Report on the Academic Track for Internship 2017-2020

REPORT ON THE ACADEMIC TRACK FOR INTERNSHIP 2017-2020 Mr Evan Blake Dr Elaine Burke Prof Martina Hennessy Prof Finbarr O’Connell Ms Aine Wade Dr Peter Wheen

Dublin South East Intern Network June 2020

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Table of Contents List of Figures and Tables .................................................................................................................................... 3 Figures ............................................................................................................................................................. 3 Tables............................................................................................................................................................... 3 List of Abbreviations ............................................................................................................................................ 4 Executive Summary ............................................................................................................................................. 5 Numbers at a glance ............................................................................................................................................ 6 Background .......................................................................................................................................................... 7 The need for a clinical academic workforce .................................................................................................... 7 Benefits of early exposure to research............................................................................................................ 7 Combined clinical academic training programmes: experience overseas ...................................................... 8 Clinical Research, the Irish Context ................................................................................................................. 8 Genesis of the Academic Track Programme and Stakeholder Engagement. .................................................. 9 Aims of the Academic Track .......................................................................................................................... 12 Challenges in programme design, addressing barriers to research .............................................................. 12 Curriculum Design ......................................................................................................................................... 12 Clinical training and rotations ....................................................................................................................... 13 Recruitment to the academic track ................................................................................................................... 15 Stage 1 Application ........................................................................................................................................ 17 Stage 2 Application ........................................................................................................................................ 17 Shortlisting ..................................................................................................................................................... 19 Interviews ...................................................................................................................................................... 20 Ranking candidates ........................................................................................................................................ 20 Reliability and validity.................................................................................................................................... 20 Addressing Gender Balance and Implicit Bias ................................................................................................... 21 Gender Balance 2017-2019 ........................................................................................................................... 21 Gender Differences in Mentoring Academic Interns .................................................................................... 22 Outcomes of the Academic Track...................................................................................................................... 24 Feedback from exiting interns 2017/18 and 2018/19 ................................................................................... 24 Publications and presentations: .................................................................................................................... 25 Database review of outputs ...................................................................................................................... 25 Self-reported outputs ................................................................................................................................ 25 Career Progression and Retention ................................................................................................................ 27 Academic Track Events ...................................................................................................................................... 29

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Study Days ..................................................................................................................................................... 29 Academic track showcase event ................................................................................................................... 29 Impact of the Coronavirus Pandemic on Academic Track 2019-20 .................................................................. 31 Academic Track Interns 2019-20 ................................................................................................................... 31 Case for funding: SWOT Analysis ................................................................................................................... 31 Costings ......................................................................................................................................................... 33 Conclusion: Fulfilment of the Objectives of the Academic Track for Internship............................................... 34 1.

Providing opportunities ......................................................................................................................... 34

2.

Promoting scientific development and sustained academic achievement ........................................... 34

3.

Retaining medical talent in Ireland ....................................................................................................... 35

4.

Addressing gender imbalance in academic medicine ........................................................................... 35

Future Directions and Recommendations ......................................................................................................... 36 Our vision for the future ................................................................................................................................ 36 Recruitment: .............................................................................................................................................. 36 Delivery: ..................................................................................................................................................... 36 Planning: .................................................................................................................................................... 37 Evaluation: ................................................................................................................................................. 37 References ......................................................................................................................................................... 38

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List of Figures and Tables Figures Fig 1:

Student perceptions of the importance of aspects of the academic track

Fig 2:

Overview of the governance of the AIT

Fig 3:

Academic Intern posts and their locations

Fig 4:

Timeline of recruitment to AIT

Fig 5:

Expression of interest at Stage 1

Fig 6:

Number of full applications for the Academic Track received per year and comparison with ICAT applicant numbers

Fig 7:

Stage 2 Applications to the Academic Track by University 2017-2020

Fig 8:

Recruitment to AIT by gender 2017 and 2018 combined

Fig 9:

Recruitment 2019 by gender

Fig 10:

Changes in gender balance of academic interns year on year 2017-2020

Fig 11:

Publications with academic interns from 2017-2019 listed as authors found in PubMed June 2020

Fig 12:

Breakdown of self-reported academic outputs 2017-2019 (n=32)

Fig 13:

Self-reported Additional outputs 2017-18 cohort (n=12)

Fig 14:

Specialties represented by academic intern projects 2017-2019 (n=72)

Fig 15:

Longer term career plans

Fig 16:

Title page of 2017 Study Day

Fig 17:

Detail from Title page of 2018/19 Showcase

Fig 18:

SWOT Analysis

Fig 19:

Costing distribution

Tables Table 1:

Characteristics of applicants to AIT

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List of Abbreviations AIT

Academic Intern Track

BST

Basic Specialist Training

CRF

Clinical Research Facility

DML ITN

Dublin Mid-Leinster Intern Training Network

DNE ITN

Dublin North East Intern Training Network

DSE ITN

Dublin South East Intern Training Network

EEA

European Economic Area

GIM

General Internal Medicine

HRB

Health Research Board

HST

Higher Specialist Training

ICAT

Irish Clinical Academic Training

IMC

Irish Medical Council

IMSC

Irish Medical Schools Council

INE

Intern Network Executive

MIB

Medical Intern Board

MIU

Medical Intern Unit

MW ITN

Mid-West Intern Training Network

NDTP

National Doctors Training and Planning

NIH

National Institutes of Health

RCPI

Royal College of Physicians of Ireland

SFI

Science Foundation Ireland

SHO

Senior House Officer

SOM

School of Medicine

UKAFP

UK Academic Foundation Programme

WNW ITN

West North West Intern Training Network

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Executive Summary The Academic Track for Internship in Ireland is a combined clinical and academic training programme which offers newly qualified doctors experience in clinical research, medical education or healthcare leadership from the earliest stage of clinical training.

Twenty-four Academic interns are appointed competitively per annum. During a twelve-month period, they undertake one three-month academic rotation during which they are allocated protected time amounting to 50% of the working week (160 hours p.a.). This time is utilised to progress an authentic research project, which they have designed themselves and execute with support from the network.

Academic interns also benefit from mentorship, a named supervisor, a €2,000 bursary and access to study days and seminars throughout the year. Three further rotations taken over 9 months are completed as per standard internship, ensuring sufficient on-call, clinical exposure and time to complete the educational and experiential competencies expected of internship.

In its fourth year, the academic track has been offered to almost 100 interns and completed by 72. It is successful beyond early expectations with sustained interest from undergraduate students. Academic interns express high levels of satisfaction with the research rotation and the mentorship received, rate their clinical experience as excellent and are far more likely than their peers to remain in Ireland after internship, the majority plan to do so long term. There is 100% uptake of posts.

Academic interns have produced over 100 research publications while undertaking the programme.

Almost all have either presented or published their work; many have done both, with over half winning awards and accolades for research undertaken during the intern year. Their academic outputs are double what is typical for their peers on a comparable clinical academic training programme overseas, but this has been achieved in half the time.

For the majority the experience has affirmed their desire to pursue a career in clinical academia. A review of the projects demonstrates significant contribution to traditional disciplines such as oncology, orthopaedics and paediatrics but also impactful contribution to emerging areas such as digital health, medical devices, machine learning and virtual reality approaches to care.

In this report, we describe the aims of the academic track and alignment between programme design and objectives. We outline the recruitment process, its reliability and gender balance. We detail Academic outcomes and outputs from the first two cohorts and provide a brief update on the impact of COVID-19 on the programme.

Scientific literature and input from key stakeholders highlight a need to sustain and grow such a programme in Ireland and consolidate its position at the forefront of integrated career pathways. We describe our vision for the future of the academic track and make recommendations for its future including a small expansion in numbers to meet demand, along with a targeted approach to increasing opportunities in emerging and cross-disciplinary areas. We also recommend investment in academic and administrative support to the programme and creation of a fund to support academic events and other structural elements such as a dedicated website. With the ongoing support of NDTP, the Medical Intern Board and the University medical schools, it is timely and desirable to embed this programme for the long term and make our shared vision to provide high quality opportunities for integrated training at the earliest career stage a reality.

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Numbers at a glance

96 academic interns

92% rate clinical component of internship as good or excellent

100% uptake of posts

83% rate academic component of internship as good or excellent

95% retention after internship

96% agreed that their careers had benefitted from the academic track

97% produce/prepare papers or

95% would recommend the academic track

presentations during internship

to a friend

109 publications arising from academic

287 full applications received since 2017

track projects

1.5 publications per intern

>800 shortlisting reviews of applications

28 different specialties represented by

>150 interviews conducted

academic intern projects

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Background The need for a clinical academic workforce Clinical academics are an essential link between patient care and clinical research. Their combined clinical and academic practice offers a unique perspective on the manifestation of disease, facilitates identification of research questions that are most pertinent to patient care and aids the successful translation of research findings to improved patient outcomes. (BMA, 2014, Eley et al., 2017). Clinical academics have the potential to transform patient care through innovation and discovery (Windsor et al., 2015, Harding et al., 2017). There is strong evidence linking a research active healthcare culture with positive patient outcomes (Windsor et al., 2017, Ozdemir et al., 2015).

The clinical academic workforce is under threat, its numbers are shrinking globally, and the workforce is ageing. In the US the average age at which a first independent NIH grant is awarded is approaching 43yrs. A leaky pipeline compounds the problem: a third of young investigators with mentored NIH grants never apply for independent R01 grants, and many more are lost at later career stages (Schafer, 2010). Similar problems exist in Australia and New Zealand, where the ability to recruit and retain clinical academics is potentially outstripped by an increase in demand to deliver undergraduate medical education (Willcox, 2011). This has led to fragmentation of clinical academic career structures and an increase in fractional and casual appointments that make a secure and sustainable a research career difficult.

These challenges are balanced by potential opportunities including Ireland’s continued investment in innovation and the growing calibre of the supervisor pool. The modernisation of internship has made “taster” rotations and creation of an academic track possible. In contrast to the past, medical students’ express interest in medical teaching and research, at levels that would be more than sufficient to ‘replenish’ the clinical academic workforce. The key is converting their ‘interest’ to action.

Benefits of early exposure to research International literature suggests that those who engage with research early in their clinical careers will continue to do so. Graduates of the UK’s Academic Foundation Programme (UKAFP) –are over forty times more likely to progress to academic training compared to graduates of the standard foundation programme (12.4% vs 0.3%) ((UKFPO), 2017).

A U.S review of 25 years of NIH-sponsored Medical Student Research Fellowship programmes (MSRFs) found that up to half of former participants (n=1,000) considered themselves to be working in academic medicine, and the vast majority had conducted additional research after their medical student experience (Solomon et al., 2003). Publication during residency is recognised as a determinant of the capacity to publish in a future career. (Yang et al., 2011, Macknin et al., 2014). In Psychiatry for example, the decision to pursue a research career is already well established by residency and very few who have less than the highest level of interest in research by that time eventually enrol in research career tracks. Together these indicate the crucial importance of early influences. (Silberman et al., 2012).

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Combined clinical academic training programmes: experience overseas Combined clinical and academic training programmes exist overseas, including in the UK, USA, Canada and Australia, although these are largely aimed at doctors at the later postgraduate years.

The UK Academic Foundation Programme (UKAFP) is similar to the Irish academic internship track (AIT), in that both offer protected time for academic activities and opportunities to develop skills in research and/or education and/or leadership. The UKAFP is a two-year programme representing 5% of all foundation posts (510) and has great diversity in the range of projects on offer across multiple deaneries (Carney et al., 2013). Uptake of posts is around 98% (Gallen, 2016).

The Irish programme differs from the UKAFP in that it is still in a pilot phase. It is only one year in length and accounts for 3% or 24 posts nationally. The AIT emphasises performing a research project conceptualised by the intern but executed with support to provide realistic research experiences.

This is consistent with evidence from the UKAFP that planning and preparation combined with exposure to an authentic project contributes to the satisfaction of trainees and supervisors (Darbyshire et al., 2019). In Ireland, Trinity College Dublin medical School administers the pilot scheme on behalf of the national intern network and the NDTP. This has provided insight into the range of research opportunities and supervisors available nationally, as well as identification of challenges and solutions to feasibility issues. It has also provided clarity on costs (appendix 1) and the application of governance (Appendix 2) throughout this early phase of start-up.

Clinical Research, the Irish Context Opportunities for clinical research in Ireland are increasing. There has been considerable investment in clinical research infrastructure over the last decade. There now exists some seven Clinical Research Facilities nationwide, multiple Clinical Trial Networks and SFI-funded research institutes across the University and healthcare sector. Ireland has retained its reputation and position in the top 10 most innovative countries in Europe (24). The Irish government has pledged to build a strong research and innovation base in Ireland with the aim of becoming a Global Innovation Leader (25). This has prompted expansion of the number of HRB funded clinician scientist awards, as a result academic capacity has increased in cancer, Immunology, personalised medicine, neuroscience, ageing, bioinformatics and medical devices. (28).

If opportunities for clinical research are increasing, clinical training and education must provide a workforce that is able to avail of these opportunities. It is estimated that only 6% of consultant posts in Ireland combine clinical and academic work, and that 6-10 appointments per year are necessary to merely sustain that workforce without expansion. Prior to 2017, there was no combined clinical and academic training programme in Ireland for junior doctors at any level. In November 2017, a few months after the first AIT intake commenced, the Irish Clinical Academic Training programme (ICAT) was launched; it is an integrated programme running over 6-7 years which offers fully funded clinical specialty combined with PhD training and post-doctoral mentorship to junior doctors at Higher Specialist Training (HST) level (2017). The Wellcome Trust, HRB, NDTP, and Universities fund ICAT collaboratively; there are just 8 fellowships annually. Importantly, there is a gap of four years or more in training of clinical researchers, between the time of graduation and HST. The AIT aims to partially fill this deficit and establish the opportunity for an integrated clinical –research training pathway from the time of graduation onwards.

As we reflect on the post COVID environment with the re-invigoration of public trust in science and medicine, it is more crucial than ever that appropriate training and supports for the upcoming

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generation of clinical academics is maintained and enhanced, so that the future of clinical research in Ireland can be secured.

Genesis of the Academic Track Programme and Stakeholder Engagement.

Prior to submitting a proposal for the creation of an academic track for internship in Ireland, extensive stakeholder consultations were held with the six intern networks, the NDTP, the Medical Council, the Irish Medical Schools Council (IMSC) and through an anonymous questionnaire with over 200 students from the penultimate year pre-graduation.

Results confirmed the full support of the INE, the IMSC, RCPI and the Medical Council for the creation of AIT and we are grateful to these groups and external advisors in the UK for providing input into programme design. In addition, coordinators confirmed availability of a pool of willing and research active supervisors within the networks.

Among students the results showed 50% intended to apply for the AIT (response rate 24.6 %) when available and most planned to apply for the UKAFP if it was not. Of these 62% were female, the majority had no previous third level qualification. The most popular stream within the AIT was Clinical Research, (20/41) followed by Medical Education (17/41) and lastly healthcare Leadership and Management (4/41). This is not surprising since the latter is under-represented as a discipline within undergraduate curricula.

The most frequently cited reason for wanting to participate in the academic track was “To progress my career in a particular specialty” (28/42). This was followed by “I wish to pursue a career in academic medicine, medical education or healthcare leadership and management”, (27/42) and “I am interested in clinical research and would like to participate in a research project” (26/42).

Students responded that the most important aspect of the academic track should be protected time for research, with all respondents rating this as important or very important. This was closely followed by the presence of an academic supervisor, which was rated important/very important by 95% of respondents (Fig 1).

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Fig 1: Student perceptions of the importance of aspects of the academic track The most common concern about participating in the academic track, cited by 58%, was uncertainty about their ability to achieve all of the clinical competencies in addition to research (Burke et al., 2018). This early concern was unfounded, since its inception, no academic intern has failed to reach the clinical competencies required of him or her and indeed many have been commended for their excellence in this domain. From this data, it was clear that the introduction of the AIT was welcomed both by students and by their trainers.

Subsequently, detailed proposals were submitted to the IMC and NDTP and funding granted for the creation of twenty-four academic track internship posts to begin in 2017. The governance structure of the AIT is shown, all important decisions are made by consensus at INE level, and the academic track remains a standing item for all INE discussions. Representation at higher levels of intern governance such as at the Medical Intern Unit is currently lacking.

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Fig 2: Overview of the governance of the Academic Track

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Six full internships are required, one per network to provide 24 posts. These are funded directly by NDTP which supports the programme through the Medical Intern Unit (MIU) led by Dr Gozie Offiah.

A breakdown of costs is provided later in the report and Appendix 2. Principally Trinity College Medical School as the university partner of the Dublin South East Network provides administrative, academic and ancillary support to the AIT, with bursaries provided by each medical School and by NDTP. All the network administrators and coordinators warmly support the programme. We are very grateful for their ongoing engagement, which includes assistance with recruitment and selection, design and delivery of study days, processing of bursaries and assistance to academic interns and their supervisors; their support represents a successful example of cross-institutional collaboration.

Aims of the Academic Track The academic track aims to: •

•

• •

Provide opportunities for doctors at the beginning of their careers to continue or develop research, education and healthcare leadership and management skills, in addition to the competencies outlined as part of the National Intern Training Programme Promote scientific discovery and sustained academic development within the context of contemporary medicine and clinical practice, in keeping with the government’s strategic plan (McCraith, 2019) Retain medical talent in Ireland Address gender balance in academic medicine

Challenges in programme design, addressing barriers to research Barriers to junior doctors’ participation in clinical research are well described. Obstetrics and Gynaecology residents in Canada (N=175) cited time constraints owing to clinical/workplace duties, personal reasons and a lack of statistical knowledge (97%, 90% and 74% of trainees) respectively as main issues (Clancy and Posner, 2015). Similarly, resident physicians in Saudi Arabia (n=191) found that lack of research training (93.2%), time (89.5%), work-related stress (83.2%) and lack of supervisors (73.3%) were perceived barriers to doing research; and while 97.9% agreed that research is essential, only 30.4% had any research involvement (Mitwalli et al., 2014). Australian medical students who participated in a mixed methods study identified; protected time, a clear training pathway and funding as the three main factors that would encourage them to participate in research (Eley et al., 2017). The AIT was designed specifically with these barriers in mind. Thus, an academic intern enjoys the benefit of: • • • •

Protected time for a research project within the working week A named academic supervisor Funding in the form of a €2,000 bursary to cover research and travel costs for the year Study days and seminars to provide training in research, education and leadership skills

Curriculum Design A curriculum was designed, to ensure the aims, objectives of the programme were communicated, and to provide information and guidance to academic interns and their supervisors about what they can expect to achieve. Interns are encouraged to identify realistic goals that are achievable having regard to the short space of time they are allocated to complete their project. Design of the 12

curriculum was influenced by the UKAFP curriculum, with modifications, mainly increased emphasis on project conception and planning. The curriculum is divided into the three streams of the academic track: Clinical Research, Medical Education and Healthcare Leadership and Management, with suggested outcomes listed along with competencies to be achieved and the evidence that can be submitted to support these achievements. Interns are asked to select a minimum but not all, of the skills and competencies listed, document them at the start of the year along with their supervisor, and record those that have been achieved and which are pending at the end of the year (Appendix 3).

Clinical training and rotations Academic track interns are required to achieve all the same competencies as interns on the standard intern-training programme, in addition to their academic goals, however they have a little less time in which to do so. In creating academic track rotations, each network identified an appropriate rotation that would provide clinical posts with excellent supervision, broad clinical exposure and a wide range of skills, to compensate for any potential shortfall in rotational exposure. Informal and formal feedback from consultant trainers regarding achievement of this standard is that academic interns perform exceptionally well in their clinical duties, they have all been signed off since the beginning of the programme. Remediation of an academic intern has occurred only once since 2017 and was resolved at Stage 1 of the process.

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Hospitals: Beaumont Hospital, Dublin

Dublin North East Academic/General/Breast surgery Gastroenterology Nephrology General/Vascular surgery

Mater Misericordiae University Hospital, Dublin St James’s Hospital, Dublin

Dublin Mid Leinster

University Hospital Limerick

Academic Medicine Gastroenterology Medicine for the Elderly Orthopaedic surgery

Cork University Hospital University Hospital Galway

Dublin South East Academic/ICU Respiratory Medicine Clinical Pharmacology & Therapeutics/GIM General/Vascular Surgery

Mid-West Academic/General Medicine Care of the Elderly Peri-operative medicine General/Colorectal surgery

South Academic/GP Endocrinology/Immunology Nephrology General Surgery

West North West Respiratory/GIM Academic/Psychiatry or Dermatology or Radiation Oncology or Radiology Surgery Breast/General Endocrinology/GIM

Fig 3: Academic Intern posts and their locations

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Recruitment to the academic track Recruitment to the AIT is a competitive process that runs in tandem with recruitment to the standard internship. The latter is a national match based on an agreed calculation of centile rankings across all universities. Applicant offers are tiered according to Health Service Executive (HSE) recruitment policies.

Running both processes in parallel ensures that all applicants remain eligible for internship until all offers are exhausted, thus removing any disadvantage from applying to the AIT that might otherwise cause anxiety. The timeline and interaction between processes is shown, with more detailed explanation provided in (Appendix 4). Application is encouraged by provision of information, presentations and meetings with final year students across all networks, often complementing information provided about internship more generally.

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Fig 4: Timeline of recruitment to AIT

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Stage 1 Application Applicants wishing to apply for the AIT need only tick a box as part of the stage 1 application process.

Expression of interest at Stage 1 is consistently high between 320 -450 approximating to 27% of the cohort nationally, evenly split between EEA and Non-EEA students. There has been no fall off in interest since inception suggesting the program remains popular and considered of benefit (Fig 5).

The 2020-21 recruitment process saw the highest number ever of initial expressions of interest.

Expressions of interest (Stage 1) 500 450 400 350 300 250 200 150 100 50 0 2017

2018

2019

2020

Fig 5: Expression of interest at Stage 1

Stage 2 Application Stage 2 is more rigorous. Applicants submit detailed Curriculum Vitae and research proposals, exam transcripts and a document ranking their choice of academic posts in order of preference (Appendix 5a: application form). Each year 18-20% (60-80) of those who expressed an interest proceed to make a full application, resulting in 3-4 times as many applicants as places. This is a pattern also seen with the ICAT programme (Fig 6). Almost three times as many EEA candidates submit a full application compared with their non -EEA counterparts. This is not surprising as the tiered system precludes nonEEA applicants from receiving first round offers, even if they were successful.

Effective some 10 % of the graduate pool with a realistic chance of taking up an AIT post make a full application, attesting to its popularity and their serious intent. However, with places for just 3 % of the total cohort, two thirds will be unsuccessful. This pattern is likely to continue unless the number of posts can be increased to further meet demand. Judging from the calibre of those who proceed to interview (Table 1.) it is likely this could be accomplished with any detriment to quality.

Completed academic interns have not reached the ICAT application stage yet. However, if the numbers for both remain consistent and AIT graduate preferences to apply to ICAT remain high, it is likely ICAT will also see a significant increase in the demand for places. The Recruitment process is open to all applicants, but the majority come from EEA students attending one of the six Irish medical schools. All Schools are represented with some variation in numbers noted according to the size (Fig 7).

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Applications to clinical academic programmes 20172020 100

82

82

80

61

60

59

50

54 39

35

40 20 0 2017

2018

2019

Academic Track

2020

ICAT

Fig 6: Number of full applications for the Academic Track received per year and comparison with ICAT applicant numbers.

Stage 2 Applications by University 30 25 20 15

10 5 0 NUIG

RCSI

TCD 2017

UCC

2018

2019

UCD

UL

2020

Fig 7: Stage 2 Applications to the Academic Track by University 2017-2020 Table 1 provides the characteristics and typical achievements of applicants to AIT. The academic merit of those called to interview after shortlisting is high, and scores awarded to their project. proposal for feasibility and transferability are almost always within the top 50%

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Characteristics of Interview Candidates Applicants 2017 PROCESS 2018 Process 2019 Process 2020 Process Total Number 51 48 48 48 195 Gender (F/M) 20/31 19/29 24/24 22/26 85/110 EEA/non-EEA 38/13 30/18 36/12 36/12 140/55 Achieved additional 3rd level qualitifcation * 36 17 18 28 99 Peer teaching displayed in application 43 48 48 45 184 Graduating School of Medicine 2017 PROCESS 2018 Process 2019 Process 2020 Process Total 14 7 5 14 40 13 13 11 11 48 4 7 5 8 24 5 9 12 5 31 6 2 9 5 22 9 10 6 4 29 0 0 0 1 1

RCSI TCD UCC NUIG UL UCD Other

Academic performance of applicants who progressed to interview 2017 PROCESS 2018 Process 2019 Process 2020 Process Total 28 22 29 31 110 23 24 18 15 80 0 2 1 2 5 0 0 0 0 0

Quartile 1 (number of applicants) Quartile 2 (number of applicants) Quartile 3 (number of applicants) Quartile 4 (number of applicants)

Feasibility of proposed research 2017 PROCESS 2018 Process 2019 Process 2020 Process Total 21 20 13 18 72 28 25 30 28 111 2 3 5 2 12 0 0 0 0 0

Quartile 1 (number of applicants) Quartile 2 (number of applicants) Quartile 3 (number of applicants) Quartile 4 (number of applicants)

Transferability of proposed research Quartile 1 (number of applicants) Quartile 2 (number of applicants) Quartile 3 (number of applicants) Quartile 4 (number of applicants)

2017 PROCESS 2018 Process 2019 Process 2020 Process Total 21 16 19 17 73 28 21 21 23 93 2 8 8 8 26 0 3 0 0 3

Combined score was used in 2017 process

*may be Moderatorship or Intercalated Masters Academics who shortlist 2017 PROCESS 2018 Process 2019 Process 2020 Process Total Number 24 24 28 26 102 Gender (F/M) 12/12 15/9 11/17 14/12 52/50

Table 1: Characteristics of applicants to AIT Note: Quartile refers to the distribution of scores amongst candidates e.g. Quartile 1 refers to candidates whose scores were in the top 75%

Shortlisting Applications are reviewed and scored independently by a minimum of three clinicians with research experience. Reviewers may not be from the same university or that of the candidate (where possible).

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Marks are combined and an average score awarded to each candidate. Candidates scoring above a certain cut-off mark are invited to interview.

Between 2017-2020, 287 full applications have been processed, resulting in more than 800 reviews.

Feedback is collated and made available to all applicants, regardless of progression to interview.

Where a >10% discrepancy between marks awarded exists, these are discussed. If the discrepancy persists, a fourth independent reviewer reviews the application and an average mark obtained.

Interviews Interviews are carried out in two locations (in Dublin and outside) with panels of three to four senior clinicians and scientists, each marking individually and then collectively ranking their candidates (Appendix 5b: scoring and ranking sheets). An external examiner is present to oversee the process.

Interviews are semi-structured, with candidates required to give a short opening statement as to why they wish to become an academic intern and then to defend their project proposal, in particular to consider its feasibility and impact.

Between 2017-2019, over 140 interviews have been conducted. This year 37 candidates were interviewed remotely, as interviews occurred during the COVID-19 pandemic. A debrief is held to provide feedback on the process. Interviewers consistently indicate satisfaction with no major changes suggested.

Ranking candidates Panels rank candidates, most preferred to least preferred, the top four ranked candidates from each panel are usually offered places depending on the number of panels. Candidates are allocated to panels according to shortlisting score thereby ensuring each panel interviews a full range of candidates.

Once all candidates are ranked, the final list is approved by the INE executive and passed back to HBS recruit. Thereafter, successful candidates are tiered and matched according to HSE policy. This prioritises Irish and other EEA graduates of Irish medical schools in the first round. A reserve panel is also created. On average there is 90% acceptance on round one, and 100% uptake of posts overall.

Notably, many candidates accept posts that were relatively low down on their preference list, and which require them to move to another network. This speaks to the perceived benefit of the AIT relative to a standard intern post even if in a preferred network.

Reliability and validity This approach is reliable and valid. There is strong consensus across reviewers in the shortlisting process, with an average deviation from the mean score of 6/60 (10%) for the CV and 6/40 (15%) for the research proposal. Any greater deviation from the mean score prompts an additional review. Regarding validity: in 2017 we reviewed the data and found that nine out of the top ten ranked eligible candidates from the shortlisting process also scored highly at interview and were offered a place on the academic track. This suggested that shortlisting score alone may be sufficient to make offers, however a re-analysis of this in 2020 showed sufficient change to the rank order after interview to justify maintaining the present approach, which will be kept under review.

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Addressing Gender Balance and Implicit Bias Gender Balance 2017-2019 Women are under-represented at the highest levels in academia across all specialties. Even though the majority of third level staff are female (54%), only 23% of professors are female, and out of the seven universities in Ireland, none has a female President (HEA, 2016). In its National Strategy for Women and Girls 2017-2020, the Irish government has pledged to work towards “an Ireland where all women enjoy equality with men and can achieve their full potential, while enjoying a safe and fulfilling life”(Equality, 2017).

One of the initial aims of the academic track was to promote gender equality in academic medicine by providing an early career momentum to female graduates that could help overcome some of the barriers that can arise at later career stages. However, for the first two years of the programme, female interns were under-represented compared to male, with 6 female interns in 2017 and 7 in 2018. On investigating the recruitment process, we noted that while more female students initially applied for the AIT, their numbers dropped significantly and repeatedly throughout the process.

% candidates

Recruitment process by gender 2017 and 2018 by gender 100 80 60 40 20 0 Stage 1

Full applications

Shortlisting

Male

Ranked 1st at interview

Achieved AT post

Female

Fig 8: Recruitment to AIT by gender 2017 and 2018 combined This issue was considered by the Intern network executive (INE) and two approaches to improving gender balance were proposed for the 2019 recruitment process: 1. Anonymisation of application forms.

2. Interviewers undergoing implicit bias training In 2019, half of the shortlisting reviewers received anonymous applications and the other half received them non-anonymised. Results of the shortlisting were then compared. Female applicants scored higher whether their application was anonymised or not. Data was subjected to two-way repeated measures ANOVA, the repeated measures were the anonymous and non-anonymous scores (within subjects) and between subjects variable to gender; no evidence of an interaction was found. However, we believe the conclusion is unreliable due to small sample size and warrants further investigation. Thereafter, implicit bias training became a pre-requisite for becoming an interviewer. From 2019, we saw a significant increase in intake of female academic interns for with 11 out of 24 (46%) female interns and 54% male. This represents almost doubling of the ratio of females to males in the space of one year (Fig 9).

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% candidates

Gender balance 2019 90 80 70 60 50 40 30 20 10 0 Expression of Full applications interest

Shortlisted

Male

Ranked first at Post accepted interview

Female

Fig 9: Recruitment 2019 by gender Overall review of four years of recruitment, the trend we see is an increase in the ratio of female academic interns to males, which now approaches that seen at undergraduate level (Fig 10). While this is encouraging, gender balance is an issue that will require ongoing monitoring.

Number of AIT interns

Changes in gender balance 2017-2020 20 18 16 14 12 10 8 6 4 2 0 2017

2018

2019

Female academic interns

2020

Male academic interns

Fig 10: Changes in gender balance of academic interns 2017-2020

Gender Differences in Mentoring Academic Interns Women in leadership positions in academic medicine are subjected to stereotyping with respect to scholarly pursuits, that is, female leaders are more likely to be engaged in activities relating to education and public image making as opposed to basic and clinical research (Schor, 2019). On considering how evidence of gender stereotyping might manifest itself in the academic track, we reviewed the applications for 2019-20 to consider how the gender of the main supervisor related to the gender of the candidate. We note that female candidates were almost twice as likely as male to nominate a female supervisor. Potential reasons for this finding could include role stereotyping; 22

however further investigation is required especially with respect to alignment between supervisor and project type. What is clear is that we are only scratching the surface of gender issues in the academic track. Further research may contribute to the global discussion on gender balance in academic medicine.

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Outcomes of the Academic Track Outputs of the academic track are measured in the following ways: 1.

2.

3.

4.

Feedback survey from exiting interns Publications and presentations Retention rates Career progression

Feedback from exiting interns 2017/18 and 2018/19 An anonymous online survey is circulated to all twenty-four academic interns in the final month of their internship. Interns rate various aspects of the AIT and provide free-text responses. The response rate to the survey is 69% (n=33) for both years (2017/18 and 2018/19). The 2019/2020 survey will shortly be performed.

In the first year of the programme 92% indicated that their experience of the clinical component of the year was good or excellent, and 83% indicated that the quality of experience of the academic part of the year was good or excellent. Of that first cohort, 42% had also applied for the UKAFP prior to accepting the post on the AIT and 53% held another third level qualification.

Ninety-two per cent of respondents perceived a benefit from participating in the AIT. As well as learning new skills, producing papers for publication and learning good time-management skills, participants appreciated the opportunity to work closely with mentors and get a sense of life as a clinical academic. Several participants mentioned that they found the overall experience to be very fulfilling. Eighty-three per cent would recommend the academic track to a friend. The 2018/19 survey showed very similar results.

Below are some of the direct quotes from academic interns who completed the survey across years: Do you feel that you benefitted from participating in the academic track?

“Massively - The opportunity to balance clinical work alongside research in the same area has been invaluable and has affirmed my desire to pursue research and clinical work in the one field simultaneously.”

(2019) “Yes. I engaged in a dynamic field of research, met likeminded people, learned from worldrenowned clinician-scientists, honed new skills (e.g. PCR, SCAT assessments) and had the opportunity to work with mentor who inspired and challenged me to achieve my highest potential. I thoroughly enjoyed the experience and found the combined training deeply fulfilling and exciting.”

(2018) “Extremely; the protected time, funding and networking opportunities were invaluable.

Furthermore, I was offered my new position in July based on my academic track work” (2019) Some participants discovered the frustrations of academia “Yes, I learned that research is a tiring and unrewarding endeavour – an insight that I did not have before.”

(2018)

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Publications and presentations: Database review of outputs We conducted a review of PubMed titles associated with the academic interns between 2017- 20, N=72. Only listed publications excluding letters and conference proceedings were included. It is possible additional publications may be identified if other databases were searched (Appendix 6).

Published papers were attributed based on alignment between name, affiliation, recognised supervisor and project proposal keyword and categorised as pre-AIT academic track, or during/postAIT. The review of PubMed took place between June 10-20th 2020.

One hundred and sixty PubMed publications were attributable to current and former academic interns. Fifty-one of these were published before the AIT and one hundred and nine published either during or after (Fig 11). Excluding a single prolific author, the average publication rate was 1.5 per intern. Twenty-six current and former academic interns have no publications listed on PubMed to date.

Academic Intern Publications

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109

Publications prior to Academic Track

Publications during/after Academic Track

Fig 11: Publications with academic interns from 2017-2019 listed as authors found in PubMed June 2020

Self-reported outputs Interns also self-report their achievements. In the first two years of the programme, the majority (31/32) cited papers or presentations either completed or submitted as main outputs (Fig 12).

However, we are also aware many took on teaching duties and engaged with other extra-curricular activities associated with their affiliated institutions. Information on additional outputs is available only for the 2017-18 cohort. This shows this highly accomplished group also undertake outreach activities, teaching and further qualifications (Fig 13).

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Outputs Academic Interns 2017/18 and 2018/19 Presentation done Paper published Presentation pending Publication pending 0

10

20

30

40

50

60

70

80

90

Fig 12: Breakdown of self-reported academic outputs 2017-2019 (n=32)

Additional Outputs 2017/18 Other (outreach, additional qualifications) Award

Teaching

Learned research skills 0

10

20

30

40

50

60

70

Fig 13: Self-reported Additional outputs 2017-18 cohort (n=12)

These combined outputs should be viewed in the context of other similar programmes such as the UKAFP. A study from 2016 found that 33% of AFP interns had papers submitted or in the process of being published (there was no data on completed publication) and 50% had achieved an oral or poster presentation (Gallen, 2016). Despite the Irish AIT being shorter, the achievements are at least comparable and, in some respects, better than expected.

There may be several factors differentiating the AIT and the UKAFP which might contribute to productivity of the academic interns such as; a requirement to submit a detailed draft project at the application stage and an emphasis on defence of this at interview including feasibility and adaptability. In addition, there is a clear expectation that supervisors and mentors will be involved at an early stage of project conception and throughout the application. Project feasibility and planning is taken as a reasonable marker of commitment and capacity to manage future workload.

Projects are not intended to be rigidly fixed, they often require modification and support, and this is offered in the post award period. INE network co-ordinators are a very active and rich source of local support to interns and supervisors. Another difference is the size of the cohort compared with the 26

UKAFP and how this affects the management of the programme. We have 732 interns in total across six intern networks but only four academic interns per network. This has allowed us to adopt a consistent national approach, with academic interns in all networks receiving broadly the same experience. The Trinity Network has provided a 0.5FTE lecturer/registrar and administrative support to the programme; this facilitates stewardship thorough project planning and preparation stages prior to commencement.

The academic interns’ projects encompass a broad range of specialty interests (Appendix 7), with twenty-eight specialties represented in total*. The most commonly represented specialties are Oncology (n=8), Anaesthesia (n=6), Obstetrics and Gynaecology (n=6), Orthopaedic surgery (n=5) and Paediatrics (n=5), all areas where high quality supervisors have been identified. Analysis suggest interns publish predominantly in the specialty represented by their academic track projects. Eightyfive of the 109 publications attributed to academic interns during and after the AIT are within the same field as their academic track project. Even at the most junior level, academic interns are making substantial contributions to their areas of interest.

Specialties represented by academic track interns 9 8 7 6 5 4 3 2 1 0

Fig 14: Specialties represented by academic intern projects 2017-2019 (n=72) *There is some overlap between clinical specialty and medical education or healthcare leadership and management. Where >1 field was involved, the project was attributed to the specialty of the supervisor.

Career Progression and Retention In 2017/18 on formal reporting, 10/12 participants confirmed they were remaining in Ireland for their first SHO year, with two planning to travel abroad. However, informally 22/24 or (92%) planned to stay in Ireland and subsequently did. In 2018 /19 none intended to apply for a training scheme abroad and just 10% planned to take up non-scheme work abroad. Of the remainder, 42.6% planned to take up a BST post in Ireland, join a GP schemes, take a stand-alone post or undertake further study. In contrast, 50%-70% of interns who have completed the standard intern-training programme emigrate abroad for at least their first SHO year, most often to Australia, New Zealand or the UK. The first AIT cohort provided open-ended responses regarding 5yr career intentions, 50% were aiming for HST scheme and 42% were aiming for ICAT in Ireland. By the second cohort, this had risen 27

to (66.7%) indicating an aspiration for HST and the ICAT programme. Other preferences such as GPs and non-integrated research/academia are shown (Fig 15).

Fig 15: Longer term career plans Factors influencing the higher retention rate may include intrinsic factors such as a focussed career plan. Alternatively, academic interns having fostered relationships with other researchers may wish to continue to build their networks emphasising the importance of mentors to early career clinical academics.

A different perspective might suggest that the academic track creates greater job satisfaction and hence greater retention. Burnout is high among Irish junior doctors, and that this contributes to the decision to emigrate (Hannan et al., 2018). A highly demanding job combined with low or scarce resources can negatively impact on employee’ wellbeing, whereas a highly demanding job with high levels of support and resources can have a positive impact (Page et al., 2017). It’s possible provision of additional resources to achieve their academic goals (in the form of time, funding and mentorship) enhance the academic interns’ experiences of intern year, mitigate against burnout, and encourage their retention within the Irish healthcare system. It is likely multiple factors are at play. If the programme is permitted to continue, we plan to investigate this further by tracking graduates over at least a 5 year period to follow their career trajectory and investigate whether the academic track impacted upon their career choices, provided a perceived benefit to the pursuit of their goals or influenced decisions around emigration.

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Academic Track Events Study Days Dedicated mandatory study days are held quarterly across the networks for academic interns. With exceptions the entire cohort are usually invited to avail of these sessions, which occur in addition to regular intern education and training. Topics relevant to academic interns are prioritised including clinical trial design, drug development, medical ethics, statistics, systematic review and academic writing for success. Feedback is generally positive. The final virtual study day included reflections on life as an academic clinician by the 2019 Nobel Laureate for Medicine or Physiology, Sir Professor Peter Ratcliffe, a Dragons Den style pitch for funding and a panel discussion on the future of clinical research in Ireland (Appendix 8). Academic track study days are funded by each university, with greater investment, these could be improved. We are also grateful to the ICAT programme for including academic interns in some of their study days and retreat activities.

Fig 16: Title page of 2017 Study Day

Academic track showcase event Each year a national showcase event is held to disseminate the work of the academic interns.

(Appendix 9a and 9b). The showcase takes place in a venue that symbolises excellence, is prestigious, neutral and easily accessible for those travelling. Interns are encouraged to explore innovative science communication techniques to explain the impact of their work. PowerPoint presentations are not allowed! As a result, we have seen live demonstrations of techniques, panel discussions, TED style talks, creative modelling and virtual reality as well as real life patient encounters that illuminate

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their work and engage the audience. There are two prizes for outstanding performance in the areas of Research Skills and Science Communication.

The showcase is well attended by current and incoming academic interns, supervisors and other senior academic clinicians as well as representatives from the HSE, NDTP, Irish Medical Council and the Postgraduate Training Bodies. The Minister for Higher Education, Mary Mitchell O’Connor, has been a strong supporter of the AIT since its inception. To date the showcase has been funded by the Trinity School, again a small investment would facilitate other Universities to take on organising the event.

FUTURE-LEARN:

The future is in our hands

Venue: Palatine Room, The National Museum of Ireland, Collins Barracks Tuesday June 11th, 2019

Fig 17: Detail from Title Page of Showcase 2018/19

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Impact of the Coronavirus Pandemic on Academic Track 2019-20 In February 2020, Ireland was struck with its first case of COVID-19. Academic interns were mid-way through their third rotation and the recruitment process was underway, with shortlisting complete but interviews still pending. Tremendous flexibility was evident on the part of the current academic track interns in prioritising their frontline practice at the short-term expense of their projects.

Similarly, with flexibility from the NDTP, INE and HBS recruit we were able to complete the recruitment process using digital interviews and with minimal deviation from the usual procedures.

Again, we have 100% uptake of academic track posts for 2020, despite great uncertainty ahead.

Academic Track Interns 2019-20 During COVID obstacles to project completion arose, these were overcome. We are delighted all AIT interns completed the full range of competencies and have been signed off. Moreover, they inspired others with their commitment to patient care and leadership skills during the COVID crisis, for example in taking on rostering duties and reconfiguration of services in line with pandemic contingencies. Senior management teams have remarked upon this. Others have acted as role models to their peers and exerted a stabilising force in what has been a time of great uncertainty for NCHDs. The importance of retaining these doctors in Ireland has never been greater.

Case for funding: SWOT Analysis We propose the funding of a dedicated Academic Track Intern Lecturer post (0.5 FTE) and Administrator post (0.3 FTE) to support to ongoing development and enhancement of the training programme.

In order to illustrate the need for an Academic Track Intern Lecturer and Administrator, we have conducted a SWOT analysis on the current training programme (Fig 17).

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Strengths

Weaknesses

Robust recruitment process

Time and staffing issues

High calibre of participants

Limited engagement with supervisors

Experienced team Large pool of potential supervisors

Difficulties engaging with academic interns nationally

Good collaboration between networks and INE/NDTP

Study days are somewhat ad hoc and lack coherence

Successful pilot which enhanced the reputation of programme

Limited scope for performance evaluation and ongoing improvement of the programme

Significant interest in the programme among undergraduate students

Limited engagement with undergrads Lack of promotional material/website

Opportunities

Threats

Provision of greater individual support to interns, ensuring the success of the programme

Reports of a poor training experiece

Overseeing all study days nationally to provide enhanced coherence and a better learning experience

Failure to continue to attract high calibre graduates, impacting on the success of the programme

In depth analysis of recruitment process

Loss of potential supervisors due to lack of support

Enhanced support of supervisors

could undermine the value of the programme

Loss of talented graduates to similar programmes overseas

Refinement of the curriculum Development of a dedicated website

Increased burden of work on intern training team could detract from standard training programme

Enhanced evaluation of the programme and graduate tracking

Fig 18: SWOT Analysis 32

Costings

Fig 19: Costing distribution 33

Conclusion: Fulfilment of the Objectives of the Academic Track for Internship The proposal for the Academic Track for Internship, submitted to the NDTP by the INE and DSE Intern Network in 2017 outlined four main objectives: 1. To provide opportunities to doctors at the beginning of their career to develop skills in clinical research, medical education or healthcare leadership and management in addition to the core competencies of internship 2. To promote scientific discovery and sustained academic development in keeping with the government’s strategic plan 3. To retain medical talent in Ireland 4. To address gender balance in academic medicine

1. Providing opportunities Data from the first two years of the academic track indicates that academic interns perform well beyond expectations. Almost all academic interns had already either presented or published their work; many did both, over half won accolades and awards for work undertaken during their intern year. Their academic outputs are double what is typical of their peers on a comparable clinical academic training programme overseas, and they have achieved this in half the time.

In addition to achieving their academic goals, they also achieve all the competencies of standard internship. They do this and more. To date all have been signed off on all clinical rotations. Far from allowing their academic duties to impinge on their clinical work, we regularly receive feedback from consultant trainers on how impressive this group are in a clinical setting. What is notable about them is their sense of fulfilment and satisfaction and their level of engagement in every aspect of their work. This may be the effect of mentorship and of professional identity formation. A concept analysis of the term clinical academic revealed some of the antecedents (required conditions) to producing academic clinicians. These match the resources we aim to provide in the AIT– an appropriate academic environment and adequate resources including protected time and mentorship. The consequences are also noted – advancements in healthcare, research based on patient care and improved health outcomes (Burke E, 2018) The academic track provides a “taster” of life as an academic clinician, similar to other sub-specialties that nurture interns who demonstrate an interest. A few realise the burden of juggling clinical and academic duties is not for them. In our experience most find it an affirmation of their chosen career path with one or two high impact individuals remaining uncertain regarding academia but increased confidence regarding their personal talents.

2. Promoting scientific development and sustained academic achievement There is a global shortage of clinical academics, with international groups calling for increased investment in combined clinical academic training programmes that provide a clear career structure.

The academic track represents the first step towards structured integrated clinical academic training; it lays a strong foundation of excellent research combined with clinical experience on which to build a successful career in their chosen specialty. Now more than ever the value of clinical academic practice which bridges innovation with patient care is truly felt, and a pressing need to sustain this crucial workforce should be fully realised.

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3. Retaining medical talent in Ireland The academic track has succeeded in retaining over 90% of interns for their first SHO year, with most academic interns planning to remain in Ireland long-term. By contrast, over half of interns who complete the standard training programme emigrate overseas in their first SHO year; a significant number do not return. The reasons for this increased retention are yet to be fully described, but focussed career plans, building a research network, combined with job satisfaction enhanced by the provision of supports and resources to carry out their academic work, are likely contributing factors, further investigation is required.

4. Addressing gender imbalance in academic medicine Gender bias occurs in all professional fields and academic medicine is no exception. It is thought that the influence of gender bias is particularly important in the early career stages (Universities), 2018). Providing a combined clinical and academic training programme for junior doctors may give women a momentum at an early career stages that can help overcome some of the barriers that arise later, e.g. family commitments.

In the first two years of the programme, we noticed that males outnumbered females by nearly three to one. Taking some steps to address this has seen the balance change from 3:1 to almost 1:1 for both 2019 and 2020. Further work is needed to follow the career pathways of all academic interns, to monitor the programme for signs of gender imbalance, and to implement strategies to minimize all kinds of bias and ensure our processes are based on merit The academic track has succeeded in fulfilling its stated objectives. Academic interns continue to excel both academically and clinically. The programme remains as popular as it did in its first year, with strong competition for a small number of places and 100% uptake of posts. Feedback from exiting interns indicates their satisfaction with the programme and agreement that they have benefitted from participating (https://vimeo.com/431982014/fe6d51bd40). There is still work to be done, but with ongoing support and investment by the NDTP, the INE and the University Medical Schools, we hope to see the academic track continue to flourish, helping to build and sustain a skilled workforce that is becoming more critical than ever before in our uncertain and challenging times.

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Future Directions and Recommendations The academic track for internship is a programme worth investing in for the future. It is imperative the programme continues to grow and develop to build upon the high standards set by the pilot programme and so it can continue to attract the highest calibre of students.

Our vision for the future There is great interest in the academic track amongst undergraduate students, they view it as being beneficial for their future careers and the system must recognise the potential of the programme to retain talented graduates, for internship and beyond. We are grateful to the NDTP for supporting this pilot but now make the following recommendations for programme sustainability expansion and investment.

1) We recommend the academic track convert from a pilot programme to a fully embedded and funded part of internship.

2) We recommend as a national programme the AIT should be represented separately at the Medical Intern Unit with monitoring reports on its progress submitted regularly to the Medical Intern Board.

3) Based on applicant interest and calibre and the number of highly qualified individuals who cannot obtain a place annually, we recommend the number of posts are increased to a 36 initially and growing over time to 48. Such an expansion would facilitate a planned and targeted approach to; retaining strong links with traditional disciplines active in clinical and translational research while increasing engagement with medical education and healthcare leadership and with emerging cross-disciplinary innovation such as medical device technology, artificial intelligence, machine learning and digital health.

4) From an investment perspective, we advocate a minimum of 0.5 FTE lecturer/registrar (or assistant professor post) should be appointed to the programme as well as a 0.5FTE administrative officer. These are necessary to ensure a coherent approach to recruitment and liaison with the medical schools and to support interns and their supervisors. They are also essential to maintain inter-institutional collaboration across the networks and to gather high quality data that supports continuation of the programme.

5) There is the need to identify a small amount of funding to support a more coherent range of trainee and supervisor events and specific training where necessary. Support for the annual showcase event would be welcome as would capacity to have a dedicated website and a mechanism for graduate tracking. This minimum investment will facilitate the continued improvement in areas such as: Recruitment: ➢ In depth analysis of the recruitment process with a view to maximising its validity, transparency and merit, and minimising potential issues such as implicit bias and gender inequality Delivery: ➢ Greater engagement with academic interns at a national level to ensure they are supported in the successful completion of their research projects ➢ Greater engagement with supervisors and mentors to ensure they are well supported in their important role 36

➢ Increased oversight of the national study days, providing greater cohesion and improving the overall training experience ➢ Revision of the curriculum to align it more closely with the Irish context ➢ Development of a prospectus for the programme ➢ Development of a dedicated website for the programme Planning: ➢ Engagement with undergraduate students at a national level to identify and prime those

with the capacity for research Evaluation: ➢ Greater tracking of graduates of the programme ➢ More detailed feedback from supervisors and those involved in the recruitment process ➢ Carry out research to investigate the reasons behind the increased retention of academic interns in Ireland ➢ Carry out research on the academic track and similar programmes internationally to help solve any potential problems and identify opportunities to further enhance the programme

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