DEVELOPING AND INSPIRING THE NEXT GENERATION OF LEADING CLINICAL RESEARCHERS IN AUSTRALIA

The Group of Eight universities recently argued that to ensure a sufficient future supply of clinician researchers in Australia around 5 per cent of medical graduates should be able to access an integrated clinician researcher training program as currently exists in the UK.

To address this gap, the Melbourne Academic Centre for Health (MACH), an NHMRC-accredited Research Translation Centre, launched MACH-Track in 2020, with the first cohort starting in 2021.

This pilot program is developing the future leaders of clinical innovation by offering an opportunity to integrate pre-PhD, PhD and initial post-PhD research training through the University of Melbourne, with completion of advanced clinical training in any of the 10 health services affiliated to MACH.

MACH-Track, which is now recruiting its fourth cohort of Fellows, expanded in 2023 to include nursing professionals and physiotherapists in addition to doctors.

It currently comprises 20 Fellows undertaking the program with the aim of securing a post-doctoral fellowship upon completion of the track – and ultimately independent academic leadership.

Professor Sir John Savill, MACH Executive Director, together with a team of expert co-directors led the development of the first-in-Australia program, which is modelled off both the structure and ethos developed over many years across successful schemes in the UK such as the Edinburgh Clinical Academic Track.

“MACH-Track is now an established program that allows promising health practitioners to integrate career development in research, including a PhD, with completion of postgraduate specialist or generalist training and clinical career development in their health discipline,” Sir John says.

“This exciting scheme is a pilot for development of healthcare leaders that will ensure our nation has the research-active clinical innovators it needs to deliver a healthy future for all Australians.”

MACH-TRACK BENEFITS

Continuity – Trainees engage with both clinical and research training throughout the program ensuring continued engagement with the translational mission of MACH

Cohort – Appointees join a MACH-wide community of well-mentored MACH-Track colleagues and are also members of a cohort of developing leaders in their parent health service Choice – Trainees select from a wide range of potential PhD projects towards the end of the initial year of 80 per cent clinical training / 20 per cent PhD run-in, which provides “taster” mini-projects

Inspiring The Next Generation

MACH-Track has inspired a new generation of clinician researchers across a wide range of disciplines and specialties who will become the research translators of the future to improve health care delivery in Australia.

Current MACH-Track Fellows Dr Asha Jois and Dr Jason Ha say the program is bringing their research and clinical work together.

“To me, being a clinician-researcher allows you to bridge the gap between medical practice and medical research, says Dr Jois, a Paediatric Gastroenterology Registrar based at the Royal Children’s Hospital, Melbourne.

“It facilitates the generation of ideas that will influence practice and enables the application of these ideas.

The MACH-Track program recognises the benefits of learning to do both research and clinical medicine alongside one another, allowing trainees to learn the skills to integrate both in day-today practice early on in their careers.”

Dr Ha, Ophthalmology Registrar at the Royal Victorian Eye and Ear Hospital adds: “There are a plethora of benefits from having ‘the best of both worlds’ as a clinicianscientist.

“Not only are we able to craft the paradigms of best clinical practice, but we can experience and appreciate first-hand the ways in which ground-breaking science can truly make an impact on not only the patient in front of us, but the countless others like them that follow.”

Dr Ha continues: “I look forward to using the opportunities and networks afforded through the MACH-Track dual PhD-clinical training pathway as a catalyst to a future challenging, but rewarding and fulfilling, career, where fundamental scientific discoveries can ultimately bring the greatest benefit to patients worldwide.”

Scale Up And Expansion Across Health Professions

From last year, MACH-Track for the first time expanded its offering beyond doctors-in-training and is now adapted to also suit the needs of research-minded nurses, midwives and allied health professionals such as physiotherapists.

As improvement of health care requires clinician researchers from all professional backgrounds it is hoped that the MACH-Track pilot program will be expanded to offer a career track for research-minded clinicians from even more health professions – and scaled up nationally to ensure aspiring clinician researchers across Australia become the clinical innovators of the future.

For more information about MACH-Track, visit machaustralia.org/future-leaders/mach-track

For more information on the Melbourne Academic Centre for Health, visit machaustralia.org

Authors: Nick Walsh, Senior Project Officer, Melbourne Academic Centre for Health Eleanor Bonikowski, MACH-Track Coordinator, Melbourne Academic Centre for Health

2022 MACH-Track cohort

L-R: Dr Jason Ha, Dr Farrah Rodrigues, Dr Luke Fletcher, Prof Sir John Savill, Dr Asha Jois, Dr Michael Moso, (Absent: Dr Megan Ball)

The Challenges In Establishing Medtech Manufacturing In Australia

Australia is a net importer of pharmaceuticals, medical devices, and diagnostics.

Michael Junger

While we have a strong reputation for developing technology, we don’t have a vibrant manufacturing industry to support our research, develop skills and take our ideas through to revenue.

We don’t have a culture of success in supporting medtech through to manufacture. Rather, many of our ideas and innovations move offshore to countries with existing infrastructure and where raising funds is easier. The reality is we are a huge, isolated land mass with a small population, limiting our ability to fund commercialisation and establish manufacturing.

Gardasil, a cervical cancer vaccine, is an Australian invention and the first vaccine shown to prevent cancers. It is, by revenue, the second highest grossing vaccine in the world1. Imagine if we had funded its manufacture in Australia? The domestic biotech landscape might look very different.

The challenge for companies attempting to establish manufacturing is that historically you might be alone. While we do have examples of successful medtech manufacturing, they are the exception and not the rule. Financing medtech is high cost, high risk and often not understood. Products can range from simple non-invasive technologies, to implantables and combination products involving software, drugs, vaccines and devices.

The return on investment (ROI) can easily be a runway of 10+ years. The challenge around medtech manufacturing is that you need to establish a final manufacturing process long before you can sell commercial product. To achieve regulatory approval, you need to build product to allow the collection of clinical data to support your product registration. The way you manufacture must be equivalent to your commercial process or you will be asked to justify why not. And, at the end of that journey, you’re required to submit your clinical data for the regulators to decide your fate.

As a country, we need to rethink the way we look at these significant investments in medtech infrastructure. Even once you’ve established manufacturing, there is always an inherent risk your technology may fail; your regulatory approach may not be accepted; you may be overtaken by a competing technology; or the market may just not be ready for you. However, if we invest in the infrastructure for a technology that did not reach its potential, this should not be considered a ‘fail’ but rather a ‘start’.

Building manufacturing capability closes the loop on research and encourages further innovation. It stimulates universities and builds on sovereign skills in regulatory, quality, engineering and science. The opportunity cost of not taking the risk, is that you will never see the generational types of revenue that will allow you to build an industry. If your first medtech venture fails, you have still built infrastructure, you have still developed knowledge and you have still created a workforce that will enable manufacturing of the next technology.

The challenge is to change the mindset of investors to look beyond just one company or technology to the collective and encourage governments to support and build their own investment in the future.

I’ve had many instances in the past where I wanted to explore a process methodology or test the suitability of a machine or process. Invariably, most of the companies and their machinery and processes were in Europe or the United States with little or no representation in Australia making access difficult and expensive. Out of necessity, we developed our own home-grown solutions separated from the conventions of others. We created our own IP and added value to our businesses. We turned these challenges into opportunities.

I had a situation where a large multinational company approached us with the intention of selling us their manufacturing technology. Their perception may have been that, isolated from the major technology powers, we needed their assistance. After seeing what we had developed, they walked away with a different perception.

The bottom line is, that the challenges of medtech manufacturing are the very things that make it worthwhile. A unique ability to conquer technical, quality and regulatory hurdles will make you and your product very valuable and provide a platform of knowledge, resources and infrastructure for taking the next (and next!) technology leap easy.

Author: Michael Junger, Senior Vice President, Advanced Technology, Vaxxas

1 https://www.statista.com/statistics/314566/leading-global-vaccine-products-by-revenue/