Becoming a Clinical Lecturer is a major step up on the clinical academic careers ladder. For many, it comes straight after a period of full time research ie doing a PhD. And for others it may mean a change of location and a whole new working environment. Add to that a step up as a specialty trainee after being away from patients, the need to finish all your PhD papers and write new grants and it can all seem quite daunting.
A few months ago I wrote to all Clinical Lecturers in Severn to ask for their views on a variety of matters that kept cropping up in conversation or in emails. The result was a series of very illuminating replies covering a wide number of issues. I felt that a ' qualitative' approach was needed to synthesise these data and asked the two CLs who sit on the CAT board, Shona Methven and Shelley Potter, if they would undertake the analysis. This they have done magnificently and the result is this report. I hope you find it useful. Do pass it on to those who follow you and make sure your academic and educational supervisors have a copy.
Severn PGME July 2015
The Rough Guide to Clinical Lecturer Posts in Severn
The following ‘rough guide’ to clinical lecturer posts has been compiled based on the experiences of 16 CLs across all specialities in the Severn Deanery.
It details what, in our combined experience, works well as well as what doesn’t; situations to avoid (if possible) and some tips for how to get the most out of your CL post.
The key to success is to develop good working relationships with your Academic Supervisor and Training Programme Director (TPD) so that together you can negotiate clinical placements that allow you to develop both as a clinician and an academic as you work towards independence as a senior lecturer and prepare clinician scientist and other important fellowship applications.
The academic clinical training pathway is definitely not an easy option and every lecturer and project is different and has individual needs. We hope this guide may provide a valuable framework for defining and addressing how specific requirements may best be met and help CLs manage the sometimes challenging balance of clinical and academic training without compromising their sanity.
Getting the ‘right’ type of clinical placement is extremely important. Communication with your supervisors and TPD about your training needs early and planning ahead is vital. Duration of placements should also be carefully considered. A six month placement is equivalent to only 3 months of full-time training which is not sufficient to build up good relationships with your trainers, especially in craft specialities. Placements of at least a year are often the most beneficial and again should be discussed early with your TPD and Academic Supervisor to help you get the most out of your CL post. When selecting a post consider the following;
- Supernumerary posts have been described as the ‘the ideal scenario’ for CLs and overall have had the best feedback from the current cohort of academic trainees.
- Supernumerary posts provide maximum flexibility for organising clinical and academic time and permit participation in either 50% or 100% of an on call slot depending on the trainee’s needs (see later).
- A note of caution - when choosing a placement, it is important to ensure the clinical team has sufficient capacity to accommodate an ‘extra’ trainee – jostling for lists and clinics creates animosity that is best avoided. Speak to previous CLs – they may help you identify what posts and what units work well.
- Gaining sufficient clinical experience in certain supernumerary posts may also require planning so thinking ahead and good organisational skills are vital to get the most out of these fantastic training opportunities.
Job-shares with a fellow academic trainee
- Academic trainee slot-shares are an excellent alternative to supernumerary posts, although their availability may be limited to larger specialities and units with more than one academic trainee.
- As CLs tend to have similar priorities and are generally more flexible than other less than fulltime (LTFT) trainees, the ‘right’ job share can be extremely productive and these arrangements have received very good feedback.
- Academic job-shares tend to involve sharing a single on call slot, however, so consideration may be required if CLs require a full slot to achieve required on call experience.
Job-shares with less than full time trainees
- Fixed day job-shares with LTFT trainees (especially if the days are non-consecutive) have received extremely poor feedback from CLs.
- Clinical lecturers in these posts were generally dissatisfied and unhappy with the impact of the arrangement on both their clinical and academic work as the lack of flexibility and rigidity of their job-plans compromised both continuity of clinical care and access to academic and clinical training opportunities.
- If possible, fixed day job-shares should be avoided.
- Not all job-shares with LTFT trainees are problematic, however, and some LTFT trainees are extremely flexible so communication is vital and forward planning is key.
On call commitments
On call experience is an important part of clinical training and CLs should expect to participate to a greater or lesser degree in the on call rota. The 50:50 split provides a number of opportunities for CLs, either to participate in 50% or 100% of an on call slot. This decision is an important one and should reflect your training needs. Your decision may depend upon:
- Your need/desire for emergency experience in your speciality and CCT requirements
- Financial considerations
- 50% will mean a decrease in banding supplement that not all trainees can accommodate and individual circumstances need to be considered.
- The on call rota pattern of the placement you are in
- Some hospitals/specialities have very onerous on call rotas due to intensity, frequency, amount and/or pattern of compensatory rest or other considerations which can dramatically impact on your academic time if you decide to or need to participate in 100% of an on call slot. Examples include having an academic day after a 24 hour on call when you are too exhausted to do anything or an academic week after a weekend of nights when the first one or two days are lost due to sleep deprivation.
- The on call rota and your participation in it should be something discussed with your TPD and academic supervisors. It may vary according to placement and early planning is needed.
- On call patterns can be negotiated locally and again good communication and team-working can be beneficial.
- Having responsibility for planning the rota can also be advantageous and should be considered as the extra work entailed may be beneficial.
After you have taken up an ACL post you will have to give careful thought to if/ how much you wish to extend your training. The NIHR Trainees Co-ordinating Centre guidance suggests that your CCT does not necessarily have to change at all, as award of a CCT is competency based not time served. However, depending on the nature of your research and the type of specialty, you may want to extend by a variable amount of time. For example, you need sufficient time to develop skills in craft specialties. But remember any extension of your CCT also gives you more time to develop your research and strengthen your application for that all important next fellowship award, so it may be beneficial to both aspects of your career. This is very personal, and as with the other aspects needs to be agreed with your academic supervisor and TPD. NIHR awards last for a maximum of 4 years. Usual FAQs for NIHR trainees can be found here.
Planning your time
Different types of research suit different working patterns, but consider what would suit you AND your clinical team. Flexibility and developing a good working relationship with your clinical trainers so they understand your dual responsibilities can be extremely worthwhile and may help when you require flexibility in return. In general;
Consider how you wish to organise your research time
- Blocks of academic time generally work better than odd days as this allows focus on clinical or research activities and promotes continuity of care whilst undertaking clinical work.
- It is possible to alternate clinical and research, weekly, biweekly or monthly depending on speciality or trainees’ needs
- Laboratory based research may even benefit from 6-monthly rotations
- Most CLs prefer blocks of clinical and academic time, but some trainees find long periods away from the lab/office difficult.
- It is also possible to continue to participate in specific weekly clinics or on call during your academic time as long as this does not have too significant an impact – creative approaches to training can work well and should be encouraged but require advance planning and good communication.
- Decide what would fit best with you and your post and consider changing it if it doesn’t work (after consultation with your team).
- Consider prospectively planning a review after six months in case any issues (expected and unexpected) arise.
Communicate and plan ahead
- The importance of good communication and planning ahead cannot be over-emphasised.
- Placements work best when expectations are clearly defined and agreed in advance by both parties.
- Consider a weekly rota (planned several months in advance) so clinical teams and colleagues know who is covering what sessions. This also allows you to negotiate with other trainees to get additional time to attend meetings/conferences if necessary and to ensure you are getting adequate clinical training opportunities.
Be flexible – but remember - quid pro quo
- Offering to cover if there are weeks when the clinical team is short-staffed can be mutually beneficial (more clinical experience/happy team/more likely for team to understand and be happy to cover for meetings/conferences) – flexibility, if your research will permit it is definitely a good thing.
- While flexibility is a good thing, your research time should be ‘protected’ and not viewed as ‘free time’ when you can be called if needed. Again, developing good working relationships with your clinical team will help develop a greater understanding of the demands of academic training and respect for your academic ‘boundaries’.
Clinical academic training can be challenging but extremely rewarding. It is also the ‘road less travelled’ so many clinicians still do not understand the demands of an ACL post and this can cause its own difficulties. With the success of the clinical academic programme in Severn, however, things are changing for the better and there has never been a more exciting time to be an academic in the South West. Good communication, flexibility and meticulous planning combined with careful post selection and understanding TPDs are the cornerstones for success as an ACL. We are ambassadors and role models for academics of the future and together we can make the ACL pathway a productive and enjoyable experience.
It’s hard work, but definitely worth the effort.