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CRT Fellowship Evaluation

Curran, B., Hastings, G., (2006) An Evaluation of The Clinical Research Training Fellowship Scheme: September 2006. (pdf)  Dublin: Health Research Board.

The Clinical Research Training (CRT) fellowship scheme began in 1998 and since then the HRB has awarded 6.5 million to 56 individuals. The scheme has an application success rate of approximately 20 per cent,although this varied over the eight years from a high of 33.3 per cent in 1998 to just 7.9 percent in 2003. An evaluation of the scheme was undertaken to assess the extent to which it is meeting the primary objective of developing clinical and dental research careers in Ireland. The aim of the evaluation was to provide both clarification of the scheme objectives and recommendations for the future of the scheme in the context of the evaluation findings and other key contextual developments.

With regard to medical graduates, the CRT scheme was originally targeted at candidates who had completed, or were near the completion of, higher specialist training. However, an analysis of successful applicants revealed that just 18 per cent had completed all clinical training, while 34 per cent had not commenced higher specialist training at the time of application. Some 71 per cent of successful applicants stated that their career intention was to become an academic clinician or physician scientist, and perceived the CRT fellowship scheme as the first step towards realising this ambition. The analysis also showed that a significant proportion (39 per cent) of fellows were employed in a research environment at the time of application; 80 per cent intended to register for an MD qualification; and 16 per cent intended to register for a PhD. An analysis of the type of research proposed by successful applicants showed that 61 per cent met the criteria set by the US National Institute of Health's broadly adopted definition of 'patient-oriented' clinical research.

An on line survey of past fellowship holders revealed that 79 per cent of respondents are currently employed in a clinical service environment, while 29 per cent are employed overseas. Encouragingly, 68 per cent of respondents are involved in research in their current position, although this is tempered by the very low proportion currently in receipt of a research grant. The vast majority of respondents completed the full term of their fellowship and the rating of training and supervision received during the fellowship was generally positive, although a few areas for concern were highlighted. Indeed, 82 percent of all respondents believed they now possessed the skills necessary to be an independent academic investigator.

A total of 57 per cent of respondents had completed higher degrees at the time of the survey (56 per cent had got an MD or an MSc, while 44 per cent had got a PhD). Furthermore, 78 per cent of MD/MSc registrants and 100 per cent of PhD registrants stated that it was necessary to acquire additional funding from an alternative source to complete their target degree. Conversely, of those who had not successfully completed their target degrees (and who where not in the process of writing a thesis), 71 per cent stated that this was due to a lack of sufficient time or funds to do so. An additional finding of interest was that a quarter of all respondents used one day per week to undertake clinical sessions during the fellowship term. The main suggestion for the scheme put forward by survey respondents was to provide the option of a third year of funding to enable completion of a PhD.

An analysis of successful applicants revealed that no awards had as yet been made to dental graduates, while only one application from this cohort was received since 2003. Whether or not this is due to a lack of awareness about the scheme among dental graduates or to a paucity of such graduates involved in research is not known and should be explored further. However, the latter reason is unlikely given the fact that dental graduates have successfully applied to the HRB's Health Services Research (HSR)Fellowship scheme in the past.

The opinions of a sample of key individuals identified as having a career involvement in clinical research training were solicited for a further qualitative input to the evaluation. When asked how the scheme might better fulfil its primary objective, these individuals agreed unanimously that the scheme should at least be amended to allow successful applicants to obtain a PhD. Some also felt that the scheme should be re-structured into a dedicated and structured PhD training programme for medical and dental graduates in order to effectively train future cadres of academic clinicians. There was also a general consensus among interviewees that resolution was urgently required of key contextual issues affecting the development of a career path for academic clinicians, most notably the lack of available positions in academic institutions for suitably qualified individuals and of provision for research and teaching in a new consultant contract. For comparative purposes, information was also provided concerning clinical research training programmes in other countries that could inform the current evaluation.

A specially convened Working Group put forward a series of recommendations for the CRT scheme based on the findings of the evaluation, and concerned with (i) the need to clarify the objectives of the scheme, (ii) the conditions of the award, including eligibility, and the adoption of a more flexible approach to clinical sessions during the term of the fellowship, (iii) the structure of the scheme and how this might be altered to better meet the scheme objectives, and (iv) the quality of mentoring and supervision. Some other suggestions concerning the HRB's support for clinical research as a whole were also put forward based on the views of the clinical research community.



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