As Research Director of ASGBI, I spend a lot of time speaking with trainees - those brimming with ideas, enthusiasm, and ambition. Yet despite the innovation and energy they bring, many face increasingly steep challenges when trying to integrate research into their clinical careers. The landscape is shifting, and not necessarily in a direction that supports sustainable academic progression.
The goals for surgical trainees have changed dramatically. Where research was once driven by curiosity and a desire to advance the field, it now increasingly feels like a box-ticking exercise for job applications. This instrumental approach is understandable in a system where competition ratios are high, and metrics are king - but it risks undermining the very spirit of academic inquiry.
The introduction of NIHR training pathways, including the Academic Clinical Fellowship (ACF), was, in principle, a step forward - offering protected research time and a defined route into academia. Yet many ACFs do not progress to undertake a higher degree, and fewer still (less than 10%) go on to Clinical Lectureships. If such a small fraction continue down the formal academic route, we must ask: is the current structure fit for purpose?
Discontent in the System
This week’s junior doctor strikes are a stark reminder of the growing dissatisfaction with the current system. Pay erosion and burnout are only part of the story. The lack of opportunities to explore parallel career pathways - combined with the pressure to relocate families for the few available posts - adds further strain.
For those considering a career that blends surgery and research, the current environment offers little reassurance. Financial security is fragile, with each research role at risk of being cut short if a grant application fails. Are we creating an overly narrow, elite path that deters all but those who can afford to take on this insecurity?
Rethinking Academic Surgery
The challenges facing academic surgical trainees are not isolated - they are symptoms of wider tensions between service provision, workforce pressures, and a research infrastructure that hasn’t evolved to meet today’s demands.
Perhaps it’s time to reconsider what we mean by an academic surgical career. ACF posts often provide protected time to begin research and prepare funding applications - but are we investing enough in the individuals to guide them through this process successfully? Could we better integrate short-term research experiences into mainstream training programmes? Should we ring-fence funding to support trainees during the long (often three-year) application pipeline, which still leaves the vast majority without the means to fund time out of programme for the illusive higher degree?
Most importantly, we need to foster a culture that values research not just as a career-enhancing metric, but as a vital contribution to patient care and surgical innovation. If we don’t, we risk losing a generation of surgeon-scientists - and with them, the progress they might have made.
