The next step is the completion of a higher degree. In the context of training as a clinical academic, this should ideally be an MD or a PhD. This requires three years of research training, though an initial year may be completed in some centres as part of an MPhil which is undertaken as part of ACF training. In some centres the individual may have completed a four year PhD programme, with an initial year of basic research training. The desired outputs of a fellowship are for the academic trainee to learn appropriate research skills, complete their PhD, achieve publication of high quality papers, understand the broader context of their research area (both nationally and internationally), and to develop ideas and plans for post-doctoral research.
Regardless of the length of the PhD, the key limitation in getting through this stage of research training depends on securing adequate salary funding. While some centres can provide salary funding for the entire period of research, it is highly desirable that academic trainees compete for (and obtain) a PhD, since this encourages a discipline of thought, and experience of the funding process allows trainees to act more confidently and competently as supervisors when they become principal investigators in their own right. Many PhDs are funded as part of a larger project, trial or programme grants, and may be tied to a specific subject area or clinical trial. The disadvantage of restricting the research area is offset by the advantages of joining a well- managed and supported project, usually in an established centre. It is essential that all regional training schemes have academic trainers who can advise trainees about the sources of such funding.
One challenge for academic doctors in training may be the need to move to another centre to obtain funding for a PhD, especially when competing for advertised positions. A consequence of this is that it may mean subsequent planning of the best geographical location for continuing training becomes challenging. Early communication with regional trainers is key to facilitating an academic career.
It is important to make sure that doctors in training have the widest choice of PhD research projects available ranging from experimental medicine to clinical trials. Indeed, a PhD project may provide access to research in labs that are not conventionally part of the ICM academic community in a given region and expand the research capacity in the specialty through such collaboration. Regardless of the project, it is critical that doctors in training clearly understand the importance of completing their research and writing up their PhD thesis (and at least some of the related publications) during the course of their doctoral fellowship Attempts to acquire additional data after return to clinical training are rarely successful, and even completion of a thesis after individuals have returned to their clinical training schemes places substantial burdens on trainees, and compromises both academic progress and clinical training.
Depending on where the ACF years map onto the training scheme, clinical academic doctors in training will return to clinical research during stage one or stage two. The specification of entry to a PhD programme after the FFICM exam is recommended since it allows doctors in training to cross a significant hurdle in their clinical training pathway before starting on their research training.
NIHR doctoral fellowships allow a nominal clinical commitment during the course of the PhD to maintain clinical skills. This is often undertaken as a regular weekly commitment (e.g. on the on call rota). However, an alternative may be to integrate such clinical time within a fellowship or to provide an eight to twelve week of clinical refresher at the end of the fellowship during which the individual assumes increasing clinical responsibilities. It is key that consideration is given to allowing this time to count towards training. Such return to clinical work schemes are particularly important for individuals whose PhD studies are exclusively lab based, and do not involve interactions with patients.