September 28, 2017 | Thomas E. Kaier, MD, MRCP, MBA
International

Following on from the article Cardiology Training ‘Across the Pond,’ written by Amardeep Dastidar, MBBS, I want to provide an insight into higher academic training in the UK. As my colleague has eloquently described, cardiology training is a five-year program following on from two years foundation and two years core training in General Medicine. Access to a more academically-themed post can be obtained at different levels, however, is most commonly sought at the beginning of cardiology training (as an Academic Clinical Fellow, ACF) or by interrupting clinical training through a formal period of Out Of Program for Research (OOPR). The former offers the ACF training for three years in core cardiology with a 75 percent clinical, 25 percent academic mix, with the ultimate goal of applying and completing a higher research degree (usually towards the award of an MD or PhD). The 25 percent protected academic time is generally arranged in a three-month block each year, hosted at a research-active institution. This provides the ACF with the opportunity to develop his or her research ideas under the supervision of seasoned academics and apply for external funding. The OOPR time has to be applied for during clinical training but allows the fellow to retain his clinical fellowship position while focusing full-time on research.

It has become increasingly competitive to secure funding towards a research degree in the UK. Even established academic institutions lack the funds (colloquially referred to as “soft money”) to support an aspiring fellow through more than one year of research. Ideally, the fellow coordinates his research interests with a prospective supervisor at an institution that has a proven track record of successful MD/PhD students. Together, the fellow and supervisor then prepare and submit a fellowship application to one of the “big four” –  organizations offering funding for a two to three-year research fellowship: British Heart Foundation, Medical Research Council (MRC), Wellcome Trust, and National Institute for Health Research. Upon award of the fellowship, the fellow arranges a prospective start date for the OOPR period to begin, and the deanery providing the clinical training will free the fellow from commitments other than what is relevant to the clinical research program.

Being funded by an external body such as a charity (BHF) or the MRC has several advantages. First, there is the obvious “independence” enabled through a three-year fellowship. Technically, the awarding body provides the funds to the trainee, who is then at liberty to conduct the research at a host institution of his or preference. In reality, this will, of course, be somewhat pre-determined by a supervisor who is experienced in the particular field of interest. However, the relationship is likely to be less dependent than if the funds came solely from the host institution. Second, a three-year research grant in the fellow’s name is a strong distinguishing factor on the CV, adding to the candidate's competitiveness in future applications targeting either an academic or clinical appointment. While this might be of less relevance to cardiology trainees outside the academic “hot spots,” consultant jobs (equivalent to an attending in the US) in highly sought-after areas such as London predominantly attract applicants who have completed a higher research degree, irrespective of whether the individual plans to further develop a research interest.

From personal experience, I can only recommend pursuing a period of dedicated time in the field of cardiovascular research, which is ideally not intertwined with a clinical job role. In the right circumstances, one has the opportunity to develop skills nigh impossible to acquire outside a full-time role as clinical researcher. It further gives the trainee/fellow the opportunity to develop a “special interest” and become an expert in a field of cardiovascular medicine. Many current and former research fellows speak very highly of the opportunities and, in particular, autonomy experienced during their time “out of (clinical) program” – flexibility, that is a welcome change to the well-structured and otherwise highly effective clinical training program in the UK.

Links:

British Cardiovascular Society

British Junior Cardiologists’ Association

This article was authored by Thomas E. Kaier, MD, MRCP, MBA, Fellow in Training (FIT) at St. Thomas’ Hospital in London, England.