The Importance of Clinical Research: the Mutual Interdependence of Clinical and Laboratory Research, and the Relevance of both to PhD Training
Doctoral Research Training for Psychiatrists and for Clinical Epidemiologists.
Professor David Gordon, President of AMSE, Vice President of ORPHEUS
Vice President, University of Manchester, Oxford Road, Manchester,13 9PL
It has been argued that there is little evidence for the effectiveness and utility of research training at PhD level in the clinical setting. Should there be support for medical graduates who are not yet fully trained in their clinical specialty to undertake research, at doctoral level, in the clinical setting and on a clinical problem?
This paper describes the outcome of two programmes for clinical research training for medical graduates, supported in the United Kingdom (UK) by the Wellcome Trust1. The Wellcome Trust also has a scheme of general support for medical graduates undertaking research training, the outcome of which has been described previously2.
In 1979, the Wellcome Trust began to provide support for medical graduates wishing to obtain a research training in mental health, or in clinical epidemiology. The argument in each case was that there was a shortage of research-trained clinicians working in these disciplines, at a time when scientific advance implied that there would be excellent opportunities for original research in both fields. ìClinical epidemiologyî for this purpose was as defined by ìthe study of the distribution and determinants of health-related states and events in populations, and the application of this study to control health problemsî3.
The research training fellowships in mental health were targeted at psychiatrists in clinical training, typically between 3 and 6 years after medical qualification. Funding was provided normally for 3 years, and included the salary of the research training fellow, and his or her necessary research expenses. (This scheme also provided funding for basic scientists working on mental health problems: these basic science fellowships were not examined for the purposes of this paper.) Awards were made on the basis of the merits of the candidate, the strength of the academic setting in which research was to be conducted, the suitability of the supervisor for the research, and the quality and nature of the research project. The integration of basic and clinical sciences relevant to the research problem was regarded by the Trust as a high priority. Projects covered a wide range, from studies of the neurochemistry of the brain in psychiatric patients, to studies in a completely clinical setting, for example using neuroimaging or cognitive psychological approaches to the analysis of disease.
The research training fellowships in clinical epidemiology were open to graduates working in any clinical field, again typically between 3 and 6 years after medical qualification. Support was normally provided for 4 years, including the salary of the research fellow, and his or her research expenses. The funding also included the costs of attendance at an appropriate masterís degree course in clinical epidemiology, in order fully to equip the research training fellow with essential epidemiological methodologies. Awards were made according to the same criteria as for research training fellowships in mental health.
The records of the first 50 clinical fellows in mental health and the first 50 clinical epidemiology fellows were examined. In mental health these included awards made between 1979 and 1994, and in clinical epidemiology between 1979 and 1993: thus, ample time (at least 10 years) has elapsed since the completion of each fellowship to allow an assessment of the fellowís later career. Publicly available databases, including, inter alia, the Public Library of Science, PubMed Central, and the UK Medical Directory were examined to trace each fellow. Available on-line resources were searched until each fellow was unequivocally identified: two fellows (2/100) could not be found.
Three pieces of data were obtained where possible.
- Where (in the UK or in another country) was the fellow now working?
- What was the nature of his or her appointment ñ was it primarily an academic appointment in a department of a university, or a clinical appointment in a healthcare system?
- Was there evidence that the former fellow had published academic work in the last 6 years? The period of 6 years was chosen, to allow for any delay in published research reaching online databases.
The results are summarised in tables 1 and 2.
Table 1 ñ Mental Health Fellows
Of 50 mental health fellows, 42 are still active in academic publication. Most of these (35/50) are working in an academic setting, either in the UK (27) or in another country (8). Only 6 of the former fellows still in employment are not active in academic publication. Ten of the former mental health fellows were working outside the UK (in Australia, Canada, Hong Kong, Ireland, New Zealand and the United States of America). All of these were still active in publication. As far as could be ascertained, 48 of the former mental health fellows are still in active practice as a psychiatrist.
Table 2 ñ Clinical Epidemiology Fellows
The former clinical epidemiology fellows show a similar picture. Almost all (44/50) are still publishing academic work, mainly from an academic setting (40/50). Four former clinical epidemiology fellows were working abroad, in academic posts in Ireland, Japan, the USA, and the West Indies.
These data demonstrate the excellent long-term academic careers of holders of research training fellowships both in mental health and in clinical epidemiology. Noteworthy is the wide range of research undertaken both during research training and in subsequent careers, and that much of this research is now in an academic (or occasionally clinical) setting in a country outside the UK. Many of the individuals are recognised as leaders in their field of research in the UK and abroad. Most have continued in research in a field related to the subject of their doctoral training, but some have ranged more widely: one psychiatrist is now publishing in the History of Medicine, and two are publishing primarily in Medical Ethics.
Also remarkably is the range of clinical specialities in which clinical epidemiologists work as a consequence of this scheme. These include cardiology, respiratory medicine, infectious disease, clinical pharmacology, gastroenterology, dermatology and psychiatry.
These data amply demonstrate the effectiveness of doctoral research training in these two fields: mental health and clinical epidemiology. Former fellows have both distinguished academic careers and have made many contributions to the biomedical literature.
Potential conflict of interest:
I was personally responsible for the academic administration of these schemes at various times between 1983 and 1998.
The help of Giles Radford and Anne Sanderson in the Management Information section of the Wellcome Trust is acknowledged.
- Lacković, J. and Božikov, J., eds. European PhD Programmes in Biomedicine and Health Sciences: Second European Conference on Harmonisation of PhD Programmes in Biomedicine and Health Sciences Zagreb 2006
- Last, J. M., ed. A Dictionary of Epidemiology. New York: Oxford University Press, 1983.