Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Have we lost something in the success of academic family medicine? We produce quality research, have created successful interdisciplinary academic teams, demonstrate competitive publication outcomes and generate significant grant income. But, academic primary care may have drifted away from, and perhaps even alienated, some family medicine colleagues. There are thoughtful and reflective family doctors who read, write, discuss and debate many aspects of general practice but feel undervalued as they do not fit the university based academic profile. Those who teach undergraduates, train postgraduates, or educate nursing and paramedical colleagues sometimes feel peripheral. And, even the individual doctor who studies patterns of consultation, thoughtfully analyses his or her own results, or thinks deeply about the nature of the doctor patient interactions, may struggle to find a place within the current academic model. Yet, these thoughtful individuals have an important role within the intellectual discipline of family medicine. Clever people with great ideas thinking deeply about what they do. Scholarship is an inclusive label that offers a unifying model for all those exploring the intellectual challenge of family medicine
This idea was discussed at the recent Society for Academic Primary Care’s Annual Scientific Meeting. It is explored in more depth on the SAPC website and endorsed by the Royal College of General Practitioners. They are together working to raise the profile of clinical scholarship. Their objective is to integrate the intellectual capacity of individual GPs within collective professional wisdom. It is seen as a necessary part of professional excellence both in the consultation and, in other roles that include education, innovation, leadership and research. Further information is available on the SAPC and on the British Medical Association websites: “Every doctor a scientist and a scholar”.
I liked this idea. It resonated with my perception that there are many doctors who think deeply about their work yet feel excluded by our current academic model. The contemporary university funding model has accentuated this feeling of exclusion as it values publication and grant income much more than ideas. I also worry that it restricts the development of academic practice. Family medicine academics who follow an academic track that moves through undergraduate, through doctorate, to clinical lectureship with little exposure to real world clinical practice may have the experience to reflect on what is important in doctors and patients. If academic practice distances itself from patients and the ideas that patient contact generates, we are doomed to irrelevancy. As medical journals we too find we have to conform to strict boundaries of the academic model and the established criteria that define research. As a result, some of the most useful writing, which we might now more accurately describe as scholarship, is seen in our blogs. And, the term blogs doesn’t always accurately describe what we are trying to achieve- interesting challenging and stimulating writing.
The SAPC meeting was a unique opportunity to explore this idea with Joanne Reeve from SAPC, Helen Stokes-Lampard from the RCGP, Jane Gunn from Melbourne and, Chris Dowrick from Liverpool and I include some of their reflections in this brief video.
I have been doing GP research for 22 years & found resrsrch beaurocracy getting more & more of a demotivator for a GP with a “bee in his/her bonnet”. What can we do about this barrier to original thinking? Perhaps a journal for GP hypotheses & protocols??