Factors that influence career progression among postdoctoral clinical academics: a scoping review of the literature

Background: The future of academic medicine is uncertain. Concerns regarding the future availability of qualified and willing trainee clinical academics have been raised worldwide. Of significant concern is our failure to retain postdoctoral trainee clinical academics, who are likely to be our next generation of leaders in scientific discovery. / Objectives: To review the literature about factors that may influence postdoctoral career progression in early career clinical academics. / Design: This study employed a scoping review method. Three reviewers separately assessed whether the articles found fit the inclusion criteria. / Data sources: PubMed, Scopus, Web of Science and Google Scholar (1991–2015). / Article selection: The review encompassed a broad search of English language studies published anytime up to November 2015. All articles were eligible for inclusion, including research papers employing either quantitative or qualitative methods, as well as editorials and other summary articles. / Data extraction: Data extracted from included publications were charted according to author(s), sample population, study design, key findings, country of origin and year of publication. / Results: Our review identified 6 key influences: intrinsic motivation, work–life balance, inclusiveness, work environment, mentorship and availability of funding. It also detected significant gaps within the literature about these influences. / Conclusions: Three key steps are proposed to help support postdoctoral trainee clinical academics. These focus on ensuring that researchers feel encouraged in their workplace, involved in collaborative dialogue with key stakeholders and able to access reliable information regarding their chosen career pathway. Finally, we highlight recommendations for future research

Facilitating integrated delivery of services across organisational boundaries: Essential enablers to integration

Introduction: Integrating services is a key tenet to developing services across the United Kingdom. While many aspects ofintegration have been explored, how to facilitate integration of services remains unclear.Method: An exploratory qualitative study was undertaken in 2015 to explore occupational therapists’ perceptions on integratingservice provision across health and social care organisational boundaries. The views of practitioners who had experiencedintegration were sought on a range of aspects of integrating services. This paper focuses on the facilitators for deliveringintegration and the essential enablers are identified.Findings: Numerous factors were noted to facilitate integration and three essential enablers were highlighted. Leadership,communication and joint education were recognised as playing a central role in integrating services across organisationalboundaries; without these three essential enablers, integration is liable to fail.Conclusion: Integration is a process rather than an event; continued emphasis will be required on leadership, communication andjoint education to progress integration achievements made to date

Evidence use as sociomaterial practice? A qualitative study of decision-making on introducing service innovations in health care

A policy aspiration is that evidence should inform decision-making on introducing health service innovations. Internationally, innovation adoption has historically been slow and patchy. Three innovations in the English and Scottish National Health Service were analysed qualitatively: stroke service reconfiguration; revised national guidance on cancer referral; and ‘virtual’ glaucoma outpatient clinics. The authors identify three sociomaterial mechanisms through which evidence and context shape each other in decision-making: connecting, ordering, resisting. Shared preferences for research evidence enabled the medical profession to exert influence on decision-making, while other professions used alternative evidence. Implications for promoting inclusive public management around service innovations are discussed

One to one specialling and sitters in acute care hospitals: a scoping review

Background One to one specialling is a type of care which is provided to ensure the safety of patients who may be suffering from cognitive impairment, exhibit challenging behaviour, or may be at risk of falls or of causing harm to themselves or others. Care such as this, often referred to as ‘specialling’ or ‘sitting’ is common practice in most hospitals around the world, but there is a lack of evidence regarding its cost effectiveness and the quality of care provided. Aim The aim of this scoping review was to explore the breadth and scope of literature on one to one specialling, sitters and similar types of care in acute secondary care settings, in order to identify the challenges and concerns relating to the quality of care (process and outcomes) and cost effectiveness emerging from the literature, and determine the implications of this for policy, practice and future research. Design This review was based on scoping review methodology following a five stage scoping review process. A keyword search was conducted in the following databases: MEDLINE, Scopus, CINAHL Plus, Web of Science, ProQuest Social Science, and ProQuest Nursing and Allied Health. The time limit placed on the search was January 2000 to April 2016. Inclusion and exclusion criteria were applied. The Mixed Methods Appraisal Tool was used to assess the quality of primary research articles. Findings Forty-four articles were included in the review. We found a lack of clarity in the terms used to describe one to one specialling and variability in what this type of care entails, who provides the care and the needs of patients requiring this type of care. High costs of specialling are often seen as a concern, but there was a lack of economic evaluations considering the full cost of specialling and balancing these against the benefits. Some of the articles proposed alternatives to one to one specialling or the use of sitters, but only some of these were evaluated. Conclusion There is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling

A New Advanced Backcross Tomato Population Enables High Resolution Leaf QTL Mapping and Gene Identification.

Quantitative Trait Loci (QTL) mapping is a powerful technique for dissecting the genetic basis of traits and species differences. Established tomato mapping populations between domesticated tomato (Solanum lycopersicum) and its more distant interfertile relatives typically follow a near isogenic line (NIL) design, such as the S. pennellii Introgression Line (IL) population, with a single wild introgression per line in an otherwise domesticated genetic background. Here, we report on a new advanced backcross QTL mapping resource for tomato, derived from a cross between the M82 tomato cultivar and S. pennellii This so-called Backcrossed Inbred Line (BIL) population is comprised of a mix of BC2 and BC3 lines, with domesticated tomato as the recurrent parent. The BIL population is complementary to the existing S. pennellii IL population, with which it shares parents. Using the BILs, we mapped traits for leaf complexity, leaflet shape, and flowering time. We demonstrate the utility of the BILs for fine-mapping QTL, particularly QTL initially mapped in the ILs, by fine-mapping several QTL to single or few candidate genes. Moreover, we confirm the value of a backcrossed population with multiple introgressions per line, such as the BILs, for epistatic QTL mapping. Our work was further enabled by the development of our own statistical inference and visualization tools, namely a heterogeneous hidden Markov model for genotyping the lines, and by using state-of-the-art sparse regression techniques for QTL mapping

The clinical academic workforce of the future: a cross-sectional study of factors influencing career decision-making among clinical PhD students at two research-intensive UK universities

OBJECTIVES: To examine clinical doctoral students’ demographic and training characteristics, career intentions, career preparedness and what influences them as they plan their future careers. DESIGN AND SETTING: Online cross-sectional census surveys at two research-intensive medical schools in England in 2015–2016. PARTICIPANTS: All medically qualified PhD students (N=523) enrolled at the University of Oxford and University College London were invited to participate. We report on data from 320 participants (54% male and 44% female), who were representative by gender of the invited population. MAIN OUTCOME MEASURES: Career intentions. RESULTS: Respondents were mainly in specialty training, including close to training completion (25%, n=80), and 18% (n=57) had completed training. Half (50%, n=159) intended to pursue a clinical academic career (CAC) and 62% (n=198) were at least moderately likely to seek a clinical lectureship (CL). However, 51% (n=163) had little or no knowledge about CL posts. Those wanting a CAC tended to have the most predoctoral medical research experience (χ2 (2, N=305)=22.19, p=0.0005). Key reasons cited for not pursuing a CAC were the small number of senior academic appointments available, the difficulty of obtaining research grants and work-life balance. CONCLUSIONS: Findings suggest that urging predoctoral clinicians to gain varied research experience while ensuring availability of opportunities, and introducing more flexible recruitment criteria for CL appointments, would foster CACs. As CL posts are often only open to those still in training, the many postdoctoral clinicians who have completed training, or nearly done so, do not currently gain the opportunity the post offers to develop as independent researchers. Better opportunities should be accompanied by enhanced career support for clinical doctoral students (eg, to increase knowledge of CLs). Finally, ways to increase the number of senior clinical academic appointments should be explored since their lack seems to significantly influence career decisions

Cost-Effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

© 2016 Graves et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of$29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the AustralianCapital Territory and Queensland, with ICERs of $1,030 and$8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26$64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of$42,000 per life year gained. The return on investment varied among the states and territories of Australia

Implementing changes to hospital services: factors influencing the process and 'results' of reconfiguration

OBJECTIVES: Acute hospital reconfiguration is often presented as a problem to be solved by calculations of optimal design, a rational process amenable to influence by open and responsive consultation. We aimed to analyse factors in the process and 'results' of hospital reconfiguration in three case study sites in the English NHS. METHODS: In-depth semi-structured interviews were conducted with internal and external stakeholders at each site. Analysis within each case was complemented by cross-case analysis focusing on the relationships between the features of the origins and process of reconfiguration and progress in the implementation of plans. FINDINGS: We identified a number of inter-related factors operating in the process of implementation which influenced the 'results': the drivers for change, the reconfiguration, its content (particularly the extent to which services are withdrawn or made less accessible), the influence of stakeholders, such as local politicians, financial pressures, and the role of the management team. CONCLUSIONS: We argue that the differences in reconfiguration implementation between the three cases reflected the nature of the proposed changes and local politics, rather than the strength of the 'evidence' for change. National policy has tended to over-emphasise the importance of consultation using 'evidence' and underplays these influencing factors