools Council (formerly the Council of Heads of Medical Schools) and the number of ACF, Clinical Lecturer and Senior Lecturer posts that have been announced. Additional, funded posts should be made available in order to reverse the continued downward trend.

Context
15. At a time when the clinical NHS consultant workforce expanded by 24%, clinical academic numbers actually declined by 12% between 2000 and 2004. In absolute terms, the clinical academic workforce fell below 3,000 for the first time ever in 2005. Seen over a longer time period, the current academic workforce is only 83% of number in 2000. It is also an ageing population with a 16% increase in the number of academics aged over 46 since 2004. There is thus an acute and ongoing requirement to train the clinical academics of the future.

16. The numbers of posts that have been announced for the integrated academic training pathway do not appear to equate with the decline in numbers in staffing since the year 2000, and as such they are unlikely to replace the current workforce. Although it has always been acknowledged that there is no one way to become a clinical academic, adequate opportunities for exposure to academia in the training grades and sufficient posts at consultant level is vital to maintaining numbers of clinical academics into the future.

17. Clinical academic training varies by specialty but generally requires completion of clinical competencies to CCT, plus a research-based MD/PhD (two or three years), and increasingly postdoctoral experience (one or two years).

18. Responding to this need, three new types of clinical academic training post were created in 2006 and 2007; academic F2 placements, ACFs and CLs. These were aimed at individuals in their early (foundation years), predoctoral (ST1-ST3) and postdoctoral (ST4 and above) phases of clinical training. They provided clinical training but with protected time for research, generally to be used in preparation for intercalated full-time research experience.

19. The numbers of training posts created in this way were small, representing less than 1% of the training grade posts (for example, in 2007 181 ACF posts were recruited through MTAS from a total of 18,500 posts). They are therefore insufficient to provide ongoing replacement of the current clinical academic consultant cohort, which should represent 8-10% of the workforce. Following the most recent decline in numbers, fully qualified clinical academics represent only 6% of all consultants.

20. Successful provision for clinical academic training therefore has two basic requirements. First, adequate provision for intercalated academic training within clinical pathways, so that further research can be undertaken and qualifications can be gained in addition clinical skills. Second, informed recruitment of some of the most promising trainees to specifically academic pathways. Flexibility of entry and exit from these pathways at all levels is critical.

21. While MMC can in principle deliver these requirements, in practice the implementation of MMC has seriously damaged clinical academic training. First, transition was poorly thought through and did not take account of the needs of academic trainees. Second, the implementation of MTAS itself was chaotic, failed to be trainee-centred, and has proven disastrous for clinical academic training.

22. These mistakes may have damaged the opportunity to develop a stronger clinical research capacity through academic training and must never be repeated. This document sets out the considered BMA MASC position for the way forward.

The prelude to MTAS
23. Awards to run specialty-specific ACF programs were made in two national competitions in 2005 and 2006. The second of these rounds concluded in November 2006, perilously close to the planned start of MTAS. Nevertheless the working assumption for all parties was that ACF recruitment would take place through MTAS, but in a separate and smaller round running ahead of the main MTAS match. The rationale for this assumption was that the academic training programme would integrate academic and clinical training, therefore a link to the clinical selection process was vital.

24. At some point in between November and December 2006, separate recruitment through MTAS was abandoned and it was announced that ACFs would now be recruited in the main MTAS match. This had immediate negative consequences for ACF programs. First, it meant their visibility dropped dramatically as they now represented fewer than 1% of the posts. Second, detailed information about ACF programmes was dispersed in as many as four potential websites (MTAS, MMC, the NCCRCD and individual Deaneries), further reducing visibility and making it difficult for applicants to understand the locations and programmes on offer. Third, it meant that the ACF posts would be subject to the limitations of the MTAS system, which were subsequently revealed as lacking professional input, lacking agreed scoring arrangements and an absence of access to candidate’s academic credentials.

25. In December 2006, it became apparent that although many programme directors desired to recruit to ACFs at multiple ST levels, this was not permitted by the MTAS implementation, which only allowed a single ST level in a single UoA to be ‘tagged’ as having an academic option available. In the absence of any central guidance about how to resolve this question, it is now apparent that different Deaneries adopted different strategies.

26. In the two UoAs with the largest number of academic opportunities, very different strategies were adopted. In neither case were candidates informed. In London/Kent, Surrey & Sussex, program directors were told in December 2006 they could not recruit at multiple ST levels and had to choose to offer posts at a single level. This had two consequences; a dramatic fall in the ST2 academic opportunities (many program directors electing to recruit at ST1), and changes in the proposed level of recruitment from ST1 to ST3 (because it was easier to recruit at a specialty-specific level).

27. In North Western Deanery (Manchester) a very different strategy was adopted. Recruitment at multiple levels for a specialty-specific ACF would continue, but the posts would only be advertised through MTAS at a single level. This would ultimately lead to interviews being conducted for posts that were not advertised. Although advertising posts at a single level and appointing across many levels is insupportable, the principle of appointing the best academic candidate to the appropriate specialty training level, closely reflects the flexible academic selection as recommended by the Academic Careers Sub-Committee of MMC.

Design and operation of MTAS
28. Very little information was available on MTAS about academic posts when it opened. It was unclear how to search for ACF posts (not a pull-down menu option) and where posts existed, descriptions were perfunctory or non-existent. Contact details of individual programme directors existed (on the NCCRCD website) but were not cross-referenced from MTAS so were effectively invisible to candidates. Information on the content of individual programmes (as provided in the original institutional competition process, for example) was not available anywhere to candidates.

29. The BMA MASC has documented examples that appear to show that some academic posts were only advertised part-way through the MTAS application period. In addition, for London/Kent, Surrey & Sussex detailed information about almost all London/Kent, Surrey & Sussex academic programs was missing on the day MTAS opened, having been only requested from program leads a couple of days previously.

30. At least some London academic programs were listed incorrectly. For example, the ST1 Neuroscience ACF program at the National Hospital for Neurology and Neurosurgery did not even mention that hospital in the program description advertised when MTAS opened. This was subsequently corrected, but emphasizes both the haste and inaccuracy with which academic posts were incorporated into MTAS.

31. The application process for ACF posts through MTAS was particularly obscure and widely misunderstood. In a section principally concerned with FTSTAs, candidates were asked to tick a box if they ‘prefer academic’. There was no information pointing out that this would open up a ‘hidden’ section of the application form for completion, with academic-specific questions. In addition, candidates were able to tick this box (‘prefer academic’) even for UoAs where no academic posts existed. This lead to widespread confusion, as almost 1/3 of applicants ticked the ‘prefer academic’ box but a reported 2/3 of those either answered ‘I do not want an academic post’ in the academic-specific questions, or had applied for a post that didn’t exist.

32. The new entry and exit criteria for ACFs (e.g. that individuals with a PhD could apply) were not widely disseminated. Some program directors gave incorrect advice, telling candidates that they could not apply if they already had a PhD. The NCCRCD website offered (until corrected, subsequent to MTAS applications closing) two, contradictory Word documents about entry and exit criteria on different webpages.

33. As with all MTAS posts, there was no information provided about banding and salary, which may have put applicants off applying for academic posts due to concerns about pay parity.

34. Important information about academic histopathology posts was posted on the NCCRCD website on 25^th January 2007, after MTAS opened:

“Applications for posts in academic histopathology programmes will not be processed through MTAS this year”

It is not clear whether this information was available to histopathology applicants through MTAS.

35. Applicants were generally unaware of the rule that academic applications ‘trump’ non-academic applications, even for lower academic UoA preferences.

36. BMA MASC received evidence that several candidates were put off from applying to ST1 academic clinical fellowship posts because they perceived that the lower percentage of time devoted to clinical training would make them less competitive for subsequent competitive application for ST3 posts. This fear was reinforced by the widespread reports that shortlisting for almost all posts (including many academic posts) heavily weighted clinical experience over academic qualifications and experience.

37. Evidence received by BMA MASC suggested that some candidates were put off from applying to academic clinical fellowship posts due to pressure on program directors to modify clinical training commitment to 100%, leaving no time protected for research.

Shortlisting and interview
38. There were no agreed national criteria for scoring system to be applied to supplemental academic questions. Each Deanery made up own scoring system without any inter-Deanery communication.

39. There was no agreed method for how to rank academic candidates; based on scores on academic supplemental questions, academic questions + section B (CV, papers), or academic questions + all clinical questions. There are advantages and disadvantages to each, but no consistent national policy or indeed across UoAs within a Deanery. Consequently candidates were ranked differently in different UoAs. Nor was there an agreed method for how to rank the academic section for clinical candidates.

40. The supplementary academic questions proved poorly discriminatory for some UoAs where a large number of candidates scored 4 on both questions.

41. At least a quarter of candidates in one UoA (ST3 Neurology) entered ‘I have not applied for an ACF’ in the supplementary academic questions box, indicating they misunderstood the application process (see paragraph 17)

42. Academic shortlisting ran way behind time in London/Kent, Surrey & Sussex for at least two levels (ST1 CMT and ST3 Neurology). Shortlisting only complete and candidates notified on 05 March despite MTAS announcing shortlisting complete a week previously

43. No formal panel meetings or panel chair for at least one UoA (ST1 CMT ACF London) – although horizontal scoring by at least four scorers, plus good co-ordination by email, this does not make up for absence of clear minuted meeting.

44. Particular problems with ST1 CMT where multiple ACFs in different specialties (e.g. London/Kent, Surrey & Sussex ST1 CMT in neuroscience, allergy/immunology, microbiology etc). Some candidates expressed a strong preference in their academic questions for research in ACF posts that did not exist (e.g. medical oncology, gastroenterology) in that UoA. This indicates candidates had misunderstood the application process (thinking that ACFs were pluripotential within CMT and that they could e.g. undertake medical oncology research in a microbiology ACF).

45.Problems with multiple ACF UoAs at ST1 CMT where top candidates came almost entirely within one specialty. Consequently shortlisting on basis of score alone would result in no shortlisted candidates for some ACFs. No established procedure for how to deal with this.

46. More particular problems with multiple ACF UoAs at ST1 CMT where most candidates expressed a strong preference for a particular specialty ACF, but some did not. Not clear whether candidates expressing a strong preference might accept a different specialty ACF, nor whether no expression of preference indicated low levels of commitment to a particular specialty ACF or knowledge that there were multiple ACFs at a single level within the UoA.

47. Employment history was not available for shortlisting despite being highly relevant for establishing academic experience and competencies. For example, *where* candidates have obtained a PhD/MD is highly relevant as it cannot be argued that the competencies denoted by a PhD/MD are equivalent throughout the UK or throughout the world.

48. Many UoAs used manual shortlisting (e.g. London/Kent, Surrey & Sussex) precluding any use of the on-line ‘plagiarism detection’ software.

Interview problems
49. BMA MASC received evidence of non-standard interview practices and potential replacement of ACF posts with clinical posts ‘on the fly’ e.g. this poster on DNUK

“I emailed the Professor in charge of the ACF I have applied to in Manchester today. Apparently the clinical interviews will be in the morning. They will then look at the successful candidates and if either or both of them had expressed an interest in the ACF on their application form then there will be a separate interview in the afternoon. If neither of the top candidates for the clinical program have expressed an interest in the ACF, then the ACF will become a standard clinical post.”

50. In Manchester (see point 27), the decision to recruit the best candidates at multiple ST levels that were nevertheless only advertised at a single ST level resulted in candidates being shortlisted who had ticked the ‘prefer academic’ box even though no job was advertised in that UoA. In other Deaneries candidates doing precisely the same thing would have been rejected.

51. In parallel with these problems with ACF interviews, BMA MASC has also noted that the established practice of including academic representation and questions probing academic and research knowledge was not followed for all clinical training posts. We strongly oppose this failure to include clinical academic representation on clinical appointment panels. The consequences of failing to ensure such representation will be twofold. First, a further unnecessary, inappropriate and incorrect labelling of ACF posts as ‘the academic training pathway’, leading to increased difficulties for trainees seeking to combine academic training with clinical posts and a false separation between ‘clinical’ and ‘academic’ medicine given that medicine is an inherently academic pursuit. Second, lack of assessment of research awareness among the clinical training stream and cognisance of these attributes amongst candidates.

52. We have been concerned about reports that academics have not been involved in the clinical recruitment process in 2007, despite this being a regular and established practice of many postgraduate deanery specialty training committees in acknowledgement of the standard academic component to clinical training.

Recommendation
53. We recommend that the established practice in many Deaneries, specialty training committees and clinical training interview panels of routinely including clinical academic representatives be formalised. This practice appears to have been lost in the 2007 recruitment process.

Round 1b
54. Following stakeholder consultation initiated by Mark Walport, proposals to reshortlist all ACF applicants to objective scoring criteria devised by Professor Geraint Rees in consultation with BMA MASC, Professor Elisabeth Paice and the wider community, were approved by the MTAS Review Group.

55. As part of round 1b, specialty-specific competition ratios were published for all clinical specialities. However, no ratios were published for any of the ACF posts.

56. Contrary to the outcome of the stakeholder consultation, reshortlisting for academic GP posts apparently did not take place.

The future of MTAS
57. ACF recruitment for 2007 was a failure for two reasons. First, the absence of any national guidance or national co-ordinating body with authority to provide information to candidates about posts, approve the application forms, devise shortlisting criteria, provide interview guidance and so on. This led to fragmentation and heterogeneity of recruitment practice. In the event that ACF posts are not filled in 2007 they must be made available in 2008.

58. Second, the incorporation of recruitment to a small number of specialised ACF posts within a very much larger number of purely clinical training posts led to confusion, disinformation and failure to disseminate important information about the type and location of training being offered.

59. Notably, both of these academically specific problems are likely to recur in any future system that combines ACF and clinical recruitment that may have worked well locally in under previous recruitment arrangements, as no mechanism for national dissemination of information and co-ordination across Deaneries exists; and ACF posts will also be a small proportion of clinical posts.

Recommendations
60. Our chief recommendation is that from 2008, ACF recruitment is conducted in a separate round outwith the main clinical training MTAS process. The risk of attracting large numbers of speculative applicants is no more significant than the 2007 process where 1/3 all applicants ticked ‘prefer academic’; while the benefits in terms of central provision of program information, job descriptions and tailored academic application forms are very significant. While advertising of ACFs must be separate from the main clinical round, recruitment will necessarily continue to be via a joint academic and clinical assessment. It is absolutely imperative that unsuccessful candidates retain the ability to access clinical posts with no detriment as is currently the case. Consideration must be given as to how clinical colleagues are to be made aware of academic training programmes and their input into the process.

61. Our second recommendation is that this new process utilises a revised application and objective scoring system, focusing on objective competencies. The basis for such a system lies in the MTAS Review Group approved objective scoring system for ACF posts, and it existing experience and data from the current round should be collected to modify this system appropriately for the next round. This may include appropriate modification of the basic principles of such an objective approach to take account of local and/or specialty-specific issues, but within the national objective standards outlined.

62. Our third major recommendation is that consideration be given to either formally placing responsibility on NCCRCD for collating and disseminating specific descriptions of individual ACF programs and posts, or creating a new body (e.g. a UKCRC ‘Academic Training Network’) specifically tasked with promoting a central collection of material, easily accessible by trainees, that outlines not just the general scope of UK academic training but the specific posts and programs available, with appropriate contact details.

63. We also recommend

e. ‘disaggregation’ of specialty-specific ACF posts associated with common stem clinical training (e.g. in the medical specialties), with separate application and shortlisting for each specialty-specific ACF (though joint interviewing with clinical colleagues remains desirable)

f. the ability to advertise and recruit ACFs at multiple ST levels (subject to local clinical training programme approval)

g. transparent publication of competition ratios for all ACF posts which includes a breakdown by gender and ethnicity.

The future of MMC
64. Academic training above all requires flexibility, to enter and exit clinical and academic components of training at different stages. Every individual academic career is unique, and the ability to provide trainee-centred support for an academic career is one of the founding principles of MMC. In its current implementation though, we believe that this flexibility has been lost and now needs to be restored. There are two particular areas that need attention:

65. One is the problem of ‘returning researchers’; individuals currently in an academic portion of their training (e.g. PhD/MD) but who have not yet obtained an ST training position. MMC proposed a limited transition period of two years during which such individuals could compete for deferred entry to an ST position. This is proving impossible to implement in some specialties, such as neurology, where there are very large numbers of out-of-program trainees relative to the number of candidates that can feasibly be interviewed or appointed in 2007 or 2008. These very able and often academically minded individuals can be accommodated over either a longer time scale (e.g. 10 year transition), or by awarding them NTN(A)s directly to allow them to compete in open competition for ST entry. We recommend that one of these two solutions be adopted.

66. A more subtle, yet important, issue is that of out of programme experience. We have already shown that ACFs, even if expanded, will not provide the necessary numbers of trainees to stop the decline of academic clinical medicine in the UK. Consequently the ability to step out-of-program with prospective approval to pursue a period of research (e.g. for higher degree) will remain vital for the foreseeable future.

67. However, there is much anecdotal evidence that candidates, consultants and Deaneries believe that OOPE will be forbidden, impossible or greatly reduced in scope as part of the implementation of MMC. Indeed, many candidates in the 2007 recruitment round made career decisions on this basis, sometimes with information to this effect from careers advisers. PMETB is also reputed to be considering plans to make OOPE almost impossible in future. This is unacceptable and must be combated vigorously for the future health of academic medicine. We therefore recommend that OOPE for the purposes of academic careers be vigorously supported and promoted widely. Given the importance of trainees understanding research methodology and indeed the potential benefits to the NHS of trainee exposure to periods of research inside the UK or in recognised centres, these opportunities should be available to all trainees, not only those who aspire to a career in academic medicine.

68. The difficulties associated the dual employment of clinical academics between universities and the NHS will be compounded for academic trainees and may make posts unattractive for many trainees, unless the disadvantages that arise from changing employers on commencement of a clinical lectureship are addressed and national contracts are in place. In particular, the current structure of the junior doctor contract will mean academic trainees have lower salaries for longer periods of time unless adequate recognition of academic experience is acknowledged. In order not to discriminate against women a solution to the loss of maternity entitlement on transfer to a new employer must be found. Further, we recommend that discussions between the BMA, NHS and University employers should commence on developing nationally agreed principles for academic trainee contracts.

Recommendations
69. Given the benefits to the NHS of trainees understanding research methodology and undertaking periods of research, out of programme experience should be vigorously supported by Deaneries and clinicians and promoted widely to able doctors, especially but not only for those interested in pursuing an academic career.

70. Work must be undertaken to address the pecuniary disadvantages that accrue to clinical academic training and to maintain parity with the NHS on pay and conditions, including loss or denigration of entitlements on transfer or return to the NHS. Development of the key contractual principles that should apply to NHS and University contracts for the new academic trainees should be undertaken with the key stakeholders, including the BMA.

71. Workforce planning must be undertaken in relation to the clinical academic workforce to ensure that the future numbers accord with the maintaining the clinical academic workforce at 6% rising to staffing levels in 2000 or 8-10% of the consultant workforce. This modelling must take into account the latest figures on clinical academic staffing from the Medical Schools Council (formerly the Council of Heads of Medical Schools) and the number of ACF, CL and SL posts that have been announced. Additional, funded posts should be made available in order to reverse the continued downward trend.

List of abbreviations

ACF	Academic Clinical Fellowship
BMA MASC	BMA Medical Academic Staff Committee
CCT	Certificate of Completion of Training
CL	Clinical Lecturer
CMT	Core Medical Training
F2	Foundation Programme Year 2
FTSTA	Fixed Term Specialty Training Appointments
MTAS	Medical Training Application Service
MMC	Modernising Medical Careers
NTN (A)	National Training Number (Academic)
NCCRCD	National Coordinating Centre for Research Capacity and Development
OOPE	Out of Programme Experience
PMETB	Postgraduate Medical Education and Training Board
SL	Senior Lecturer
ST	Specialty Training Level
UKCRC	UK Clinical Research Collaboration
UoA	Unit of Application

References
1. Clinical Academic Staffing Levels in UK Medical and Dental Schools A report by the Medical Schools Council (previously the Council of Heads of Medical Schools May 2007

2. Medically and dentally qualified academic staff: Recommendations for training the researchers and educators of the future (Academic Careers Sub Committee on Modernising Medical Careers and the UK Clinical Research Collaboration) March 2005

3. A guide to Specialist Registrar Training, NHS Executive on behalf of The Department of Health, Welsh Office, DHSS – Northern Ireland and the Scottish Department of Health February 1998