A career as a clinical lecturer

Authors: Hedley Emsley 

Publication date:  28 Oct 2009

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Hedley Emsley talks you through his experiences of academic medicine

Academic medicine training pathways are changing rapidly. My experience as a recent pre-Walport clinical lecturer may provide useful insights for those considering a clinical academic career or those embarking on integrated clinical-academic training posts. The Walport integrated academic training pathway for researchers started in England and Wales in 2006.

I’m not sure whether I always wanted to pursue a clinical academic pathway, but I knew about the possibility of doing an intercalated BSc before I applied to medical school. I seized the opportunity to gain a first publication from a final year project. Once I’d negotiated general professional training and the membership of the Royal College of Physicians hurdle, I was keen to take up a clinical research fellow post leading to a doctorate of philosophy (PhD). Securing a clinical lecturer post in neurology was somewhat serendipitous—right place, right time—but if I had to make the choice again I wouldn’t hesitate.

Scepticism

I found the wide variety of activities stimulating, challenging, and rewarding, and I believe the range of experience to be considerably greater than that offered by purely clinical training posts. Of course, as with all things in life, clinical academic training posts (and indeed senior clinical academic posts) have their detractors. A considerable degree of scepticism surrounds clinical academics in some quarters: “The trouble with academic registrars is that they’re never around,” or “You can be a successful clinician or a successful academic, but it’s very difficult to be good at both,” and “Of course you will get a senior clinical academic job—nobody else is going to want one.” This attitude can become tedious, especially when starting out, and you may need to look to academic rather than NHS mentors for initial words of encouragement.

A servant of (at least) two masters

Finding oneself caught between two masters—the university and the NHS—can be problematic. You need to negotiate a successful path in the eyes of both masters to be considered reasonably competent in both clinical and academic domains. Bridging two institutions can be associated with bureaucratic niggles, and occasionally difficulties with contractual arrangements. You may sometimes feel you belong to neither institution—for instance, when it comes to study leave claims. Throughout clinical training there is effectively a third master, in the shape of the Joint Royal Colleges of Physicians Training Board. Although essential to secure a certificate of completion of training, this third factor undoubtedly makes life more complicated. In defence of the clinical training credentials of a clinical academic post, because the clinical lecturer post added 50% to the duration of my specialist registrar training I gained more clinical experience than my clinical counterparts, in so far as participating in the on-call rota over a longer period, doing additional ad hoc clinics during academic periods, and so on.

Balancing commitments

Good time management skills seem to be a crucial aspect of life in general. But such posts are particularly demanding in this regard, given the need constantly to juggle clinical, research, and teaching commitments and manage ongoing activities in each of these areas in parallel. I suspect this issue would have been even more challenging in other “harder pressed” specialties. Overall, my training was split into sequential four month attachments, mirroring those of my purely clinical counterparts, with one entirely academic four month block every year. There is probably no right or wrong way to plan one’s timetable and no perfect balance between clinical and academic commitments. Some tension between the two will always exist. I found it important to do the full time four month clinical attachments and not just because I wanted to be seen to be around. I would have been concerned that I was compromising the continuity of my clinical experience and patient care by, for example, dividing individual weeks between clinical and academic activities. But doing sequential four month blocks meant that at times I found myself struggling to make much progress with academic projects.

If at first you don’t succeed . . .

In terms of research activity, my first priority was to get my PhD finished. Although I had no choice as I faced a four year time limit on submission, the importance of this approach cannot be overstated. Delay in completion not only hangs over you (especially when it comes to appraisals and so on), but possession of a PhD or equivalent is a prerequisite for many research fellowship applications, such as the various clinician scientist schemes. Despite reaching a shortlist for a clinician scientist scheme, I failed to impress the 15 or so “great and good” from clinical academia at the Medical Research Council. My subsequent NHS consultant interview seemed a piece of cake by comparison. Despite several other setbacks with unsuccessful grant applications, perseverance paid off, and in the end I had generated income well in excess of £200 000 (€220 000, $330 000) during my five and a half year post through a combination of research grants, clinical course registration fees, sponsorship, and donations.

Points make prizes

Beware the expectation of universities for consistently high levels of research income—six figure grants may soon be considered relatively small (although not necessarily at the clinical lecturer stage). Generating research income (as well as publications) is the most crucial element of academic life, though teaching doesn’t really feature in this equation. The advantage of research income is that one can do research with it, but crucially not just any old research; independent funding gives the opportunity to tackle one’s own research question (alone or in collaboration with others). A key aspect of research funding is the ability to employ people to help with the research, and I was able to recruit and work with a clinical research fellow and research nurses during my post. A wealth of experience is gained as one negotiates the various stages, such as developing research proposals, preparing grant applications, recruiting and supervising staff, gaining approvals, handling budgets, doing the research, analysing data, and presenting results. However, negotiating the various layers of research bureaucracy poses particular challenges.

Research portfolio

The post enabled me to build a small research portfolio of studies in relatively diverse areas, encompassing children and adults and employing a range of clinical, imaging, blood marker, and genetics methodologies. Crucially, this variety was facilitated through multidisciplinary collaboration with a range of researchers, from laboratory basic science to medical physics, across different institutions. All these elements—that is, diverse populations, research methods, and collaborations—are important in broadening your horizons. I achieved around 15 publications while in the post, perhaps a modest number by some standards but none the less important for strengthening one’s CV and research profile. At the same time I received invitations to review journal articles, grant proposals, books, and book proposals, and even one film script. Getting studies up and running also provides opportunities for supervising undergraduate and postgraduate research projects, another key area where it is important to build experience.

Key skills and attributes

Some key skills or attributes are helpful in an academic role, either from the outset or to work on. As well as the importance of good time management skills, writing is a key skill for academic life, given that much of what a clinical academic does revolves around writing in the form of grant applications and preparing manuscripts, reviews, and so on. Some individuals thrive more than others when stretched or challenged, and it’s worth considering how you respond when faced with stressful situations, tight deadlines, multiple competing time commitments, or even dealing with academic problems that may initially appear beyond one’s grasp. Being able to cope with rejection is also important. For instance, not all applications for funding will succeed, nor will every manuscript be accepted for publication (or at least not where you might like it to be), and one has to accept that this is part of academic life. One piece of advice from an academic mentor was that few pieces of writing are ever completely wasted as work done for one grant application or manuscript will often form the basis of or be reused for other work.

Can you teach? Does it matter?

A key point that struck me during my post was the low priority given to teaching in comparison with research activity. The research assessment exercise that informs the allocation of research funding may be partly to blame because it focuses on research output, but this system is expected to change. None the less I found myself involved in both undergraduate and postgraduate teaching. The post gave me experience of a wide range of different teaching methods, including problem based learning, special study modules, bedside teaching, and seminars and lectures, and not only their delivery but also the development of various modules. My involvement with teaching prompted me to complete a postgraduate certificate in clinical education because I felt I lacked formal guidance on how best to go about it. With the need to generate additional income for research, I also set up a postgraduate clinical neurology revision course for the membership of the Royal College of Physicians exams and ran various study days.

Room for improvement

There is always room for improvement, and perhaps one key aspect is ensuring that you have appropriate mentorship. I have been fortunate to have had willing advice from senior academic colleagues. The Academy of Medical Sciences runs a formal mentoring scheme (using mentors external to one’s everyday clinical or academic interactions) with the aim of providing guidance to clinical academics developing their careers; I would recommend exploring this option. For example, I became enthusiastic about every new research (or teaching) idea, and although this can be beneficial, maintaining clear focus is also crucial and is probably facilitated by having an experienced (and impartial) mentor. In competitive situations, such as grant or fellowship applications, seek advice from those who have been successful. You’re likely to have only one shot at some opportunities, so take heed of advice such as the need to practise, practise, practise when it comes to interview preparation.

Experiences of other clinical academics

A brief email questionnaire based on the points contained in this article was sent to other clinical academics of varying seniority and from different specialties at different institutions in the United Kingdom. They appear to convey similar experiences to my own. The table gives unselected responses from three individuals.

I recommend a clinical academic pathway to anyone wanting to do their own research, teach, and provide patient care. I hope I have shed some light on what life might be like in such a post. Although more complex than a purely clinical training post, such posts are also substantially more rewarding, and I would hope that ultimately they contribute in some small way to the advancement of knowledge.

I thank the Academy of Medical Sciences for their help in securing the views of the clinical academics who responded to a questionnaire based on the points in this article.

Competing interest: HE has accepted sponsorship from the drug industry to support research and teaching activities.

Hedley Emsley consultant neurologist and honorary lecturer Department of Neurology, Royal Preston Hospital

 h.emsley@liv.ac.uk