Jonathon

Rest assured that you are not a dreamer, but rather one of the few ostriches 
who has pulled his head out of the sand and seen that research is important 
! Our specialty has been slow in addressing this - offering scholarships is 
a good start but we haven't developed a research culture yet, despite the 
best efforts of Rod Little, Mike Clancy and others. To be credible as 
researchers, we need to stop pretending this can be done in spare time, with 
no money and no expertise. The pressure for change needs to be initiated by 
NHS consultants, since there are so few academics in A&E.

I had to come out to Hong Kong to secure adequate funding for a proper 
academic unit. I can honestly say, having spent the money, that the minimum 
set-up costs are of the order of 250,000 pounds capital plus four salaries 
(Prof, lecturer, tech and secretary). It takes 1-2 years to produce good 
output, but then that track record forms the basis for getting more cash. A 
spin off is that funds for clinical facilities may also follow - the Jockey 
club gave us HK$ 85 million (over 7m pounds) to build a new trauma centre, 
including an observation ward and a new home for the academic unit.

At the time (1995) when I departed for HK, one or two academic posts were on 
offer in the UK which aimed to convert a vacant NHS consultant post into a 
chair. The job descriptions allowed only 2-4 half days for academic work 
(teaching included) ! The research team MUST have a foothold in the clinical 
arena, but that is not the way to arrange it, and a stand-alone post without 
support staff is bound to fail.

Anyone in a University post is judged by their output of research, and 
nowadays this has to be in good journals. To get this sort of work done, a 
lot of time has to be spent producing credible grant applications, which 
have to get past trained scientists for validity of method. This becomes a 
sort of cottage industry within every unit and Faculty of Medicine, but A&E 
has not yet learned the rules and put its own players around the high table.

Let's stop viewing research as skiving time for SpR's and go kick ass ! 
(oops, sorry for the expletive, now it's me getting worked up !). There are 
so many good clinical research questions needing answers, it would only take 
a little organisation and some persuasive political skills to get the money 
for a few academic units.

I'm just off to Gloucestershire for a holiday, so I hope you'll  all 
continue this interesting thread. Back on 7 August.

Best wishes

Rob Cocks
Prof. & Director
A&E Medicine Academic Unit
G05, G/F Cancer Centre
Prince of Wales Hospital
Shatin, NT, Hong Kong

 ----------
From: acad-ae-med-request
To: acad-ae-med
Subject: Re: Academic Training
Date: Friday, July 16, 1999 9:09AM

The way in which provision is made to train "academics" seems critically
important with regards to the future of A&E medicine in the UK. If we
are to consolidate our position as credible practitioners we must
develop a sound research base, and whilst an academic career will only
suit a proportion of trainees it is essential to establish a method by
which researchers of the future can be effectively developed and
supported.

"Calmanisation" has caused similar problems in most specialities, in
that there is inadequate provision for high-quality research during
higher specialist training. Instead the modern SpR is too often
encouraged to undertake "research for research's sake", churning out
papers that are high in quantity but low in quality.

Personally I am not in favour of research before SpR posts, since
although this may work well for a number of highly motivated individuals
I for one did not have the direction or perception to undertake
meaningful A&E research at that stage. As Tim Coats suggests, there
currently seem to be a lot of "senior" SHOs in other specialities
undertaking one to three years research for a higher degree not because
they want to, or are even interested in what they are doing, but because
they see it as a necessary hurdle to be overcome before they can
progress to an SpR post.

Similarly there are major problems in taking time out of an SpR rotation
to pursue an appropriate project and higher degree. Perhaps the biggest
of these is funding; as I have discovered from my own prolonged and
agonising experiences, monies are short and competition fierce,
particularly from some of the more established specialities who often
have considerably more experience at the "grant game". This is
particularly frustrating when there are so many fundamental A&E research
questions which remain largely unaddressed. The other problem lies in
ensuring that trainees who wish to pursue this goal are properly
supported in a knowledgeable and effective research environment.

For these reasons, the four year post described by Tim Coats seems
ideal. It attracts SpRs who have already gained some experience and an
understanding of the issues that need to be addressed and supports them
in a permanent, funded system which combines research with "real life";
though it is clear from previous comments that the way in which research
and clinical committments are separated must be clearly defined.
The increase in training by one year is unlikely to put most trainees
off (since many are already happy to prolong their SpR training by a
year or two; it certainly beats becoming a consultant!), and although it
does only produce one MD every four years, the obvious (if a little
optimistic) solution is simply to create a few more of these posts
around the country to further enhance the A&E academic network.
Such centres could also provide "academic attachments" for
those interested in research but unwilling (or uncertain) regarding a
full-scale research post.

I guess I'd better stop now before I get too much of a reputation as a
dreamer!

Jonathan Benger.
SpR, Bristol.



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