The future of academic training (2)

Having just said that we’re all paediacademiatricians, maybe I should be happier about the suggestion that my academic training should/could “count” towards my training time.  After all, I’m training as a paediatric academic; so surely both my academic & clinical roles should be included in my training time.  And there are some important and amazing things that I’m learning during my PhD that is relevant to paediatrics: communication, and shared decision-making.  My ACF showed me how important team-working is to parents; how an open culture of discussion improves patient safety… Loads of things that are clinically relevant, but that probably aren’t part of the core curriculum.

So why don’t I want my academic time to “count” towards my clinical training time? After all, I’ve just said how useful it is.

Here it is: when I’m on-call in my clinical world, I’m not an “academic paediatrician registrar”.  I’m the paediatric registrar.  That’s it.  If I’m looking after your child at 3am on the acute admissions unit, or at 3pm in clinic, you don’t care if I have a PhD or an MD or a lab full of cilia.  (Not that I would ever have a lab full of cilia, but apparently, some people like that kind of thing).  You probably don’t even care if I’ve learnt that stickers are really, really important.  You might not even care that my research has shown me that young children are social actors who are frequently ignored in the clinical setting… (We’re paediatricians – we should probably know the last two anyway).

All you care about is my clinical skill, because when I go to work on acute admissions or clinic or wards, I go to work as a clinician.  On Thursdays & Fridays & alternate Wednesdays, I am a paediatrician.  I don’t want my Mondays/Tuesdays to count for that time, because on Mondays & Tuesdays, I’m an academician.

That child in clinic or admissions or on the ward deserves a consultant who is a competent clinician.  If doing research gives me some extra skills, then that’s great.  If having your own children gives you different skills, then that’s brilliant too.  But nobody says that having your own children means that you should spend less time training as a clinician, even though that’s a whole load of multi-tasking, time-management, people-management skills that sound quite useful.  My research path might give me some great insights & skills that I don’t get as a clinician, and but they don’t make me a clinician.

What makes me a clinician is my training time as a paediatrician, and I don’t care how long that takes.

The future of academic training (1)

Bear with me, because this could turn into several long & rambling worries.

As is hopefully clear from the title of this blog, I am both a paediatrician in training and an academic in training.  It’s taken me a long time to realise that, and even longer to decide to pursue this as a career path, but that is what I do. I love what I do, but it is hard.  And along the way, I’ve made decisions that have meant that other things have come second (or third, or fourth).  That’s my decision.  In retrospect, I’ve done the classic NIHR integrated academic training pathway (up to a point).  I did a BMedSci, an academic foundation programme, and an ACF, and even I struggled to decide that this is what I wanted to do.

If you decide that you don’t want an academic career after all that, then that is a decision that you make for your life.

IT IS NOT A FAILURE.

There seems to be this idea that if you do an academic foundation programme, you have to do a PhD.  If you do a PhD, then you have to want a Professorship…  And if that isn’t what you decide to do with your life, then somehow, you are a failure.

The integrated academic pathway doesn’t help: it looks like a single, linear pathway from medical school to senior lecturer.  Leaving that programme is falling off that pathway, not a conscious decision that this isn’t your pathway.

Not every academic foundation trainee will become a Professor; only about 1/3 will do an academic clinical fellowship (at least, last time I looked at the numbers).  And I don’t think that’s a problem…

This is what I think.  Research training is a great thing for all clinicians.  Delivering the best care for our patients means using the best available evidence, which means that you have to know about research which is out there.  You also need to be able to appraise that evidence, and decide how it’s applicable to that particular patient in front of you.  So all clinicians need to understand the basic principles of research.  

There are other skills that come with doing research: I think you learn to appraise decisions differently. You may question & critique & appraise in a different way. (This might not make you very popular with your consultants, but it’s an important part of learning how decisions are made).

Having a group of trainees who have had some additional research experience & training who are now “pure” clinicians is a massive boon to the workforce.  We’re trying to drive a programme of research in paediatrics: recruitment to trials “on the front-line” depends on having front-line clinicians who understand research, can explain to patients & families and answer their questions, and who understand the paperwork.  

So please, don’t see a decision to leave the integrated academic training pathway as someone who’s fallen by the wayside.  Be thankful that next time you go to recruit from a clinical area, there will be sympathy for the process you’re going through; that the families will be able to discuss the research with their clinical team; and understanding of the importance of the work that we’re all trying to do.

We’re all paediacademiatricians in some way – just in different percentages.