Abstract
Dear Editor:
Within the last decade, concerns have been expressed about the global state of academic medicine. 1 Academic medicine has been highlighted as an unattractive career path due to a lack of a clear training structure, inflexibility in training, and a shortage of supported and structured posts on completion of training. 2 When looking specifically at the interaction of academic medicine and palliative medicine, further difficulties are apparent. In most countries palliative medicine has developed outside of traditional medical and higher education institutions, restricting the academic development of the speciality. 3 Currently there are limitations to the evidence base of palliative medicine, with the majority of published research studies small, descriptive in nature, and lacking in internationally agreed core-outcome measures for key research priorities. 3 However, as palliative medicine continues to grow, engagement with the academic sector is required to assist in facilitating studies that generate evidence to support practice, to create educators to train a palliative medicine workforce, and to provide direction for the development of the speciality. 4
In order to increase the number of clinical academics, a new integrated clinical academic training program was established in 2007 by the English National Institute for Health Research (NIHR). Following the foundation program, the Academic Clinical Fellowship (ACF) training scheme marks the start of a formal clinical academic training program. Post holders have 25% protected time for research for a maximum duration of three years, after which the trainee is expected to undertake a higher degree (MD or PhD), or return to the clinical training pathway. Further, ACFs progress at the same pace as clinical trainees and are required to attain the same competencies. Upon completion of a higher degree, the applicant would be eligible to undertake an Academic Clinical Lectureship (ACL) for a maximum of four years, which combines 50% clinical and 50% academic time, prior to obtaining an academic position or clinical consultant post upon completion of training.
Palliative medicine was highlighted by the NIHR as a priority area for research and received funding for the establishment of ACF and ACL posts. I have experienced the benefits of this training scheme and I am excited about the possibilities that exist to further develop academic palliative medicine.
In 2009 I was appointed to an ACF palliative medicine post in the Mersey Deanery, Liverpool, United Kingdom. I remained in this post for two years, during which I developed the protocol for a research project on methods of assessing hydration states in palliative cancer patients. Following the ACF I was appointed to a funded research position at the Marie Curie Palliative Care Institute Liverpool, University of Liverpool (MCPCIL); in this position I will undertake the developed research and register for a PhD. Below I will share a few of the many opportunities of how the ACF position has enabled me to develop my research skills.
OPCARE9
OPCARE9 was an EU 7th framework funded international collaborative project, coordinated by MCPCIL, focused on optimizing research for the care of cancer patients in the last days of life. This collaboration offered a unique opportunity to share practice with a developing network of seven European countries, in addition to, New Zealand, and Argentina. 5 International colloquiums were conducted in each of the participating countries to evaluate the existing international evidence base and develop novel methodologies for future research. As an ACF I was involved in the project and attended international meetings, with the benefit of forming relationships that can be used for future collaboration.
Harvard Medical School
During the month of September 2011, I had the opportunity to travel to the Dana-Farber Cancer Institute (DFCI), Harvard Medical School, Boston, to see how palliative medicine is practiced there and to further develop opportunities for research collaboration between MCPCIL and the DFCI. The trip made use of connections established by the OPCARE9 project with Professor Susan Block (Chief, Psychosocial Oncology and Palliative Care, DFCI) who in her role as a critical friend, provided structured appraisal of the OPCARE9 colloquiums.
The trip was a two-week placement consisting of observation of clinical activity in the hospital, one-on-one meetings with academic staff members, and attendance at administrative and educational events run by the palliative care faculty. Visiting the DFCI provided valuable insight into how palliative medicine is practiced in another country. The visit has helped to identify areas of mutual interested between DFCI and MCPCIL, hopefully enabling opportunities for future research and collaboration. We envisage the sharing of resources and ideas will ultimately improve the delivery of palliative care in our respective countries.
Future plans include the development of an exchange program of academic palliative trainees between Liverpool and Boston.
Local Collaboration
The ACF post has been used to develop local research links within the Mersey Deanery. Existing associations with the research and development departments of the University of Liverpool and new associations with the Liverpool Cancer Research United Kingdom (CRUK) Centre and the North West Hub for Trials and Methodology Research (NWHTMR) have been sought. We envisage these associations will assist in the methodological and statistical support for future research, in addition to strengthening research funding applications. Locally, I was appointed as the representative for ACFs in the Mersey region, which has further added exposure to academic palliative medicine within the university.
Publications and Grant Writing
The ACF post has been useful in developing my scientific writing ability. I assisted in writing grant applications for current research projects at MCPCIL. In addition, I have used some time within the academic component of the post to write manuscripts, which have subsequently been accepted for publication in peer-reviewed journals.
The Future
Further ACF posts in palliative medicine have been advertised in the 2012 national NIHR recruitment. This suggests a bright future for academic development within the speciality. However, in order to ensure maximal benefit, attention must be focused on ensuring trainees are able to progress through the entirety of the training scheme. Difficulties in obtaining research grants and lack of the available ACL positions may prevent doctors from realizing their true potential. 6 This is an exciting period in academic palliative medicine and trainees need to be carefully supported. The long-term benefits are potentially far-reaching, as ultimately improvements in the evidence base will enable health professionals to provide better care for their patients.