Downloaded from http://bmjopen.bmj.com/ on November 1, 2016 - Published by group.bmj.com Open Access Research Factors that influence career progression among postdoctoral clinical academics: a scoping review of the literature Veronica Ranieri,1,2 Helen Barratt,2 Naomi Fulop,3 Geraint Rees4,5,6 To cite: Ranieri V, Barratt H, ABSTRACT Strengths and limitations of this study Fulop N, et al. Factors that Background: The future of academic medicine is influence career progression uncertain. Concerns regarding the future availability of ▪ among postdoctoral clinical In this article, we identify six factors that may qualified and willing trainee clinical academics have academics: a scoping review influence career progression among postdoctoral of the literature. BMJ Open been raised worldwide. Of significant concern is our clinical academic trainees. 2016;6:e013523. failure to retain postdoctoral trainee clinical academics, ▪ Our methodological approach enabled us to doi:10.1136/bmjopen-2016- who are likely to be our next generation of leaders in include a wide range of types of literature, from 013523 scientific discovery. empirical studies to editorials. Objectives: To review the literature about factors that ▪ Including such a broad range of literature may ▸ Prepublication history and may influence postdoctoral career progression in early have introduced a risk of bias. additional material is career clinical academics. ▪ The literature we sourced was predominantly available. To view please visit Design: This study employed a scoping review North American, so may be of limited relevance the journal (http://dx.doi.org/ method. Three reviewers separately assessed whether to clinical academic training in other countries. 10.1136/bmjopen-2016- the articles found fit the inclusion criteria. 013523). Data sources: PubMed, Scopus, Web of Science and particular significance is the failure to retain Google Scholar (1991–2015). postdoctoral trainee clinical academics in Received 19 July 2016 Article selection: The review encompassed a broad search of English language studies published anytime clinical academic careers, once they have Revised 27 September 2016 completed doctoral studies.4 This is note- Accepted 29 September 2016 up to November 2015. All articles were eligible for inclusion, including research papers employing either worthy as the sustainability of academic medi- quantitative or qualitative methods, as well as editorials cine and future improvements in clinical and other summary articles. practice are both contingent on a continuous – Data extraction: Data extracted from included pipeline of researchers.5 7 publications were charted according to author(s), In response to these concerns, a number sample population, study design, key findings, country of bodies around the world have invested a of origin and year of publication. substantial amount of effort into improving 1Academic Careers Office, Results: Our review identified 6 key influences: the recruitment and retention of medical – School of Life and Medical intrinsic motivation, work life balance, inclusiveness, academic researchers. For instance, in 2003, Sciences, University College work environment, mentorship and availability of an international group of medical academics, London, London, UK funding. It also detected significant gaps within the 2 academic publishers and stakeholders came Department of Applied literature about these influences. together to form a campaign to promote Health Research, University Conclusions: Three key steps are proposed to help College London, London, UK support postdoctoral trainee clinical academics. These partnerships and global debate about how 3Health Care Organisation 8 focus on ensuring that researchers feel encouraged in best to revitalise academic medicine. In and Management, England and Wales, this campaign preceded Department of Applied Health their workplace, involved in collaborative dialogue with Research, University College key stakeholders and able to access reliable the roll out of a new Integrated Academic London, London, UK information regarding their chosen career pathway. Training (IAT) programme for clinicians. 4Faculty of Life Sciences, Finally, we highlight recommendations for future The aim of this programme, overseen by the University College London, research. National Institute for Health Research, was London, UK to develop a clear pathway for aspiring 5Department of Cognitive Neurology, University College medical academics. Trainees on this pathway London, London, UK receive protected research time that includes 9 6Academic Careers Office, their medical training. This pathway consists University College London, INTRODUCTION of three key specialist academic training London, UK Concerns about the future of academic stages: a predoctoral Academic Clinical Correspondence to medicine and, in particular, a potential Fellowship, succeeded by a doctoral training Dr Veronica Ranieri; shortage of trainee clinical academics have fellowship and, finally, an Academic Clinical – [email protected] been expressed worldwide.1 3 A concern of Lectureship.9 Ranieri V, et al. BMJ Open 2016;6:e013523. doi:10.1136/bmjopen-2016-013523 1 Downloaded from http://bmjopen.bmj.com/ on November 1, 2016 - Published by group.bmj.com Open Access The IAT programme has yet to be formally evaluated. single tool exists for consistently appraising the breadth However, there are indications that only around a third of the article types sought; qualitative, quantitative and of trainee doctors who complete a PhD within the UK opinion.14 16 In line with recent enhancements to the progress to posts with clinical and academic responsibil- framework, discussion between team members and sep- – ities.10 12 These figures suggest that some postdoctoral arate reviewing of a proportion of abstracts and full-text trainee doctors experience either a change in their papers were undertaken to ensure that relevant studies – career preferences, having completed a PhD, or difficul- were included in the review.14 16 All potentially relevant ties in their career progression that prevent them from articles references were uploaded onto referencing pursuing academic medicine. software where duplicates were accounted for a Examining the available literature about the experi- removed manually. (EndNote X5 [program]. X5 ences of early career trainee clinical academics may help version: Thomson Reuters, 2016) Screening was con- us understand the factors that influence this cohort’s ducted by VR, and a selection of included articles was choice to pursue or discontinue a career in academia. reviewed by two other authors (HB and NF) to ensure The aim of this review is to describe the range of motiva- that the topic they addressed adhered to our inclusion tors, facilitators and barriers experienced by this group criteria. in their career development. For the purpose of this study, we use the term ‘early career clinical academics’ Search strategy to describe medically qualified postdoctoral researchers This scoping review encompassed a broad search of who are in a clinical academic position typically within English language studies published anytime up to 5–7 years of obtaining their PhD qualification. From the November 2015. The following search engines were factors identified in this scoping review, we make a chosen as they covered a broad range of journals within number of proposals that could help support early health sciences: Web of Science, Scopus and PubMed. career trainee clinical academics, as well as highlight Google Scholar was used as an additional search areas where future research is warranted. engine to identify additional studies, including those present within the grey literature. Our search terms were (‘academic medicine’ OR ‘clinical academia’ OR METHODS ‘clinician scientist’ OR ‘research physician’) AND (‘bar- Scoping review riers’ OR ‘motivators’ OR ‘facilitators’ OR ‘predictors’) The goal of this review was to map out the literature on AND (‘career progression’ OR ‘career development’) the factors that influence career progression among within the publication. Further information pertaining postdoctoral clinical academics and identify areas within to our search terms is given in online supplementary the research that need further clarification and appendix 1. emphasis. To achieve this, we undertook a scoping We included all English language publications that review as this method provides a way to synthesise a examined any influences experienced by early career – broad outline of the available evidence.13 16 Although clinical academics in any medical specialty. This systematic reviews may be viewed as the ‘gold standard’ included either the current perspectives of early career when evaluating the evidence on a topic, they typically clinical academics or the retrospective viewpoints of seek to answer specific questions, by summarising only researchers who progressed to a more senior position or the findings of studies with a predetermined design.13 left clinical academia following an early career post. In In comparison, scoping reviews seek to describe the full this study, early career clinical academics referred to range of literature relating to a broad area of research, individuals who had recently completed a PhD and in a including publications with a range of designs, such as junior research post typically lasting no more than editorials and systematic reviews, as well as quantitative 5–7 years since their completion date. We excluded pub- or qualitative research