Academic psychiatry in the UK is currently at a ‘crossroads’ (Shankar Reference Shankar, Bowater and Laugharne2026). Academic psychiatrists have a substantial research and/or teaching component to their roles, alongside their clinical work (Critchley Reference Critchley, Tracy and Malhi2024). Despite a considerable expansion in the number of medical schools in the UK over the past 20 years, the number of academic psychiatrists has reduced and those who remain are older (Critchley Reference Critchley, Tracy and Malhi2024). To bridge this gap there is a need to train more resident doctors to become academic psychiatrists (Critchley Reference Critchley, Tracy and Malhi2024; Shankar Reference Shankar, Bowater and Laugharne2026). One way of producing more academic psychiatrists is by supporting their training and development, including through integrated clinical academic training (variously called ICA, ICAT and IAT programmes) (Modernising Medical Careers 2005).
Formal academic psychiatry training consists of the standard clinical pathway combined with protected research time. In the UK, Academic Clinical Fellows (ACFs) have run-through training, with around 25% of their time protected for research over several years during core training. ACFs are encouraged to seek a funded PhD programme and return to higher specialist training as clinical lecturers, where they will have 50% protected research time (Modernising Medical Careers 2005). Clinical academic trainees are expected to complete the same clinical competencies as their clinical peers within a similar overall time frame, despite reduced clinical exposure. Thus, by the time they receive their certificate of completion of training (CCT), they could also be a post-doctoral researcher gaining independence in a field of mental health research.
In this commentary, we critically appraise a review article by Koelkebeck et al (Reference Koelkebeck, Pantovic Stefanovic and Frydecka2019) in which the authors examine from an international perspective barriers and facilitators to accessing academic opportunities experienced by early career psychiatrists (ECPs). The term ECP includes residents and newly qualified psychiatrists in their first few years as specialists.
The review article
Koelkebeck et al screened 524 articles and included 16 in their review. The barriers identified were insufficient protected time, limited mentoring and funding, work-related stress and a lack of research training. Facilitators included access to mentorship and funds, integration of research into clinical practice and early exposure to academic psychiatry. In the discussion the authors consider how opportunities could be improved for ECPs.
Critical reflection
The research question
Koelkebeck et al’s review takes a global look at research involvement by ECPs, seeking ‘To understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career’. The review included ‘primary studies reporting data on: i) psychiatric trainees or ECPs and ii) factors that represent barriers or facilitators towards research in psychiatry’.
The broad objectives and inclusion criteria seem appropriate, as little research has been done on this topic. The authors did not use a framework such as the PICO (Population, Intervention, Comparator and Outcomes) to conceptualise their research questions, nor did they present a hypothesis or null hypothesis.
Study design
The authors described their paper as a literature review. A literature review is a summary of the known information on a topic. Compared with a systematic review it can be more narrative and may not be so rigorous in its approach (Box 1). The authors did use some elements of a systematic review, such as a structured search strategy and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. However, they did not include other common components of a systematic review, such as an assessment of risk of bias or summary of the overall certainty of evidence.
Types of review
Literature/narrative review A synthesis of the known available research on a topic, which can be broad. A narrative approach is often used to synthesise findings and authors are not required to describe which information sources were interrogated or how.
Systematic review A rigorous and structured summary of all available evidence on a (usually narrow) topic. Authors are expected to take a comprehensive approach to finding all research available on the topic, including searching the ‘grey’ literature not available in traditional databases. Systematic reviews are usually expected to follow the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Box 2).
Scoping review A broad review of the available studies on a topic (often an emerging one), designed to map out the evidence, without necessarily assessing its quality. Can be used to gain a wider overview of a topic and identify a more focused question for a subsequent systematic review.
Search strategy and screening
The authors searched two relevant databases (PubMed and the Cochrane Library) using appropriate search strings, including MeSH terms (Medical Subject Headings – search terms using specific vocabulary to support coding of research papers). They also contacted experts on the topic, searched the grey literature and reviewed abstracts presented at major international psychiatry conferences. They used broad search terms to be as inclusive as possible and included papers in three languages: English, French and German.
To ensure their search strategy was comprehensive, the authors could have searched other major databases such as Embase, and psychiatry-specific databases such as PsycInfo. Efforts to contact experts are admirable, but the limited information reported about how experts were identified and contacted makes it difficult to assess the effectiveness of this approach.
In a systematic review there are two stages of screening papers for inclusion. The first is a title and abstract search, when obviously irrelevant papers are excluded. The second is the full-text search, when papers are screened for inclusion based on predefined criteria. Although this study described itself as a literature review, the authors did screen to decide which papers to include. Inclusion criteria for the study are given, but it is not made clear whether these applied to the title and abstract, full-text screening or both. One author completed a full search of the titles and abstracts, reading the full manuscript if unsure, and a second checked 20% of the identified studies. This limited dual screening seems appropriate for a literature review. However, the level of agreement between screeners is not reported and there is no explanation of how disagreements between screeners were resolved.
A PRISMA flowchart is presented, which is an approach often used in systematic reviews (Page Reference Page, McKenzie and Bossuyt2021) (Box 2). A large proportion of the studies initially identified were found through sources other than the two databases searched (n = 165). This may mean the database searches were insufficient and other databases should have been searched. At the full-text screening stage 166 papers were excluded on the basis of language, age or subject.
PRISMA guidelines
The Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page Reference Page, McKenzie and Bossuyt2021) describe how authors should report a systematic review:
-
• It should have a rationale and an objective, with clear methodology detailing the information sources interrogated and search strategy used, as well as attempts to assess bias;
-
• It should include a flow diagram of each study included or excluded at different stages of the selection process, and a summary of each study included in the final review;
-
• It could include a meta-analysis, where results from several studies are combined statistically to produce pooled estimate;
-
• The discussion should describe limitations of the review and its impact on policy and practice.
Methodological rigour of the primary papers
In total, 16 papers met the inclusion criteria, 12 of which were original research studies. There were 11 cross-sectional surveys; one mixed-methods study (cross-sectional survey and interviews); one expert consensus; one literature review; one opinion piece; and one essay.
The authors make few comments on the quality of the studies presented. Interestingly, all the included papers describe either observational cross-sectional studies or expert opinion. No tools were used to measure the evidence quality or risk of bias; however, the absence of longitudinal or experimental designs will inevitably limit the certainty of evidence.
Data analysis and results presented
The authors chose to present themes common to the primary sources, rather than focus on any statistical findings. They split the themes into factors supporting ECPs’ research careers (access to mentors; opportunities for funding and integration into clinical practice; encouraging research from as early as medical school) and barriers (lack of protected time and work-related stress; lack of funding; lack of support and mentorship; lack of training in research). This approach appears reasonable given the limited evidence identified, although mirroring of themes between the barriers and supporting factors (access to/lack of mentors, access to/lack of funding) was repetitive.
The authors present a table summarising the research studies, giving authors, publication date, number of participants and job roles, country of study and study design. The table also includes the main facilitators and barriers for research, study bias and limitations. No attempt was made to synthesise the data in a meta-analysis, as the authors state the data and studies were too heterogeneous, although no formal measure of heterogeneity (such as an I 2 statistic) is reported.
The authors could have been more explicit on how and why the data were extracted, and they could have presented measures of data precision, such as confidence intervals and p-values. Attempts to categorise the quality of included studies and any publication bias could have enhanced the overall assessment of the literature.
The studies included were evidently of variable quality, with most being cross-sectional surveys of resident doctors. No studies included longitudinal approaches or comparators of different interventions (for example, providing resident doctors with funded research time compared with training-as-usual). Therefore, many of the studies were based on the opinions of experts and residents. The authors do reflect on the potential bias and limitations of individual studies, such as low response rates and the consequent risk of response bias.
Study limitations
The authors recognise some limitations of their study, such as searching only two databases and being unable to conduct a meta-analysis because of incomplete reporting of data. They highlight that most data came from high-income countries and that limited qualitative data were available. They also note that the study’s focus on ECPs means that findings may not be applicable to psychiatrists at different career stages.
The authors describe various initiatives designed to improve ECPs’ access to research and link their study findings to the work of various international organisations, such as the European Federation of Psychiatric Trainees (EFPT). They make several suggestions how academic training opportunities could be improved for ECPs. Although these suggestions appear sensible and could be effective if implemented, there is not always a clear link between these approaches and the study findings.
Implications, including relevance for UK psychiatry training
The review identified only a limited number of studies on their research question and their quality is poor. Studies with more robust designs, such as longitudinal observational studies or randomised controlled trials of different approaches to academic psychiatry training are needed to demonstrate the effectiveness of alternative models. An evaluation of the UK’s integrated clinical academic training programme, focusing on issues raised in the review, such as funding, mentoring, protected time and work-related stress, would be helpful in determining the future direction nationally.
The review could be used to guide the development of UK psychiatry training programmes, which have a 100% fill rate at core training level (NHS England 2025). Implementing the facilitators identified by the review (such as providing ECPs with more funding, mentorship and protected time) would support the development of more clinical academic psychiatrists in the UK. Policymakers may also want to consider how these opportunities could be expanded beyond the traditional ICAT programme for interested individuals whose career pathway does not align with the standard model.
Conclusions
This literature review uses a broad approach to map the evidence-base on academic opportunities for ECPs internationally. Despite including some elements of a more systematic methodology, the overall approach remains mostly narrative. Although reasonable given the limited evidence identified, greater scrutiny of the quality of included papers would have enhanced confidence in the authors’ conclusions. Nevertheless, the paper provides a helpful overview of an important topic. The results are relevant to UK ECPs, so could be useful in guiding programme development and informing further research.
Author contributions
C.E.W. and H.R. jointly conceptualised this article. C.E.W. wrote the first draft, which H.R. reviewed and substantially edited. Both authors reviewed and agreed the final draft.
Funding
C.E.W. is funded by the National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer. H.R. is funded by an NIHR Senior Clinical and Practitioner Research Award and the NIHR Biomedical Research Centre: Oxford Health.
Declaration of interest
H.R. is a member of the BJPsych Advances editorial board and did not take part in the review or decision-making process of this article.
eLetters
No eLetters have been published for this article.