In search of the clinical scientist

In 1999, Bill Gillies, then President of the Royal Australian College of Ophthalmologists, wrote that ‘clinical research in the field of ophthalmology is a largely neglected field in this country’1 further exhorting his colleagues ‘with the increasing complexity and effectiveness of both medical and surgical options in our field, we need to be more active in clinical research’. Since that time, this journal has metamorphosed into Clinical and Experimental Ophthalmology, encouraging a diversity of research papers published within its covers and a more international readership. Moreover, the article by Davis and Wilson in this issue shows that Australia has significantly increased its contribution to the published ophthalmic research over the last 20 years2, seemingly predicting a bright future for vision science in Australasia. Does Australasia have the momentum to sustain the advances made in the last two decades? Insights into the attitude to research of consultant ophthalmologists and trainee ophthalmologists in New Zealand can be gleaned from the article by Jayasundera, Fisk and McGhee in this issue3. At face value the article appears to support the robust future of clinical research in ophthalmology in New Zealand, with 93% of the respondents having already undertaken some form of research and a large majority (67%) intending to undertake further research in the future. However, some disturbing traits lie dormant within the results of the article which I have the opportunity to discuss here. In an ideal world, medical research involves the unbiased, unrestricted search for scientific truth in order to improve clinical knowledge and benefit the afflicted. In the real world, medical research also benefits the researcher as an educational experience providing increased understanding of research methodology. In the mind of would-be ophthalmologists, medical research may also benefit the researcher by aiding in the acquisition of the training post of choice, according to the responses from the New Zealand ophthalmologists. The data of Jayasundera et al. show that less than half of those questioned believed that research would benefit clinical practice, while over half believed research was a worthwhile benefit to one's career3. Worryingly, from this data, these two diametrically opposed camps could be mutually exclusive, leading to the undesirable situation where the majority of ophthalmic research is conducted for personal benefit rather than the benefit of medical science. Our trainees at the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) are not alone in believing that research prowess leads to accelerated career advancement. Batshaw et al. studied promotions at Johns Hopkins Medical School over a 5-year period and found no difference in promotions between clinical and research faculty members, even though staff members believed that research members would be promoted ahead of clinician teachers4. How should we train our trainees? When questioned by Jayasundera et al., 97.5% of ophthalmologists thought that trainees should undertake a period of research, but only 21.5% felt adequately equipped to supervise that research. Who then should supervise the research that most ophthalmologists think should be performed? It would seem that this problem is ongoing because it is clear that the previous generation of trainees who are now consultants feel under-trained for the role of research supervisors. Furthermore, it would appear that the New Zealand cohort in this study are not significantly different from clinicians in other countries or disciplines5. Indeed, a study of Canadian obstetric practitioners revealed that the majority felt unqualified to appraise the medical literature6, while a controversial report in the USA exposed scientific illiteracy as a major failing of medical education7 and the Association of American Medical Colleges asked for ‘increased emphasis on critical evaluation of medical literature to develop skills in analysis and criticism’8. In this period of change for ophthalmology in Australasia, especially with the lack of a defined prevocational training programme, RANZCO is ideally placed to address these issues by defining research training periods within the vocational programme. Hopefully this will help our young ophthalmic trainees value the scientific evolution of medicine and nurture it by adding to the wealth of medical knowledge from which we have all benefited. Clinical and scientific studies have become so divergent as to become almost mutually exclusive. Physicians once played the major part in the discovery of medical treatments, but are increasingly surrendering that role to the basic scientist. The advance of molecular biology led many clinicians with a scientific background to move into full-time science, leaving the clinical academic posts to be filled by pure clinicians without a basic science background9. This situation led Goldstein to propose the existence of PAIDS (paralysed academic investigators disease syndrome), where clinicians lack the basic science training to use new approaches and techniques10,11. Although Goldstein's suggestion was partially tongue-in-cheek, it highlighted the decline in clinician scientists, a decline so acute that a proposal for a clinician scientist training programme (CSTP) in the USA has been put forward by Mark and Kelch12. It is my belief that the future of the clinician scientist lies within translational research, the process involved in translating laboratory advances into clinical treatments. However, Ryan et al. note that despite the phenomenal progress of science, discoveries in the clinic proceed at a snail's pace13. These authors note that the problem lies in com­munication, lending a second meaning to translational research. Clinicians and scientists have diverged into speaking separate languages and now need a translator − this translator is the clinical scientist. In his 1999 editorial with which I started, Bill Gillies concluded ‘we ophthalmologists need to become visual scientists too, or perhaps true clinical scientists’1. If the upward trend in Australasian ophthalmic research is to continue, would the true clinical scientists please stand up! Trevor Sherwin PhD

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