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Progressing UK clinical academic training in 2020: Addressing the challenges of COVID-19

 

Contents

Clinical  Academic Training Forum: Subgroup to support returning clinical academics from the COVID-19 front line  

 

Aim


This document sets out overarching principles and practical actions in response to the disruption to clinical academic training by COVID-19 to be addressed by all UK institutions and organisations responsible for supporting and progressing the careers of trainee clinical academics.
 

Background

 
The career development of clinical academics is of strategic importance to the NHS and to all funders of health-related research; an importance that has been underlined by the current challenge of COVID-19. It is widely recognised that developing a clinical academic career is challenging, with a need to balance research, postgraduate training, and the pressures of clinical service. It is, therefore, essential that clinical academic trainees are appropriately supported at critical stages and transitions in their careers. (Ref:  https://mrc.ukri.org/documents/pdf/review-of-early-career-clinical-academics/ and https://wellcome.ac.uk/sites/default/files/clinical-principles-and-obligations-plus-faqs-2018-08.pdf)

The COVID-19 pandemic has resulted in extraordinary challenges for medicine in the UK and worldwide. Clinical academic trainees, both those in full-time research and those in posts with both clinical and academic training, e.g. clinical lecturers, have responded to the health emergency in large numbers by returning to full-time clinical duties. Preliminary estimates suggest that over 1,500 academic trainees in England alone have been deployed to clinical duties, representing over 90% of all trainees on the Integrated Academic Training (IAT) pathway. Similar responses have been seen from those in out of programme research and across the four nations. Many have made exceptional contributions to service and/or to COVID-19 related research and these contributions should be celebrated. These contributions and other commitments such as childcare have, however, resulted in considerable disruption to the research plans of many individuals. This has been further exacerbated by closure of most university research facilities and suspension of non-COVID-19 clinical trials and experimental medicine studies within hosting NHS organisations.

Academic trainees, their HEI mentors and supervisors and those responsible for their clinical training are being asked to rapidly assess the consequences of the often-substantial disruptions to training and develop an action plan to achieve optimal overall career progression for each individual.

The major challenges to be addressed are:
  • Restarting research effectively, especially where there is significant delay anticipated due to stalled clinical trials, rebreeding for animal experiments, closed research facilities, on-going restrictions to access to laboratories, etc
  • Developing plans for project evolution where original plans may no longer be feasible
  • Delivering effective ‘re-entry’ mechanisms for individuals who have needed to take particularly prolonged periods away from clinical training and research due to clinical service needs or other reasons.
  • Allowing new applications for OOP(R) whilst granting permissions to extend periods of out of programme for research for those whose plans have been disrupted by these exceptional circumstances.
  • Ongoing need to support the COVID-19 response in the possible scenario of multiple waves of infection across the UK
  • Retention in the NHS to manage the backlog of non-COVID-19 cases
  • Funding for necessary extension of research or clinical training arising because of the COVID-19 pandemic
These challenges need to be considered in the coming days and weeks, especially for the cohort of individuals scheduled to return to clinical training in August 2020 following a period of research training. The effects on individual trainees are variable and non-linear, but careful consideration should be given to the individual circumstances of all trainees.

The Clinical Academic Training Forum (CATF) has established a working group (membership below) to bring together representatives of postgraduate training, research funders, medical schools and others across the UK to produce guidelines on a way forward. The aim was to provide practical and timely guidance to academic trainees, their clinical and research supervisors, HEI and postgraduate deanery/HEE regional office.
 

Principles


All clinical academic trainees, whether currently OOP or in mixed clinical/research roles, e.g. Academic Clinical Lecturers and equivalent posts across the four nations of the UK, should have a bespoke assessment of the disruption to their research and clinical training needs led by an experienced member of the local academic partnership or equivalent.

The assessment should include structured input from the trainee, their academic and clinical supervisors, and representatives of the relevant HEI and postgraduate deanery who are empowered to make relevant recommendations. An individual action plan to optimise overall career progression should be agreed by all parties.

The assessment should be timely for all, but priority will need to be given to those for whom opportunities to make up lost academic opportunities are time limited and those at career transitions. For those due to complete their PhD within the next 6 months then a local process should be put in place as a matter of urgency and jointly overseen by the HEI/NHS training partnership with appropriate academic representation. For many the assessment could occur as part of the annual ARCP process.

All parties should undertake to conduct these discussions in a transparent manner.
 

Actions for Postgraduate Deans and Training Programme Directors

 
To assess educational needs with the aim of facilitating the optimal research and clinical outcomes for trainees.

To provide maximum flexibility for periods of additional research training where possible, either as an extension to current placements or through a further placement(s) in the future, and in facilitating transitions between clinical and research roles.

Wherever possible to support the release from clinical training of academic trainees who are close to completion of OOP(R), allowing them to write up their thesis and complete necessary experimental work if feasible. Conversely where possible to retain in clinical training those who cannot yet return to, or start, research.

Where possible to accredit competences gained during the COVID-19 service towards specialty training.

Where an extension to academic training is required, this should be discussed with the academic/OOP lead for the postgraduate deanery/HEE local office and agreement reached. In the rare situation where the academic trainee is not content with the decision made, this should be raised with the local post-graduate Dean who can take advice from the relevant Lead Academic National Dean where appropriate.

For new OOP(R) requests – there should be a conversation with the academic/OOP lead for the postgraduate deanery/HEE local office and individual trainees as soon as possible. Funders can also be brought into these discussions where plans may need to be modified.
 

Actions for Universities and Research Institutes

 
To provide support and mentorship to all academic trainees in the current situation.
 
To provide timely and realistic schedules for re-starting research and prioritise opportunities for those on time-limited research funding.

To facilitate access to additional salary support where needed, whether from the funder, the NHS, consideration of the Government’s Job Retention Scheme where appropriate or internal resources.

To accommodate any higher degree extensions without financial penalty to the trainee.

To ensure the challenges faced by trainees are recognised in assessment of their higher degree and any future retention or promotion decisions.
 

Actions for Funders

 
To be flexible where trainees require changes to projects and to their training and development plans, noting that funders will want the original objectives of the funded project to be achieved as far as possible.

In cases where there is no alternative, to consider applications for salary and other financial support for trainees to cover the costs of an extension to their funding period where it is essential for successful completion of their research training (noting that for some funders, particularly medical research charities, costed extensions may not be an option).

If granted, funders will endeavour to permit additional support to be used as flexibly as possible according to the needs of the trainee, and for delivery of the project. This might include, for example deferring the funding if experimental work cannot be undertaken, until a clinical study can restart, or mouse lines are again available.

To recognise the challenges faced by trainees in this cohort by considering revisions to future fellowship competitions.
 

Actions for Trainees


To plan, in discussion with research supervisors, a realistic and achievable research strategy, considering whether an extension to their research time would or would not make a “step-change” to the academic outcomes achieved

To work constructively with training programme directors and clinical educational supervisors to plan re-engagement with clinical training

Fully inform current NHS employers of plans to return to academic training, giving due notice as required

Fully inform funders about changes to research plans and log time spent in clinical service as a consequence of COVID-19

Engage with professional support and wellbeing services if required, and to constructively engage with occupational health if needed

To use their time as productively as possible, including thesis writing and preparation of manuscripts and review articles, where their experimental work cannot progress currently

To prioritise completion of research, in particular the timely writing up of a thesis before the end of OOP, accepting that a complete or “perfect” PhD is not always achievable
 
 
 
 
Working Group members included representatives from: The Academy of Medical Sciences, Association of Medical Research Charities, Cancer Research UK, Conference of Postgraduate Medical Deans of the United Kingdom, Medical Schools Council, Medical Research Council, Health Education England, National Institute for Health Research, The Royal College of Physicians, The Wellcome Trust.
 

Supporting information

 
Framework for restarting NIHR research activities paused due to COVID-19:  https://www.nihr.ac.uk/documents/restart-framework/24886 
 
An online AMS support space has been co-developed with early career researchers and will continue to evolve with feedback over time, and can be found here: https://acmedsci.ac.uk/grants-and-schemes/whats-available-to-me/career-support-space