How to get involved in pathology research

Research, the process by which investigations are performed to establish new facts, is an exciting and highly rewarding activity, particularly within the field of medicine.  As a medical speciality, pathology represents an excellent route into medical research by virtue of the central role it takes in the diagnosis of disease through the detailed examination of human tissues.

Previous experience

If you are considering the possibility of research as a career, previous experience, either within pathology or outside, is not essential.  Many pathologists who get involved in research often have some experience as an undergraduate, for example in special study research modules, intercalated degree or elective projects.  Increasing numbers of foundation doctors are now also undertaking academic placements as part of an Academic FY2 programme and a minority may have already undertaken an MD/PhD.

Ways to get involved

Most pathology trainees will be exposed to research at some point during their training and it is usually possible to integrate a small research project into the normal clinical training pathway without having to extend the time to CCT.  Trainees with a serious interest in academic pathology will, however, be expected to take a more extended period of research usually leading to a higher degree. T his will involve some time outside of the normal training programme and will lengthen the time to CCT by a variable amount.

The academic pathway

Most trainees who embark on an academic career now do so through entry into the Integrated Academic Training Pathway by appointment to posts funded by the National Institute for Health Research (NIHR). Alternatively, it is still possible to seek funding for an 'out of programme' PhD directly from a clinical training post. A small, and decreasing, number of academic SpR or lecturer posts remain around the country that have extra time built in to training in order to complete a higher degree although these are likely to disappear in the near future.

 

The Integrated Academic Training Pathway

Following publication of the Walport report in 2005, the Integrated Academic Training Pathway was launched by the NIHR in order to facilitate academic training in medicine. The Pathway facilitates the integration of both academic and clinical training though funding of pre-PhD academic clinical fellowships and post-PhD academic clinical lectureships.

 1) Academic Clinical Fellowships (ACF)

ACF's are funded by the NIHR for a maximum of 3 years duration. Approximately 25% of the time is spent in academic medicine with the remaining 75% spent in clinical training. You will remain employed by the NHS trust or Deanery with an honorary university contract.

These posts serve as an introduction to the academic career path and allow you to build up some research data to strengthen an out of programme PhD fellowship application. Basic research skills will be taught and there will be the opportunity to join in with established research projects and undertake undergraduate teaching. The exact structure of the post will differ between regions and usually a series of standards and targets will have been set locally. Part 1 of the FRCPath examination will usually be sat during the ACF post if not already completed.

Anyone who is within two years of their CCT date is eligible to apply and as a minimum you must have completed your ST1 year. At interview you must be able to demonstrate an interest in and potential aptitude for an academic career. Previous publications, presentations and degrees are desirable. If you decide that academic medicine is not for you, or if you are unsuccessful in obtaining out of programme PhD funding then a return to the normal training pathway is guaranteed.

  2) Out of programme PhD

Funding for an out of programme PhD may come from a variety of sources. The majority of PhD studentships will come from the big charities e.g. the Medical Research Council (MRC) or Cancer Research UK (CRUK), although a variety of other opportunities are available. Most of these will involve completion of an application form followed by an interview for all shortlisted candidates. It is essential that you demonstrate that you have the potential to be a successful academic so some form of research experience is highly desirable. You will need to specify a research project so the experience and skills of the laboratory and your proposed supervisor are very important.

An out of programme period of research will allow you to start to gain some academic independence while undertaking a higher degree. Funding is usually covered for your basic clinical salary (banding will not be covered unless you maintain some form of clinical out of hours work) along with degree fees and laboratory consumables. Most serious academics will be expected to undertake a PhD and will therefore require 3 years out of programme although some will spend 2 years doing an MD. You will usually be employed by the university during this appointment and clinical duties will be minimal.

At the end of the PhD, the options are to return to full time clinical training, obtain a NIHR ACL post or look for an alternative academic position. Re-entry into the training programme at the end of the out of programme period of study should be guaranteed.

  3) Academic Clinical Lectureships (ACL)

In order to apply for an ACL post, you must have submitted your PhD/MD thesis, which must have been awarded by the time you take up the position. These posts are again funded by the NIHR but allow you to spend up to 50% of your time in academic work. The remaining 50% is therefore spent doing clinical work in order to work up towards taking the part 2 FRCPath examination. Employment will usually remain with the university.

The appointments process is again highly competitive and it is essential to demonstrate evidence of academic competence on the application form and during the interview. Publications, presentations and evidence of international level research are highly desirable. Many of these posts are not speciality specific so any clinical trainee with a training number and PhD can apply.

Options at the end of an ACL post are to obtain a senior lectureship (with honorary consultant status), find some other senior level research fellowship or obtain a standard hospital consultant position.

Considerations

If you are considering an academic career, there are several things that you should consider. Firstly, the institution is very important. You need to make sure that the projects available including diseases and techniques fit in with your interests. It is important to ensure that they have a track record of success, both in research and clinical training. Secondly, the supervisor is critical. It is essential to find a supervisor that is supportive and right for you. It helps if they are experienced and if they are accessible, particularly if you do not have much research experience. Ask trainees who have previously undertaken research degrees in the department and identify potential problems early on.

The ACF and ACL positions were designed for flexibility in order to maximise the clinical academic training experience. The exact training pathway should be designed to ensure that it is right for you, your supervisor and your project. For some people, taking extended periods of research may be appropriate. For others, research blocks may only be 1 to 2 weeks long or even 1 or 2 days per week.

 

Opportunities

An academic pathology career is exciting and rewarding. There is an opportunity to work in excellent laboratories with world class researchers who are at the cutting edge of science. The entire research process will be covered including study design, ethics applications, grant writing, paper writing and presentations. With papers and presentations comes the opportunity to win prizes that could be local, national or even international awards. Dissemination of research findings are essential and therefore travel to meetings in the UK and abroad is possible. One major advantage is the variability of research, teaching and clinical work within the same job ensuring that no day is ever the same.

 

Potential drawbacks

An academic career is not for everyone and the entire process is highly competitive at all stages. You must be prepared for disappointment with funding and job applications. There are frequently more grant applications than there is money available and only around one in three applications will be successful. If you are not successful the first time around then other opportunities are likely to arise in the future so it is important not to give up! Taking time out of programme is likely to lengthen the training time to CCT and to some this is seen as a disadvantage. Also with the variability of the job comes the difficulty of time management and sometimes it can be difficult to juggle both academic and clinical commitments.

 

Further information

Further information on academic careers in pathology can be obtained from:  The NIHR website (http://www.nihr.ac.uk)

The Pathological Society of Great Britain & Ireland website (http://www.pathsoc.org)

The RCPath website (http://www.rcpath.org)