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Abstract
Objectives To examine and synthesise current evidence on the factors that affect recruitment, retention, participation and progression within the clinical academic pathway, focusing on equitable participation across protected characteristics including gender, ethnicity and sexual orientation.
Design Scoping review and meta-thematic synthesis.
Data sources Web of Science, Google Scholar.
Article selection We conducted a scoping review of English language articles on factors affecting recruitment, retention, progression and equitable participation in clinical academic careers published in North America, Australasia and Western Europe between January 2005 and April 2019. The most recent and relevant 39 articles were selected for meta-thematic synthesis using detailed inclusion/exclusion criteria.
Data extraction The articles were purposively sampled to cover protected characteristics and career stages and coded for factors related to equitable participation. 17 articles were fully coded. No new themes arose after nine papers. Themes and higher level categories were derived through an iterative consensual process.
Results 13 discrete themes of factors impacting on equitable participation were identified including societal attitudes and expectations; national and organisational policies, priorities and resourcing; academic and clinical workplace cultures; supportive, discriminatory and compensatory interpersonal behaviours and personal factors related to social capital, finances, competing priorities, confidence and ambition, and orientation to clinical, academic and leadership roles.
Conclusions The broad and often interconnected nature of these factors suggests that interventions will need to address structural and cultural factors as well as individual needs. In addition to standard good practice on equality and diversity, we suggest that organisations provide equitable support towards early publication success and targeted mentoring; address financial and role insecurity; address the clinical workplace culture; mitigate clinical–academic–personal role conflicts and overload; ensure that promotional structures and processes encourage diverse applicants and promote family-friendly, coherent and transparent national career pathways.
- medical education & training
- qualitative research
- health policy
- organisational development
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Footnotes
Twitter @doctorkayleigh
Contributors Our team comprised an early career clinical academic (CV), an established educational researcher (KL-G) and a professor of medical education (SS), all experienced qualitative researchers with professional insights into the subject of enquiry. The Faculty of Medicine at Imperial College has a strong research interest in widening participation and its School of Medicine has more graduates entering the clinical academic pathway than any other UK medical school. These factors combined to stimulate our interest in identifying factors surrounding equitable participation in the clinical academic career pathway. All authors were involved in the conception and design of the study and in the acquisition, analysis and interpretation of our findings. CV and KL-G identified and coded the papers. SS audited the process and coding. All authors worked together to generate the themes and categories. CV and KL-G drafted the work, and KL-G created the results section and tables. All authors revised it critically for intellectual content. All authors gave approval to the final version and agree to be accountable for all aspects of the work. All authors undertake to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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 None declared.
Patient consent for publication Not required.
Ethics approval Research ethics committee approval was not required as this is a review paper.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Coding data are available from the corresponding author upon reasonable request.