The Balancing Act of Academic Clinical Fellows in UK Emergency Medicine: A Qualitative Study
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Background
Emergency medicine (EM) faces workforce challenges in sustaining clinical academic careers. Academic Clinical Fellowships (ACFs) offer protected research time, but little is known about how EM ACFs experience and navigate these posts.
Methods
Semi-structured interviews with 20 current and former EM ACFs across 12 UK regions. Interviews were analysed using thematic analysis following Braun and Clarke’s six-phase approach. A mixed inductive and deductive framework was applied. Reflexivity and positionality were addressed through multi-researcher coding and consensus development.
Results
Six themes were identified: (1) Elements of surprise — structural ambiguity and unexpected barriers; (2) Unclear direction — limited guidance and inconsistent supervision; (3) Loneliness — professional isolation and detachment from clinical peers; (4) Engagement — enthusiasm linked to research alignment and supervisory support; (5) Repeated generic hurdles — difficulty balancing academic and clinical demands; (6) EM-specific hurdles — reduced exposure to key rotations and limited academic mentorship within EM. Fellows reported uncertainty about training extensions and programme variability.
Conclusions
The EM ACF provides valuable entry into clinical academia but inconsistent structures, supervisory support, and clarity in expectations hinder its potential. Standardised induction, tailored supervision, and flexible but transparent pathways are needed. Findings can inform policy, training programmes, and institutional practices aimed at supporting the next generation of clinical academics in EM in the UK.
Highlights
What is already known on this topic
Academic clinical fellowships (ACF) provide protected research time and are vital for clinical academic careers. However, little is known about how EM ACFs experience these posts.
What this study adds
This study reveals that EM Academic Clinical Fellows (ACFs) face significant challenges including unclear structures, inconsistent supervision, professional isolation, and difficulty balancing clinical and academic demands. EM-specific barriers such as limited mentorship and reduced exposure to key rotations.
How this study might affect research, practice or policy
To support EM clinical academics, there is a need for standardised induction, clear training pathways, consistent supervision, and tailored mentorship. Addressing these issues can improve retention and development of EM academic clinicians, informing policy and training programme improvements.
