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Clinical academic pathways: reorienting our approach to research for doctors in training

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By Dr Chloe Abbott, AMA Council of Doctors in Training, ACT Representative; Chair of ACT Doctors in Training forum

Numerous doctors, in both their prevocational and vocational training years, express a desire to incorporate academic research into their expertise as a medical practitioner. Motivations for this range from satisfying professional requirements to wishing to pursue a full-time career in medical research. 

However, these doctors face a dilemma regarding how and when are they can pursue these opportunities.

A lack of coordinated clinical academic pathways that would allow doctors to complete clinical obligations while also undertaking the requirements of research is a major issue for those in the prevocational and vocational workforce.

This has manifested in a decline in the number of academic positions in the past decade, as many doctors veer away from the field because of the perceived or actual disadvantage involved in sacrificing clinical experience for academic research.

At the same time, doctors are faced with the issue of higher education requirements to secure training positions, or employment after their training completion.

As competition for places has intensified, academic research experience has become an increasingly significant point of difference for trainees, but this is yet to be reflected in many pathways currently available in Australia. Instead, trainees are burdened with meeting their clinical training requirements while simultaneously attempting to pursue academic research, often leaving them in difficult financial circumstances – the remuneration of these endeavours is significantly less than a full time medical trainee income. 

Australia is not alone in what has been labelled an “academic medicine crisis”.

As early as 2005, the International Campaign to Revitalise Academic Medicine was warning that academic medicine was at risk of “failing to realise its potential and global responsibility due to lack of both infrastructure and structural change required to capitalise on investments in this field”.

In a report published by the Milband Fund, the Campaign identified a number of barriers to the development of academic medicine through to mid-2025, and discussed a number of potential solutions to reviving the clinical academic workforce.

The AMA Council of Doctors in Training is currently working with universities, medical colleges and the Medical Deans Australia and New Zealand (MDANZ) to support existing pathways to academic medicine and provide direction for the development of programs that would enable trainees to meet vocational requirements and academic pursuits simultaneously, without financial or employment disadvantage.

There are a number of attractive options for improving the integration of clinical academic pathways into the Australian medical training system.

The successful implementation of the UK Academic Foundation Program, which has fostered the development of an optional pathway which incorporates academic research in the first two years of a medical career, provides a potential model for Australia, particularly given the growth in medical graduate numbers and the limited opportunities to expand training places. 

Ways of formally integrating research opportunities into vocational training and strengthening the linkages between undergraduate, prevocational and vocational research pathways, must be examined.

As we delve into the challenges facing the Australian health system, including ballooning health care costs associated with an aging population, it is obvious that competition for funding will intensify.

Just as workforce planning is beginning to focus on population demand, research concerned with the biggest and most costly health conditions should be fostered, both for its potential to improve patient care and to reduce health care costs. 

For more information, see the AMA Position Statement on Clinical Academic Pathways in Medicine (2013) at: position-statement/clinical-academic-pathways-medicine-2013