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It has been suggested that medical research within the UK may be in decline.1,2 Possible explanations for this could be the shortened training scheme created by the Calman Specialist Registrar (SpR) post, reduced availability of research funding, or the progressive expansion of the consultant body (as a government imperative to provide a consultant delivered service).1–4 Although this may be the perception, there has previously been no published evidence to demonstrate a reduction in research output. In this study, we wished to observe any overall trend in the number of publications and higher degrees that trainees (in gastroenterology) have at the time of their National Health Service (NHS) consultant appointments over a nine year period.
Participants, methods, and results
All consultant appointments and place of training were noted over a fixed period from February 1993 to April 2001 (courtesy of the British Society of Gastroenterology (BSG)). The BSG is considered to have a comprehensive list of its trainees and consultants.4 This has been used as a source for the prediction of manpower needs in gastroenterology.4 This model has subsequently been applied to other medical subspecialties.4 We cross referenced this source with the Medical Directory and BSG members’ handbook. We performed a PubMed and Embase search noting the number and type of publications of each consultant. This search included a lag time of up to 19 months post-appointment. This period has previously been described as the mean time from submission to publication.5 Higher degrees held by each consultant were also noted.
Over the nine years, 349 appointments were made. We excluded consultant to consultant transfers and appointments to or from academic posts (n = 52). Also excluded were trainees who had subsequently left the UK or the medical register, as well as individuals where data were difficult to obtain due to name and centre similarities (n = 50).
Statistical analysis was performed using Microsoft Excel to produce a linear regression line and correlation coefficient (r) to show the trend and strength of any relationship of the median publication rate over the time sampled. The nine years of medians gave 7 degrees of freedom (df = 7). We used χ2 distribution to show any significant difference between the groups.
There was a year by year significant decreasing trend in the median number of publications by SpRs prior to their NHS consultant appointment, from 19 in 1993 to five in 2001 (fig 1).
Specifically assessing first author publications revealed a similar downward trend (r = 0.836 df = 7; p<0.01). No statistical differences were observed between university hospital and district general hospital consultants when considering mean publication rates or obtaining a higher degree (data available but not supplied).
This is the first study to demonstrate a significant decreasing trend in the number of publications obtained by a gastroenterology trainee at time of their appointment to an NHS consultant post. The total publication rate can act as a tool in assessing academic activity among trainees and could be extrapolated to all medical specialties.5
There are limitations to our observations—publications may have been missed despite using Embase and PubMed. In addition, we excluded 50 consultants (50/349 = 14.9%) due to an inability to recognise their publication data or they were untraceable. We would not expect this omission to skew our results significantly due to the uniform proportional distribution of these individuals over the nine year period. It may be that they represent trainees who never published throughout their training. This would suggest even less overall academic activity than we have described.
Our data support the hypothesis that medical research (at least among NHS consultants) is in decline. Similar studies are required to validate this observation within other medical subspecialties (in the UK) and in other countries.
We would wish to thank Diane Mathias (Trainees in Gastroenterology) for her invaluable help in the collection of this data.
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