Proposal for an academic component of the Foundation years programme under Modernising Medical Careers
BMA Medical Academic Staff Committee
4 March 2004, revised 26 March 2004
Abbreviations explained:
F2: Foundation year 2
APEL: Accreditation of Prior Experiential Learning
GPPS: General Professional Practice of Surgery
SSM/SSC: Special Study Module / Student Selected Component
- Context
- Approach
- Academic proposal
- Costs/funding
- Clinical training
- Competencies
- Linking undergraduate programmes to Foundation years
- Assessment
1. There is much to welcome in the MMC proposals for clinical academics. It must be ensured that the proposals result in a meaningful implementation that adequately supports an expansion of academic practice.
2. The document introducing Modernising Medical Careers included a number of key principles, the two most relevant to academic medicine being that:
- “A clear structure is necessary to encourage and support the development of academic, research and teaching skills and to support those who opt for an academic career”.
- “Training should be trainee-centred and programmes should reflect a variety of career choices, from those who decide on a particular career early on to those who need more time to do so and to those who want to train part-time. Individual programmes should be available to reflect individual needs”.
3. Headline data provided by the Council of Heads of Medical Schools in January 2004 showed that between 2000 and 2003 there had been a 23% decline in junior medical academic staff numbers. Clearly academic careers need to be made more attractive, and the opportunities to pursue such careers need to be far more visible, accessible and structured.
Approach
4. As part of a structured means of incentivising academic careers, the MASC believes that the skills and competencies to be developed in years one and two of the foundation programme should include a clear option (or options) for trainees to work in an academic setting. This would promote “an effective understanding of the different settings in which medicine is practised” as referred to in the government’s response to “Unfinished Business”. Such an approach would give trainees direct experience of academic medicine, without a long-term commitment being necessary.
5. To maintain and expand the current levels of academic representation (for teaching and research) in the workforce, it would be sensible to designate a proportion of foundation positions for trainees with academic backgrounds and intentions. A figure of at least 20% would ensure a suitable proportion remain at the completion of training. This would be without prejudice to the principle of all trainees being able to experience academic medicine.
6. Academic medicine is increasingly interdisciplinary, and career pathways for aspiring young academics should be flexible enough to allow such interdisciplinary training. This is especially true of surgery and technological sciences or anaesthesia and applied physiology. Moreover, MASC believes that promoting academic experience at an early stage provides a positive opportunity to stimulate academic careers in all areas, including those disciplines that have been under-represented in the past.
7. There are certain basic academic competencies, common to all fields of medical practice, which could usefully be included in or alongside the standard NHS foundation programmes as well as academic foundation training. These academic competencies would cover both teaching and research and would also serve to complement any laboratory or clinically based research project.
8. So in addition to those programmes designated “academic” (see below), the MASC would welcome all foundation programmes incorporating training in areas such as the clinical research evidence base; how clinical research is conducted; and the role of various organisations involved in regulation and data interpretation.
Academic proposal
9. Medical students have a diversity of experience and interests including non-medical first degrees amongst others and so on graduation it would be appropriate to provide new doctors with a flexible framework of career options responsive to the needs of individuals as well as the needs of the NHS (and university sector).
10. Within such a flexible framework, the Committee proposes the establishment of F2 'research tasters' comprising 4-month blocks (or similar). These research tasters could focus on any aspect of research (clinical, laboratory, epidemiology, medical education etc). As an example of how the Committee sees the proposal working we consider that a suitable model is that of the laboratory rotations done in the first year of the Wellcome 4-yr PhD programs (e.g. www.physiol.ucl.ac.uk/wellcomephd/). In this program, the candidates apply to the program rather than an individual supervisor. A large number of different supervisors offer possible projects to candidates as part of the program. In their first year, they rotate through three laboratories (four-month periods) doing a short research project in each. In addition they receive structured teaching as a group on research skills. They then choose (typically from one of the lab rotations) a lab and PhD project for the remaining three years.
11. In the F2 context, it is straightforward to see how an analogous system would work. Programs would be organised at university/medical school level to accept a certain number of F2 students per annum. A large number of clinical researchers, greater than the number of F2 places, would offer projects. Upon acceptance, the F2 student would select a laboratory and project for the four-month period. They would be part of that laboratory for the whole period, but also receive tuition (in general research techniques etc) as a group at a medical school/university level. In addition, they could be on the on-call rota for their Trust (easing workforce problems). The proposal could initially be rolled out as pilots.
12. This would inject research awareness into F2 trainees at an early stage, allowing them to see how translational research and clinical practice interacted. It would introduce them to research methodology in a structured way and provide high quality training relevant to clinical practice. Organisationally, it would be relatively simple and would sit well with existing 4-year PhD program structures.
13. The primary attraction of short placements would be to allow trainees to have a 'taste' of academic medicine without significant commitment. Trainees could get a feel for their research aptitude and what type of research might attract them, rather than having to make potentially risky and uninformed choices at a PhD level. Trainees returning into the F2 program will enhance research awareness in the wider cohort.
14. This proposal should be supplemented with provision of structured information about academic careers to help proper career planning and 'demystify' the speciality. Academic mentors could be identified early and provide pre-doctoral support. Specific academic appraisal can be established.
15. This proposal envisages trainees primarily taking part in translational clinical research projects. However, the structure is extremely flexible, and could be adapted readily to trainees wishing to undertake (for example) a project that developed specific competencies in teaching, for those seeking a clinical academic career that emphasises a teaching component.
Costs/funding
16. Research tasters are likely to appeal to a significant but still small number of trainees, in a small number of locations. F2 trainees will be low-cost relative to clinician-scientists and other academic trainees. The programme can be run centrally like the 4-yr PhD programs, reducing administrative overheads.
17. An initial estimate of costs purely for illustration purposes works out at £240k per annum recurrently, excluding out of hours commitments, which is based on 24 trainees through the program in London per year (which is 8 F2 trainees at any one time). This is equivalent to the cost of one Senior Fellow.
18. The chance of funding a program to energise academic trainees earlier in their careers is an opportunity not to be missed. This could well help address the difficulties experienced by academic medicine under the Calman system.
19. Informal approaches to possible funding bodies have been made, and the responses have been supportive in principle. It would be an extremely cost-effective way of ensuring the future of academic medicine. The next step is to make more formal representations to the MMC Delivery Board and others.
Clinical training
20. The argument has been put that the priority for MMC is to ensure that trainees are clinically competent and professionally fit. The MASC believes that the research ‘taster’ could easily include for example a clinical session a week. Furthermore, research 'tasters' could incorporate out-of-hours work, which is routine for most trainees in research posts.
Competencies
21. As part of the development of an academic foundation programme, the identification of teaching and research competencies is a key task. This requires significant consideration, but by way of illustration, the following have been suggested (in this case for a teaching-oriented taster):
· The trainee should be able to apply to teaching and training sound educational theory and principles;
· The trainee should be able to use a range of teaching methods, including those suited to lecture, small group discussion, bedside and theatre-based teaching.
22. Academic competencies must be clearly defined. Any F2 placement should be set within a framework of achievable goals and outcomes which might fit an APEL type of model - which could be a very useful mechanism to allow graduates a track of point collection towards an academic career. APEL is not employed in medicine but could a valuable way to link undergraduate experiences in a meaningful manner with post-graduate F2 placements and aspirations. It might also avoid duplication and help in developing flexible PhD/MD programmes that might be possible in a clinical field.
23. Any programme of F2 placement must be within an academic position that is recognised on a CV as such. The term research fellow, qualified by “clinical” or “science” might be helpful.
24. To encourage the uptake of F2 academic programmes and give them currency across the whole profession, it might be appropriate to issue a “certificate of research training” on completion of the academic foundation period.
Linking undergraduate programmes to Foundation years
25. F2 entrants come from a wide variety of undergraduate programmes. Many schools offer a core programme which can include attachments to disciplines and units where high quality research may be being undertaken. Students also can develop research training goals within the options aspects of a course (SSM/SSCs), and many universities also have a number of 'lectures' and tutorials in basic research/academic competencies that students should be encouraged to attend if they express an interest in research and academic pursuits. However, it must be acknowledged that the time frame is very short and could preclude adequate opportunity to fully develop a research programme.
26. Some students also may intercalate and undertake a science based or clinically based honours programme. These can include research methods and as a part of the honours process will include options for a dissertation or report. Such programmes could be developed to include a compulsory module that would be devoted to research methods, and could also include laboratory methodologies/safety as well as opportunity to understand the implications and difficulties of patient centred clinical research.
27. Intercalated students and those having done research-focussed SSM/SSCs need to identified and offered the opportunity to return to their previous field of activity if at all possible during the F2 period. Use of the Foundation programme should allow further development of a continuum of education and experience. However, an agreement on outcomes on both periods is essential for adequate measurement of outcome and to avoid a development of service driven needs rather than meeting the aspirations and needs of the individual.
Assessment
28. The purpose of any assessment, which must employ light touch approaches and be clearly defined, is to ensure quality of the learning experience and that added value though the definition of the outcomes are achieved.
29. Assessment must therefore be achieved using an apprenticeship model, be workplace based and employ attainable methods. Formative and summative triggers on achieving a given competency could be developed alongside a reflective portfolio. Full training of supervisors and assessors is a key prerequisite of any assessment programme. Adequate time for all involved at all stages is an essential and mandatory prerequisite.
30. It would also be sensible to examine the changes possible in the specialist SHO and SpR grades using a similar assessment procedure which moved away from the present over-reliance on paper-based assessments in the current diploma college models. Some innovation is required across the whole training programmes in post-graduate medicine that sees commonality of approached being put in place. An example that should be examined is the GPPS model of the Royal College of Surgeons of England.