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

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

Patients’ Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study

Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emerge ncy presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in n iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients’ (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients’ capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek further healthcare. The findings also point to potentially avoidable breakdowns in the diagnostic process. In particular, to encourage patients to return to the GP if symptoms escalate, a stronger emphasis is needed on diagnostic uncertainty in discussions between patients and doctors in both primary and secondary care. To improve appropriate access to rapid investigations, systems are needed for primary care to communicate directly with secondary care at the time of referral

New Exactly Solvable Two-Dimensional Quantum Model Not Amenable to Separation of Variables

The supersymmetric intertwining relations with second order supercharges allow to investigate new two-dimensional model which is not amenable to standard separation of variables. The corresponding potential being the two-dimensional generalization of well known one-dimensional P\"oschl-Teller model is proven to be exactly solvable for arbitrary integer value of parameter $p:$ all its bound state energy eigenvalues are found analytically, and the algorithm for analytical calculation of all wave functions is given. The shape invariance of the model and its integrability are of essential importance to obtain these results.Comment: 23 page

String Theory on Lorentzian AdS_3 in Minisuperspace

We investigate string theory on Lorentzian AdS_3 in the minisuperspace approximation. The minisuperspace model reduces to the worldline theory of a scalar particle in the Lorentzian AdS_3. The Hilbert space consists of normalizable wave functions, and we see that the unitarity of the theory (or the self-adjointness of the Hamiltonian) restricts the possible sets of wave functions. The restricted wave functions have the property of probability conservation (or current conservation) across the horizons. Two and three point functions are also computed. In the Euclidean model functional forms of these quantities are restricted by the SL(2,R) symmetry almost uniquely, however, in the Lorentzian model there are several ambiguities left. The ambiguities are fixed by the direct computation of overlaps of wave functions.Comment: 32 pages, no figures, minor changes, references adde

Comparison of the LUNA 3He(alpha,gamma)7Be activation results with earlier measurements and model calculations

Recently, the LUNA collaboration has carried out a high precision measurement on the 3He(alpha,gamma)7Be reaction cross section with both activation and on-line gamma-detection methods at unprecedented low energies. In this paper the results obtained with the activation method are summarized. The results are compared with previous activation experiments and the zero energy extrapolated astrophysical S factor is determined using different theoretical models.Comment: Accepted for publication in Journal of Physics

Dementia, infections and vaccines: 30 years of controversy

This paper reports the proceedings of a virtual meeting convened by the European Interdisciplinary Council on Ageing (EICA), to discuss the involvement of infectious disorders in the pathogenesis of dementia and neurological disorders leading to dementia. We recap how our view of the infectious etiology of dementia has changed over the last 30 years in light of emerging evidence, and we present evidence in support of the implication of infection in dementia, notably Alzheimer’s disease (AD). The bacteria and viruses thought to be responsible for neuroinflammation and neurological damage are reviewed. We then review the genetic basis for neuroinflammation and dementia, highlighting the genes that are currently the focus of investigation as potential targets for therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the intriguing possibility that amyloid beta may itself possess antimicrobial properties. We further describe the clinical relevance of the gut–brain axis in dementia, the mechanisms by which infection can move from the intestine to the brain, and recent findings regarding dysbiosis patterns in patients with AD. We review the involvement of specific pathogens in neurological disorders, i.e. SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 (HSV1), and influenza. Finally, we look at the role of vaccination to prevent dementia. In conclusion, there is a large body of evidence supporting the involvement of various infectious pathogens in the pathogenesis of dementia, but large-scale studies with long-term follow-up are needed to elucidate the role that infection may play, especially before subclinical or clinical disease is present