Research

Introduction

Pathology has a distinguished record of research with many members and Fellows contributing to significant advances in medicine. The potential impact of new discoveries can be huge as exemplified by the recent Nobel prize award for the discovery of Helicobacter pylori to a pathologist Robin Warren. Pathology and research are inseparably linked and all the branches are rapidly developing bringing greater understanding of disease and how to manage it more successfully.

 

A good understanding of science is a pre-requisite of practicing pathology and this can be derived most effectively through research. Today’s research is tomorrow’s clinical and scientific practice.  A research culture engenders a healthy inquisitive atmosphere within individuals and Departments.

 

Research can be undertaken at a variety of levels and each is important. The vast majority of pathologists will publish work at some time in their career.  For many this will be observations made in the course of their clinical work, others will decide that part of their time will be set aside for undertaking research projects or supervising more junior staff to undertake the leading role.  In Teaching Hospitals individuals employed by the NHS may has substantial research activities and be widely recognised for their skills.  In Universities academics usually combine clinical work and basic, translational or clinical research however some choose to become full time researchers.  Research also takes place in Industry where it is focussed on Company priorities and tends to take place in larger teams but none the less can be groundbreaking and developments can make a major contribution to human and animal health.

 

All of the above types of research are valuable and the impact of even small pieces of work can be very large. Day to day observations at the bench can yield important questions the answers to which have an impact around the world.

 

Research training also improves the quality of professional practice equipping the pathologist with new skills and a critical mind allowing them to weigh up the evidence base for a particular treatment or approach to diagnosis.

 

The Royal College of Pathologists are determined that research will be one of its four pillars of activity, alongside education and training, standards and workforce.  The position of Director of Research has been created and the Director chairs the RCPath Research Committee.  We are developing an action plan and each pathology specialty has been charged with developing an R&D strategy and implementing it.  The RCPath’s vision is, “To enhance pathology research and the understanding of that research for the benefit of the patient and society at large.” 

 

This area of the website is meant to inform and educate and hopefully to stimulate young trainees to consider a research career.  Feedback is welcome as are additional contributions.

 

Pathways to postgraduate research

 

Areas

Histopathology

Haematology and blood transfusion

Microbiology

Chemical pathology

Toxicology

Genetics

          

Pathways to postgraduate research

 

Background

Since 2000 there has been a significant decline with a 25% reduction in the numbers of academics and a number of key national initiatives have followed:

 

a)      UK Clinical Research Collaboration (UKCRC).  Developed out of the Academy of Medical Sciences report on ‘Strengthening Clinical Research’. Activity is focussed on 5 major areas including building up the research infrastructure (Clinical Research Networks, Experimental Medicine funding, IT), building up the research workforce (new clinical fellows, clinical lecturers and ‘new blood’ senior lecturers), developing incentives, streamlining the regulatory and governance frameworks and the co-ordination of research funding.

 

b)      Best Research for Best Health.  Launched January 2006 to direct the government’s strategy for health research with the creation of the National Institute for Health Research (NIHR). Main areas are establishing membership from the academic community (during 2007/2008), development of skills and career pathways, strengthening existing and establishing new funding streams, research centres, governance advice and ethics and Clinical Research Networks.

 

c)      The Cooksey Report.  This recommended a ring-fenced ‘Joint Health Research Fund’ for academic clinical fellowships, lectureships and clinical scientists and that future increases in funding should be weighted towards translational and applied research.

 

d)      Recommendations for Training the Researchers and Educators of the Future – report from the Academic  Careers Subcommittee of Modernising Medical careers (MMC) and the UKCRC (Walport Report).  This recognised lack of clarity regarding entry requirements for academic medicine, lack of flexibility in the balance between clinical and academic training and a lack of suitable posts. 

 

Research Training and Education

 

Medical Training – the recommendations of the Report of the Academic Careers Subcommittee of MMC and the UKCRC (March 2005) are summarised below:

Medical schools - intercalated BSc  or PhD

Foundation Programmes – these are the integrated F2 programme, academic F2 rotation and 2 year integated programme.

Specialist Training – dedicated academic training programmes consisting of two phases: (i) academic clinical fellowship leading to a competitive externally-funded training fellowship and either PhD or MD and(ii) clinical lectureship phase leading to CCST.  These trainees are given an NTN(A) at entry.  Specialist registrars may also be given NTN(A)s and pursue research leading to the award of PhD or MD during their training whilst other trainees with non-academic NTNs may do a PhD or MD as out of programme research (OOPR).  It is important to maintain flexibility, allowing trainees to take up research when motivated to do so and also to leave academic programmes if they feel that a research career is no longer appropriate.   Trainees in related areas e.g. surgery, nephrology and immunology should also be given the opportunity to undertake research.  The availability of adequate numbers of national training numbers (NTN(A)s) is essential.  It is important to give trainees adequate support and consideration should be given to the use of mentoring schemes wherever possible.  There are many instances where these have been used with great success.   Some feel that the MMC agenda has inhibited research since a  relative lack of weight is now given to it. 



For all trainees subsequent academic progression depends on gaining a further career development fellowship, clinical lectureship or MRC clinician fellowship. Funding for these posts is still inadequate.

 

A number of fellowships and lectureships have been awarded by major funding bodies including the Department of Health (“Walport” awards), the Higher Education Funding Council for England (HEFCE), the Medical Research Council (MRC) and the Wellcome Trust.

 

 

Department of Health “Walport” Awards

250 Academic Clinical fellowships; 100 Clinical Lectureships; Personal Awards; 20 Researcher Development Awards; 5 Post-doctoral Awards; 5 Career Scientists; 10 Clinician Scientist Awards.

 

The first found of the Walport Initiative has been open to all specialties but this had been reduced to a shorter list of specialties for the second and third rounds.  Infectious diseases has been included in the first and second rounds but inclusion in the third round was dependent on the outcome of the second round of the initiative.


 
Changes within the general NHS training programme can be seen at the modernising medical careers website http://www.mmc.nhs.uk/pages/home.

The academic training pathway is complex but flexible with a number of entry/exit points. This has also recently been restructured by the recommendations of the Walport report being introduced with new investment in these training pathways.

 

Specific posts

Academic foundation year two         

These posts are specifically advertised as having an academic component. One of the 4 month slots is set aside to gain experience of research and possibly teaching. The FY2’s would usually be expected to undertake a small research project during their time.  There are not enough of these posts around the United Kingdom.

Academic clinical fellowships

Details of this process can be obtained from http://www.nccrcd.nhs.uk/intetacatrain/iatacf . These posts are intended to provide a base from which a young trainee can develop a love for research and generate pilot data that allows them to apply for funding for a PhD or MD. They are for three years during which the trainee should spend one third of their time on a research project. Individuals can start in ST1 or in Histopathology in ST2 or later. If individuals fail to progress in the academic stream then they would revert to ordinary specialist training, however the expected progression is to a funded higher degree.

 

Academic Specialist Registrar post

These posts were established pre-Walport and have the advantage that they offer longer term training (a full SpR training period extended to take account of the lower intensity of service work in theses posts) than the three year academic clinical fellowships. That said, failure to progress in an academic clinical fellowship will usually mean transfer to an SpR post. Academic SpR’s may reduce in number with the introduction of Walport posts but if you can obtain one they offer an alternative pathway to the academic clinical fellowships programme.

 

Gaining entry to research from a Specialist Registrar post

Specialist registrar posts in Histopathology now start at ST1, equivalent to SHO training and run for a minimum of 4 years with training usually taking 5 years. They do not set aside time for research and are intended to train an individual for a consultant post. It is however necessary for SpR’s to undertake research as this not only benefits the individual and their experience but can provide a competitive edge in an increasingly competitive market.

 

Research fellowship

Of two or three years duration these are competitively acquired positions that fund the individual to undertake research and obtain a higher degree. The key components of these positions are the supervisor, the facilities and the research question to be answered. In a three year position you will undertake a PhD and in a two year job an MD. Sources of these fellowships can be found below.

 

Clinical lectureship

Details can be obtained from http://www.nccrcd.nhs.uk/intetacatrain/iatcls2 . These posts are intended for individuals with a PhD or an MD who wish to undertake further research. They would be under the supervision of a successful academic who will foster and mentor your research with the aim that you will subsequently be able to apply independently for your own research monies and obtain a clinician scientist or senior lecturer position.

 

Clinician scientist

These are 5 year posts usually with technical support that allow an individual to undertake their own research programme and establish themselves as an independent researcher. Many of these grants will come with laboratory support.

 

 

Clinical Senior Lecturer

These posts are for individuals who hold their CST and have a higher degree. They will have published in good journals and optimally they should have established an independent research programme but in shortage disciplines an individual may be appointed with less experience. Details of a new scheme for appointing such people can be found at http://www.hefce.ac.uk/research/cslaward/

 

 

Modular pathway for clinical scientists with 9 blocks including PhD and MRCPath leading to consultant clinical scientist position  with both service and R&D commitments.  MRCPath taken in Clinical Chemistry, Haematology, Immunology or H&I most for  Scientists PhD and further research training without service commitment or requirement for MRCPath

Sources of funding

NHS R&D http://www.dh.gov.uk/en/Policyandguidance/Researchanddevelopment/index.htm 

                    

 

Research councils

MRC   http://www.mrc.ac.uk/index.htm

ESPRC   
http://www.epsrc.ac.uk/default.htm

BBSRC   http://www.bbsrc.ac.uk/

CRUK  http://www.cancerresearchuk.org/

Wellcome Trust  http://www.wellcome.ac.uk/


Leukaemia research fund          http://www.lrf.org.uk/

Kay Kendall   http://www.kklf.org.uk/


Other specialist cancer charities

Association of medical charities             http://www.amrc.org.uk/

BUPA         http://www.bupa.co.uk/

BMA           http://www.bma.org.uk/ap.nsf/content/splashpage

 

 

Specialist pathology research society links

            Pathological Society                              http://www.pathsoc.org.uk/

            British Society of Haematology             http://www.b-s-h.org.uk/

 

Links

United Kingdom Clinical Research Collaborative (UKCRC)          http://www.ukcrc.org/

United Kingdom Clinical Research Network (UKCRN)            http://www.ukcrn.org.uk/index.html

National Cancer Research Institute                    http://www.ncri.org.uk/

Clinical Trials Advisory Committee (CTAAC)  http://science.cancerresearchuk.org/news/researchawards/recent_ctaacawards?version=2

Translational Research in Clinical Trials (TRICC)                                                          http://science.cancerresearchuk.org/gapp/fundingcommittees/tricc/tricc_tor.pdf

Ethics
http://www.nres.npsa.nhs.uk/applicants/index.htm
http://www.ukcrc.org/activities/regulation_and_governance/

 

 

Important publications

          

Walport report for academic training
http://www.ukcrc.org/pdf/Medically_and_Dentally-qualified_Academic_Staff_Report.pdf
 or

http://www.nccrcd.nhs.uk/intetacatrain/Medically_and_Dentally-qualified_Academic_Staff_Report.pdf

 

Academy report on strengthening UK clinical research
http://www.acmedsci.ac.uk/images/publication/pscr.pdf

Bioscience report
http://www.bioindustry.org/bigtreport/

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