Are you thinking about an Academic Clinical Fellowship in Emergency Medicine?

There are many different routes into academic EM, as demonstrated by the RCEMLearning Personal Journey blog posts, but one of the recognised ways to start on this pathway is through an EM ACF.

An ACF is a speciality training post which allows you to spend 25% of your time on academic training alongside 75% clinical training.¹ They typically last 3 years and the aim is to allow for preparation towards applying for a higher degree such as a PhD. They are primarily offered through the National Institute of Health Research (NIHR) and are usually available at ST1 or ST3, although they can often be accessed at ST2 and ST4.

ACFs allow for dedicated time to develop academic skills such as literature searching, scientific writing and laboratory skills but the associated opportunities are often wider. They allow you time to network, attend conferences, pursue a research area of interest and to have the dedicated time to become fully immersed in research, which is often tricky when working a full clinical rota.

If you feel considering an ACF is worthwhile, allow a good period of time for preparation. You’ll need to ensure that you can fulfil the national application criteria but also that you have good knowledge of where you would like to apply and the research opportunities available. There is more information about the ACF’s on the NIHR website here and applications are completed through Oriel.

The ACFs are the formal training pathway for NHS doctors interested in pursuing a career in academia; however it’s not the only way to get research experience, or to be successful in research.

One of the advantages of the ACF programme is that it is affiliated with the NIHR and therefore training is geared towards assisting you in your academic career progression. The fellowship is awarded with named mentors already in place to offer you support and you will have access to Masters-level training to help develop your academic skills. The ACF should therefore (in theory) offer a natural, albeit competitive, progression towards a PhD in your chosen area of research.

Another benefit of the ACF pathway is that trainees are given protected academic time without extending their clinical training time. This does mean, however, that ACFs have to achieve the same exams and yearly competencies in less time than non-academic trainees. Also, the provision of 25% academic time may not allow enough of a focus on academia for some trainees.

So what other options are there?

Other informal stand-alone Research Fellow posts are available at a local level and allow a wide range of opportunities for academically-minded EM trainees. These can help trainees gain short-term experience in research out of training, or even to gain a competitive edge before applying to an ACF. The requirements for application are generally less rigorous than the ACF programme and applications often open throughout the year, allowing greater opportunity for those out of training compared to the annual ACF applications. The split of academic and clinical time can be generous but varies between posts; however, given that jobs are created at a local level this split may be negotiable. Research Fellow posts also offer a solution for trainees looking for local opportunities in academia within their region: ACF posts by comparison are offered in a limited number of areas. The main disadvantage of these jobs is that time in these posts is not counted towards training time in EM. They are also not affiliated with the NIHR, so opportunities for progression are not embedded into the structure of the posts as they are with the ACFs.

Rather than apply to a specific post providing paid time in academia such as an ACF or a stand-alone Research Fellow post, trainees may wish to undertake a research project within non-clinical time or in their own time outside of work. An obvious issue with this form of research experience is the lack of protected time or financial remuneration. In addition, there is no guarantee of mentorship or support from a research team. However, doing research in this way does allow a greater degree of freedom for people to work on a topic of their choice, at their own pace. A ‘portfolio’ research project can be put to one side whilst exams or training requirements divert attention and trainees can use this informal experience to demonstrate sought after personal attributes for formal academic applications, such as the use of initiative and communication skills.

A new opportunity available to EM clinicians interested in research is involvement with the Trainee Emergency Research Network (TERN). TERN was established in 2018 with the remit of widening access to EM research and it provides an excellent range of opportunities for clinicians interested in research. So far, TERN has provided opportunities for people to propose original research ideas, understand and perform a pilot study and collaborate on a UK-wide research project. Projects are nationally coordinated and there is variation in the level of commitment required of different roles so that people can choose a role to suit their availability. For example, clinicians can help to collect data, coordinate a study at their hospital, volunteer to take on a committee role, or even applying to work as TERN’s next Fellow for August 2020. The different roles also mean people can commit to either a single project or to taking on a fixed-term role within TERN. You can find out more about TERN here.

Whilst it might seem daunting preparing an application for an ACF or Research Fellowship, knowledge of the NIHR ACF Academic Person Specification can help you prepare and will guide you on what criteria are required.¹ There are lots of opportunities available within EM but preparing in advance is key to allow you time to gain evidence of academic commitment such as poster submissions, attendance at conferences and engagement with research activity.

The NIHR ACF Academic Person Specification is broken down into four elements: eligibility, knowledge and achievement, educational and personal aspects and communication skills. Each is discussed below, along with some suggestions for how you can provide evidence of them.

Eligibility

The only essential criteria for eligibility is achievement of foundation competencies. However, this is also the section to shout about intercalated BSc projects or any postgraduate diplomas or certificates you have achieved.

Knowledge and Achievement

Essential criteria in this section relate to demonstration of, and commitment to, an academic career. Whilst you might think that this is difficult, actually most EM trainees didn’t set off on this pathway knowing they definitely wanted to be an academic so you are not alone. Look for evidence and examples in things you have already done which show a tendency towards academia e.g. quality improvement projects, journal club presentations, departmental guideline review or attendance at local or regional conferences. If you don’t have any experience, there are a wide range of opportunities within EM for those interested in academia. You could write a BestBET, get involved in blog writing, submit an abstract to the RCEM Annual Scientific conference or Emergency Medicine Trainees Association (EMTA) conference, or attend the RCEM Clinical Studies Group or Academic Trainees Day in January. Additionally, many Trust Research and Development teams run conferences or provide local training opportunities in areas such as Good Clinical Practice, as do the regional NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) teams. All of these can be used to provide evidence of commitment.

Finally, ensure you understand what an ACF involves and read through the RCEMLearning blogs to gain a better understanding about the types of EM academic careers available.

Educational and Personal Aspects

In this section, your application needs to demonstrate both your educational and personal reasons for applying for an ACF. Hopefully this article will help you articulate some of your reasons but it is also useful to have early conversations with your educational supervisor or to find an academic mentor or another academic trainee to discuss your ideas with. These conversations can be a really helpful in the initial planning stages to understand what is involved and start formulating ideas for how you would spend your time as an ACF.

Communication skills

Communication skills are important for all job applications and so there will be some crossover here from EM roles. Team working is an important part of being an ACF and evidence gained from undertaking team or leadership roles (e.g. quality improvement or audit projects) can be commented on in the application, so do ensure it is documented. Written communication is an important academic skill; you should list any publications and presentations you have but also think about wider examples of written communication to provide evidence of your skills in this area e.g. writing departmental policy or completing a literature review.

The ACF interview style differs from the interview you may have already undertaken when applying for EM training. However, guidance on the type of questions you are likely to be asked (as well as how these are marked) is available online in the NIHR Guidance for Recruitment and Appointment, making interview practice easier. Be aware that preparation time in the few days between the invite and the interview itself will have to fit around your existing rota, so do as much as you can in advance. The interviewing sites may also opt to create a few additional questions which will not be available prior to the interview so make sure you’re prepared for this.

Whilst most of the questions are relatively set, your answers should be tailored to the unique opportunities available at the hosting institution. It is a good idea to discuss your application with the current ACF in the post that you are applying to in order to gather information about whether this post is right for you. You can use this information to inform your answers at interview. Clarify as soon as possible whether a portfolio is required: unlike the EM training interviews, supporting documents usually aren’t required and you can spend this preparation time working on your interview technique instead.

The interview will last around 30 minutes and will be hosted by the ACF Lead for EM as well as Leads from other specialties, whose candidates attend the same interview and are competing against you for the available places. A non-medical lay person will also be present. There are a variety of question types common to all ACF interviews¹ and we’ve outlined these below with hints and tips on how to try and prepare for them. Further additional questions may follow these topics, but they have to fit into the 30 minutes allocated for the interview. After this, you will be free to leave. The panel will then rank your interview score and you will be notified of the result via the online application platform within a few weeks. Be aware though that successful candidates may require ‘clinical benchmarking’ at a national EM interview to ensure you are also eligible for clinical training.

Understanding of data

For these questions, you will usually be given a dataset or publication to read; this can be anything from a single result to a short paper. You will be expected to be able to explain the data to both the academic members of the panel and the lay person. Practicing data interpretation is essential for this; try using a systematic approach to ensure you rehearse reading between the lines. Interviewers may also expect to hear your personal interpretation of the story told by the data, and how you think this relates to the bigger picture. This may be the first time you’ve had to explain research to a non-medical person. Try practicing with non-medical family members to gain confidence in summarising data and presenting findings without using jargon.

Evidence of academic achievements

This is the time for you to describe what academic achievements you have under your belt. Rather than listing projects you have been involved with, the panel expect you to be able to describe your personal involvement and the skills you are able to demonstrate through them. Practice selling yourself to a colleague or family member who can tick off your answers against the ACF person specification.

Knowledge of academic medicine related to the advertised ACF post

This topic looks at your appreciation of the opportunities offered specific to that particular ACF post. You will be expected to demonstrate your knowledge of the host institution, and how you feel it will help you succeed in your post. Remember that the ACF provides mentorship and gains you access to the resources available at the institution. However, this question can seem tricky if the field of research at that institution doesn’t align with your personal research interests. Consider how you could make use of the opportunities on offer and align these with an idea for an interesting and topical research project.

Experience of research

The aim of this question is not to cover your personal achievements again, but to ascertain your understanding of research methods using examples from your own work. The examples you use don’t need to be grand projects that were wildly successful; the panel are looking for a candidate that can weather any setbacks in research planning and, most importantly, learn from any mistakes.

General knowledge of other areas of science / academic medicine

To assess this, interviewers will often ask you to share an academic paper you have read that has inspired you outside of your own research interest. This question is testing whether you can keep abreast of the developments within academia and if you can pick out relevant methods, research or novel ideas to apply to your own setting. The paper you choose doesn’t need to be a large successful trial; try to choose a paper that you were genuinely inspired by and make sure you relate your answer to your future in the ACF.

Balancing your clinical and academic responsibilities

Remember when answering this question that the panel are looking for a candidate who is realistic and honest, not in denial. Try to think of an example where you have identified and reconciled a similar challenge in your career and make sure you mention specific support you know is available from the host institution.