Academic Clinical Careers in Geriatric Medicine Julia L. Newton Senior Lecturer in Ageing Medicine Institute for Ageing and Health Newcastle University

Outline Academic Clinical Career Pathway Biomedical Research Centre in Ageing The Campus for Ageing and Vitality

Clinical Academics figures are 84% of 2000 level Below 3000 for first time % reduction in clinical lecturers 30% reduction in senior lecturers 7% increase in professors Particular specialities hit hardest Differences between medical schools Differences between genders

Why? Competing pressures of service, research and teaching activities Increased length of time to complete specialist training Lack of exposure to academia in postgraduate training programmes Lack of flexibility in the postgraduate training programmes e.g. p/t working Lower financial rewards than in the NHS The RAE

Funding of clinical academics HEFCE 45% NHS 38% Other 16% - charities, endowments, industry, etc Varies by speciality Varies by medical school/region

Deterrents for a clinical academic career Lack of both a clear route of entry and a transparent career structure Lack of flexibility in balance of clinical and academic training and in geographical mobility Shortage of properly structured and supported posts on completion of training UKCRN/MMC March 2005

Key signposts for recovery of clinical academia Treasury reports: central role of applied biomedicine in economic growth UKCRN/MMC (Walport) report: ‘Medically and dentally-qualified academic staff: recommendations for training the researchers and educators of the future’ Best Research for Best Health: restructuring NHS R&D

MMC and UKCRC Clear route of entry to an academic career Transparent career structure Properly structured and supported posts after training Academic Foundation posts Academic Clinical Fellowships Academic Clinical Lecturer

Academic training programmes - Walport

Academic Foundation Programme Newcastle had the first programme in the UK

Academic Foundation Programme 3 x 4 month blocks for both F1 and F2 years 1 x 4 month block in each year is “academic” Other blocks in F1 are medicine and surgery Other blocks in F2 mirror academic interests

Academic Foundation Programme Appointment Process Academic domain in addition to normal foundation form Academic domain concentrates on “why” not “what” Presentation and interview (c30 minutes) Interview concentrates on foundation and academic issues equally Appoint people to the scheme not to individual subject areas

Academic Clinical Fellowship Combination of 25% academic / 75% clinical training. Central funding Speciality specific Central application system Now out with ‘MMC’ system Competency based Leads to application for externally funded fellowship and Phd/MD

Academic Clinical Fellowship

13 programmes awarded in round 1 & 2, in round 3, 3 more. ACF-Newcastle

ACFs in Newcastle /Northern Neurology Hepatology Dermatology Reproductive Medicine Urology Paediatric Oncology Geriatric Medicine Clinical Dentistry Psychiatry (child; adult; old age) Ophthalmology Otolaryngology Trauma and Orthopaedics Pathology of Ageing (Respiratory) (Rheumatology) (Clinical Pharmacology)

ACF in Geriatric Medicine Oxford total 2 ( post) (James Kennedy) St Georges total 4 ( post) (Emma Baker) combined with CP. Southampton total 2 ( post) (Avan Sayer) Newcastle total 7 ( post) (Julia Newton)

ACF in Geriatric Medicine - Newcastle 7 posts over 5 years 1 ST – SpR 2 nd ST1 As of now – will recruit from ST1

Academic Clinical Lecturer

ACL 50% research / 50% clinical training. Post doc Developing own research grouping Leads to application for Senior fellowship

13 matching CLs awarded Probable additional 5 ACL - Newcastle

3 programmes Ageing Specialities Dental Psychiatry

ACL in Geriatric Medicine Oxford total 1 (2007) Newcastle total 5 (? 5 more) – Age related medical specialties

Academic Senior Lecturers

New blood ASL posts 4 awarded in 2006/7 Academic Senior Lecturers

Clinical Academic Career Path Committee

Academy of Medical Sciences guidance ‘Training needs to be flexible and trainee-centred, with mentoring to ensure the attainment of both academic and clinical goals’. ‘The academic component of the training period must include preparation of an application for a competitive peer-reviewed research training fellowship or educational training programme leading to the award of a higher degree, the completion of which is considered as the end-point of the ACF period’. ‘It is essential that ACFs have the opportunity to develop competencies that enable them, in Year 1, to define a research question, and in Year 2, to develop a research proposal. The Academic RITA should record the ACF’s progress specifically in relation to these training goals’.

Criteria for the Assessment of Academic Progress Academic educational supervisor separate individual from the clinical educational supervisor usually be an established clinical academic formal mentoring role responsible for drawing up an Academic Training Programme with the trainee, and a realistic/achievable timetable for delivery. required to identify training goals relating to generic academic competencies and specific academic goals for each individual as appropriate. These targets will be summarised within the Personal Development Plan (PDP) for the trainee, which should be agreed within a month of commencing work and annually thereafter.

RITA The academic component will be an integral part of the RITA process for the Academic Clinical Fellows (ACFs) and Clinical Lecturers (CLs) MMC & UKCRC.

Generic academic competencies Three domains: 1) Research Experience, 2) Research Governance, 3) Communication/Education. Academic progress is to be assessed in relation to each of these domains.

Academic Competencies and Outputs 1) Generic and applied research skills Examples include: Identifying a research supervisor Identifying a research topic Defining a research question Observational and experimental research design Developing a research proposal Writing a grant application Critical appraisal of a paper or topic Carrying out an experiment Data interpretation and statistical analysis Writing a research paper or thesis Commercialisation of research outputs

Academic Competencies and Outputs 2) Research Governance Examples include: Information storage and retrieval Patent and Intellectual Property issues Laboratory safety Clinical trials / clinical trials legislation Research ethics and how it is monitored (including COREC processes) Home Office and Animal Licences Animal husbandry Storage of human tissue NHS structure and regulations Fraud/Scientific misconduct Research and Integrity (awareness of complex dilemmas in scientific research).

Academic Competencies and Outputs 3) Communication/Education Examples include: Writing skills Verbal presentation skills Electronic media / audio-visual presentation skills Poster presentations Teaching skills/experience Supervision skills/experience Science and the Media Effective networking and collaboration Collegiality/ability to work co-operatively and creatively with colleagues Assertiveness skills

Outputs Significant outputs should be recorded on the Assessment of Academic Progress form, and supporting evidence should be provided. Presentation at national / international research meetings Submitting an application for a grant or fellowship Publishing a peer-reviewed article Delivering an educational lecture or seminar

Assessment of Academic Progress – documentation Training record Records of 6-monthly (or more frequent) progress review meetings Educational Supervisor’s report (to have been shared with and signed by trainee at least 2 weeks before meeting). This should include a listing of the academic competences achieved in the period under review, listed under the 3 headings: generic and applied research skills research governance communication / teaching skills Record of academic outputs (provided by trainee) Research proposals Academic placements / modules Publications/ Courses Personal Development plan Miscellaneous

Assessment of Academic Progress - process The trainee should be asked to comment on progress through the year, competences gained, significant milestones and future aspirations. The panel will discuss the achievements, comment on any deficiencies and make recommendations about the training goals for the next 6 months. They will complete the “Assessment of Academic Progress” Form, which should be agreed and signed by the trainee.

Overview of the programme Newcastle Academic Clinical Career Pathway committee Chaired by Dean of Clinical Medicine Brings together the University, Trust and Postgraduate Deanery Academic Interviews in addition to the same clinical interview Academic RITA / Progress assessment in addition to the same clinical interview Academic Lead for Programme Lead on RITA panel Active and effective mentorship programme

National Institute for Health Research

NIHR Academic Links ■Virtual National Research Facility ■Position, manage and maintain the research, the research staff and the infrastructure of the NHS. ■Enable the NHS to become an organisation that supports outstanding individuals (both leaders and collaborators), working in world-class facilities (both NHS and university), conducting leading-edge research focused on the needs of patients and the public.

NIHR Infrastructure “The UK is at the international forefront of developments in basic biomedical research that have the potential to transform patient care. It is vital that we turn that potential into reality.” Biomedical Research Centres “We will create Research Centres within our leading NHS / university partnerships to drive progress on innovation and translational research in biomedicine and NHS service quality and safety.” Experimental Medicine Facilities “We will support purpose-built, cutting-edge clinical research facilities and specialist clinical, research and support staff in locations where universities and NHS Trusts can work together on dedicated programmes of patient- orientated research.” Technology Platforms “Access to technology platforms is increasingly essential for the conduct of leading edge health research. Current access to these platforms is inadequate across the NHS in England. The initial focus will be on diagnostic imaging, the area identified as most critical in scoping work conducted by the Academy of Medical Sciences and our recent survey of NHS providers.”

Biomedical Research Centres Eleven Biomedical Research Centres have recently been created to drive forward innovation and translational research. "Comprehensive" Biomedical Research Centres NHS OrganisationAcademic Partner Cambridge University of Cambridge Guy's & St Thomas‘King's College London Hammersmith & St Mary's Imperial College London Oxford Radcliffe University of Oxford University College London "Specialist" Biomedical Research Centres NHS OrganisationAcademic PartnerSpecialism Great Ormond Street UCL Inst. of Child HealthPaediatric/Child Health Moorfields Eye Hospital UCL Inst. of OphthalmologyOphthalmology Newcastle Newcastle UniversityAgeing Royal Liverpool & Broadgreen University of LiverpoolMicrobial Diseases Royal Marsden Institute of Cancer ResearchCancer South London and Maudsley KCL Institute of PsychiatryMental Health

Clinical Research Facilities for Experimental Medicine £84 million joint initiative including Wellcome Trust, Wolfson Foundation, British Heart Foundation, Cancer Research UK and MRC. MRI key component of funding. Cambridge: … nutrition and appetite laboratory to study genetic disorders and obesity. Dublin: neuropsychiatric disease, cancer, and infection and immunity – inflammatory bowel disease, hepatitis and HIV infection. Edinburgh: inflammation in cardiovascular and central nervous system conditions and work on metabolism in a range of tissues. Oxford: patients admitted as emergency cases after heart attacks or strokes. Belfast: cancer, nutrition and metabolism, and vision science. Newcastle: new Clinical Ageing Research Unit - dementia and cognitive decline, and basic mechanisms of cell and tissue damage during ageing. Manchester: biomarkers for cancer prognosis. Birmingham: gene- and cell-based therapy for cancer and immune diseases, as well as on heart disease, high blood pressure and obesity. Four centres in London:  Imperial College: drug development and early clinical trials in Alzheimer's disease, Parkinson's disease, arthritis and cancer.  King's College: neuroimaging and development of treatments for mental illness along with the study of drug addiction and use of stem cell therapy for neurological disease.  University College London  Institute of Cancer Research

Institute for Ageing and Health Campus for Ageing and Vitality

The Campus for Ageing and Vitality Existing and in the pipeline: Wolfson Research Centre Henry Wellcome Biogerontology Building Newcastle Magnetic Resonance Centre NHS Centre for the Health of the Elderly IAH Research Laboratories Clinical Ageing Research Unit NHS Falls Unit Regional Medical Physics Planning in progress for: Translational Research Building, including new laboratories (biomarkers and nutrition), clinical and social science facilities, incubator space and opportunities for new commercial linkages PET molecular imaging Centre for Assistive Technology Teaching and public engagement space

Campus for Ageing and Vitality 2004

Campus for Ageing and Vitality 2006 Newcastle MR Centre

Campus for Ageing and Vitality 2007 Edwardson Building (new IAH Labs)

Campus for Ageing and Vitality 2008 Clinical Ageing Research Unit - CARU

Translational Research Facility Campus for Ageing and Vitality 2010

Campus for Ageing and Vitality 2012 Further development proposed

There has never been a better and more exciting time for a career in Academic Geriatric Medicine