Promoting Early Radiation Research Exposure Through the Royal College of Radiologists' Summer Undergraduate Research Fellowship.

The last decade has seen considerable growth and development of the UK radiation research landscape and the infrastructure that underpins it [[1]Chalmers A.J. Chan C. Sebag-Montefiore D. Executive Group of the National Cancer Research Institute’s Clinical and Translational Radiotherapy Research Working Group (CTRad). CTRad 10 years on: from 10-point plan to top 10 achievements.Clin Oncol. 2020; 32: 9-12Abstract Full Text Full Text PDF Scopus (4) Google Scholar]. There is a growing recognition of the need to sustain the momentum this has generated through cultivating a research-competent and active workforce [[2]Jones C.M. Spencer K. Nurturing a research-active clinical oncology workforce: a trainee perspective.Clin Oncol. 2021; 33: e39-e43Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. Clinical oncologists are a key component of this, with contributions stretching from driving hypotheses for in silico and in vitro analyses through to leading, and recruiting to, clinical trials. Despite this, the proportion of clinical oncologists who hold a research post has fallen over recent years to just 8% [[3]Royal College of RadiologistsClinical oncology UK workforce census report.2020https://www.rcr.ac.uk/publication/clinical-oncology-uk-workforce-census-2020-reportGoogle Scholar]. Although this is at least in part attributable to multiple challenges to the retention of academic clinical oncologists, we and others have written about the equal importance of attracting an adequate supply of fledgling research-motivated and radiation-interested trainees [[2]Jones C.M. Spencer K. Nurturing a research-active clinical oncology workforce: a trainee perspective.Clin Oncol. 2021; 33: e39-e43Abstract Full Text Full Text PDF Scopus (2) Google Scholar,[4]Payne S. Burke D. Mansi J. Jones A. Norton A. Joffe J. et al.Discordance between cancer prevalence and training: a need for an increase in oncology education.Clin Med. 2013; 13: 50-56Crossref PubMed Scopus (21) Google Scholar,[5]Rallis K.S. Wozniak A. Hui S. Stammer A. Cinar C. Sun M. et al.Mentoring medical students towards oncology: results from a pilot multi-institutional mentorship programme.J Cancer Educ. 2022; 37: 1053-1065Crossref PubMed Scopus (7) Google Scholar]. One obstacle to establishing this pipeline is that most clinicians receive only limited exposure to clinical oncology until well into their postgraduate training. We have, for instance, shown that only a quarter of medical schools have a standalone radiation oncology module and there is additional evidence that some medical students receive as little as 4 h of oncology-related ward or clinic time while at medical school [6Heritage S.R. Lynch-Kelly K. Kalvala J. Tulloch R. Devasar A. Harewood J. et al.Medical student perspectives on undergraduate oncology education in the UK.Clin Oncol. 2022; 34: e355-e364Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 7Walls G.M. Houlihan O.A. Mooney C. Prince R. Spencer K. Lyons C. et al.Radiation oncology teaching provision and practice prior to and during the first wave of the COVID-19 pandemic in medical schools in the United Kingdom and the Republic of Ireland: a cross-sectional survey.Br J Radiol. 2021; 94: 20210614Crossref PubMed Scopus (3) Google Scholar, 8Rallis K.S. Wozniak A.M. Hui S. Nicolaides M. Shah N. Subba B. et al.Inspiring the future generation of oncologists: a UK-wide study of medical students’ views towards oncology.BMC Med Educ. 2021; 21: 82Crossref PubMed Scopus (8) Google Scholar]. Meanwhile, the advent of the integrated academic training pathway means that students are increasingly encouraged to select a specialty and academic area of interest very early on in their training. This may result in more research-motivated students opting to pursue specialist foundation programme places and their subsequent academic careers in specialties that have a greater presence in undergraduate curricula. Recognising this, a number of specialties now target research opportunities at medical students as a means to compensate for their relative absence from day-to-day medical school teaching. Summer undergraduate research experiences are one such initiative. These funded placements have long been a feature of undergraduate science, technology, engineering and mathematics (STEM) programmes in the USA [[9]Mackenzie C.J. Elliot G.R. Summer internships: 12 years’ experience with undergraduate medical students in summer employment in various areas of preventive medicine.Can Med Assoc J. 1965; 92: 740-746PubMed Google Scholar,[10]Butler P.J. Dong C. Snyder A.J. Jones A.D. Sheets E.D. Bioengineering and bioinformatics summer institutes: meeting modern challenges in undergraduate summer research.CBE Life Sci Educ. 2008; 7: 45-53Crossref PubMed Scopus (13) Google Scholar]. A number have also been available to UK STEM and undergraduate medical students for approaching two decades, including from specialty-specific organisations, such as the Society for Endocrinology, the Pathological Society and the British Association of Dermatologists, as well as via larger funding bodies, such as the Medical Research Council and the Wellcome Trust [[11]Cleland J. Engel N. Dunlop R. Kay C. Innovation in medical education: summer studentships.Clin Teach. 2010; 7: 47-52Crossref PubMed Scopus (9) Google Scholar,[12]Rocheteau E. How to organise a summer research placement.BMJ. 2017; 358: j2888Crossref PubMed Scopus (1) Google Scholar]. Having established a need to entice medical students to consider a career in academic clinical oncology, the Royal College of Radiologists' (RCR) Clinical Oncology Academic Committee sought to establish an equivalent radiation-focussed Summer Undergraduate Research Fellowship (SURF) programme in 2019. Here, we outline the programme and review the role this scheme plays in developing a research-active clinical oncology workforce of the future. The RCR SURF scheme was established to provide medical students with an insight into radiation-related research and to support their long-term development as future radiation researchers through structured, targeted mentorship. SURFs are available annually via an open and competitive application process overseen by the RCR. Each is awarded to a student with a named supervisor for a specific project lasting a period of 8 weeks over the summer vacation period. A total of £1440 is provided to the student and £500 to the supervising department to cover their respective direct and indirect expenses. Awards are advertised via medical school bulletins, RCR webpages and through the British Oncology Network of Undergraduate Societies (BONUS), as well as via social media channels. Interested students are asked to approach potential supervisors, who may be a Fellow or Member of the RCR. In order to apply, medical students must be in their second, third or fourth year of undergraduate study, or first, second or third year of graduate study. There is no stipulation on the type of project that students undertake, but the focus must strongly relate to radiation oncology. A standardised application form and scoring system are used to evaluate each student's motivation for undertaking the project and their previous academic experience. The project aims, learning opportunities and supervisory oversight are additionally evaluated. Supervisors are also asked to provide details of how students will be proactively provided with an insight into the specialty of clinical oncology, as well as what long-term mentoring arrangements will be established by the host department in order to support the student's continued development as an academic clinical oncologist. Applications are independently scored by at least two members of the Clinical Oncology Academic Committee, with SURFs awarded to the highest-scoring candidates. Individual feedback is sought from each student following their SURF using a standardised feedback form. Students who are unsuccessful in their SURF application are encouraged to seek funding for their project via other summer research internships available nationally. Students who complete a SURF are expected to present at an RCR-affiliated event, such as the Clinical Oncology Undergraduate Day. The first SURFs were awarded to five students from four institutions in 2019 following a total of 21 applications. The outbreak of the coronavirus disease 2019 (COVID-19) pandemic led to significant restrictions to research activity in 2020 and, consequently, the SURF programme was not open for applications. The SURF programme returned in 2021, with five awards made to students from four institutions following 18 applications. Following a review of initial feedback, the budget for the SURF scheme was increased to allow for the award of 10 SURFs, which in 2022 were granted to students from eight institutions. In total, 20 students from 11 separate institutions have been awarded a SURF from a pool of 49 applicants. Three (60%) of the five SURF awardees in each of 2019 and 2021 were female, as were eight (80%) of the 10 awardees in 2022. Selected projects involved wet (n = 4; 20%) or dry (n = 1; 5%) laboratory work; imaging, radiomics or radiotherapy outlining (n = 7; 35%); analysis of data collected from retrospective cohorts (n = 7; 35%); or a systematic review (n = 1; 5%). Written feedback has been provided by 19 (95%) of the 20 SURF awardees thus far and was for the most part collected a few months after each SURF award had been completed. The feedback received is broadly positive, with a majority (n = 18; 95%) confirming that the project had increased their understanding of the specialty of clinical oncology. Most SURF awardees reported challenges with their project, although for a majority (n = 12; 63%) these were technical or related to time constraints, with the remainder (n = 2; 11%) pertaining to award administration. When asked how the award had shaped their career intention, most reported a greater desire to pursue a career in either clinical oncology (n = 13; 68%), or another cancer-related (n = 4; 21%) specialty, while 16 (84%) reported an increased interest in pursuing a research-related career. SURF awardees were less certain on the tangible academic outputs of their work, which probably represents the short interval between project completion and the time at which feedback was sought. Nevertheless, 14 (74%) had already submitted or were working up a conference abstract and five (26%) considered that their work was likely to be incorporated into a broader manuscript. Others noted that their project had provided them with broad scientific skills relating to statistical analyses, coding and scientific communication, in addition to a plethora of project-specific skills. Although this initial feedback is encouraging, it is important to note that the long-term advantages of this scheme are not yet clear and are unlikely to be certain until the first cadre of students reach specialty applications in around 5 years. The extent to which long-term mentoring relationships proposed in SURF applications have been realised is also unclear. Both aspects will need to be monitored through the collation of granular, long-term feedback and careers data. The fall in applications across the years in which the scheme has run additionally merits reflection, with a 4:1 application ratio in the first 2 years of the scheme, reducing to a 1:1 ratio in the most recent year. Although this partly reflects a doubling in the number of available SURFs in 2022 to 10, it is in the main a result of a fall in the total number of applications. It is unclear whether this is a reflection of medical student and potential supervisor awareness of, or instead a reflection of enthusiasm for, the SURF programme. In light of this, it is important that efforts to advertise the SURF programme to medical students and their prospective supervisors are redoubled. Given the relative invisibility of clinical oncology to medical students, it may also be prudent to provide students and medical schools with practical advice on how to link medical students with prospective supervisors. This is of particular pertinence to newer medical schools and those with less active radiation research programmes that are currently underrepresented among those awarded a SURF. Equally, efforts should be made to ensure that there is strong representation among SURF awardees of students with backgrounds and characteristics currently underrepresented in clinical academia, including through integrating with initiatives such as the RadReach widening participation mentoring scheme. We nevertheless concede that a combination of clinical and academic pressures, coupled with post COVID-19 weariness, may limit the capacity of potential supervisors to commit to supervising a SURF. Finally, it must be noted that the reach of the SURF scheme is for the most part limited to a relatively small group of students who are already sufficiently aware of, and interested in, research to invest their time into applying for the programme. As such, there remains a pressing need for the RCR and other relevant radiation research stakeholders to consider and implement strategies that encourage greater awareness of academic clinical oncology among medical students and early career trainees. Support for BONUS and the National Oncology Trainees Collaborative for Healthcare Research (NOTCH) is welcome in this regard, but these initiatives, and indeed the SURF programme, require coordination within a supervised and concerted overall strategy [[13]Jones C.M. Olsson-Brown A. Dobeson C. Trainee Board of the National Oncology Trainees Collaborative for Healthcare Research. NOTCH: The National Oncology Trainees Collaborative for Healthcare Research.Clin Oncol. 2020; 32: 632-635Abstract Full Text Full Text PDF Scopus (6) Google Scholar,[14]Khoury E.G. et al.BONUS: the national oncology network for students and junior doctors.Clin Oncol. 2022; 34: 678-682Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. The fourth round of recruitment for the SURFs commenced in March 2023, with a closing date in May 2023. Find out more about the scheme by visiting https://www.rcr.ac.uk/clinical-oncology/academic-oncology-and-research/summer-undergraduate-research-fellowships. C.M. Jones founded the SURF programme with support from A. Choudhury and P.J. Hoskin, who respectively currently chair, and previously chaired, the RCR Clinical Oncology Academic Committee that oversees these awards. C.M. Jones is supported by a Clinical Lectureship part-funded by Cancer Research UK RadNet Cambridge. A. Choudhury and P.J. Hoskin are supported by the National Institute for Health Research Manchester Biomedical Research Centre. C.M. Jones, A. Choudhury and P.J. Hoskin are grateful to Dr Jeanette Dickson, immediate past President of the RCR, for her invaluable support in setting up the RCR SURF programme. We are also grateful to Charmaine Mukherjee for administering this scheme on behalf of the RCR and to Mariam Butt for auditing the progress of the scheme to date. Finally, we are grateful for all SURF participants and their supervisors for their contribution to the scheme.