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The goals of National Institute for Health Research funding for trainees

The Cochrane Collaboration celebrated its 20th an niver-sary in 2013. The Collaboration’s logo contains a forest plot: this shows what a particular meta-analysis would have looked like in 1981 had it been done then, which it was not. The intervention is corticosteroid administration to pregnant women before anticipated preterm birth. The outcome is neonatal death. The pooled estimate of eff ect size shows a hugely signifi cant decrease. In fact, the fi rst meta-analysis of prenatal corticosteroids was not published until 1989. Although it showed clear evidence of eff ectiveness in reducing neonatal mortality and morbidity, corticosteroids were not much used for this purpose in obstetric practice until around 1995. A gap of almost 15 years between the availability of evidence to show that a particular treatment is highly eff ective and its uptake into clinical practice is manifestly not good enough. There are a many reasons for slow acceptance of innovations by clinicians, and by health systems—and many possible solutions. The National Institute for Health Research (NIHR), for example, funds Collaborations for Leadership in Applied Health Research & Care (CLAHRCs) to develop implementation science, and the new Academic Health Science Networks will, it is anticipated, facilitate rapid uptake of clinical innovations on a region-wide basis.

However, clinical academics have a pivotal role. Clinical academics, with one foot in the clinic and the other in research, are in a key position to ensure that research eff ort targets really important clinical problems (working with patients and the public of course), that potential treatments are tested in trials quickly and effi ciently, and that research fi ndings that do demonstrate benefi t are rapidly translated into practice. NIHR manages three major training programmes, two of which are specifi cally for the development of clinical academics (one for doctors and dentists; and one for nurses, midwives, and allied health professionals) and a third (the personal

fellow ships scheme) that supports both clinical and non-clinical researchers with applied health research interests, from doctoral to very senior levels. These three schemes, taken together with training opportunities in NIHR Biomedical Research Centres and Units and in CLARHCs (the NIHR infrastructure), represent an annual investment of not much short of £100 million, and a crystal clear demonstration of the importance that NIHR places on developing health researchers of the future.

The Integrated Academic Training Pathways for doctors and dentists were established in 2006. Each year for medical graduates, there are 250 early career academic clinical fellowship (ACF) posts, 100 clinical lecturer (CL) posts to be matched by locally funded positions, and a smaller number of highly competitive clinician scientists posts (for applied health research). Unlike other NIHR funded research schemes, ACFs and CLs can opt to undertake basic rather applied research. The ACF posts (75% clinical training, 25% academic training) provide a springboard for application for competitive doctoral research fellowships (NIHR, UK Medical Research Council, Wellcome Trust, charities). The CL posts (50% clinical training, 50% academic training) allow transition from supervised research to independent research. Thus—and this is not without controversy—NIHR insists that these posts are postdoctoral.

NIHR, uniquely among research funders in the UK, also supports much-needed empirical research into medical education. A similar scheme for nurses, midwives, and allied health professionals is funded by Health Education England and managed by NIHR. The aims are similar to that for doctors and dentists: to create a cadre of academic clinicians who continue clinical work while developing as researchers, acting as bridges between research and practice in disciplines in which this has not previously been the tradition. NIHR training schemes

Published Online February 26, 2014

professionals should seize the opportunity of the arrival of stratifi ed medicines in our health care and be prepared for the future challenges that may arise.

John Bell

University of Oxford, Oxford, UKinfo@medsci.ac.uk

Professor Sir John Bell is the Regius Professor of Medicine at the University of Oxford and former President of the Academy of Medical Sciences, London, UK.

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Engaging with the mediaWhy should scientists engage with the media about their research? This question is often answered these days with words like ”duty” and ”responsibility”. Most scientists are publically funded and the argument goes that the public has a right to hear how this money is being spent and in what directions scientists are taking us. I agree that this is a powerful case for engagement, and it has been gratifying to be part of a huge cultural shift in science over the past decade which has seen ever more scientists emerge from their ivory towers to embrace their responsibility to engage the public on their work. At the Science Media Centre’s tenth anniversary celebrations in 2012, I welcomed the arrival of a new breed of scientist, one for whom engaging the media and public is seen not as an add-on for an enterprising few but part and parcel of what it means to be a good scientist. But in another way words like ”duty” and ”responsibility” fail to capture the range of benefi ts that come from engaging the media, and I welcome this opportunity to describe some of these.

You do not get a job at the Science Media Centre unless you give the right answer to the interview question ”Do you shout at the radio and TV when science is covered badly?”. The truth is that much of the misrepresentation of science in the news comes from a 24-h news machine hungry for guests and happy to use self-appointed experts

with axes to grind who are only ever a phone-call away. If you do not want to fi nd yourself shouting at the radio when your area of research is being misrepresented by politicians, campaigners, or agenda-driven journalists you have to make yourself available to the media and make it just as easy for time-poor journalists to reach a great scientist as they do to fi nd others with rather less respect for the evidence.

Former Education Secretary Estelle Morris once told a packed meeting in the House of Commons that she learned more about the real threat from nuclear radiation from scientists talking to the media during the Fukushima crisis than she ever learned from school science lessons. Science hitting the headlines is often uncomfortable for researchers with all the sensationalism, hype, and fear-mongering that characterises science as front-page news. But what researchers do not appreciate is that it is also a fantastic opportunity to get good accurate evidence-based science into the public domain at the very moment when the wider public really cares. The British public said no to genetically modifi ed foods after a year-long media frenzy in which very few of the best plant scientists took part. From fracking to vaccines to synthetic biology to embryonic stem-cell research to mitochondrial DNA transfer we need scientists with deep expertise and respect

are England-specifi c; the devolved administrations have diff erent schemes.

To the well-established scheme of NIHR personal fellow ships, two others have been added recently: transitional fellowships to assist researchers with a background in basic research to move to acquire translational expertise, and Clinical Trial Unit fellowships to develop trial-knowledgeable clinician-researchers. The NIHR Trainees Co-ordinating Centre, based in Leeds, expends much eff ort in creating relationships with trainees and providing additional support that can be important in helping individuals to shape and develop their careers towards success. Thus, for senior trainees, a leadership development programme with Ashridge Consulting has proven very successful and is highly rated by participants. The Academy of Medical Sciences has provided a mentorship programme for more senior medical trainees.

The very fi rst human trial of prenatal corticosteroids directly followed studies in sheep in New Zealand, aiming at an understanding of the still poorly understood physiological mechanisms that trigger the onset of labour. The aim of NIHR is to see similar future discoveries in basic science translated into real health gains for patients and the public. Talented, well trained, and well supported researchers, comfortable with and respectful of multidisciplinary research, working in or alongside the National Health Service, will be central to the achievement of this mission. Economic gains will accrue through healthier populations, better evidence-based practice and policy, and collaboration with the biosciences industry.

James P NeilsonCentre for Women’s Health Research, Liverpool Women’s Hospital, Liverpool, UKjneilson@liv.ac.ukProf James P Neilson is the NIHR Dean for Faculty Trainees.

Published Online February 26, 2014