So you want to be a clinical academic?
Take the red pill.
Being a clinical academic involves spending part of your time doing clinical work and part of it doing research. The academic side can be pretty brutal and occasionally thankless. That said, I absolutely love it and can’t imagine doing anything else.
I have the pleasure of being a personal academic tutor for a few medical students (who happen to all be quite exceptional). One of them is interested in pursuing a career as a clinical academic, so we met for coffee to chat about it. What follows is a summary of my advice, given from the viewpoint of an early career researcher with a few years under his belt.
Why it is a good thing to do
If you have no interest in science or research1, then clinical academic is not for you. If these things do interest you, then combining them both in a job is magical.
It is magical because it is worth much more than the sum of its parts.
Working in research gives you a much deeper understanding of the evidence upon which your clinical practice is built. You will find yourself at the cutting edge of knowledge in your field as you are informed of the latest developments through reading and attending conferences, and through your networks within research.
Working clinically informs your research. It helps you understand where the gaps are in current knowledge and practice, and what types of evidence would best meet the needs of those at the frontlines delivering and receiving care.
Being a clinical academic makes you a better clinician and a better researcher. They are symbiotic and highly complimentary.
Why it is a bad thing to do
Being a clinical academic, at its core, means trying to become world class in not one, but two cognitively challenging disciplines. Both can be extremely time consuming and demanding of your efforts outside of core working hours. Academia also suffers from many things the clinical world does not, such as a lack of reliable funding and job security.
Research is not like clinical medicine, where you simply pay someone a salary to do a service. Specific projects require specific funds, and there are more people demanding funds than there are to go round. The process for getting funding to do your research (or even secure your salary!) is highly competitive, and despite the tens or hundreds of hours that might go into grant applications, most of them fail. This can be extremely demoralising, especially if unprepared. It is best to go into it with eyes wide open.
How to be good at it
Unfortunately, at this stage I must insist you take the red pill (this is a reference to the film “The Matrix” for those who are unaware). I am afraid to inform you that the vast majority of the medical research literature is of truly abysmal quality. Once you have seen it, you can never unsee it. It is due to a number of issues.
Doctors (or medical students) who have no interest in research are almost forced to churn out small, terrible projects in order to garnish mandatory sections of their CVs to secure the jobs they want. It is in the best interest of universities to have staff continue to churn this stuff out, as despite its woeful quality it boosts institutional metrics and scores.
There is also a huge underappreciation for the centrality of statistics, in not only the analysis and interpretation of research, but its design. The classic scenario is that some sort of experiment or data collection process is hashed together quickly, then the ravaged scraps of data are brought to a statistician afterwards to ask them what can be gleaned from the mess.
Statistics are the core thread which run through the whole project from start to finish, and there is a fundamental lack of statistical knowledge and expertise among many (dare I say, most) clinical academics. This includes right at the top of the chain, among those who are training the future clinical academics. As a result, the trend continues and junior researchers are not taught these fundamental skills, other than a token week long course on how to calculate p values from basic statistical tests in point and click software.
The best single piece of advice I could give budding career clinical academics is to get stuck into understanding the core concepts of statistics and methodology in research design. It will help you ask better, more specific research questions. It will help you design more effective studies. It will allow you to analyse you own data effectively. And, possibly most importantly, it will enable you to competently interpret the deluge of published medical literature without being hoodwinked.
I wish there was a simple piece of advice for how to do that, but unfortunately I have largely taught myself (the little I know) from a diverse range of sources.
I would highly recommend starting from Darren Dahly’s blog. This gives a highly accessible overview of some of the practical and philosophical issues of statistics in modern clinical research. The history of how this mess was created is a good start!
There are now lots of resources for helping you learn statistics online. I’m sure many of them are excellent (so long as they are accompanied by some of the background you can get from Darren’s blog for example), but many are either too technically advanced or too simple. My personal recommendation is Imperial college’s “Statistics for public health” on Coursera.
https://www.coursera.org/specializations/statistical-analysis-r-public-health
One of its authors is Professor Victoria Cornelius, who is a wonderful collaborator of mine. It uses R programming language, which seems intimidating at first, but is absolutely what I would recommend as the gold standard for handling and analysing data (plus you can make very cool data visualisations in it too).
There are other bits of advice I could offer at this stage, but they all pale into insignificance compared to the most important thing.
Find a good supervisor.
A knowledgeable, engaged and loyal supervisor can take you from zero to hero. It is almost impossible to accomplish anything without a supervisor. A bad supervisor can quite easily ruin your life or turn you off research forever. It is worth the time and energy to find a good one and invest in them. If they really are good, they will invest in you too.
Summary
Being a clinical academic is a wonderful, and occasionally (but rarely) awful thing to be. I would highly recommend it. Unfortunately, most clinical research which gets published is truly terrible. The worst pitfalls can be avoided by focussing on core data and statistical skills early on in your career which are highly transferable, generalisable and enduring. If you cannot achieve anything else, find a good supervisor and don’t let them go.
then why did you become a doctor?!