Healthy pursuit of research and medical practice

Professor Leech

Read Professor Michelle Leech's opinion piece, published in The Australian, 12 October 2016:

There is an interesting figure in the annual survey conducted by the Medical Deans Australia and New Zealand. A little more than 60 per cent of last year’s 2500 final-year medical students questioned expressed an interest in medical research. While the figure is slightly lower than in 2014, the overall five-year trend points to an increase in this specific area.

Increasingly, medical students are taking on research projects. Some conduct clinical research that flows from their studies. Some are first authors of high-impact papers, while others are involved in clinical trials.

These students are likely using their after-hours, summer vacations and those rotations with friendlier hours to complete their projects.

The question is why? One reason may be that they embrace research as a consequence of our oversupply of medical graduates, and the concomitant need to make your resume different from those vying for the same job.

It’s probable that many new graduates with research experience under their belts never conduct research again once their busy practices get going. Between 1997 and 2008 the Australian clinician medical labour force increased by 45 per cent, while the non-clinician medical labour force, which includes clinical academics, grew by only 14 per cent.

So there is a clear disconnect between the 63 per cent of graduates who want to pursue research compared with the actual number of doctors who continue in these areas when further along in their careers.

In 2011, MDANZ published a review of the clinical academic workforce — or clinicians who also undertake regular research — recommending the development of an integrated training pathway for clinical academics. Then last year the deans, with the Royal Australasian College of Surgeons, published a paper in the Internal Medicine Journal warning that “the ageing clinical academic workforce in Australia and New Zealand is being outstripped by the growth and demand for medical education. Unless steps are taken to train a sustainable clinical academic workforce better, it may not be possible to maintain healthcare standards or overcome the many healthcare challenges we face.”

Given that it is these people who train the next generation of doctors and who contribute significantly to the body of world-class, evidence-based research for which Australia is globally recognised, then this drop-off in teachers and scientists with medical training is concerning.

Research enables medical students to understand evidence-based practice which, in turn, leads to best clinical practice. Unless medical students understand research methodology, and the strengths and weaknesses of clinical research, they will never comprehend the significance and relevance of new standards of care and change in clinical practice based on new studies.

So how do we harness this growing pool of medical students who actively pursue research, for whatever reason, and keep that expertise at least in part in the research sector?

Recently Monash University joined the growing band of medical schools offering MDs rather than MBBS degrees.

Similar to the US model, it will allow students who have a talent for or love of research to pursue it as well as a career in medicine without having to disrupt their clinical training careers following their graduation. These PhD programs will have the added advantage of providing the necessary research training for medical students to enter directly into hospital physician training programs and establishing a new generation of clinician scientists for our fast-evolving healthcare system.

We aren’t the only medical school offering innovative ways to introduce research to our future clinicians and to ensure they continue being involved in research throughout their careers. Remember there are 1500 of last year’s medical graduates who expressed an interest in research. What benefits would they bring to our health system and academe if most of them committed to a lifetime of both research and medicine?

Michelle Leech is deputy dean of the Monash faculty of medicine, nursing and health sciences.