Author: Damian Roland / Editor: Govind Oliver / Code: / Published: 06/02/2020
There are many old and unhelpful stereotypes in medicines. The burly orthopaedic surgeon ignoring everything but the bone, the pipe-smoking, cardigan-wearing psychiatrist and the jack-of-all-trades emergency doctor just looking for the next cool gadget to play with. None of these represent a true reality. However there are some myths in relation to academic practice where there is some supporting evidence.
On paper Emergency Medicine (EM) research is flourishing. There is growing demand to understand how emergency services are used and there is an urgent need to ensure that the medications and treatments provided in the Emergency Department are effective. Some of the world’s biggest trials have involved emergency care (the CRASH-2 trail randomised over 20,000 trauma patients to receive tranexamic acid or control) and some of the most novel trails designs are emergency care orientated (the ECLIPSE study used deferred consent to enable a study of different drugs for children with status epilepticus to occur). Furthermore the utilisation of social media in medical practice, predominantly in emergency medicine and critical care, has allowed an environment of research debate and dissemination to exponentially grow. Despite this, due to it being a ‘relatively’ new speciality, EM has not had the history to develop a large Royal College (it was only invested in 2015) or a significant academic background. In fact, at the moment:
“There are fewer Emergency Medicine Professors than there are Professors of Ancient History“
The National Institute for Health Research (NIHR) funds a number of fellowships to support doctors in the early stages of their career to help them gain research experience and competencies. The Academic Clinical Fellowship (ACF) scheme has been running for over a decade and enables Specialty trainees in the first years of training 25% protected time to develop a research project. While Emergency Medicine ACFs exist, and a few trainees have successfully used them to fund PhD proposals, there are far fewer opportunities compared to general medical training for example. A reason for this is simple supply-and-demand. There isn’t an excess of applicants to obtain these awards from those entering Emergency Medicine in comparison to other specialties where they can be extremely competitive and sought after.
Are you thinking about an Academic Clinical Fellowship in Emergency Medicine? Click on this link to our blog on this to find out more
Is Academic Emergency Medicine perceived poorly and if so, why? Or are there other obstacles to generating a larger academic workforce? Clearly the issues are multifactorial but it is interesting to note that enthusiasm to be involved in research is not in short supply. Being a collaborative specialty a few research networks have already emerged. For example, Paediatric Emergency Research United Kingdom and Ireland (PERUKI) has undertaken a number of studies recruiting large numbers of patients. This includes the recent study of children presenting with a fever and a non-blanching rash, the world biggest in this area. These studies are delivered by clinicians without any additional research support to actively engage in improving the care their patients receive. Similarly a trainee network (TERN) supported by RCEM has successful launched its first survey involving thousands of EM clinicians around the country. On social media the large number of hits to sites that discuss the latest EM research is testament to the interest in academic pursuit. This may be why EM is a growth specialty in relation to raw number of recruits into new studies each year. However doctors describing themselves as academic emergency clinicians are few and far between. This may because the term ‘academic’ is not something that suits this dynamic specialty. Perhaps it implies a slow, ponderous approach to problems, something that might not be particularly innovative or even worse, not open to dynamic change. The specialty does need research leaders though. Not just clinicians keen to recruit and support studies, it needs those who want to develop new ideas and see research studies put into practice.
“We are all EM researchers“
Academic Emergency Medicine is not an oxymoron. EM prides itself on providing prompt evidence based care to those who need it. In order to continue delivering this, in the face of huge increases in attendances and poor flow in hospitals, it is going to need to make every treatment count. More research is indeed needed. Another term used is clinician-scientists but this is likely to bring up the same negative conations that ‘science’ is only for a select band of people. Perhaps we need to just continue to remind people that we are all EM researchers; whether it be by keeping up to date on the latest paper, recruiting into the next study or sense checking the feasibility of the next big randomised control trial. This way everyone can help in academic opportunities.