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While research is mentioned in only three of the vision statements of eight universities, it has been identified as an important mission in all but one of the universities. Six of the eight universities either had a strategic plan specifically for research, or research was enshrined in the strategic plan available on their respective websites.
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intercalated degrees in the uK medical schools
As opposed to the tiny proportion of South African medical students who choose this option, about one third of medical students in the UK add an additional year to the basic five-year undergraduate course and intercalate a degree in medical science (a BSc or BMedSci) (McManus et al., 1999). The UK Medical Research Council has concluded that the intercalated degree is extremely valuable in introducing future clinicians to research, and in providing a cadre of graduates who are likely to become attracted to, and excel in, a career in academic medicine (Smith, 1986). A longitudinal study of final-year medical students who had taken intercalated degrees has provided evidence that they were more interested in medical research than their comparators, and had better ‘deep and strategic style’ scores. The effects of the intercalated degree were greatest in medical schools where a relatively small proportion of students took the degree; differences between medical schools are most easily explained by resource dilution (McManus et al., 1999).
The barriers to expansion of intercalated years in the South African situation are financial (additional costs to both funders/sponsors and families), social (cohort cohesion), and academic (extra costs of intense supervision in scientific disciplines). These barriers could obviously be lowered if prioritised plans were carefully developed and adapted to local conditions. For example, exemption from one year of compulsory community service on successful completion of an intercalated degree would have little effect on national health person power but a big effect on research capacity development.
Among the systemic enablers of researcher development, two deserve special mention. The first, discussed in Chapter 6 with a firm proposal for remediation, is the existence of a high-quality local journal for clinical research which is multidisciplinary and so designed that it encourages broad reading and ‘lateral’
learning amongst most or all people who are active in research in the country, young or established. The second is concentration on local conferences to make them hothouses for presentation skills, networking, collaborations and generally ‘getting the hang of it’. Again, multidisciplinary conferences are important even though ‘deep-focused’ workshops and conferences can also be valuable when participative attendance is encouraged and skill-enabling objectives are built into the design of their programmes.
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Md/phd programmes in uS and uK universities – a high-powered model for the development of a medical research workforce
Joint Md/phd programmes are offered at nearly every US medical school in a wide range of fields. Many MD/PhD programmes receive institutional support through the Medical Scientist Training Program (MSTP) of the National Institute for General Medical Sciences of the National Institutes of Health (NIH). The primary intent of these joint MD/PhD degree programmes is to produce highly trained physician-scientists who will engage in biomedical science research careers.
A report of the MSTP cohorts enrolled between 1970 and 1990 revealed that MSTP graduates were more likely than other medical school graduates to receive postdoctoral fellowships, to hold academic appointments, to receive external research funds, to apply for NIH grants, and to have published more than their MD counterparts (Rosenberg, 2008).
It is worth noting that Cambridge and other universities in the UK now also offer the equivalent degree of MB/PhD, which may be more suited to our medical curriculum which is based on the British model. The Cambridge website describes the degree as follows:
The MB/PhD Programme leads to the MB, BChir and PhD degrees and is designed for medical students who are interested in academic or research careers by enabling them to integrate a three-year period of research with their clinical education.
The clinical component of the curriculum is designed to equip students for a lifetime of medical practice in a changing world with emphasis on the acquisition of clinical skills by direct patient contact. At the start of the programme, students follow the Standard Course Stage 1 curriculum up to and including the Stage 1 student-selected component. Following a clinical academic module and subject to satisfactor y progress, this is followed by a three-year period of full-time research combined with three hours a week of clinical education. It concludes with students rejoining the clinical course to complete their studies with either the Standard or Cambridge Graduate courses, depending upon the time of completion of the PhD.
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As in the case of intercalated degrees, a national MB chB/phd programme would have to be adequately resourced and adapted to local conditions. The many BScMed honours programmes already available could readily become
‘qualifying courses’ for concurrent and subsequent hands-on research leading to PhD degrees – this effectively spreads the load of development work between non-clinical and clinical staff, and establishes sustained networks of personal support and encouragement amongst both ex-students and their teachers.
Experience in certain countries, notably the UK, has indicated that concurrent MB ChB and PhD/M studies can cause some students to ‘fall between two stools’, and it is probably necessary in each instance to ensure that mentoring takes place to avoid such situations. A flexible approach to career development is absolutely necessary in relation to the challenging issues confronting individual students/trainees.