Academic General Practice
A Career In Academic General Practice
A bit of history
General practice was for many years open to practice by those without a substantive postgraduate training, but now is a speciality in its own right. 'Family medicine' or 'primary care physicians' are terms used in other countries to differentiate it from those practising without postgraduate qualifications. This position of parity with other disciplines is reflected both in the new career structure (MMC), which embraces general practice, and in the presence of academic units of primary care, with GP professorial leads, in each medical school in the U.K. The academic Foundation Programme rotations and the academic specialist registrar trainings have been opened to those expecting to do general practice, and junior doctors will be able to apply for these through nationally and regionally advertised schemes.
Why think of academic general practice?
In spite of the existing option to try academic life at an early stage in postgraduate training, a doctor making a career choice must think of their preferred speciality first and the academic track second. People considering general practice as their first choice, will generally be excited by the breadth of clinical challenge, the relative autonomy of community based practice, contact with people in all their variety of health and illness experiences, and an enjoyment of relationships. The kinds of criteria sought for selection into general practice are a solid knowledge base, being an effective communicator, self motivating, team worker, tolerant of uncertainty, hard working, and pragmatic. Other aspects include a degree of self - confidence (resilience) and some entrepreneurial ability.
Four domains define the academic - discovery of new knowledge (research); integration (transdisciplinary merger of ideas to create new insights); application of theory to practice (new ways of problem solving; and teaching (accurate and effective communication of valid and reliable knowledge, and development of reasoning). Academic potential for research is generally defined by a quick and accurate use of intellect; ability to identify, evaluate and apply relevant knowledge to the field; problem setting and solving that allow questions to be effectively answered; the innovative use of relevant methods and disciplinary approaches to assist the process; systematic organisation in a very autonomous setting; team work and leadership; and above all, a sceptical rigour which allows research or education to be delivered to the highest quality. The skill sets for a good GP and a good academic therefore do overlap, but are not the same, and candidates considering academic general practice should consider whether they want to develop both aspects of themselves in a career.
Is academic general practice for you?
A doctor considering academic GP could test this out by their responses to the skillsets outlined above, plus consideration of the following questions:
- Which placements they enjoyed - this may vary with the specific learning experience and interpersonal dynamic, but on the whole those wanting to be academic GPs will have enjoyed both their theoretical learning and their GP placements.
- Verbal more than technical - both GP and academic are largely word based practices, although maths comes through in quantitative research, and there are some excellent academic surgeons.
- Do they enjoy reading and writing academic pieces - if journals bore you rigid and books appear a waste of time, or if the labour of writing an essay seems pointless to you, then academic life may be a chore.
- Do you have any experience of research already - a project in the course, or an intercalated degree needing a dissertation - if so, this may give some benchmark for both enjoyment and ability.
- Do you feel that clinical work and the scope of a local community will satisfy you long term? Most GPs in fact develop more than one aspect to their career, even if they do not go into university work - many are teachers or trainers, have special clinical interests, get involved in medical politics and management, and may do courses including Masters degrees at some point, but this does not mean they define themselves as academics. However, academics usually want to influence the 'big picture' - the knowledge base, the medical school, the discipline, the 'state of the art'. A sense of your own originality as a thinker and a tendency to be patient in pursuing answers to important questions is another key characteristic.
Core requirements
The Walport report expected the creation of around 250 places per year across all disciplines and sites for clinical fellowships, with 100 clinical lecturer places following on, so it is likely that in each region there will only be a few academic GP placements at Foundation, SpR or post formal training. They will be highly competitive, and prior achievement, e.g. a well rated research project during MB/BS, peer reviewed publication, a good intercalated degree (II:I or above), and references showing high academic achievement and assessment progression at medical school will all help. Anyone holding an academic placement will have between 25-50% of their time training in research methods and educational competency, with a supervisor for agreed projects, in the later years will usually lead via a Masters to a PhD. They will be part of their local academic primary care unit, and at the same time will continue as a full member of their local Foundation School or Vocational Training Scheme, with support to gain their clinical accreditation throughout.
In conclusion
Most current UK professors of GP did not start out intent on an academic career, but fell into it through a passion for educational reform, putting general practice on the speciality map, and/or intellectual curiosity and a desire to improve our knowledge base. These remain good motivations for those thinking of trying out an academic career in general practice. The opportunities are good and the infrastructure sound. If you think you may be interested, talk to your local professor or other GP linked with a medical school. Academic GP is a really stimulating way to earn a living and to contribute to patient care at all levels. We hope to hear from you.
For further information and details take a look at the following website:
> The Royal College of General Practitioners
Amanda Howe MA MEd MD FRCGP
Professor of Primary Care, University of East Anglia
Last updated 25/12/06
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