Academic General Practice Training: A Trainee's Perspective

Background

An academic component within general practice training offers an alternative route, and allows trainees to explore and experience the benefits and challenges of a portfolio career. The term ‘academic’ can sometimes feel rather alienating and give a misconception of prerequisite achievements a trainee must possess. An academic background is not a requirement for acceptance onto an academic GP training scheme.

There are currently three ways of combining general practice and academic training. Academic clinical fellowships offered by the National Institute of Health Research are 4 year programmes with entry at ST1 level. There are also two nationally funded academic fellowships available each year, which allow current GP trainees in ST2 to extend their training by a year with part-time attachment to a university department during the ST3 and ST4 year. This is currently offered at five universities: Birmingham, Bristol, Keele, Oxford and Southampton. The ratio of time spent between clinical and academic activity varies between the universities. A very useful document entitled ‘NSPCR ST3 entry Academic Clinical Fellowships’ describes in detail the individual programmes offered by the institutions.

Birmingham University also offers an academic clinical fellowship with entry at ST3 level allowing trainees to obtain dual qualification in general practice and clinical pharmacology. This post is for 4 years with ST3 and ST4 years providing a clinical:academic split of 60:40% and 40:60%, respectively; ST5 and ST6 provides further training in clinical pharmacology. This fellowship also gives opportunity to be involved in research and teaching in the pharmacology and clinical pharmacology component of the undergraduate medical training programme.

The third opportunity is the AST4 programme. In London, this was piloted in 2008–09 and is currently in its fourth year. It is a continued year of training on top of the standard GP training programme and is currently offered in the London Deanery as a stand alone post after ST3, or as part of a 4 year GP training programme offered by some training schemes.

If you are interested in any of these programmes, contact your deanery for further information as these positions are arranged locally.

My personal reflections

The registrar year can be intense and often trainees are looking forward to become independent GPs and work as a locum, salaried GP or even a partnership. This time last year, I was approaching the end of my training and although the prospect of finishing training was quite exciting, the opportunity of extending my training for another year appealed for a variety of reasons.

I have always been interested in teaching and research, and an opportunity to develop this passion, with the added benefit of continued support from a clinical trainer within a structured, but flexible programme tailored to my learning needs was an attraction to the AST4 year.

The AST4 year in London comprises five academic sessions per week, and four clinical sessions. There is also one non-clinical session, for practice development.

As GP registrars, it is often difficult to devote time to learn about the managerial aspects of general practice. From a personal perspective, with the intensity of the ST3 year and the Clinical skills Assessment exam, I did not feel that I comfortably understood the management in primary care, commissioning and terms, such as ‘DES’, ‘LES’ and ‘QIPP’ even as I was approaching the end of my training. The practice development session has been a particular highlight for me this year with an opportunity to be involved in areas, such as the Quality and Outcomes Framework, audit and enhanced services.

Having nearly completed the AST4 year, I am able to appreciate the immense rewards that this programme can offer. It is a fantastic introduction into a career in academic general practice, and offers many career opportunities. It can lead to an application for an externally funded research training fellowship that allows you to study for an MD or PhD. Previous trainees have also started working towards a postgraduate certificate in medical education. There is also an option to return to a clinical career track, with interests in teaching, for example, becoming an undergraduate or GP tutor.

Trainees of the traditional 3 year programme have often described how their training has been well focused with often not much scope to ‘think outside the box’. The AST4 year allows you to take responsibility for your learning and you are given ownership of your time. This helps you to tailor the programme to your individual needs so that you can gain the maximum potential benefits from the year. The academic work is flexible and adds variety to the clinical week. Trainees are encouraged to pursue avenues of interest, such as writing book chapters or journal articles, teaching medical students and developing the undergraduate medical curriculum, examining objective structured clinical examinations (OSCE) and developing skills related to qualitative and quantitative research.

The AST4 year has enabled me to consolidate my clinical knowledge without the worries of looming exams. It has also offered fantastic opportunities to become involved in commissioning, actively participate in local medical committee meetings, and develop my leadership and negotiation skills through a separate project I have been working on with NHS London.

Working with a different patient population from my ST3 year has been a challenging but invaluable clinical experience, and fellow ST4 colleagues have also had an opportunity to become familiar with the different IT systems used in primary care. Developing critical appraisal skills, experience in making an objective assessment and moving projects forward in teams during the AST4 year will be very useful in my future work, especially in the current climate of upcoming political changes within the NHS and commissioning. Box 1 provides some examples of curriculum areas covered by the training.

Box 1. Examples of curriculum areas covered in academic general practice training

Teaching

Challenges

A portfolio career does have its challenges. You are often trying to juggle multiple commitments towards your clinical work, research and teaching and it is important to be able to manage your time in the best way. I find prioritizing my tasks and setting personal deadlines that is useful to ensure the work is completed ahead of the schedule. Treating the clinical and academic parts to the job as separate entities avoids allowing clinical commitments to creep into academic time and vice versa.

It is important to be honest about your commitments to the departments and practices you are involved with, and this may sometimes require you to reject certain proposals in order to effectively manage the workload. Although the AST4 year does not involve any exams, it can still be quite intense and demanding; therefore, it is important that you develop techniques to look after your personal well-being and ability to deal with stress to help maintain momentum through the year and a good work–life balance. There are times when you will be faced with dealing with uncertainty and the structure of your working week may change at short notice. As the clinical work is part-time, you may not have the same continuity of care with patients that full-time clinicians have. Nevertheless, turning these challenges into successes will increase your confidence in your work and prove useful lifelong transferable skills for any work within general practice, not only within a portfolio career or academic setting.

Tips

If you are a current trainee in an academic programme and due to start working on an academic project, ensure there is sufficient time to obtain ethics approval for the project and apply early as this can take many months.

Be realistic in what you can expect to achieve within the post. Consider whether you want to focus on a single project at a time, or be involved with multiple projects simultaneously, ensuring you allow enough time to also focus on clinical commitments and assessments.

For trainees considering applying for an academic component to their current programme, find out early on what opportunities there are available to you in your deanery and the application process. Inter-deanery transfers may be possible in specific cases so it is worth looking specifically at the individual programmes as they differ across the country. Useful contact details are within the document ‘NSPCR ST3 entry Academic Clinical Fellowships August 2012’.

When applying for programmes you are interested in, look into the detail between posts within the same institution, as different research groups will have special areas of interest and focus. It is useful to speak to current trainees regarding their experiences to be able to make an informed choice.

There are many avenues to engage in an academic general practice training programme with often high competition. It is important to stay determined and not to get disheartened if you do not succeed initially, as the training programmes are constantly under change and new opportunities often arise along the way.