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The 5 Most Influential Medical Research Charities in the UK

An unusual characteristic of the UK’s healthcare landscape is that charities fund the vast majority of medical research.  According to the  Association of Medical Research Charities (AMRC) , in 2017, 8 million people donated to medical research charities which funded £1.6bn in research and accounted for 47% of all publicly-funded medical research in the UK.

UK charities income is generated by individual donations, legacies left behind and from the incredibly British model of the charity shop.

Here are 5 of the most influential UK research charities that are doing the most to overcome some of humanities biggest health challenges.

British Heart Foundation

The British Heart Foundation (BHF) pours over £100 million into research each year for heart/circulatory related diseases and their causes and is the largest independent funder of cardiovascular research.

The BHF was founded in 1961 by a group of medical professionals concerned about the increasing death rate from cardiovascular disease. They wanted to fund extra research into the causes, diagnosis, treatment, and prevention of heart and circulatory diseases.

In 2018 BHF received £108.4m in medical research grants, £83.4m left in legacies, £53.0m from public fundraising activities, £27.7m from the 727 BHF shops across the UK and £4.6m in eBay and online sales.

The BHF is currently lead by Simon Gillespie who joined as CEO in April 2013.

Read our 2018 interview with Gillespie.

Cancer Research UK

CRUK supports research into all types of cancer, from understanding the biology and causes of cancer to investigating how to prevent, diagnose and treat the disease. The charity funds over 4,000 scientists, doctors and nurses who are leading the work that has already seen cancer survival rates in the UK double in the last forty years.

CRUK’s ambition is to “accelerate progress and by 2034 see 3 in 4 people surviving cancer.”

In 2017/18, CRUK received £634 million in underlying income of which £423 million was spent on research and £104 million was spent on understanding cancer’s underlying biology. 12,000 patients were also enrolled in clinical trials.

In November 2018 Michell Mitchell OBE became Cancer Research’s first female CEO.

Wellcome Trust

The trust funds a vast array of research areas including: Ageing,  Blood,  Cancer,  Cardiovascular,  Child health,  Congenital disorders,  Ear,  Eye,  End of life care,  Infection,  Inflammatory and immune system,  Injuries and accidents,  Mental health,  Metabolic and endocrine,  Musculoskeletal,  Neurological,  Oral and gastrointestinal,  Renal and urogenital,  Reproductive health and childbirth,  Respiratory,  Skin,  Stroke,  Generic health relevance.

The charity’s main asset was the share capital of Sir Henry’s company, Wellcome Foundation.

In 1986 the Wellcome Foundation was floated on the stock market under a new name: Wellcome plc. The Wellcome Trust sold a quarter of its holdings in the company.

This was followed by a second share sale in 1992. Then, in 1995, the Wellcome Trust sold most of the remaining interest in Wellcome plc to Glaxo plc. This created Glaxo Wellcome plc, which merged with SmithKlineBeecham in 2000 to create GlaxoSmithKline.

By selling the shares, the Wellcome Trust’s assets grew from £3.4bn in 1988 to £15bn in 2000. The Trust’s average annual charitable spend grew from £28m in the 1980s to £650m in 2007.

By September 2016, the Wellcome Trust’s investment portfolio was worth £20.9 billion.

As of 2013, the Trust is directed by Sir Jeremy James Farrar OBE FRCP FRS FMedSci, and Baroness Eliza Manningham-Buller became the chair in 2015.

Versus Arthritis

Their primary research areas are inflammatory, immune system and musculoskeletal disorders. Additional research areas include —  Ageing,  c ardiovascular,  c hild health,  e ye,  m ental health,  r espiratory,  s kin and g eneric health relevance.

According to their 2017 report 400,000 people live with rheumatoid arthritis in the UK and the NHS spends £1.9 billion in hospital costs for hip fracture alone.

In 2017 Versus Arthritis funded £126m in research grants supporting work at more than 70 institutions across the UK.

Liam O’ Toole is Versus Arthritis’ CEO as of November 2009.

Alzheimer’s Research UK

Alzheimer’s Research UK was founded in 1992 as the Alzheimer’s Research Trust. Early work in establishing the charity and bringing in their original trustees and scientists was spearheaded by Dr Sarah-Jane Richards and Barbara Langlois along with Joe Pollock and Dr Martin Weale with support from Kings College London. Shocked by the lack of investment in dementia research, this small team set out to fund the building of a dedicated research centre in Cambridge.

Between September 2017 and March 2018  ARUK received £17.3 million in donations and they committed £15.5 milli0n towards charitable activities of which £13.1 million was put directly into research.

Big on innovation and new tech to tackle Alzheimer’s,  in 2016 ARUK joined forces with Deutsche Telekom to launch  Sea Hero Quest , a smartphone game where two minutes of play equates to five hours of dementia research. This fun game was designed to help researchers learn more about spatial navigation to inform new diagnostic tests for Alzheimer’s. It has now had over 2.7 million players, generating over 9,400 years’ worth of dementia research!

In the same year, ARUK become a founding funder of the  UK Dementia Research Institute , a landmark £250m investment in dementia research.

In December 2018 ARUK announced that they were to receive a government-led boost of up to £79m for research into the early detection of diseases. The programme will bring together the NHS, industry, leading charities including Alzheimer’s Research UK, Cancer Research UK and the British Heart Foundation.

In 2018 we interviewed Hilary Evans, ARUK’s CEO since 2013.

https://pharmaboardroom.com/interviews/interview-aisling-burnand-ceo-association-of-medical-research-chairities-amrc-uk/

Kezia Parkins

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Largest study of UK health research funding released today

1 February 2024

UK health research funding has increased since 2004, reaching £5 billion in 2022 with growth in translational and infection research, but is now plateauing.

A report published today, the UK Health Research Analysis 2022, provides the most detailed overview yet of UK health research funding from 2004 to 2022 from all public sectors, including:

• the governments of the four nations of the UK
• professional bodies

This report is part of a series published every four to five years.

The report was commissioned by the UK Clinical Research Collaboration (UKCRC), a partnership of the main stakeholders that influence clinical research across the business, public and charitable sectors in the UK.

Tracking annual funding

The report found that annual funding had increased overall during this 18 year period, reaching £5 billion in 2022.

Most of this growth was in the first five years covered by the study (2004 to 2009) increasing by only 1.5% annually between 2009 and 2018.

Impact of COVID-19

However, since 2018 this growth has slowed to just 0.2% annually, resulting in a real terms decrease in funding of £110 million between 2018 and 2022.

The report attributes this decrease to both high inflation pressures and a shrinking of the charity sector’s contribution to health research due to the impact of the COVID-19 pandemic on charitable income.

This reduction is offset in part by increased public expenditure driven by the COVID-19 response.

Noteworthy trends

The report also found that funding for research projects over the study period was relatively stable for most areas of health but with some noteworthy trends:

• translational research, in detection and diagnosis, treatment development, and treatment evaluation, received an increasing proportion of total health research spend (up 13.0%, from 22% to 35%) between 2004 and 2022. This resulted in a real term increase of £676 million over 18 years
• prevention research has also received an increased proportion of total health research expenditure (up 4.6%, from 2.5% in 2004 to 7.1% in 2022), meaning a real term increase of £163 million since 2004
• research on discovery science remains strong, accounting for almost half of all funding, but growth in spending has been prioritised to other research activities
• the largest growth has been in infections research (up 6.4%, from 9.0% in 2004 to 15.4% in 2022) as funders sought to address the challenges of antimicrobial resistance, COVID-19 and post-pandemic recovery
• almost a fifth of health funding was spent on cancer research, but this has declined in proportion to overall funding (from 20.3% in 2004 to 16.8% in 2022, down by 2.1% since 2018)

Overview of all public health funding

To produce the report, the authors took an overview of all public funding for health relevant research.

Whether by the government, memberships of societies and professional bodies, or by donation via medical research charities.

The authors then used the Health Research Classification System to identify the main area of health for each research award.

23,500 projects, 173 funding organisations

This system was applied to over 23,500 projects supported by 173 funding organisations, corresponding to just over £5 billion of spend within the UK in 2022.

The analysis showed that of the £5 billion spend:

• £2.8 billion was invested directly on research projects
• £1.4 billion was spent on infrastructure and other indirect support
• £865 million of health-relevant support funding was added from other sources not directly captured in the analysis, such as estimates of university core funding used for biomedical research

The authors then compared the results from 2022 with previous analyses in this report series, in 2004, 2009, 2014 and 2018, to assess how the health research landscape has changed over time.

The UK Health Research Analysis 2022 dataset has been made publicly available so that other funders can perform their own analyses and better support health and biomedical funding in the future.

World-leading research and innovation

Professor Lucy Chappell, Chair of UKCRC, and Chief Scientific Adviser, Department of Health and Social Care, said:

The UK health funding ecosystem successfully brings together government spending with the charity and private sector to drive world-leading discovery research and innovation that is having impact for patients and the public, the NHS, and for the UK life sciences industry. This report shows how the £5 billion annual investment made by public and charitable funders is being spent, including substantial growth in patient-focussed research. We have seen this ecosystem discover and deliver new technologies for early detection and diagnosis alongside new treatments and vaccines for prevention. This was only possible through sustained investment over many decades in discovery science and our translational infrastructure. The health funders across the public, charity and private sectors will continue to work together closely to address the current and future health challenges. UK health research is world-class; we should continue to see increasing research and development funding in order to drive health and economic impact.

Joined-up landscape

Professor Patrick Chinnery, Executive Chair, Medical Research Council (MRC), said:

The MRC is proud to have produced this report on behalf of the UKCRC in collaboration with other funders. The combined analysis shows the UK’s major commitment to health research through a joined-up landscape from basic discovery to clinical translation.

Top image:  Credit: mkurtbas, iStock, Getty Images Plus via Getty Images

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• Health and social care

UK’s next generation of medical researchers given funding boost

Investment is aimed at sparking a new wave of revolutionary medical research across the industry.

• £50 million given to 90 charities to fund revolutionary new medical research into diseases such as cancer, dementia and motor neurone disease.
• Over 1,200 early career researchers set to benefit from the funding, sustaining the future of the medical research industry.
• Funding backs PM’s priorities to support the NHS, provide improved treatments and cut waiting lists.

Over 1,200 researchers in medical research charities will receive over £50 million in funding to help solve some of the biggest global health challenges and secure the future of the UK’s world-class life sciences sector.

Announced by Science Minister George Freeman today (Sunday 2 April), the funding will support researchers across 90 charities early on in their careers at a time when the UK is committing record amounts to R&D, reaching £20 billion a year by 2024/25. The £50 million investment is aimed at sparking a new wave of revolutionary medical research across the industry, including in dementia, motor neurone disease and brain tumour research.

Science, Innovation and Technology Secretary Michelle Donelan said:

The next generation of researchers are the key to solving the greatest medical challenges of our times, tackling hundreds of different diseases and conditions, preventing illnesses and developing lifechanging therapies. By investing in those very people that make up our world-class medical research community, we hope to inspire a new wave of budding researchers that can continue to improve the lives of those affected by these diseases across the UK.

Ninety charities across the UK have received the funding, ranging from larger household names to smaller charities working on rarer diseases such as cystic fibrosis or conditions such as epilepsy. Regional charities operating across the UK such as the Yorkshire Cancer Research and Wessex Medical Trust are included, alongside charities in Scotland, Wales and Northern Ireland.

Over £2.8 million will be delivered to dementia charities, such as the Alzheimer’s Society, supporting early career researchers to defeat dementia by researching the causes, cure, care, and prevention of the disease. 

Over £1.3 million will also be delivered to brain tumour charities and over £1.7 million to motor neurone disease charities, two causes that are close to the hearts of many affected by it through their own experiences or that of friends and family across the UK.

Other examples of charities receiving funding include:

• Epilepsy Research UK
• North West Cancer Research
• Medical Research Scotland
• Wellbeing of Women
• Leukaemia & Lymphoma NI

Minister of State for Science, Research & Innovation George Freeman said:

Medical research charities from Cancer Research UK to the thousands of smaller specialist charities like Cure Leukamia , the Cystic Fibrosis Trust and the MND Association are the jewels in the crown of UK Medical Research and patient access to medical breakthroughs. Medical charity fundraising collapsed in the pandemic. That’s why we’re extending our pandemic relief with this £50m Government funding to help 90 medical research charities support over 1,000 early career researchers.

Minister of State for Health Will Quince said:

We’re cementing our position as a global leader in life sciences by investing in the next generation of medical researchers to cultivate and harness the innovation of young, pioneering minds and secure the future of our healthcare. This is yet another example of how we’re leading the way to support research into conditions like dementia and helping accelerate the delivery of cutting-edge medical advancements and bolstering patient care through faster and more accurate diagnoses.

First introduced in 2021 to provide economic security to medical research charities in the wake of the COVID pandemic, the Medical Research Charities Early Career Researchers Support Fund is helping to attract, retain, and develop the most talented and diverse researchers into these roles so that the budding world-class researchers of tomorrow are persuaded to work, remain, and develop within the UK, underpinning the Government’s plans to make the UK into a science and technology superpower.

Early career researchers are the lifeblood of the UK’s medical research community, serving as the future of life sciences research which aims to tackle hundreds of different diseases and conditions, seeking to prevent illness, develop therapies and generally improve public health.

In the Science and Technology Framework published in March, the newly formed Department for Science, Innovation and Technology identified boosting public investment into research and development as a key target for government, seeking to foster new economic growth and better productivity across the industry.

The Medical Research Charities Early Career Researchers Support Fund (2022-23) is administered by the Medical Research Council (MRC) and UK Research and Innovation (UKRI) with the help of the Association of Medical Research Charities and is made up of £45m funding from Department for Science, Innovation and Technology alongside £5m from the Department for Health and Social Care.

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Cancer Research UK is first Founding Charity Member of Our Future Health

Founding charity member

Cancer Research UK is one of the leading health research charities who are providing valuable support to help develop Our Future Health. They were previously an affiliate charity of Our Future Health and have been contributing to Our Future Health since its launch. With their new Founding Charity Membership, Cancer Research UK will play a bigger role in the programme, including sitting on our Founders Board , a crucial part of our governance that brings together the charity and industry partners who are co-funding the programme.

The Founding Charity Members will work collaboratively, sharing knowledge, expertise and resources to accelerate progress in improving health outcomes for the entire UK population, including under-served communities who historically have not been well represented in research programmes of this nature. Working together we will strategically reach and engage scientific and clinical communities, along with cancer patients and the wider public, to contribute to the scientific vision of the programme and to maximise the use of Our Future Health.

Dr Raghib Ali, Chief Executive and Chief Medical Officer of Our Future Health, said, “We’re delighted that Cancer Research UK has signed as our first Founding Charity Member. They have provided us with a significant amount of support since the inception of our programme and their new role within our programme provides us both with an exciting opportunity to work together to make discoveries that can prevent, detect and treat cancer.” 

David Crosby, Head of Prevention and Early Detection Research at Cancer Research UK, said, “This partnership has the potential to unlock new discoveries through research and it’s a step forward to identify more equitable ways of cancer prevention and detection.”

There are around 375,000 new cancer cases in the UK every year, which is around 1,000 every day. 38% of cancer cases in the UK are preventable. Cancer Research UK is the largest fundraising medical research charity in the world, funding almost 50% of all non-commercial cancer research in the UK, primarily through public donations. They support researchers across the UK in their institutes and centres, as well as through response mode grants through their funding Committees.

Read more about  our partnerships . 

Association of Medical Research Charities

Feb 23, 2022 | Medical & Health Sciences

When we last spoke to AMRC in 2019 and since then, the arrival of COVID-19 changed the world as we knew it. What has been the impact of the pandemic on medical research charities and how have they fared?

Since the pandemic started, medical research charities have lost at least £292 million in income, forcing them to cut £270 million of their research spend . This is the first substantial decrease in fundraising charity research spend in the last decade, a drop that is over seven times greater than the drop after the 2008 recession.

To honour existing research commitments many charities had to dig into precious reserves, adapt their fundraising activities, make redundancies, and cut funding for other activities. Our charities plan to cut their research spend by over £148 million over the next year and expect it to take three years for their research spend to return to normal levels.

With these funding uncertainties, the UK risks losing a generation of talented young scientists, potential future research leaders. In an AMRC survey, 40% of charity-funded early-career scientists indicated that they were considering leaving research . This would have a severe impact on decades of research crucial to finding new ways to diagnose, manage and treat diseases.

At the height of the pandemic, 70% of trials conducted in the NHS funded by AMRC members were on hold. That figure is now coming down but, despite best efforts, non-COVID research trials are struggling to recruit patients. In April 2019, about 200,000 people were recruited to trials. This April, the figure for non-COVID research was half that. The pandemic also forced charities to invest additional funding into ongoing trials to keep them going, funding that may have otherwise been used to start new clinical trials.

Despite these hardships, the sector stepped up to support the national research effort; providing a skilled workforce, infrastructure and support for testing and vaccine development, and they pivoted to fund new COVID-19 research. Cancer Research UK donated equipment and reagents to national COVID-19 testing and have set up their own testing hubs and the Asthma UK and British Lung Foundation Partnership co-funded a £1.3 million national research programme to evaluate coronavirus tests in hospitals, general practices and care homes and launched a post-COVID Hub and helpline for people left with breathing difficulties after COVID-19.

Between June 2020 and May 2021, AMRC and over 150 of our charities campaigned for Government to provide financial support to protect charity-funded research at risk. Over 105 MPs and Peers supported our call, 7,000 letters were sent to the Prime Minister from the public, and the campaign featured in over 150 news pieces. We raised awareness of the breadth of research that charities support and highlighted the vital role they play in the ecosystem. Finally, in May this year, Government announced a £20 million allocation for early-career researchers supported by charities. We’re keen to keep working with the government to make sure they understand the value of medical research charities and ideally to encourage them to continue to support and collaborate with them.

As new CEO, what are your next steps for the sector?

AMRC does such important work to support medical research charities and so I feel incredibly honoured to take on this role. At a difficult time for the sector, I am lucky to be able to build on the fantastic legacy of Aisling Burnand’s leadership over the past seven years.

Throughout the next few months, I will be meeting with all 151 member charity CEOs to hear what matters most to our charities and how we can continue to improve our services.

We have three priorities as an organisation, moving forward. The first is t o provide our charities with the evidence and narrative to champion their vital role in the UK life sciences ecosystem. While we’ve done a lot over the last few years to advocate for medical research charities, our recent engagement with Government demonstrates that we still have a job to do to explain why medical research charities are so important.

I am also keen to make sure we are supporting our charities to collaborate effectively. The pandemic has demonstrated the power of partnerships; we need to do more to help AMRC charities identify potential partners and highlight opportunities to connect and collaborate.

The research landscape is changing and there is, rightly, increasing emphasis on the culture of research. We want to help you consider what those changes mean for charities, and to think about how we can support our charities to be responsible funders in a rapidly changing environment. We have already launched our Equity, Diversity and Inclusion Resource Hub , but we are looking at what else we can do to help share best practice.

I’m really excited to start working on these priorities with the amazing AMRC team.

Can you tell us about your 2020–2025 Strategic Plan?

In the run up to 2020, it was clear there were challenging times ahead: unprecedented political instability, economic uncertainty and an increasingly polarised society created a difficult environment for charities and the communities they represent. However, there were also new opportunities and hope to improve the life and experience of patients.

To assist with the development of our 2020–25 Strategic plan , we undertook a survey of our members. The survey highlighted that securing income had overtaken demonstrating impact as the most significant challenge for member charities. It gave a clear indication that making medical research funding more accessible to charities and research and innovation in the NHS should be higher priority focus areas.

With these insights in mind, we brought together a framework for our work and activity, setting out five overarching priorities:

• To champion the unique voice of the medical research charity sector by informing and educating internal and external stakeholders across the changing life sciences and digital health landscape.
• To influence the research and health funding landscape to ensure that medical research charities investment is leveraged efficiently for patient impact.
• To foster and enable better collaboration to address the needs of patients by working with industry, academia, NHS, regulators, our members, and other stakeholders.
• To maximise the potential for research and innovation in the NHS to ensure the investment from medical research charities has the greatest impact for patients.
• To drive forward the quality and future-focused membership offering which addresses changing needs and enhances AMRC’s delivery capability.

Why are medical research charities so important to the UK?

There’s this view of medical research charities as fluffy things doing good, whereas they’re actually an integral contributor to the UK’s life sciences: responding to the public’s priorities, tackling areas of unmet need, and accelerating health impact.

Responding to the public’s priorities

Charity research is shaped by the public’s priorities. Over 83% of AMRC charities are using patient voice in their research strategy or influencing work. This ensures funding is directed where it will make the most difference and lead to more efficient products and interventions that help prevent, diagnose, treat, cure, and improve quality of life for people. AMRC charities contribute to a quarter of medical products, interventions and clinical trials reported by public funders on the research evaluation platform Researchfish.

Areas of charity research are chosen by the fundraising public, identifying diseases that matter to them. AMRC charities account for 66% of public investment into cancer and cardiovascular research.

Tackling areas of unmet need

Charities invest in underfunded conditions, including rare diseases. 67 AMRC charities fund research on rare diseases, and 27 exclusively fund research into a rare disease.

Medical research charities also support research in common conditions where there is low investment, for example over a quarter of public funding into mental health research is provided by AMRC charities.

Charities are also helping to address geographical health inequalities, by funding research and creating infrastructure and networks that benefit people and institutions throughout the UK.

Accelerating health impact

Medical research charities’ sole purpose is to improve human health, not to make profits or cut costs. They help to convene and attract the necessary funders to move promising research forward and deliver benefits to patients sooner. AMRC charities account for a quarter of new collaborations and partnerships in the UK that have been reported by public funders on the research evaluation platform Researchfish. They have also leveraged more than £7 billion in further funding for UK research during the last 20 years.

Charities use their research to advise and shape policy and practice, helping to advance healthcare. They provide expert advice to Government committees, citations in clinical guidelines, and influence the training of health professionals, ensuring that decisions that impact patients are based on evidence. Over the past two decades, 10,000+ grants from 49 charities have led to 4,000+ unique influences on policy and practice that help advance healthcare.

What challenges and opportunities do you see on the horizon for medical research charities?

As a result of the pandemic, medical research has never been more visible, across government, the NHS, and the public. We need to build on that, to ensure continued investment in medical research, and to learn the lessons from the pandemic, including removing unnecessary bureaucracy, fostering collaborations, and engaging patients and NHS staff in the importance of research. Recent government reviews – the Spending Review settlement, the Life Sciences Vision, the Clinical Research Vision – are all moving in the right direction, and we hope there will be opportunities for partnerships with charities, but we need to see the detail of implementation plans.

At the moment, there is increasing focus on the sustainability of universities, and revisiting discussions about full economic costing. The partnership between government, charities and universities is very important for us, but there have been tensions about the current model of government support for charity-funded research in universities – the Charity Research Support Fund (CRSF). There are concerns that the size of the CRSF has not kept up with charity investment. This will be a key priority for us – we have just published a report exploring alternative models. We recognise there will be no easy answers but look forward to the start of a conversation between universities, government, and charities to find a sustainable approach.

While the pandemic has demonstrated the importance of research, there are still real challenges with capacity in the NHS workforce and dealing with the ongoing backlog from COVID-19. The Health and Social Care Bill currently passing through parliament provides an opportunity to mandate the need for research for Integrated Care Systems, but unfortunately, the amendment was not adopted at Committee stage. We hope there will be further discussions as the Bill passes through the Lords.

The UK-EU agreement reached Christmas 2020 left several issues unresolved. It is essential that charity-funded researchers in the UK can continue to collaborate with European colleagues. The uncertainty over association with Horizon Europe is a concern but the government announcement to provide a short-term scheme to cover the first wave of grant calls is a step in the right direction. The UK must also continue to attract talented science and research professionals. Unfortunately, the fast-track visa scheme to attract prize-winning scientists to the UK has received no applications over the last six months.

It’s also important to remember that amongst the challenges there are also opportunities, with proposed revisions both to clinical trials regulations and data protection. However, this needs to be done with care to make sure we don’t lose the potential for collaboration and data adequacy.

A positive new relationship between the UK and EU that benefits patients depends on resolving the outstanding problems. As a member of the Brexit Health Alliance and on behalf of our charities, we will continue to call on the government and EU to take steps to safeguard the interests of patients, and the healthcare and research they rely on.

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• Fixing lung health in the UK: accelerating respiratory research and innovation
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• Cheryl Routley 1 ,
• http://orcid.org/0000-0001-5503-8258 Samantha Walker 1 ,
• Eric WFW Alton 2 ,
• http://orcid.org/0000-0001-9933-3216 Ian P Hall 3
• 1 Research and Innovation , Asthma + Lung UK , London , UK
• 2 National Heart and Lung Institute , Imperial College London , London , UK
• 3 Queen's Medical Centre , Nottingham , UK
• Correspondence to Dr Samantha Walker, Research and Innovation, Asthma + Lung UK, London, UK; swalker{at}asthmaandlung.org.uk

https://doi.org/10.1136/thorax-2024-221939

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• cystic fibrosis
• pulmonary disease, chronic obstructive
• interstitial fibrosis
• bronchiectasis
• idiopathic pulmonary fibrosis
• respiratory infection
• respiratory measurement

Introduction

Lung conditions are the third biggest killer in the UK 1 and poor lung health costs the UK £188 billion every year. 2 Involvement in clinical translational research improves clinical outcomes. 3 4 However, while respiratory health was identified as a government priority in the Life Science Vision missions in 2021, 5 it has not yet received any additional funding. Given the acknowledged respiratory research strength of the UK, it’s therefore surprising that only 2.5% 6 of public investment is spent on researching lung conditions that would help diagnose, treat and manage them much more effectively.

Lung Research and Innovation Group’s 10 priorities for respiratory research …

X @samtwick

Contributors Contributors IH, EA, CR and SW all contributed to writing the article. SW is the guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests Eric Alton Royalties or licenses: Royalties from Boehringer Ingelheim related to cystic fibrosis gene therapy programme. Consulting fees: Boehringer Ingelheim - payments made to EA and institution; AlveoGene - payments made to EA. Patents planned, issued or pending: multiple patents filed by Imperial College. Participation on a Data Safety Monitoring Board or Advisory Board: Boehringer Ingelheim Advisory Board - payments made to EA Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid. Founder Director, AlveoGeneStock or stock options AlveoGene shares - payments to EA. Sam Walker Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid co-Chair of Lung Research and Innovation Group (LRIG). Ian Hall: Grants or contracts from any entity. NIHR Senior Investigator Award - research grant to institution. Support for attending meetings and/or travel. Travel to AUKCAR meeting in Reading, 2024 - Expenses covered by Asthma+Lung UK Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid co-Chair of Lung Research and Innovation Group (LRIG).

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Parkinson’s UK supports active living with enhanced Physical Activity Grants in 2024

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Parkinson’s UK is offering its popular Physical Activity Grants programme to help more people living with Parkinson’s get active in 2024.

Image Credit: Parkinson’s UK

Now into its fourth year, the charity’s Physical Activity Grants programme opened in June for physical activity providers, leisure groups, sports clubs, national governing bodies, Parkinson’s groups and many more across the UK to apply.  

The grants are now open for their second round of funding and providers from across the UK are still being invited to apply for a grant. Since the grants scheme started in 2021, Parkinson’s UK has awarded more than £426,000 to 192 physical activity projects across the UK.  

Physical activity initiatives ranging from wheelchair rugby to table tennis and from walking football to hydrotherapy, among many more, have all supported people living with Parkinson’s to get active and live well with the condition. 

Being active with Parkinson’s can have many benefits including better balance, strength and coordination, as well as improving mental health and sleep. Physical activity can also help people living with the condition to socialize and reduce feelings of isolation.

We are delighted to be delivering our Physical Activity Grants programme for the fourth successive year and we hope to be able to help even more people living with Parkinson’s to enjoy an active lifestyle with the condition. Whether you are part of a national sports association, you work with a local exercise group, or you are passionate about getting people active then why not apply for the grants in 2024. There are more than 40 symptoms associated with Parkinson’s and being active can be one of the best ways for a person to manage their condition, plus it’s good fun too. We are looking forward to continuing funding more innovative active projects in 2024.”     Roma Hashim, Physical Activity Grants Manager for Parkinson’s UK

The 2024 grants will only be available for a limited time and will close as soon as the funding has been allocated. Applications can be made for amounts ranging from £500 up to £3,000 and we encourage anyone who is interested in applying to submit their applications promptly and with as much detail as possible.

Posted in: Medical Condition News | Healthcare News

Tags: Charity , Exercise , Hydrotherapy , Mental Health , Physical Activity , Sleep , Tennis , Walking , Wheelchair

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• Published: 29 July 2024

Medical school origins of award-winning pathologists; analysis of a complete national dataset

• Sinclair Steele 1 ,
• Gabriel Andrade 1 ,
• Marwah Abdulkader 2 &
• Yehia Mohamed 1 , 3  

BMC Medical Education volume  24 , Article number:  814 ( 2024 ) Cite this article

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Metrics details

The ultimate aim of medical education is to produce successful practitioners, which is a goal that educators, students and stakeholders support. These groups consider success to comprise optimum patient care with consequently positive career progression. Accordingly, identification of the common educational features of such high-achieving doctors will facilitate the generation of clinical excellence amongst future medical trainees. In our study we source data from British clinical merit award schemes and subsequently identify the medical school origins of pathologists who have achieved at least national distinction.

Britain operates Distinction Award/Clinical Excellence Award schemes which honour National Health Service doctors in Scotland, Wales and England who are identified as high achievers. This quantitative observational study used these awards as an outcome measure in an analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson’s Chi-Square test was applied.

The top five medical schools (London university medical schools, Aberdeen, Edinburgh, Oxford and Cambridge) were responsible for 60.4% of the pathologist award-winners, despite the dataset representing 85 medical schools. 96.4% of the pathologist merit award-winners were from European medical schools. 9.0% of the pathologist award-winners were international medical graduates in comparison with 11.4% of all 901 award-winners being international medical graduates.

Conclusions

The majority of pathologists who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national award-winners; the largest number of international medical graduates were in these tier 3 awards (13.9%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting pathologist and non-pathologist medical education pathways that are more likely to fulfil their career ambitions.

Peer Review reports

To individuals outside the profession, the word ‘pathologist’ conjures up images of doctors performing autopsies on deceased patients [ 1 ] in an attempt to discern the cause of death. In reality, this is only a small part (approximately 5%) of the routine work of most pathologists. The vast majority of a pathologist’s time is spent in diagnostic endeavours. For example, examining tissue samples to diagnose or manage cancer, reviewing cervical Pap (Papanicolaou) smears, rapid examination of surgical specimens and presenting pathological information at multidisciplinary team meetings are more reflective of pathologists’ activities. This technical discipline is scientifically demanding and requires a foundation in training that commences in undergraduate medical degrees. Furthermore, it has historically been accepted as a truism in medical training as the science of disease that underpins the majority of subsequent clinical disciplines. In fact, in the UK the Royal College of Pathologists refers to pathology as the “ science behind the cure .” Students or trainee doctors that are interested in being well-trained doctors or wish to become pathologists often seek out medical schools/colleges that have robust embedded pathology training. One measure of the effectiveness of the pathology training is the production of successful clinical pathologists. Accordingly, our project examines the educational backgrounds of successful clinical pathologists.

Historically, in Britain there have been two clinical merit award schemes established to reward successful clinicians employed in the National Health Service (NHS):

The Clinical Excellence Awards (CEA) scheme, covering Wales and England [ 2 ].

The Distinction Awards (DA) scheme, covering Scotland [ 2 ].

The schemes are similar in aims and organization; both offer tiers of local and national awards to high-achieving doctors. However, the CEA scheme is currently being restructured, renamed and re-established as the National Clinical Impact Awards (NCIA), whilst the DA scheme remains in place in Scotland. The doctors receiving such awards gain benefits not only from the effects of these honours on their reputations and career progressions but also from the recurring financial rewards accompanying such accolades [ 2 ].

These UK national award schemes were envisioned and implemented after World War II for the pragmatic purpose of motivating senior clinicians to support the newly-created NHS. Since their inception, these schemes and their implementation have been the cause of vigorous debate in the UK medical community. As a result, these clinical merit awards have been evaluated and discussed from the perspective of award objectivity [ 3 ], specialty distribution [ 4 ], regional distribution [ 4 ], gender parity [ 2 ], age distribution [ 5 ] and ethnicity/racial distribution [ 6 ] but, until our research series, not by medical school of origin . These constructive criticisms have resulted in iterative revisions of these award schemes over the previous three decades. Many medical commentators agree that there should be a system to reward high-achieving clinicians [ 7 ] and the CEA/DA/NCIA merit awards are seen as national recognition of clinical career success - accounting for their continuing value, greater than 70 years after their inception. This original innovative research study is part of a series that contributes to the medical education discussion by relating the pathologist and non-pathologist merit award-winners to their medical schools of origin . We place our findings in the contexts of educational, career and global implications for ambitious prospective medical students, undergraduate medical students and doctors aspiring to attain career success [ 8 , 9 ].

The lists of pathologist award-winners and non-pathologist award-winners were retrieved from the source material of the DA annual report (Scotland) for 2019–2020 [ 10 ] together with the CEA annual report (England and Wales) [ 11 ] for the 2019–2020 awards round. These lists were summations of both the newly selected awardees and the previous award-winners who had retained their awards. The medical schools of origin were identified by using the published Medical Register, UK [ 12 ] as well as the published Dental Register, UK [ 13 , 14 , 15 ].The total number of award-winners was 901 - the university medical schools of origin were successfully identified for 99.8% of these clinicians [ 14 , 15 ]. Accordingly, 899 doctors were included in the analyzed dataset. Award-winning doctors in the publications above, who were designated as specializing in the core pathological disciplines, were included in this study [ 14 , 15 ]. In the 2019-20 award round the following specialties were included: (general) pathology/forensic pathology and histopathology [ 14 , 15 ].

The rankings of medical schools by number of merit award-winning alumni were determined by summation of the number of pathologist award-winners of A plus (A + ), A or B grade (or platinum, gold, silver or bronze award-winners) [ 14 , 15 ]. Only these national level Clinical Excellence Awards and Distinction Awards were included in this study [ 14 , 15 ]. Combining these parallel and similar award gradings, permitted all of Britain’s (England, Wales and Scotland) excellence award-winners to be analyzed together [ 14 , 15 ]. As part of our analysis of the grades of awards we collated the award categories to explicitly show the three tiers of national merit awards; A plus and platinum award-winners were combined to yield the top tier (tier 1) of national pathologist awards [ 14 , 15 ]. The A and gold awards were combined to create the intermediate tier (tier 2) of national pathologist awards [ 14 , 15 ]. Finally, the B and silver/bronze awards were combined to create the lowest tier (tier 3) of national pathologist merit awards [ 14 , 15 ]. The same approach was taken with the non-pathologist data [ 14 , 15 ].

The rankings of the medical schools by the number of merit award-winning alumni were approximately size corrected by dividing the total number of award-winners that were alumni of the medical school by the number of admissions to the undergraduate medical school in the 2019-20 academic year [ 14 , 15 ]. We used this pragmatic approach to estimate the size correction rather than the more ideal but inaccessible integral of medical school graduation numbers against time for approximately the last 50 years [ 14 , 15 ]. The comparison of the distributions of award-winners (pathologist merit award-winners versus non-pathologist merit award-winners) was quantified using Pearson’s Chi-Square test with the significance level set to p  < 0.05 [ 14 , 15 ].

On the basis of the frequency of award holders in the 2019-20 round, the top 20 medical schools were selected. For those 20 medical schools, a Pearson’s coefficient was calculated to determine the correlation between the age of the medical school by establishment date and the number of award-winners corrected by size (award- winners/number of admissions 2019-20).

All procedures were performed in compliance with the pertinent guidelines [ 14 , 15 ].

Patients and public involvement; no patient involvement [ 14 , 15 ]. The methods that were applied in our study, and that cover the description in this methods section, were similar to and closely derived from earlier publications in this series, which we cite here [ 14 , 15 ].

The 55 core pathologists indicated in the 2019-20 award round represent not only the new award holders but also the cumulative total of all pathologist award-winners in that year together with all previous years, at the time of publication. The largest category was designated (general) pathologists amounting to 70.9% of all the merit award-winning pathologists.

Table  1 shows the ten medical schools that attained the largest number of alumni merit award-winners; these award-winners possessed platinum, gold, silver, bronze, A plus, A or B awards. More importantly, Table  1 compares the originating medical schools of the pathologist and non-pathologist merit award-winners for the ten medical schools with the largest numbers of award-winners; the table contrasts the numbers and percentages of pathologist award-winners and non-pathologist award-winners which the graduates of each medical school attained. Pearson’s Chi-Square test demonstrated a statistically significant difference between the distributions of the medical schools of origin for pathologist merit award-winners versus the non-pathologist merit award-winners, p  < 0.01 ( p  = 0.005, Chi-Square 12.91). Graduates of London university medical schools, Aberdeen, Edinburgh, Oxford and Cambridge medical schools accounted for 60.4% of pathologist award-winners. In comparison, 53.3% of the non-pathologist merit award-winners were graduates of five British medical schools: Aberdeen, Edinburgh, Glasgow, London university medical schools and Oxford.

Table  2 displays the effect of the approximate medical school size correction on the ranking of the medical schools by number of alumni award-winners. London’s number one ranking (pathologists) before size correction dropped to a number seven ranking after size correction. Similarly, London’s number one ranking (non-pathologists) before size correction became a number seven ranking after size correction.

Our analysis included a comparison of the pathologist A plus/platinum award-winners (designated tier 1) with A/gold award-winners (designated tier 2) and B/silver/bronze award-winners (designated tier 3). The tier 1 pathologist award-winners came from 6 medical schools: Belfast, Edinburgh, London, Oxford, Sheffield and Southampton. The tier 2 pathologist award-winners came from 8 medical schools: Aberdeen, Belfast, Birmingham, Dublin, Edinburgh, Glasgow, Ireland (Royal College of Surgeons) and Oxford. The tier 3 pathologist award-winners originated from 17 medical schools: Aberdeen, Birmingham, Bologna, Cambridge, Edinburgh, Glasgow, Goethe, Ireland, Leeds, London, Manchester, Mysore, Nottingham, Osmania, Oxford, Sheffield and Tirana.

Table  3 contrasts the continental locations of the originating medical schools for pathologist and non-pathologist merit award-winners; for the ten medical schools with the greatest numbers of award-winners. 96.4% of pathologist merit award-winners were from European medical schools, in comparison 91.4% of the non-pathologist award-winners were from European medical schools. Pearson’s Chi-Square test indicated that there was not a statistically significant difference between the continental locations of the originating medical schools for pathologists and non-pathologist merit award-winners, p  > 0.05.

After evaluating the top 20 university medical schools (arranged on the basis of award-winners’ frequencies), a moderate and positive correlation was found between the age of the medical school by establishment date and the number of award-winners corrected by size (number of admissions), r [ 18 ] = 0.47, p  = 0.04.

11.4% of all the merit award-winners were international medical graduates (IMGs) - meaning that they were not graduates of UK or Irish medical schools. 9% of the pathologist award-winners were IMGs. The pathologist tier 3 award-winners included the greatest proportion of IMG award-winners at 13.9%.

Pathologist merit awards and UK medical schools

Our study is part of the first series to comprehensively analyze British clinical merit award-winners’ medical schools of origin. This project identifies medical schools that have facilitated the successful medical education of pathologists by using the outcome measure of clinical merit award-winning. As a result, the data and analysis we provide will be of significance to local potential medical students as well as current and future graduates of International Medical Programs [ 16 ]. Our series of studies are the first to rank medical schools by the number of merit award-winners originating from each school, and accordingly will provide a new comparative perspective for medical educators.

The UK has long been known to attract international medical graduates to practise medicine. This was further confirmed and quantified in the General Medical Council 2019 workforce study that stated “For the first time, more non-UK medical graduates took up a licence to practise than UK medical graduates.“ [ 17 ] As a result of such workforce migrations, the scope of possible medical schools of origin of merit award-winners has essentially become global. Specifically, our database of merit award-winners covering the 2019-20 round has 85 different medical schools represented. This study shows that after being chosen by a “transparent and defensible” assessing and scoring arrangement [ 18 ] 60.4% of the pathologist award-winners received their undergraduate training at one of only five UK medical schools (Table  1 ). These were London university medical schools, Aberdeen, Edinburgh, Oxford and Cambridge. A similar pattern of concentration occurred amongst the non-pathologist merit award-winners; 53.3% of these were graduates of Aberdeen, Edinburgh, Glasgow, London university medical schools and Oxford. The observation that there is a similar concentration of award-winners amongst graduates of similar medical schools, for both the pathologists and non-pathologists, implies that there may be common underlying non-specialty specific factors which account for the success of these doctors. The quality of undergraduate medical education may well be such a factor.

A Pearson’s Chi-Square test showed a statistically significant difference between the distributions of the medical schools of origin for pathologist merit award holders versus the non-pathologist merit award holders ( p  = 0.005, Chi-Square 12.91). Specifically, the successful pathologists were 2.6 times more likely to be graduates of Oxford or Cambridge university medical schools than non-pathologists. Considering the data presented in Tables  1 and 2 (whether or not a size correction is applied) the top four medical schools of origin of the pathologists include Oxford and Cambridge, so in this instance the prestige and good quality of medical education would seem to coincide in these universities [ 19 ]. Interestingly and in contrast, the high rankings of Glasgow and Aberdeen medical schools amongst non-pathologist merit award holders implies that a prestigious medical school alone is not as dominant a factor in the successful career development of non-pathologists. Based on our data, a strong local or international student candidate applying to medical school who has a desire to specialize as pathologist could be advised to favour Oxford, Edinburgh and Cambridge medical schools, whereas a less strong student applicant who definitely did not want to specialize as pathologist might be wiser to prioritize Glasgow medical school. A student who was not sure whether a pathologist or non-pathologist career pathway was preferable might consider Aberdeen medical school. Thus, the rankings of medical schools that we produced in this study provide data which future prospective medical students can use to select medical schools appropriate for their ambitions. Students generally make rational decisions in the field of education [ 20 , 21 ] and ranking information of this type is particularly important to an educational pathway as complex and tortuous as attempting to train to be a doctor in a particular specialty. Recent studies have demonstrated that the differences between medical schools tend to remain stable over time [ 22 ], so the guidance offered here will have valuable longevity.

Our observations regarding the concentration of award-winning pathologists and non-pathologists within a comparatively small number of UK medical schools led to an examination of the role of medical school size on our award rankings. Specifically, after aggregation of the number of annual graduates, London medical schools effectively become one of the largest medical schools in Europe. Thus, as a percentage, London university medical schools’ alumni are likely to be well represented in any essentially Eurocentric medical award schemes. In order to investigate this consideration, we carried out an approximate size correction on the medical school rankings by number of award-holders, as indicated and discussed in the Methods above, using the 2019-20 university medical school admission numbers. After applying this approach to the pathologist award-winners rankings, the combined London university medical schools fell from the number one position prior to the estimated size correction to seventh position after size correction. A similar and parallel effect was noted when the size correction estimate was applied to the non-pathologist award-holder rankings; here combined London university medical schools fell from first to seventh in the rankings. Obviously, medical school size has an effect on the medical school ranking. However, it is unlikely that size alone accounts for the concentration award-holders in a small number of medical schools; factors related to the quality of the undergraduate medical training are entirely consistent with our findings.

Pathologist merit awards and international medical schools

In view of the tendency of medical trainees and students to travel internationally in this era of globalization [ 23 , 24 ] we also evaluated the originating medical schools of the award-winners by continent of location. Table  3 depicts the comparison of the originating medical schools for pathologist and non-pathologist merit award-winners. 96.4% of the pathologist award-winners originated from European medical schools whereas 91.4% of the non-pathologist award-winners were originally trained in European medical schools. Statistically, there was no significant difference between the continental locations of the originating medical schools for the pathologists and non-pathologists, in terms of their distributions, p  > 0.05 (Chi-square test).

This study demonstrates a greater diversity of medical school origins among the lowest tier of merit award-winners than the highest tier of merit award-winners. Specifically, pathologists with tier 1 awards came from 6 medical schools representing one continent whereas tier 2 award-winners came from 9 medical schools representing one continent. In contrast, the tier 3 award-winners originated from 17 medical schools representing two continents. These findings would seem to indicate a trend towards greater globalization and inclusivity effects in the lower tier merit awards. The finding that the largest concentration of IMGs, 13.9%, was found among the lowest tier of award-holders also supports this observation. The larger number of lower tier awards and the shorter time required to achieve these lower grade awards than the higher tier awards, would understandably reveal such demographic trends more readily amongst the lower grade merit awards. Future longitudinal analyses of merit award-holders would be important in accurately determining whether this diversity trend progresses into the higher tier and more prestigious clinical merit awards.

Merit awards; undergraduate and postgraduate training of pathologists and non-pathologists

This research project is unique in investigating the relationship between national award-winning pathologists and their originating medical schools. Specifically, little peer reviewed work has been published that investigates the effectiveness of each medical school in training their students and relates this to the future postgraduate success of each medical school’s alumni. We were only able to identify three authoritative studies [ 22 , 25 , 26 ]. The MedDifs study by McManus et al. [ 22 ] was the most comprehensive and included some components that were comparable to our study. The MedDifs study involved examining UK medical school performances using 50 different criteria that were either quantitative or qualitative in nature. These criteria were grouped into categories [ 22 ]:

Selection of applicants.

Student satisfaction.

Curricular influences.

Fitness to practise.

Choice of training specialty.

Postgraduate examination performance.

Foundation entry scores.

Perception of Foundation Year 1.

Teaching/learning and assessment.

Institutional history.

In comparing our study to the MedDifs study, we were obviously more limited in the number of factors pertinent to medical education that we considered and we followed a purely quantitative approach to the research. Unsurprisingly, McManus et al. were able to correlate their range of factors and reveal educational relationships. For example:

Medical schools that focused on Problem Based Learning tended to produce doctors that scored lower in postgraduate exams.

Doctors from the bigger medical schools tended to score worse in postgraduate exams.

Medical schools that focused on self-regulated learning produced doctors that tended to perform better in postgraduate exams.

Both their study and ours shared the limitation of not being able to assess and compare medical school courses in undergraduate medical degrees. Furthermore, the MedDifs project was much more limited in its ability to identify causal relationships between its investigated educational factors.

In order to investigate the possible causalities in our presented medical school rankings for pathologist, non-pathologist and all merit award-winners (Table  1 ), we reviewed the histories of the UK medical schools [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. We noted that all seven of the oldest medical schools in the UK, measured by establishment date, were present in our top 10 medical school rankings by award-winners for pathologists and non-pathologists. These were all established prior to 1826 and were Birmingham (1825), Manchester (1824), Aberdeen (1786), St Bartholomew’s university (1785), Glasgow (1751), St George’s London University (1733) and Edinburgh (1726) medical schools. Moreover, Oxford medical school was known to have been teaching medicine since the 12th century and Cambridge had been teaching medicine since 1524; in essence, these two medical schools had been teaching clinical disciplines before the formal establishment process had even been formed. Accordingly, it can be stated that of the top 10 medical school rankings (Table  1 ), 8 are the oldest medical schools in the UK.

Furthermore, none of the more modern medical schools (established after 1999) are represented in our top 10 medical school rankings (Table  1 ). So, Warwick (2000), Norwich (2000), Peninsula (2000), Brighton and Sussex (2002), Hull York (2003), Keele (2003) and Swansea (2004) are not represented our top 10 (or top 20) medical school award-winner rankings. Whilst it may be understandable that the younger medical schools established within the last ten years may not yet have had time for their alumni to distinguish themselves to national merit award levels, it is less clear that this explanation accounts for the dearth of top 10 ranked medical schools established around the year 2000.

In summary , our observations are consistent with at least a correlation between medical school age and the number of subsequent graduates becoming merit award-winners. Furthermore, on evaluating the top 20 university medical schools a moderate and positive correlation was found between the age of the medical school by establishment date and the number of award-winners corrected by size, r [ 18 ] = 0.47, p  = 0.04.

After considering the totality of the results of our research study and also accepting the previous results of the studies into UK medical school education [ 22 , 25 , 26 ], in Fig.  1 we reiterate a model first described, elucidated and published earlier last year [ 14 , 15 ] - a model accounting for the age-dependent differential medical school performance in creating award-winning pathologists:

Cycles of institutional memory and experience

Because of their greater age, the older university medical schools have accrued more institutional memory and experience in medical education than the more youthful medical schools. Accordingly, the older medical schools have a better chance of generating successful graduates - potentially before some of the younger medical schools have even become established.

As the older university medical schools appear to produce larger numbers of obviously successful alumni, they will garner positive reputations and inevitably be designated as more prestigious institutions. Consequently, ambitious , competent and career-focused students are more likely to be apply to these university medical schools.

Having produced more successful students, these older university medical schools will also have accumulated more experience in positively managing and educating such high-achieving students. Such experience will also coincide with improved support for the better educators in the medical school.

As a result, these older university medical schools with greater institutional memory and experience will tend to progressively and steadily accumulate a greater percentage of the most able students and educators .

Ultimately, the students in these older medical schools will tend to receive and benefit from better quality teaching , better mentoring and better medical career advice .

Thus, these older university medical schools will produce better educated, better advised and better prepared doctors who are more likely to become merit award-winners. There will also be an additional benefit to the originating medical school of having trained such high-achievers; they will accumulate greater experience in training award-winners, so adding to the institutional memory of successful education. The cycle will then repeat.

A model for the creation of award-winners. Cycles of institutional memory and experience

The medical education consequences of the action of Cycles of Institutional Memory and Experience can be described as follows:

An inevitable result of the operation of the adjacent cycle is that the longer established medical schools have naturally experienced more cycling during their longer existences. This causes an accumulation of an increasing number of award-winners in the medical community, from each such originating medical school.

The differential accumulation of award-winners in the community from each medical school depends on the relative efficacy and efficiency of the cycle in each medical school. Such efficiency differences account for the ultimate medical school rankings.

The same considerations that led to development of the Cycles of Institutional Memory and Experience can also apply to the college/departmental/faculty levels. Specifically, a department that generates merit award-winning pathologists will tend to generate more such pathologists in the future. In principle, this could be termed a departmental cycle of memory and experience.

Any award scheme designed and administered by human beings runs the risk of introducing biases, thus leading to overrepresentation of particular groups. Our model provides a natural explanation and mechanism for connecting excellence/success with such bias. With every cycle of our model, increasing numbers of successful graduates originating from the older universities accumulate in the UK medical community. Subsequently, such distinguished and visible alumni are more likely to be elevated to senior leadership or managerial positions. These positions would include clinical excellence/distinction award allocators. Consequently, explicit selection biases or implicit selection biases would have a tendency to favour the graduates of these same medical schools of origin - resulting in a disproportionate number of these alumni gaining awards. Ultimately, we believe our model of Cycles of Institutional Memory and Experience , at least in part accounts for the concurrence of appropriate success/excellence in award-winning and apparent bias in our medical school rankings. Accordingly, it seems inevitable that the effects of genuine appropriate award attainment and bias are linked and would tend to be expressed simultaneously.

In the last year there has been a reorganization of the UK national clinical excellence scheme. Specifically, in January 2022, it was announced that the latest iteration would be termed the “National Clinical Impact Awards, NCIA.” [ 37 ] The governing authority announced that the objectives of this scheme would be to:

Widen access.

Simplify the application process, attempting to make it more equitable and inclusive.

Reward excellence in a wider range of activities and behaviours. [ 38 ]

This new rewards scheme offers a natural test and challenge to our Cycles of Institutional Memory and Experience model. Our model is based on the history and epidemiology of medical education in the UK. Accordingly, an analysis of the medical schools of origin of the NCIA winners should yield rankings similar to those reported in our series of publications, assuming that there is an underlying value to the model. We look forward to testing our model in this way.

Study limitations

Most of the traditional limitations of a study of this type have been implied and exemplified in our discussed comparison with the MedDifs study. We could not quantify the relative effects of postgraduate versus undergraduate professional circumstances on ultimate award-winning likelihoods. For example, a graduate of a less renowned medical school may move on to work in a successful and high profile research institute or specialized clinical settings - thus increasing their personal chance of attaining a merit award, beyond that which might have been predicted from their alma mater. We would emphasize that the medical school of origin is only one of many factors that determines ultimate career success and potential award-winning. It would be interesting to find out whether such postgraduate centres were themselves smaller scale centres of institutional learning and experience.

We also could not quantify the probable effect of the assessment criteria used for award giving, on the number of merit awards attained by specific medical schools. Undoubtedly, there is certain to be such an effect, however the dynamically changing nature of these assessment criteria since the inception of the awards in the post-World War II era make measuring such an effect more than challenging and beyond the scope of this study. In fact, the latest iteration of the merit awards, NCIA, has been designed to include a larger range of activities to measure excellence and to widen accessibility. Our study is better placed to show the different apparent attainments of the medical schools than the summation of all of the medical education factors and award assessment criteria that contribute to merit award-winning success. We do not believe that any one factor should be used alone as a predictor of future merit award-winning, by either medical schools or by individuals.

Our original study uses national clinical award-winning as an outcome measure to add training and education data to the demographic description of successful doctors in Britain. Specifically, we determine and present the university medical schools which are most likely to generate award-winning pathologists. We also determine and present university medical schools most likely to generate award-winning non-pathologists. This study is the first to calculate and present a ranking of university medical schools by the number of national award-winning pathologists. Accordingly, we present comparative medical school data that can be used in the rational choice of medical schools for ambitious pathologist inclined, non-pathologist inclined and undecided medical school applicants.

We demonstrate that international medical graduates are making significant contributions to good pathology clinical practice in Britain, as judged by their concentration amongst the lower national merit award-winners. We provide evidence that indicates globalization and diversity of medical school origin are being reflected in the merit awards, indicating that Britain is a credible destination for ambitious medical trainees that seek national or international success.

Data availability

Data from this article is available upon reasonable request to the authors. Dr Sinclair Steele is the corresponding author and will make the data available https://www.sehd.scot.nhs.uk/publications/DC20200319SACDA.pdf https://www.gov.uk/government/publications/accea-annual-report-2020 https://www.gmc-uk.org/registration-and-licensing/the-medical-register https://olr.gdc-uk.org/SearchRegister .

Abbreviations

International Medical Graduate

National Clinical Impact Awards

Clinical Excellence Awards

Distinction Awards

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S.S. and G.A. wrote the main manuscript text and G.A. performed the statistical analysis. S.S. prepared Fig. 1. All authors reviewed the manuscript.

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Steele, S., Andrade, G., Abdulkader, M. et al. Medical school origins of award-winning pathologists; analysis of a complete national dataset. BMC Med Educ 24 , 814 (2024). https://doi.org/10.1186/s12909-024-05790-8

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Received : 19 August 2023

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DOI : https://doi.org/10.1186/s12909-024-05790-8

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