To the Editor: Boundary-Crossing Communities of Practice for Aspiring Clinician-Investigators

In the October issue of the Journal of Graduate Medical Education, Burns et al1 argue for the creation of communities of practice to support aspiring clinician-investigators with an emphasis on boundary-crossing. We agree wholeheartedly with the authors’ message and would like to share our experiences of delivering this type of training.In Ireland, there are 2 clinical academic training programs for physicians-in-training (residents): the Academic Internship Track (AIT), a 1-year program for first-year postgraduate physicians (interns); and the Irish Clinical Academic Training Programme (ICAT), aimed at specialist trainees who complete a PhD while continuing higher specialist training. The AIT is a national program in the Republic of Ireland (ROI), aligned with the Specialised Foundation Programme in Northern Ireland, and ICAT is an all-island program, encompassing institutions within ROI and Northern Ireland (UK).The aspiring clinician-investigators in the AIT and ICAT programs are not restricted to their specialty of interest, and their research is diverse. Both programs hold national events—study days and a showcase event for the academic interns—and an annual 2-day retreat for ICAT fellows (trainees). These events are valued by trainees not only for the educational content and opportunity to present their work to the clinician-investigator community, but also for the networking and social aspects.Academic interns attend the ICAT Retreat, and ICAT fellows speak at academic intern events, thereby crossing boundaries of career stage. Medical students are invited to attend AIT events, providing an insight into the clinician-investigator community at an early stage. Continuity is key—bridging the gaps at different career stages helps prevent the energy from dissipating.ICAT has recently expanded its boundaries even further. Recognizing the need for disruptive thinking and cross-pollination of ideas, the program has begun recruiting fellows broadly from all disciplines in human medicine, veterinary medicine, and dentistry.2 The clinician-investigator community of practice within ROI has been strengthened by collaboration with the Clinical Academic Training Programme (CATP) in Northern Ireland. Senior clinical academics in Northern Ireland are jointly members of the CATP Board and the ICAT executive team. The mobility of ICAT fellows between ROI and Northern Ireland contributes to building a seamless landscape of practice across the island.Research funders have recognized the importance of maintaining and building a pipeline of training and career development for clinician-investigators. The Health Research Board (HRB) in ROI is one of the primary funders of ICAT and has developed the competitive HRB Clinician Scientist Fellowship (CSF) program for recent PhD graduates. Two of the first ICAT alumni were recently awarded HRB CSFs, 4-to-5-year career development awards.3 Academic interns have been shown to contribute substantially to their field of interest, despite being in the earliest career stages.4We appreciate the practical advice provided by Burns et al.1 When it comes to building boundary-crossing communities of practice for aspiring clinician-investigators, it is not just possible but essential. Crossing boundaries is integral to the clinician-investigator identity.5 The success of our 2 programs has hinged on their ability to cross boundaries and connect across disciplines, career stage, profession, and geographical borders.The Academic Internship Track is funded by the Irish Health Service Executive’s National Doctors Training and Planning and the 6 medical schools in the Republic of Ireland. The ICAT Programme is an all-Ireland partnership of 6 universities, their respective Schools of Medicine, Dentistry and Veterinary Medicine, the Health Research Board, the clinical training authorities North and South, Health Service Executive - National Doctors Training and Planning, Northern Ireland Medical and Dental Training Agency, Wellcome, the Department of Agriculture, Food and the Marine (DAFM), and the College of Anaesthesiologists of Ireland (CAI). See www.icatprogramme.org for details.

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