Inequalities in UK clinical academic careers: a systematic review and qualitative study: Short Report

Research output: Book/ReportCommissioned reportpeer-review


Background: The advancement of excellent healthcare requires a strategic funder approach to develop and retain talented, research-focused healthcare professionals who can balance clinical and academic activities effectively for the benefit of patient care. Unfortunately, there are many inequalities in clinical academia, often based upon protected characteristics. The aim of this study was to (a) conduct a systematic review to explore barriers, facilitators, and existing interventions within Clinical Academic (CA) careers and, (b) collect qualitative data to explore the lived experiences of CAs across the career trajectory.
Methods: The systematic review used comprehensive literature searches to identify relevant quantitative and qualitative studies involving qualified doctors and dentists at any stage of a CA career. Abstract screening was supported by machine learning tools. Full text screening was performed in duplicate; and risk of bias assessed. Outcomes were study defined; results of quantitative data were described narratively, and qualitative studies synthesised using a thematic approach. The qualitative phase involved (a) semi-structured interviews with 104 CAs and (b) audio-diary and written diary data provided by 30 participants over an 8-month period. Diary data collection coincided with the COVID-19 pandemic. Data were thematically analysed before being subjected to an additional text-mining stage. Further, data were triangulated through the observation of funding panels and seeking expert opinion.
Findings: 239 studies were included in the review of barriers and facilitators, 141 in the review of interventions, and seven in both reviews. Within the interventions review, 28 studies contributed to the quantitative synthesis, 17 to the qualitative synthesis, and two to both. Most studies were from North America. There were few high quality, well-reported studies. Most quantitative evidence was from multi-faceted academic training programmes, which may increase recruitment to academia among clinicians. Findings are less clear for retention and other outcomes such as participation in research and obtaining research funding. Studies reported benefits of supportive relationships for CAs, including peers and senior mentors. The qualitative data from this study broadly pertained to eight major themes: identity; motivation to pursue; barriers; enablers; myths and the hidden curriculum; interventions; advice and top tips; prescriptive and descriptive biases. Across the data, there was evidence of discrimination based upon protected characteristics; there were several instances where this contributed to CAs leaving the research environment. A lack of protected time for research was a persistent issue, as well as navigating working in two competing environments. Discrimination was well documented, particularly on the basis of protected characteristics such as gender, sexuality, maternal status, and ethnicity.
Conclusions: The findings provide comprehensive evidence that CAs struggle to navigate their career pathway and balance clinical duties with conducting research. Existing evidence is limited by rigour and reporting, but there are important lessons to be learned. Research funders should commit to evaluating any future interventions to address inequalities in the CA workforce. Successful interventions are likely to be comprehensive multi-faceted programmes of training, in which relational and supportive factors are key.
Original languageEnglish
Number of pages55
Publication statusAccepted/In press - 2021


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