Academic Surgery

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Academic Surgery Future Tense?Norman S
Williams
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Mission of an Academic Surgical Department

• Provide a clinical service
• Conduct relevant research
• Ensure organisation and delivery of undergraduate
  curriculum
• Provide academic leadership to organisation
• Contribute to postgraduate training

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Pressures

• Clinical - same as NHS - Targets, EWTD, DTCs,
  need for consultant led service, new contract,
  higher patient expectations etc, etc,
• Research - RAE, downgrading of applied clinical
  research, obsession with basic science
• Teaching - Increase in student numbers, more
  intensive tuition - PBLs, OSCEs

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RAE

• Discriminates against clinical research
• Applied physiological research - not sexy
• Overemphasis on molecular biology
• Consequences
• Universities disinterested in supporting clinical
  academic posts
• HEFCE monies used to recruit scientists to boost
  grading

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Situation at Barts and The London

• 2001 RAE
• Hospital based subjects Graded 4 (1997 3a)
• 5 million deficit
• Restructuring
• 70 of 308 (28) HEFCE posts axed
• 35 Clinical academics 35 support
  staff
• Student numbers increased in 2003 by 40 per year
  

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Data from UK Council of Heads of Medical Schools

• 1998-2005 40 increase in medical student
  entry
• Since 2000 12 decrease in clinical academic
  staff
• 33 Reduction in Lecturers

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Aspirations of Barts and The London

• Aims to be a 5 star Medical School
• Principal Investigators - Research income of
  150,000 per annum 2 hours teaching/week
• Teaching Research Post - Research income 50,000
  per annum 8 hours teaching/week

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Possible Outcome(?Doomsday Scenario)

• No Academic Surgical Departments in UK

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Likely Scenario(?Preferable)

• Primarily teaching only academic units
• -Funded entirely by NHS
• -Minimal research clinical
• trials
• Selected Research Active Units

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Selected Research Active Units

• Funded by mixed economy -
• NHS, HEFCE contribution dependant
• on external grant income

Core Academic Unit
Basic Research Group
Translational Research Group
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To secure a future we need to

• Raise profile of clinical research
• Emphasise the need to translate basic science
  discoveries into the clinical arena
• Fund infrastructure of clinical research via NHS
  - divert SIFT
• Inculcate ethos that everyone has an onus to pass
  on skills and knowledge to younger genertation
  i.e. teach

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The students of today are the doctors of tomorrow
and the consultants of today are the patients of
tomorrow!!
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In the UK we need action now particularly for
Academic Surgery !!