Finding a Voice in UK Academic Psychiatry: Barriers and facilitators to engagement among Indian International Medical Graduates: a mixed-methods study

Finding a Voice in UK Academic Psychiatry: Barriers and facilitators to engagement among Indian International Medical Graduates: a mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Finding a Voice in UK Academic Psychiatry: Barriers and facilitators to engagement among Indian International Medical Graduates: a mixed-methods study Madeleine Dale, Magdalini Moraitou, Deepika Sharma, Sridevi Sira Mahalingappa, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9531516/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Academic psychiatry in the UK is in a precarious situation with diminished academic to clinical posts. There has been a growing reduction in psychiatrists engaged in academia in the last 25 years. This has coincided with increased growth of International Medical Graduates (IMG) particularly from India working in UK psychiatry. IMGs may face unique barriers to involvement in research which might be contributing to the academic gap. IMGs from India form the largest ethnic minority group among the UK psychiatrists. This study explores interest, barriers and facilitators to academic engagement among IMGs of Indian origin working in psychiatry in the UK. Methods: A questionnaire with 14 questions was developed with the British Indian Psychiatric Association (BIPA) members. It was disseminated online among IMG psychiatrists of Indian origin. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to distribute the survey in electronic form. The survey was disseminated via a convenience sampling approach, including through local professional networks. The questionnaire covered professional characteristics, past non-UK academic involvement and perceived interest, barriers and facilitators to UK academic engagement. Quantitative analysis used Wilcoxon signed-rank test and Chi-square with significance taken as p < 0.05. Thematic analysis of free-text responses was undertaken using Braun and Clarke’s methodology was undertaken. Results: Of 89 respondents 61% reported prior non-UK academic involvement. Being male and prior academic experience was significantly associated with greater academic initial interest. Identified barriers were cultural and discriminatory, structural and navigational, and capacity and resource related. Facilitators included motivation to contribute to evidence-based practice, improved balance between clinical work and research, increased opportunities, and a supportive research culture. Conclusions: IMG psychiatrists of Indian origin are motivated to engage in research but face challenges and barriers of cultural, discriminatory, and job planning factors. Similar surveys are needed to capture the unique experiences of other diaspora groups working in psychiatry to address the glass ceiling of clinical- academic engagement. Immigrant doctors immigrant psychiatrists Indian psychiatrists Academic psychiatry Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction 1.1 The importance of academic psychiatry and its current situation Academic psychiatry is defined as generating new knowledge and evidence which can be translated into practice to improve patient outcomes. ( 1 , 2 ) In training and role as a medical professional, research capabilities are important. ( 1 , 2 ) Not only does a more research-active psychiatry work force contribute to evidence-based practice, it also cultivates an organisational culture of inquiry and improvement and results in better patient care.( 1 , 2 ) A research-engaged psychiatry workforce could help address important mental health challenges and is key to the specialty’s future.( 2 ) However, despite the numerous scientific advances over the last decade, there has been a concerning reduction in the clinical academic workforce.( 3 ) In 2023, only 2% of UK psychiatrists held academic posts, which is a reduction of one-third from 2004.( 4 ) 1.2 The role of international medical graduates and the problems faced by them Within this landscape, the role of international medical graduates (IMGs) becomes particularly salient. IMGs form a substantial proportion of the workforce in the National Health Service (NHS), with over two-thirds of all doctors joining the UK workforce between 2022 and 2023 being non-UK graduates.( 5 ) This is especially true in psychiatry, where 39% of Royal College of Psychiatrists members are Black (6%), Asian (27%) or other minority ethnic background IMGs.( 6 ) Nearly half (44%) of trainees in psychiatry at the start of this decade were IMGs.( 7 ) IMGs bring valuable, global experience and diversity.( 7 ) However, IMGs often face unique structural, cultural, and organisational barriers, which may prevent full participation in UK academic psychiatry.( 7 , 8 ) The literature points to several challenges of IMGs in the NHS, including career progression, adaptation to new teaching and learning styles, examination hurdles, and psychosocial stressors.( 9 ) Furthermore, in an analysis of data from General Medical Council databases and the 2019 National Training Survey, reported ‘very low’ numbers of academic trainees from IMG background. ( 10 ) At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen, suggesting that graduating outside of the UK was an important factor.( 10 ) Speciality, Associate Specialist, and Specialist Doctors (SAS) doctors also face unique barriers to research, given that the focus of their role is on delivering clinical care.( 11 ) Most SAS doctors in the UK are IMGs and of minoritised ethnicity, meaning the challenges faced by these groups are likely to be further exacerbated in academic psychiatry.( 11 ) In addition, IMGs struggle with the cultural nuances and formal syntax required for high-level academic writing and peer-to-peer communication.( 12 ) 1.3 Psychiatrists of Indian origin Indian psychiatry is recognised to have provided extensive and pioneering research that has made significant contributions to global mental health even though major economic and resource challenges exist. ( 13 , 14 ) Indian Psychiatry has had a considerable influence on World Psychiatry and the World Health Organization’s (WHO) mental health agenda and contributed to the development of the cultural bases of psychiatry through the work of many eminent researchers.( 15 ) It is recognised that psychiatrists who come from India to the UK have been exposed to academic psychiatry largely as training is provided by universities hence their experience, although quality may well be variable.( 14 ) Thus, the experiences of Indian psychiatric IMGs are uniquely placed to highlight the structural and institutional challenges of UK academic psychiatry in being inclusive and equitable particularly for non-UK medical graduates. 1.4 Objectives This study aimed to: Explore perceived facilitators of and barriers to involvement in academic psychiatry by IMGs of Indian origin. Characterise self-reported interest in academic psychiatry at the time of arrival in the UK and at present among UK-based IMGs of Indian origin. Explore whether self-reported academic interest (at arrival, at present, and change over time) may differ according to gender, region of work, prior research involvement, and years of psychiatric experience/grade. 2 Methods The Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross sectional studies was used to design and execute this study ( related file: STROBE ). 2.1 Design and distribution the questionnaire used in the study was developed for this study ( supplementary information1 ). The survey questions were developed collaboratively by the authors and members of British Indian Psychiatric Association (BIPA). BIPA is a diaspora organisation in the UK, established over 25 years ago to provide support and represent psychiatrists of Indian origin and promote mental health awareness in the community. BIPA is recognised as one of the largest psychiatric diaspora organisations in the UK, second only in size to the Royal College of Psychiatrists, and is continually growing, currently with a membership of professionals most of whom are first generation IMGs. More information about BIPA's aims, activities, and events can be found on its official website: http://www.bipa.org.uk/ . The survey was developed on Google Forms platform. The average completion time was approximately ten minutes. The survey was online from 18th of March 2025 to 21st of August 2025. The survey questionnaire consisted of 14 questions related to the demographic characteristics of the respondents (e.g. job role, region in which they work), their past non-UK academic involvement, and perceived interest and their views on barriers and facilitators to academic engagement among IMG psychiatrists within the UK Members were contacted via the official membership database and asked to promote it to other suitable/eligible participants. This encompasses Consultants, SAS Doctors, and resident doctors, all of whom are IMGs and who have previously provided institutional consent to receive communications regarding BIPA-led projects and research. Two reminders were sent. To ensure ethical rigor, all participants were required to provide explicit informed consent at the start of the survey for the anonymised responses to be used in subsequent publications. This dual-channel approach leveraged both formal and informal networks to maximise reach while maintaining strict adherence to participant confidentiality and data protection standards. 2.2 Sample Inclusion criteria were: ( 1 ) medical doctors currently practising psychiatry in the UK of first-generation Indian origin, and ( 2 ) those possessing a primary medical qualification obtained outside the UK. 2.3 Ethics and consent Institutional ethics was obtained from University of Kent, School of Psychology ethics committee (ref:2026177635357210551). The project proposal was also reviewed and approved by the BIPA executive committee. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey in electronic form. The survey was disseminated via a convenience sampling approach, including through local professional networks such as BIPA. No participant identifier data was collected. Further, it was to a professional participant group where consent was implicit by participation. All participants were advised at the start of the study that participation was voluntary, and informed consent would be presumed if the survey was submitted. If they chose to participate, data would be pooled, anonymised and analysed. Explicit consent to participate, use data anonymously for research and publication was obtained. This was in a written format of ticking a box to use consent to use data for publication. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. 2.4 Data analysis 2.4.1 Quantitative All quantitative analyses were conducted in the R version 4.4.0. The characteristics of respondents were summarised using descriptive statistics. Responses on a 5-point Likert scale of self-reported interest in academia (with higher scores reflecting greater interest) were summarised by median and interquartile range (IQR) as measures of central tendency and variability. Self-reported interest in academia upon arrival to the UK and at present was compared using the Wilcoxon signed-rank test for paired data. Effect size was calculated using the matched-pairs rank biserial correlation (r β ), which quantifies the magnitude of within-participant change. A Chi-squared test was used to assess the distribution of prior engagement in academic activities outside of the UK (Y/N) by gender. Wilcoxon rank sum tests were used to compare self-reported academic interest at UK entry, at present, and the change between these time points across gender, region (London vs. non-London), and prior research involvement. Boxplots were generated to visualise these differences using the ggplot2 package in R. Wilcoxon rank sum tests were also used to compare self-reported academic interest at present according to psychiatrist seniority (consultants/SAS doctors vs. residents) and years of experience in psychiatry (< 15 years vs ≥ 15 years). 2.4.2 Qualitative The study qualitatively explored participants’ responses to two questionnaire items asking participants the following free-text response question items: “ Can you identify (up to) three things that might encourage you get involved in psychiatry academia? ” and “ Can you identify (up to 3) issues that might have been barriers to you getting involved in psychiatry academia? ”. Thematic analysis was employed to analyse the participant responses for each question separately, following Braun and Clarke’s (2006) six-step framework.( 16 ) This method enabled flexible pattern identification despite participants’ short answers. Initially, two authors ( MD and MM ) conducted the analysis independently, generating codes, themes, and subthemes for all data. MD used Taguette (open-source qualitative analysis software), whereas MM used NVivo 1.7.2 software. Coding decisions and theme definitions were discussed, and disagreements were resolved in consultation with a third researcher ( PT ). 3 Results A total of 91completed the survey. Two respondents’ data were removed because they did not meet the inclusion criteria. One had retired from clinical practice, and one reported their undergraduate degree to have been in the UK. Among the 89 remaining participants, 71% (63/89, 71%) were male and 83% (74/89, 83%) held consultant positions. 82% (73/89, 82%) had 15 or more years’ experience in psychiatry. The most represented regions were London and the West Midlands (Table 1 ). Table 1: Characteristics of respondents (n=89). Characteristic % (n) Gender Male Female 71 (63) 29 (26) Level Core training (CT1 to CT3) Higher training (ST4 and above) SAS doctors Consultant 4 (4) 3 (3) 9 (8) 83 (74) Years worked in Psychiatry Less than 5 years 15 or more years 18 (16) 82 (73) Start of work in the UK Before 2000 2000-2010 2011-2020 2021 onwards 30 (27) 48 (43) 9 (8) 12 (11) Region in UK London West Midlands East of England North West Yorkshire and the Humber East Midlands North East South West Wales South East East Anglia 20 (18) 20 (18) 10 (9) 10 (9) 10 (9) 9 (8) 6 (5) 6 (5) 6 (5) 3 (3) 0 (0) Prior involvement in academic activities outside of the UK Yes No 61 (54) 39 (35) Of the 89 participants, 75 provided information on the country in which they completed their basic medical training. Among these, 71 (71/75, 95%) had trained in India, while the remainder had trained in China, Egypt, Nepal, and Turkey. Thus, they also met the criteria of being IMGs with Indian heritage. 3.1 Interest in academia There was no significant difference between self-reported academic interest from UK arrival (median = 4, IQR = 3–5) and at present (median = 4, IQR = 3–4), V = 682, p = .952, r β = .037. 61% (54/89) of respondents reported prior engagement in academic activities outside the UK (Table 1 ). There was no significant association between gender and prior engagement in academic activities outside of the UK ( χ ²(1, n = 89) = 1.75, p = .185, φ = .09). 3.1.1 Gender Males (median = 4, IQR = 3–5) had a significantly higher self-reported academic interest on UK arrival than females (median = 3, IQR = 2–4), W = 590, p = .034, r β = .28. However, there was no significant gender-based difference for self-reported academic interest at present (males: median = 4, IQR = 3–4; females: median = 4, IQR = 3–4), W = 801, p = .870, r β = .02. Females (median = 0.5, IQR 0–1) had a greater increase in self-reported interest in research from UK entry to present than males (median = 0, IQR − 1–0), W = 1035, p = .043, r β = .26. (Fig. 1) 3.1.2 Region There was no significant region-based difference for self-reported academic interest at present (London: median = 4, IQR = 3–5; non-London: median = 4, IQR = 3–4), W = 752, p = .236, r β = .18. There was also no region-based difference in change in self-reported academic interest from UK entry to present (London: median = 0, IQR = -0.75–0; non-London: median = 0, IQR = -1–1), W = 556, p = .377, r β = .13. (Fig. 2) 3.1.3 Prior research experience Psychiatrists with prior research involvement (median = 4, IQR = 3–5) reported significantly higher academic interest on UK arrival than those without prior involvement (median = 3, IQR = 2–4), W = 489, p < .01, r β = .48.Those without prior research involvement reported a greater increase in interest in research from UK entry to present (median = 0, IQR − 1–0) than those with prior research experience (median = 0, IQR − 1–0), W = 1230, p = .013, r β = .30. (Fig. 3) 3.2.4 Experience Self-reported current academic interest did not differ significantly according to years worked in Psychiatry (< 15 years: median = 4, IQR = 3–4; ≥15 years: median = 4, IQR = 3–4), W = 642, p = .524, r β = .10. There was no significant difference between consultants/SAS doctors compared to resident doctors with respect to academic interest at present (consultants/SAS doctors: median = 4, IQR = 3–4; resident doctors: median = 4, IQR = 4–4.5; W = 164, p = .052, r β = .43). 3.2 Facilitators and barriers to engaging in academia Multiple themes emerged from qualitative analysis of the open-text responses to questionnaire items X and Y (Fig. 4) . Barriers generated three main themes, each including two subthemes: a) Cultural barriers, b) Structural and navigational barriers, and c) Capacity and resource barriers. Facilitators generated two themes: a) Creating evidence-based practice and b) Institutional and resource facilitators. Indicative quotes are available in Table 2 . Table 2 Indicative quotes and their associated themes, subthemes, and codes Theme Subtheme Codes Indicative Quotes Cultural barriers Academic culture • Academia is unwelcoming • Unimpactful “Academic is a very competitive field”,” We also need a welcoming attitude from those in academics” “Academia’s limited impact on clinical psychiatry- specialty LGBT community in the UK” Discrimination • Racism • Colour • Stereotyping • Favouritism “Delays in recognition of expertise as a non-Caucasian academic” “Cultural factors like migration” “Racism at workplace” “MGs carry the burden of services while local candidates are prioritised for research opportunities” Structural and navigational barriers Lack of opportunities • Research network • Funding “Distance of main academia hubs”, “access to resources and like-minded peers” “Lack of funding” , Support and guidance • Mentoring • Employer support • Knowledge of entry routes • Applying for grants • Publishing “Lack of any guidance, mentoring”, “Unhelpful, non-encouraging professors and researchers” “No clear pathway for getting involved in research research would mean undertaking additional degree (MD or PhD”, “Lack of access and knowledge of who and how” “Getting research funds” “ Lack of support from employers” “Getting papers published” Capacity and resource barriers Limited time • Clinical workload • Job plan • Protected time • Work-life balance • Bureaucracy “Clinical demands and nature of work, busy” , “Clinical constraints, Job planning” “personal/work life balance” “children” “Lengthy protocols to get started” Lack of resources • Personal resources: • Confidence • Financial • Knowledge • Training • Language “Not knowing how to be Smart, focussed and prioritise” “lack of confidence” “cost of living”, “Financial commitments” “Lack of education”, “no help with research methodology training” “English is not first language” Creating evidence-based practice Applied research • Relevant research topic • Innovation • Patient outcomes • Service development “Topic of interest” “Research about novel therapies, “AI based personalized clinical care” “Make it related to patient care” , “Contributing in research conducting surveys Nd evaluation for service development” Dissemination and personal development • Publication • Sharing (talks and teaching) • Leading own project • Updating knowledge • Expanding horizons “Easy to do publications” “Sharing of knowledge”, “Teaching, giving talks”, “practising Specialist skills I achieved over years would be helpful for next generation” “Participation in research studies as investigator” “Updating knowledge” “Expanding horizons of professional career” Institutional and resource facilitators Balance between clinical work and research • Time • Clinical workload • Job plan • Protected time • Financial stability “Dedicated time”, “Time commitment” “Manageable clinical caseloads” “Allocating dedicated SPAs in job planning”, “Flexibility and support through job planning” , “Make it part of objectives and give time on the job” “ Protected time and money outside of clinical duties” Availability of opportunities • Partnerships • Research and teaching opportunities • Recognition • Flexibility • Funding , “Affiliation to an academic institution”, “Affiliation to an academic institution” “Research opportunities”, “Better teaching opportunities”, “Clinical or Practical teaching” “More opportunities” “Recognition by the employer”, ““Honorary roles” “Ability to do it remotely” “Funding opportunities” Culture • Support • Mentoring • Knowledge of resources • Pathway • Training “Encouragement during job planning and appraisal”, “The department's openness to research and development” “Good mentoring and guidance on how to enter psychiatry academia”, “Hand holding by native graduates” “Mentoring to do projects jointly” “More information on the options along with clinical work”, “Easy access” “Training on how to write academic writing”, “Help with research methodology” 3.2.1 Barriers Theme 1: Cultural Barriers Participants commented on cultural barriers in academia and their own cultural backgrounds, including two subthemes: a) Academic culture, and b) Discrimination. Subtheme: Academic culture Participants described the academic culture as unwelcoming and difficult to access. A participant noted that “ Opportunities (are) only for the research colleagues ”, highlighting an implicit favouritism towards psychiatrists already involved in research. Similarly, another participant expressed the need for a more welcoming academic environment: “ We also need a welcoming attitude from those in academics ”. Moreover, two psychiatrists characterised academia as competitive but also unimpactful, suggesting a perceived irrelevance of clinical practice. Subtheme: Discrimination A greater number of participants identified their cultural background and education as factors that hindered their academic involvement, stating “Cultural factors like migration” and “Feeling skills from other countries would not be recognised in the UK”. Participants reported “racism at workplace”, “colour”, and “stereotyping” , while “IMGs carry the burden of services while local candidates are prioritised for research opportunities” and “IMG trainees are implicitly discouraged to take up academic training” . Theme 2: Structural and Navigational Barriers Participants highlighted the structure of academia and its accessibility. Two subthemes emerged: a) Lack of opportunities, and b) Support and guidance. Subtheme: Lack of opportunities Participants reported lacking a research network that would allow them to engage in research activities. They mentioned feeling disconnected from where research is occurring and attributed this to physical distance and a lack of networking opportunities: “no contact with universities; no effective research network”, “working in rural community settings, lack of local networks” . Furthermore, some participants reported limited funding opportunities, with one participant mentioning “ Research funding issues ” as a barrier to their involvement in research. Subtheme: Support and guidance Navigational barriers were highlighted. Specifically, many participants reported that accessing the academic environment is challenging without adequate encouragement and guidance: “lack of support from the employer or research department” and “less guidance on teaching and research in (the) UK” . Furthermore, some participants expressed feeling uninformed about the process of getting involved with research. A participant stated: “Right information, current lack of ease of access to right programmes, better awareness of how one could take an academic career and still progress to complete training” . Participants found that there is a general lack of knowledge on how to get started, “Lack of understanding/knowledge of what is available or possible” , which creates a vague picture of whether clear procedural entry routes exist. Additionally, some participants mentioned difficulties in publishing and applying for grants. Theme 3: Capacity and Resource Barriers This theme centred on resource availability, namely, time and personal resources. Participants identified a range of resources and capacity limitations that hindered academic participation. The emerged subthemes were: a) Limited time, and b) Lack of resources. Subtheme: Limited time Most participants reported feeling unable to pursue a research activity due to time constraints. They stated they that their job arrangement was dominated by clinical practice, leaving little room for other pursuits, and that they felt they had been working at full capacity. One participant described it as “Full-time & arduous clinical work” , while another mentioned “lack of allocated time”. Another participant referred to “personal/work life balance” , further emphasising the demands of clinical work. Additionally, two participants commented on bureaucracy and administrative procedures as time-consuming, preventing them from engaging in research: “Too much administration, bureaucracy”. Subtheme: Lack of resources In this subtheme, participants primarily referred to personal resources. Specifically, they identified a lack of training as a barrier to their involvement. A participant noted: “insufficient knowledge”. Another cited a language barrier: “English is not (the) first language” . Three participants also felt less confident in undertaking research: “anxiety about outcome and imposter syndrome”. In contrast, others showed no motivation at all: “Not relevant as I don’t want to get involved in the first place”. Finally, three individuals highlighted financial barriers, such as “needing to concentrate on bills” . 3.2.2 Facilitators Two themes emerged from questionnaire item Y: a) Creating evidence-based practice and b) Institutional and resource facilitators. Theme 1: Creating Evidence-Based Practice This theme included participants’ aspirations to develop practice supported by an evidence base. Two subthemes emerged: a) Applied research, and b) Dissemination and personal development. Subtheme: Applied research Several participants expressed their desire to innovate as a reason for pursuing academic involvement. Quotes included “Innovation, new treatment” , “improving clinical care”, “patient outcomes” and “Contributing in research conducting surveys Nd evaluation for service development ”. They would also pursue a research project that would be personally relevant and applied: “ Real research which is applied ”. Subtheme: Dissemination and personal development This subtheme reflects participants’ desire to share their knowledge and expertise. Participants mentioned “sharing of knowledge” and “creating small groups to scaffold others to write papers” . Many participants emphasised the importance of teaching as illustrated by this quote “Practising specialist skills I achieved over years would be helpful for next generation”. This may suggest a view of teaching as an active form of participation that promotes personal growth and the dissemination of evidence-based knowledge. Additionally, two participants referred to publishing papers, with one specifically alluding to the difficulty of the process: “Easy to do publications” . Theme 2: Institutional and Resource Facilitators This subtheme includes three subordinate themes: a) Balance between clinical work and research, b) Availability of opportunities, and c) Culture. It reflects themes two and three of the barriers, but it differs structurally due to the size of the subthemes. Subtheme: Balance between clinical work and research Participants identified facilitators in this subtheme that share similarities with the subtheme from the barriers analysis: ‘ Limited time’ (from the overarching barrier theme ‘Capacity and Resources’). Unlike the ‘ Limited time’ subtheme, the ‘ Balance between clinical work and research’ subtheme explicitly referred to a more balanced job arrangement that allows for both clinical and academic responsibilities, as demonstrated by this quote: “Job plan changes to allow more academic involvement” . Clinicians mentioned that undertaking research is impossible without allocated time within the job plan and argued that it should not be expected of them to do it in their own time: “Paid release days - clinical duties during that time need to be covered rather than left for me to deal with on my return”. Apart from designated time, some clinicians expressed that a reduced clinical workload would enable academic involvement: “Time in job plan with corresponding reduction in clinical workload as well”. However, it was noted that this should not endanger their financial stability: “financially well remunerated for taking up academic role” . Subtheme: Availability of opportunities The identified facilitators in this subtheme centred around the availability of opportunities. Participants noted that forming partnerships would enable academic engagement. This might include a supportive peer group, “Peer group support” , or a broader research network wherein opportunities for collaboration are more likely to arise: “better relationship with academic departments, developing relationships with researchers” and “Link with academic/ professorial units” . Moreover, clinicians stated they would consider involvement if more teaching opportunities were available, demonstrating a comprehensive view of the profession that encompasses practice, research, and teaching. Participants responded: “Honorary roles” and “clinical or practical teaching”. Finally, one participant stated that there is a need for “ more funding opportunities ”, while another quoted “recognition by the employer”. Subtheme: Culture This subtheme encompassed facilitators related to the broader work culture. Some participants referred to institutional culture and expressed a need for a more inclusive and open academic environment: “Inclusive culture is needed in academic circles, which are currently closed up and non-inclusive”. They also highlighted the need for equality of opportunity and fair access to academia: “access to opportunities for all consultants not just clinical academics”. Psychiatrists also expressed the need for more support. They shared comments such as: “Friendly supportive environment”, “organisational support” , and “support from Trust” , highlighting the significance of support from various parties. Additionally, participants underscored the value of mentoring and guidance to enter, “Good mentoring and guidance on how to enter psychiatry academia ”, and to navigate the academic realm, “Happy with following the advice from established academics” . Participants also identified the need for research methodology training and academic writing: “ Guided research methodology workshops, daily clinical and academic discussions” . Lastly, two psychiatrists mentioned the need for a clear pathway and knowledge of available resources. 4 Discussion This mixed-methods study explored interest in and barriers and facilitators to academic engagement among UK-based psychiatry IMGs of Indian origin. Barriers to academic involvement were cultural (including perceived discrimination), structural and navigational (limited opportunities, support, and guidance), and capacity and resource constraints (both time and personal resources). Facilitators included motivation to support evidence-based practice, balanced clinical and research roles, accessible opportunities, and supportive academic cultures on both an individual and institutional level. Interest in academia was high on UK arrival and broadly unchanged over time, though patterns differed by gender and prior research experience: men and those with research experience reported higher initial interest, while women and those without experience showed greater increases over time. 4.1 Interest in academic psychiatry Despite the considerable barriers identified in this study, Indian IMGs in psychiatry reported high levels of academic interest upon entering the UK to work, and this interest generally persisted over time. This indicates that lack of interest itself is not a pervasive barrier among the group surveyed, consistent with previous findings from the broader UK medical workforce.( 17 ) Given these consistently strong levels of interest, addressing cultural, structural, and institutional barriers could facilitate greater participation in academic psychiatry among IMGs. Participants without prior research experience showed greater increases in academic interest from UK arrival to the time of survey (p = 0.013). This reflects previous research indicating that newly arrived IMGs often focus on “surviving” before they can begin to “thrive” in their new work environment.( 18 ) This adaptation period may reflect both growing awareness of academic opportunities and increased confidence as clinicians become more established in UK practice. On commencement of clinical work in the UK, female IMG psychiatrists self-reported lower levels of interest in academia compared to males (p = 0.034). This aligns with research highlighting that women in medical training express lower interest in academic careers than men, particularly at senior levels.( 19 ) Structural inequities may contribute to this pattern: even after adjusting for factors such as time in practice, specialty, and the number of publications, men are significantly more likely to be professors.( 20 ) As of 2022, only 35% of UK clinical professors were women, revealing a persistent gender imbalance at the highest levels of medical academia.( 21 ) These disparities could reduce early academic aspirations among women due to a lack of visible role models and mentors. However, our findings also indicate that female IMG psychiatrists experienced a greater increase in academic interest than males from the start of their UK clinical practice to the point of survey (p = 0.043). These gender differences among IMG psychiatrists may reflect inter-group differences in experiences upon arriving and working as psychiatrists in the UK healthcare system. 4.2 Culture and discrimination Survey respondents described the academic environment as unwelcoming, exclusionary, and difficult to navigate. There is a sparsity of literature focusing on discrimination of IMGs in academic psychiatry. However, in clinical roles, existing research demonstrates that IMGs feel greater discrimination from colleagues and institutions.( 22 ) Furthermore, almost a third of locally employed doctors, the majority of whom are IMGs, reported having been bullied, undermined, or harassed in the work place in the General Medical Council’s (GMC) 2019 workplace experiences survey.( 23 ) One study of IMGs in academic plastic surgery in the US found that, despite IMGs having comparable Hirsh indices, number of publications and citations, they received almost seven times lower research funding from the National Institutes of Health compared to domestic graduates.( 24 ) Although outside of the UK, it reflects an institutional discrimination against IMGs in academia that was similarly highlighted by the participants in our study. 4.3 Navigating research and structures Many of those surveyed reported limited awareness of academic career routes within the UK, challenges in accessing opportunities, and limited contact with universities and research networks. Structured pathways such as the Academical Clinical Fellowship (ACF), which provides joint clinical and academic training over three years, along with support for doctoral funding, appear to be access disproportionately by White, British doctors. In 2022, fewer than five General Practice ACF posts were accepted by doctors of Asian or Asian British Indian ethnicity.( 25 ) For IMGs, who often begin NHS work outside formal training pathways, these disparities may be compounded by a lack of tailored guidance and limited institutional support. Mentorship is recognised as highly important in developing academic clinicians. However, minoritised groups often receive less mentoring than their non-minoritised peers.( 26 , 27 ) This underrepresentation and lack of parity in mentoring suggests systemic inequities in access to academic medicine at early career stages. Our study did not find any regional differences suggesting that those with more academic interest gravitated closer to established academic centres. 4.4 Capacity and resources Time constraints and job arrangements being dominated by clinical practice emerged as key barriers. In contrast, having dedicated research time formally included in job plans and paid release days were identified as important enablers of academic involvement. This reflects findings from the Royal College of Physicians’ (RCP) Research for All report, which highlighted lack of time as the predominant barrier to research participation among doctors working in the UK.( 17 ) Participants also raised concerns about the impact of research on work-life balance, suggesting that academic activity would likely have to occur outside of working hours. This also aligns with a report by the Royal College of Physicians, where respondents described research as overwhelming home life, often being conducted during evenings and weekends.( 17 ) This pattern is also true among psychiatry registrars specifically.( 28 ) Further personal barriers were identified, including insufficient research knowledge, imposter syndrome, and English not being a first language. Some IMGs may find it difficult to conduct research due to language difficulties although Indian graduates are trained in English, dialects may create difficulties. These issues are consistent with existing literature showing that IMGs are more likely to experience self-doubt and feelings of intellectual inadequacy.( 29 ) Language challenges, especially during the initial stages of clinical work, are also described in the literature, further connecting with our observed increase in academic interest over time for some groups surveyed.( 18 ) 4.5 Implications for policy and practice Research experience is becoming a necessity for career progression in psychiatry in the UK.( 30 ) For entry into higher specialty training, candidates are awarded points for completion of research degrees, publication of academic manuscripts, and presentations delivered at national and international conferences.( 31 ) However, not all clinicians have equitable access to research opportunities. Mentorship, cultural, and discriminatory barriers are particularly important among IMGs. To prevent inequality in academic psychiatry, national training bodies and trusts could ensure protected research time is embedded within job plans, even at the core training level. Particular effort could be made to support those IMGs who arrive “pre-loaded” with academic qualifications or experience.( 3 ) Clearer guidance, improved opportunities for mentoring, and enhanced institutional support could help to cultivate a research-active psychiatric workforce that reflects the diversity of the UK medical profession. 4.7 Strengths and limitations To our knowledge, this is the first study to explore interest in, and barriers and facilitators to, academic engagement among UK-based psychiatry IMGs. The concurrent mixed-methods design, combining quantitative survey data with thematic analysis of free-text survey responses, provides both breadth and depth. We recruited IMG psychiatrists across multiple UK regions, grades and years of experience, and included clinicians with and without prior research involvement. The credibility of our qualitative analysis was improved through independent double-coding of qualitative data, discussion of conflicts, and adjudication by a third researcher. Partiality was reduced as the qualitative analytic team had diverse professional backgrounds, including a medical doctor, a PhD candidate in education research, and a senior lecturer in intellectual disabilities. The detailed reporting of participant characteristics also allows for greater assessment of the transferability of our findings. However, a relatively small number of psychiatry residents responded, and academic interest was self-reported at a single time point; retrospective ratings of past interest are vulnerable to recall bias. Although multiple comparisons were performed, we did not apply a formal correction for multiplicity. This was because these analyses were exploratory and intended to generate hypotheses. Additionally, strict family-wise error control (e.g. Bonferroni) can be overly conservative, particularly in studies with modest sample sizes and correlated outcomes, increasing the risk of Type II error. We therefore report exact p-values and place greater emphasis on effect sizes. These findings should be interpreted cautiously and warrant confirmation in larger studies. Additionally, IMG psychiatrists responding to this survey may not be representative of the wider pool of all UK-based Indian IMG psychiatrists. This may limit the generalisability of our findings to IMGs from other regions, although the majority of UK-based IMGs trained in India.( 5 ) Finally, this study lacks a non-IMG psychiatrist control group to act as a comparator; this would be valuable in determining which barriers and facilitators are specific to IMG psychiatrists (and to what extent), and which, if any, are experienced by the psychiatric workforce more generally. 5 Conclusion This study used a concurrent, mixed-methods approach to explore interest in and barriers and facilitators to academic engagement among UK-based psychiatry IMGs. Despite significant structural and personal barriers, participants expressed strong interest in pursuing academic work. Importantly, this interest was sustained or increased over time, particularly among those with less prior research exposure and female IMGs, suggesting that early barriers may ease with adaptation. Our findings suggest that the level of academic engagement is not driven by disinterest, but by access to research infrastructure, mentorship, and institutional guidance, as well as other cultural and discriminatory factors. Targeted strategies, such as integrating research time into clinical job plans, expanding mentorship schemes, and offering structured academic induction for all doctors, including new IMGs, could enhance inclusion and progression in academic psychiatry. Addressing these barriers is not only important for supporting IMG clinicians, but also for building a representative and innovative academic workforce in UK psychiatry. Declarations Acknowledgments : none Statements and Declarations including competing interests: SSM and SM serve as trustees for the British Indian Psychiatric Association (BIPA). SJT is on the editorial board of the BMC psychiatry but was not involved in the editorial or review process. He holds grants from the NIHR and Baily Thomas Charitable Fund outside of this work. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Neuraxpharm, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from various national funding bodies all outside this work. No other author has any declared conflict of interest related to this paper. Ethics Statement We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Institutional ethics was obtained from University of Kent, School of Psychology ethics committee (ref:2026177635357210551). Informed consent from participants for participation and publishing data is obtained Consent for Publication Not Applicable Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contributions All authors satisfy the ICMJE guidance by substantially contributing to the design, analysis and interpretation of the work, drafting of the manuscript, final approval of the manuscript and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved. MD - Data curation, Formal analysis, Investigation, Methodology, Visualisation, Writing (original draft); MM - Formal analysis, Methodology, Visualisation, Writing (original draft); SSM - Conceptualization, Investigation, Project administration, Supervision, Validation, Visualization, Writing – review & editing; SM -Investigation, Project administration, Writing – review & editing, DS-Investigation, Project administration, Writing – review & editing; VZ - Investigation, Project administration, Writing – review & editing; PT - Formal analysis, Validation, Visualization, Writing – review & editing; SJT - Formal analysis, Validation, Visualization, Writing – review & editing; DM- Conceptualization, Validation, Visualization, Writing – review & editing RS- Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing. Data statement All data supporting the findings of this study are available within the paper and its Supplementary Information. References Sinclair LI, Ajram L, Seneviratne G, Tracy D, Critchley H. Why does research matter to psychiatrists? Brain Neurosci Adv [Internet]. 2025 Jan [cited 2025 Oct 20];9. Available from: https://scholar.google.com/scholar_url?url=https://journals.sagepub.com/doi/pdf/10.1177/23982128241305866%3Ftrk%3Dpublic_post_comment-text&hl=en&sa=T&oi=ucasa&ct=ufr&ei=lpD1aNKXMIeVieoP9e_euQw&scisig=AAZF9b9g02PJ28yQRfiFpb3HADvb Critchley HD, Tracy DK, Malhi GS, Alexander L, Baldwin DS, Cavanagh J, et al. Academic psychiatry is everyone’s business. The British Journal of Psychiatry [Internet]. 2024 Dec 1 [cited 2025 Dec 21];225(6):521–5. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/academic-psychiatry-is-everyones-business/D69886C4AC1722383D290F0C9CE03F9A Shankar R, Bowater L, Laugharne R, Tracy DK, Critchley H, Young AH, et al. British academic psychiatry at a crossroads: lessons from the past 20 years and priorities for the next 20 years. International Review of Psychiatry [Internet]. 2025 [cited 2025 Dec 21]; Available from: https://www.tandfonline.com/doi/pdf/10.1080/09540261.2025.2560038 Medical Schools Council. Clinical Academic Survey. 2024. The state of medical education and practice in the UK Workforce report 2024. 2024; https://www.rcpsych.ac.uk/docs/default-source/about-us/equality-diversity-and-inclusivity/equality-action-plan---january-2021.pdf Lagunes-Cordoba E, Maitra R, Dave S, Matheiken S, Oyebode F, O’Hara J, et al. International medical graduates: how can UK psychiatry do better? BJPsych Bull [Internet]. 2021 Oct [cited 2025 Oct 20];45(5):299. 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Journal of Mental Health and Human Behaviour 22(2):p 77-79, Jul–Dec 2017. | DOI: 10.4103/0971-8990.229110 Patel, Vikram. Research priorities for Indian psychiatry. Indian Journal of Psychiatry 52(Suppl1):p S26-S29, January 2010. | DOI: 10.4103/0019-5545.69201 Kallivayalil, R. A., Chadda, R. K., & Mezzich, J. E. (2010). Indian psychiatry: Research and international perspectives. Indian journal of psychiatry , 52 (Suppl 1), S38–S42. https://doi.org/10.4103/0019-5545.69205 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Royal College of Physicians. Research for all: Building a research-active medical workforce. 2016. Al-Haddad M, Jamieson S, Germeni E. International medical graduates’ experiences before and after migration: A meta-ethnography of qualitative studies. Med Educ [Internet]. 2022 May 1 [cited 2025 Dec 16];56(5):504–15. Available from: /doi/pdf/10.1111/medu.14708 Leonard JC, Ellsbury KE. Gender and interest in academic careers among first- and third-year residents. Acad Med [Internet]. 1996 [cited 2025 Dec 14];71(5):502–4. Available from: https://pubmed.ncbi.nlm.nih.gov/9114871/ Li B, Jacob-Brassard J, Dossa F, Salata K, Kishibe T, Greco E, et al. Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis. BMJ Open [Internet]. 2021 Nov 2 [cited 2025 Dec 14];11(11):e050322. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8565568/ Staffing levels of medical clinical academics - Medical Schools Council [Internet]. [cited 2025 Dec 14]. Available from: https://www.medschools.ac.uk/what-we-do/championing-clinical-academia-and-research/clinical-academic-survey/ Chen PGC, Nunez-Smith M, Bernheim SM, Berg D, Gozu A, Curry LA. Professional Experiences of International Medical Graduates Practicing Primary Care in the United States. J Gen Intern Med [Internet]. 2010 Sep [cited 2025 Dec 14];25(9):947. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2917670/ General Medical Council. Survey of Specialty and Associate Specialist (SAS) and Locally Employed (LE) Doctors. 2019. Egro FM, Lai J, Muthiah N, Smith BT, Nguyen VT. Characteristics of International Medical Graduates in Academic Plastic Surgery. Plast Reconstr Surg [Internet]. 2022 May 1 [cited 2025 Dec 14];149(5):1263–71. Available from: https://pubmed.ncbi.nlm.nih.gov/35311804/ Howe A, Orkin C, Apea V. The under-representation of racially minoritised doctors in academic general practice training: a retrospective analysis. BJGP Open [Internet]. 2024 Jul 1 [cited 2025 Dec 14];8(2):1–8. Available from: https://bjgpopen.org/content/8/2/BJGPO.2023.0136 Morzinski JA, Fisher JC. A nationwide study of the influence of faculty development programs on colleague relationships. Acad Med [Internet]. 2002 [cited 2025 Dec 16];77(5):402–6. Available from: https://pubmed.ncbi.nlm.nih.gov/12010696/ Helm EG, Prieto DO, Parker JE, Russell MC. Minority medical school faculty. J Natl Med Assoc [Internet]. 2000 Aug [cited 2025 Dec 16];92(8):411. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2608609/ Koelkebeck K, Andlauer O, Asztalos M, Jovanovic N, Kazakova O, Naughton S, et al. Research by Psychiatric Trainees and Early Career Psychiatrists—Results of a Survey From 34 Countries in Europe. Front Psychiatry [Internet]. 2021 Sep 10 [cited 2025 Dec 16];12:718669. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8461014/ Legassie J, Zibrowski EM, Goldszmidt MA. Measuring Resident Well-Being: Impostorism and Burnout Syndrome in Residency. J Gen Intern Med [Internet]. 2008 Jul [cited 2025 Dec 16];23(7):1090. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2517942/ Clinical researchers in the United Kingdom: Overview Clinical researchers in the United Kingdom. Self-assessment verification process | Medical Hub [Internet]. [cited 2025 Dec 16]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/psychiatry/higher-psychiatry-training/self-assessment-verification/self-assessment-verification-instructions/domain-breakdown Additional Declarations Competing interest reported. SSM and SM serve as trustees for the British Indian Psychiatric Association (BIPA). SJT is on the editorial board of the BMC psychiatry but was not involved in the editorial or review process. He holds grants from the NIHR and Baily Thomas Charitable Fund outside of this work. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Neuraxpharm, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from various national funding bodies all outside this work. No other author has any declared conflict of interest related to this paper. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9531516","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":637733341,"identity":"cfc08370-6195-42b7-93d2-2d2feceeba65","order_by":0,"name":"Madeleine Dale","email":"","orcid":"","institution":"University Hospitals Plymouth NHS Trust","correspondingAuthor":false,"prefix":"","firstName":"Madeleine","middleName":"","lastName":"Dale","suffix":""},{"id":637733342,"identity":"525b46d6-3bf4-411b-acb8-eac9ede07f60","order_by":1,"name":"Magdalini Moraitou","email":"","orcid":"","institution":"University of 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SSM and SM serve as trustees for the British Indian Psychiatric Association (BIPA). SJT is on the editorial board of the BMC psychiatry but was not involved in the editorial or review process. He holds grants from the NIHR and Baily Thomas Charitable Fund outside of this work. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Neuraxpharm, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from various national funding bodies all outside this work. No other author has any declared conflict of interest related to this paper.","formattedTitle":"Finding a Voice in UK Academic Psychiatry: Barriers and facilitators to engagement among Indian International Medical Graduates: a mixed-methods study","fulltext":[{"header":"1 Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 The importance of academic psychiatry and its current situation\u003c/h2\u003e \u003cp\u003eAcademic psychiatry is defined as generating new knowledge and evidence which can be translated into practice to improve patient outcomes. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In training and role as a medical professional, research capabilities are important. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Not only does a more research-active psychiatry work force contribute to evidence-based practice, it also cultivates an organisational culture of inquiry and improvement and results in better patient care.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) A research-engaged psychiatry workforce could help address important mental health challenges and is key to the specialty\u0026rsquo;s future.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) However, despite the numerous scientific advances over the last decade, there has been a concerning reduction in the clinical academic workforce.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) In 2023, only 2% of UK psychiatrists held academic posts, which is a reduction of one-third from 2004.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe role of international medical graduates and the problems faced by them\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eWithin this landscape, the role of international medical graduates (IMGs) becomes particularly salient. IMGs form a substantial proportion of the workforce in the National Health Service (NHS), with over two-thirds of all doctors joining the UK workforce between 2022 and 2023 being non-UK graduates.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) This is especially true in psychiatry, where 39% of Royal College of Psychiatrists members are Black (6%), Asian (27%) or other minority ethnic background IMGs.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Nearly half (44%) of trainees in psychiatry at the start of this decade were IMGs.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIMGs bring valuable, global experience and diversity.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) However, IMGs often face unique structural, cultural, and organisational barriers, which may prevent full participation in UK academic psychiatry.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) The literature points to several challenges of IMGs in the NHS, including career progression, adaptation to new teaching and learning styles, examination hurdles, and psychosocial stressors.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Furthermore, in an analysis of data from General Medical Council databases and the 2019 National Training Survey, reported \u0026lsquo;very low\u0026rsquo; numbers of academic trainees from IMG background. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen, suggesting that graduating outside of the UK was an important factor.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSpeciality, Associate Specialist, and Specialist Doctors (SAS) doctors also face unique barriers to research, given that the focus of their role is on delivering clinical care.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Most SAS doctors in the UK are IMGs and of minoritised ethnicity, meaning the challenges faced by these groups are likely to be further exacerbated in academic psychiatry.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) In addition, IMGs struggle with the cultural nuances and formal syntax required for high-level academic writing and peer-to-peer communication.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Psychiatrists of Indian origin\u003c/h2\u003e \u003cp\u003eIndian psychiatry is recognised to have provided extensive and pioneering research that has made significant contributions to global mental health even though major economic and resource challenges exist. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Indian Psychiatry has had a considerable influence on World Psychiatry and the World Health Organization\u0026rsquo;s (WHO) mental health agenda and contributed to the development of the cultural bases of psychiatry through the work of many eminent researchers.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) It is recognised that psychiatrists who come from India to the UK have been exposed to academic psychiatry largely as training is provided by universities hence their experience, although quality may well be variable.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Thus, the experiences of Indian psychiatric IMGs are uniquely placed to highlight the structural and institutional challenges of UK academic psychiatry in being inclusive and equitable particularly for non-UK medical graduates.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eObjectives\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eThis study aimed to:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExplore perceived facilitators of and barriers to involvement in academic psychiatry by IMGs of Indian origin.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCharacterise self-reported interest in academic psychiatry at the time of arrival in the UK and at present among UK-based IMGs of Indian origin.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExplore whether self-reported academic interest (at arrival, at present, and change over time) may differ according to gender, region of work, prior research involvement, and years of psychiatric experience/grade.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2 Methods","content":"\u003cp\u003eThe Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross sectional studies was used to design and execute this study (\u003cem\u003erelated file: STROBE\u003c/em\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDesign and distribution\u003c/span\u003e\u003c/h2\u003e \u003cp\u003ethe questionnaire used in the study was developed for this study (\u003cem\u003esupplementary information1\u003c/em\u003e). The survey questions were developed collaboratively by the authors and members of British Indian Psychiatric Association (BIPA).\u003c/p\u003e \u003cp\u003eBIPA is a diaspora organisation in the UK, established over 25 years ago to provide support and represent psychiatrists of Indian origin and promote mental health awareness in the community. BIPA is recognised as one of the largest psychiatric diaspora organisations in the UK, second only in size to the Royal College of Psychiatrists, and is continually growing, currently with a membership of professionals most of whom are first generation IMGs. More information about BIPA's aims, activities, and events can be found on its official website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.bipa.org.uk/\u003c/span\u003e\u003cspan address=\"http://www.bipa.org.uk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe survey was developed on Google Forms platform. The average completion time was approximately ten minutes. The survey was online from 18th of March 2025 to 21st of August 2025. The survey questionnaire consisted of 14 questions related to the demographic characteristics of the respondents (e.g. job role, region in which they work), their past non-UK academic involvement, and perceived interest and their views on barriers and facilitators to academic engagement among IMG psychiatrists within the UK\u003c/p\u003e \u003cp\u003eMembers were contacted via the official membership database and asked to promote it to other suitable/eligible participants. This encompasses Consultants, SAS Doctors, and resident doctors, all of whom are IMGs and who have previously provided institutional consent to receive communications regarding BIPA-led projects and research. Two reminders were sent.\u003c/p\u003e \u003cp\u003eTo ensure ethical rigor, all participants were required to provide explicit informed consent at the start of the survey for the anonymised responses to be used in subsequent publications. This dual-channel approach leveraged both formal and informal networks to maximise reach while maintaining strict adherence to participant confidentiality and data protection standards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.2 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSample\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eInclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) medical doctors currently practising psychiatry in the UK of first-generation Indian origin, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) those possessing a primary medical qualification obtained outside the UK.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthics and consent\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e Institutional ethics was obtained from University of Kent, School of Psychology ethics committee (ref:2026177635357210551). The project proposal was also reviewed and approved by the BIPA executive committee. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey in electronic form. The survey was disseminated via a convenience sampling approach, including through local professional networks such as BIPA. No participant identifier data was collected. Further, it was to a professional participant group where consent was implicit by participation. All participants were advised at the start of the study that participation was voluntary, and informed consent would be presumed if the survey was submitted. If they chose to participate, data would be pooled, anonymised and analysed. Explicit consent to participate, use data anonymously for research and publication was obtained. This was in a written format of ticking a box to use consent to use data for publication.\u003c/p\u003e \u003cp\u003e The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData analysis\u003c/span\u003e\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Quantitative\u003c/h2\u003e \u003cp\u003eAll quantitative analyses were conducted in the R version 4.4.0. The characteristics of respondents were summarised using descriptive statistics. Responses on a 5-point Likert scale of self-reported interest in academia (with higher scores reflecting greater interest) were summarised by median and interquartile range (IQR) as measures of central tendency and variability.\u003c/p\u003e \u003cp\u003eSelf-reported interest in academia upon arrival to the UK and at present was compared using the Wilcoxon signed-rank test for paired data. Effect size was calculated using the matched-pairs rank biserial correlation (r\u003csub\u003eβ\u003c/sub\u003e), which quantifies the magnitude of within-participant change. A Chi-squared test was used to assess the distribution of prior engagement in academic activities outside of the UK (Y/N) by gender.\u003c/p\u003e \u003cp\u003eWilcoxon rank sum tests were used to compare self-reported academic interest at UK entry, at present, and the change between these time points across gender, region (London vs. non-London), and prior research involvement. Boxplots were generated to visualise these differences using the ggplot2 package in R. Wilcoxon rank sum tests were also used to compare self-reported academic interest at present according to psychiatrist seniority (consultants/SAS doctors vs. residents) and years of experience in psychiatry (\u0026lt;\u0026thinsp;15 years vs\u0026thinsp;\u0026ge;\u0026thinsp;15 years).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Qualitative\u003c/h2\u003e \u003cp\u003eThe study qualitatively explored participants\u0026rsquo; responses to two questionnaire items asking participants the following free-text response question items: \u0026ldquo;\u003cem\u003eCan you identify (up to) three things that might encourage you get involved in psychiatry academia?\u003c/em\u003e\u0026rdquo; and \u0026ldquo;\u003cem\u003eCan you identify (up to 3) issues that might have been barriers to you getting involved in psychiatry academia?\u003c/em\u003e\u0026rdquo;. Thematic analysis was employed to analyse the participant responses for each question separately, following Braun and Clarke\u0026rsquo;s (2006) six-step framework.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) This method enabled flexible pattern identification despite participants\u0026rsquo; short answers.\u003c/p\u003e \u003cp\u003eInitially, two authors (\u003cem\u003eMD\u003c/em\u003e and \u003cem\u003eMM\u003c/em\u003e) conducted the analysis independently, generating codes, themes, and subthemes for all data. \u003cem\u003eMD\u003c/em\u003e used \u003cem\u003eTaguette\u003c/em\u003e (open-source qualitative analysis software), whereas \u003cem\u003eMM\u003c/em\u003e used \u003cem\u003eNVivo\u003c/em\u003e 1.7.2 software. Coding decisions and theme definitions were discussed, and disagreements were resolved in consultation with a third researcher (\u003cem\u003ePT\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eA total of 91completed the survey. Two respondents\u0026rsquo; data were removed because they did not meet the inclusion criteria. One had retired from clinical practice, and one reported their undergraduate degree to have been in the UK.\u003c/p\u003e \u003cp\u003eAmong the 89 remaining participants, 71% (63/89, 71%) were male and 83% (74/89, 83%) held consultant positions. 82% (73/89, 82%) had 15 or more years\u0026rsquo; experience in psychiatry. The most represented regions were London and the West Midlands (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eCharacteristics of respondents (n=89).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"491\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e% (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71 (63)\u003c/p\u003e\n \u003cp\u003e29 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Core training (CT1 to CT3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Higher training (ST4 and above)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;SAS doctors\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Consultant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (4)\u003c/p\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003cp\u003e9 (8)\u003c/p\u003e\n \u003cp\u003e83 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears worked in Psychiatry\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eLess than 5 years\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 15 or more years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (16)\u003c/p\u003e\n \u003cp\u003e82 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStart of work in the UK\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Before 2000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2000-2010\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2011-2020\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003e2021 onwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (27)\u003c/p\u003e\n \u003cp\u003e48 (43)\u003c/p\u003e\n \u003cp\u003e9 (8)\u003c/p\u003e\n \u003cp\u003e12 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion in UK\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;London\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;West Midlands\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;East of England\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;North West\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yorkshire and the Humber\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;East Midlands\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;North East\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;South West\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Wales\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;South East\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;East Anglia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (18)\u003c/p\u003e\n \u003cp\u003e20 (18)\u003c/p\u003e\n \u003cp\u003e10 (9)\u003c/p\u003e\n \u003cp\u003e10 (9)\u003c/p\u003e\n \u003cp\u003e10 (9)\u003c/p\u003e\n \u003cp\u003e9 (8)\u003c/p\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73.1161%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrior involvement in academic activities outside of the UK\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8839%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e61 (54)\u003c/p\u003e\n \u003cp\u003e39 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003c/br\u003e\u003cp\u003eOf the 89 participants, 75 provided information on the country in which they completed their basic medical training. Among these, 71 (71/75, 95%) had trained in India, while the remainder had trained in China, Egypt, Nepal, and Turkey. Thus, they also met the criteria of being IMGs with Indian heritage.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Interest in academia\u003c/h2\u003e \u003cp\u003eThere was no significant difference between self-reported academic interest from UK arrival (median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;5) and at present (median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4), V\u0026thinsp;=\u0026thinsp;682, \u003cem\u003ep\u003c/em\u003e = .952, r\u003csub\u003eβ\u003c/sub\u003e = .037. 61% (54/89) of respondents reported prior engagement in academic activities outside the UK (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was no significant association between gender and prior engagement in academic activities outside of the UK (\u003cem\u003eχ\u003c/em\u003e\u0026sup2;(1, n\u0026thinsp;=\u0026thinsp;89)\u0026thinsp;=\u0026thinsp;1.75, p = .185, φ\u0026thinsp;=\u0026thinsp;.09).\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 Gender\u003c/h2\u003e \u003cp\u003eMales (median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;5) had a significantly higher self-reported academic interest on UK arrival than females (median\u0026thinsp;=\u0026thinsp;3, IQR\u0026thinsp;=\u0026thinsp;2\u0026ndash;4), W\u0026thinsp;=\u0026thinsp;590, \u003cem\u003ep\u003c/em\u003e = .034, r\u003csub\u003eβ\u003c/sub\u003e = .28. However, there was no significant gender-based difference for self-reported academic interest at present (males: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4; females: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4), W\u0026thinsp;=\u0026thinsp;801, \u003cem\u003ep\u003c/em\u003e = .870, r\u003csub\u003eβ\u003c/sub\u003e = .02. Females (median\u0026thinsp;=\u0026thinsp;0.5, IQR 0\u0026ndash;1) had a greater increase in self-reported interest in research from UK entry to present than males (median\u0026thinsp;=\u0026thinsp;0, IQR\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026ndash;0), W\u0026thinsp;=\u0026thinsp;1035, \u003cem\u003ep\u003c/em\u003e = .043, r\u003csub\u003eβ\u003c/sub\u003e = .26. \u003cem\u003e(Fig.\u0026nbsp;1)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Region\u003c/h2\u003e \u003cp\u003eThere was no significant region-based difference for self-reported academic interest at present (London: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;5; non-London: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4), W\u0026thinsp;=\u0026thinsp;752, \u003cem\u003ep\u003c/em\u003e = .236, r\u003csub\u003eβ\u003c/sub\u003e = .18. There was also no region-based difference in change in self-reported academic interest from UK entry to present (London: median\u0026thinsp;=\u0026thinsp;0, IQR = -0.75\u0026ndash;0; non-London: median\u0026thinsp;=\u0026thinsp;0, IQR = -1\u0026ndash;1), W\u0026thinsp;=\u0026thinsp;556, \u003cem\u003ep\u003c/em\u003e = .377, r\u003csub\u003eβ\u003c/sub\u003e = .13. \u003cem\u003e(Fig.\u0026nbsp;2)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Prior research experience\u003c/h2\u003e \u003cp\u003ePsychiatrists with prior research involvement (median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;5) reported significantly higher academic interest on UK arrival than those without prior involvement (median\u0026thinsp;=\u0026thinsp;3, IQR\u0026thinsp;=\u0026thinsp;2\u0026ndash;4), W\u0026thinsp;=\u0026thinsp;489, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, r\u003csub\u003eβ\u003c/sub\u003e = .48.Those without prior research involvement reported a greater increase in interest in research from UK entry to present (median\u0026thinsp;=\u0026thinsp;0, IQR\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026ndash;0) than those with prior research experience (median\u0026thinsp;=\u0026thinsp;0, IQR\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026ndash;0), W\u0026thinsp;=\u0026thinsp;1230, \u003cem\u003ep\u003c/em\u003e = .013, r\u003csub\u003eβ\u003c/sub\u003e = .30. \u003cem\u003e(Fig.\u0026nbsp;3)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 Experience\u003c/h2\u003e \u003cp\u003eSelf-reported current academic interest did not differ significantly according to years worked in Psychiatry (\u0026lt;\u0026thinsp;15 years: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4; \u0026ge;15 years: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4), W\u0026thinsp;=\u0026thinsp;642, \u003cem\u003ep\u003c/em\u003e = .524, r\u003csub\u003eβ\u003c/sub\u003e = .10. There was no significant difference between consultants/SAS doctors compared to resident doctors with respect to academic interest at present (consultants/SAS doctors: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;4; resident doctors: median\u0026thinsp;=\u0026thinsp;4, IQR\u0026thinsp;=\u0026thinsp;4\u0026ndash;4.5; W\u0026thinsp;=\u0026thinsp;164, \u003cem\u003ep\u003c/em\u003e = .052, r\u003csub\u003eβ\u003c/sub\u003e = .43).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Facilitators and barriers to engaging in academia\u003c/h2\u003e \u003cp\u003eMultiple themes emerged from qualitative analysis of the open-text responses to questionnaire items X and Y \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003e(Fig.\u0026nbsp;4)\u003c/span\u003e. Barriers generated three main themes, each including two subthemes: a) Cultural barriers, b) Structural and navigational barriers, and c) Capacity and resource barriers. Facilitators generated two themes: a) Creating evidence-based practice and b) Institutional and resource facilitators. Indicative quotes are available in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndicative quotes and their associated themes, subthemes, and codes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndicative Quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCultural barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Academia is unwelcoming\u003c/p\u003e \u003cp\u003e\u0026bull; Unimpactful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Academic is a very competitive field\u0026rdquo;,\u0026rdquo; We also need a welcoming attitude from those in academics\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Academia\u0026rsquo;s limited impact on clinical psychiatry- specialty LGBT community in the UK\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiscrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Racism\u003c/p\u003e \u003cp\u003e\u0026bull; Colour\u003c/p\u003e \u003cp\u003e\u0026bull; Stereotyping\u003c/p\u003e \u003cp\u003e\u0026bull; Favouritism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Delays in recognition of expertise as a non-Caucasian academic\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Cultural factors like migration\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Racism at workplace\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;MGs carry the burden of services while local candidates are prioritised for research opportunities\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStructural and navigational barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of opportunities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Research network\u003c/p\u003e \u003cp\u003e\u0026bull; Funding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Distance of main academia hubs\u0026rdquo;, \u0026ldquo;access to resources and like-minded peers\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Lack of funding\u0026rdquo;\u003c/em\u003e,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport and guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Mentoring\u003c/p\u003e \u003cp\u003e\u0026bull; Employer support\u003c/p\u003e \u003cp\u003e\u0026bull; Knowledge of entry routes\u003c/p\u003e \u003cp\u003e\u0026bull; Applying for grants\u003c/p\u003e \u003cp\u003e\u0026bull; Publishing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Lack of any guidance, mentoring\u0026rdquo;, \u0026ldquo;Unhelpful, non-encouraging professors and researchers\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;No clear pathway for getting involved in research research would mean undertaking additional degree (MD or PhD\u0026rdquo;, \u0026ldquo;Lack of access and knowledge of who and how\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Getting research funds\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;\u003c/b\u003e\u003cem\u003eLack of support from employers\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Getting papers published\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCapacity and resource barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLimited time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Clinical workload\u003c/p\u003e \u003cp\u003e\u0026bull; Job plan\u003c/p\u003e \u003cp\u003e\u0026bull; Protected time\u003c/p\u003e \u003cp\u003e\u0026bull; Work-life balance\u003c/p\u003e \u003cp\u003e\u0026bull; Bureaucracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Clinical demands and nature of work, busy\u0026rdquo;\u003c/em\u003e,\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Clinical constraints, Job planning\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;personal/work life balance\u0026rdquo; \u0026ldquo;children\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Lengthy protocols to get started\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Personal resources:\u003c/p\u003e \u003cp\u003e\u0026bull; Confidence\u003c/p\u003e \u003cp\u003e\u0026bull; Financial\u003c/p\u003e \u003cp\u003e\u0026bull; Knowledge\u003c/p\u003e \u003cp\u003e\u0026bull; Training\u003c/p\u003e \u003cp\u003e\u0026bull; Language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Not knowing how to be Smart, focussed and prioritise\u0026rdquo; \u0026ldquo;lack of confidence\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;cost of living\u0026rdquo;, \u0026ldquo;Financial commitments\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Lack of education\u0026rdquo;, \u0026ldquo;no help with research methodology training\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;English is not first language\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCreating evidence-based practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplied research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Relevant research topic\u003c/p\u003e \u003cp\u003e\u0026bull; Innovation\u003c/p\u003e \u003cp\u003e\u0026bull; Patient outcomes\u003c/p\u003e \u003cp\u003e\u0026bull; Service development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Topic of interest\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Research about novel therapies, \u0026ldquo;AI based personalized clinical care\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Make it related to patient care\u0026rdquo;\u003c/em\u003e,\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Contributing in research conducting surveys Nd evaluation for service development\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDissemination and personal development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Publication\u003c/p\u003e \u003cp\u003e\u0026bull; Sharing (talks and teaching)\u003c/p\u003e \u003cp\u003e\u0026bull; Leading own project\u003c/p\u003e \u003cp\u003e\u0026bull; Updating knowledge\u003c/p\u003e \u003cp\u003e\u0026bull; Expanding horizons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;Easy \u003cem\u003eto do publications\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Sharing of knowledge\u0026rdquo;, \u0026ldquo;Teaching, giving talks\u0026rdquo;, \u0026ldquo;practising Specialist skills I achieved over years would be helpful for next generation\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Participation in research studies as investigator\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Updating knowledge\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Expanding horizons of professional career\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInstitutional and resource facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalance between clinical work and research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Time\u003c/p\u003e \u003cp\u003e\u0026bull; Clinical workload\u003c/p\u003e \u003cp\u003e\u0026bull; Job plan\u003c/p\u003e \u003cp\u003e\u0026bull; Protected time\u003c/p\u003e \u003cp\u003e\u0026bull; Financial stability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Dedicated time\u0026rdquo;, \u0026ldquo;Time commitment\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Manageable clinical caseloads\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Allocating dedicated SPAs in job planning\u0026rdquo;, \u0026ldquo;Flexibility and support through job planning\u0026rdquo;\u003c/em\u003e,\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Make it part of objectives and give time on the job\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003eProtected time and money outside of clinical duties\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of opportunities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Partnerships\u003c/p\u003e \u003cp\u003e\u0026bull; Research and teaching opportunities\u003c/p\u003e \u003cp\u003e\u0026bull; Recognition\u003c/p\u003e \u003cp\u003e\u0026bull; Flexibility\u003c/p\u003e \u003cp\u003e\u0026bull; Funding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,\u003cem\u003e\u0026ldquo;Affiliation to an academic institution\u0026rdquo;, \u0026ldquo;Affiliation to an academic institution\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Research opportunities\u0026rdquo;, \u0026ldquo;Better teaching opportunities\u0026rdquo;, \u0026ldquo;Clinical or Practical teaching\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;More opportunities\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Recognition by the employer\u0026rdquo;, \u0026ldquo;\u0026ldquo;Honorary roles\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Ability to do it remotely\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Funding opportunities\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCulture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Support\u003c/p\u003e \u003cp\u003e\u0026bull; Mentoring\u003c/p\u003e \u003cp\u003e\u0026bull; Knowledge of resources\u003c/p\u003e \u003cp\u003e\u0026bull; Pathway\u003c/p\u003e \u003cp\u003e\u0026bull; Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Encouragement during job planning and appraisal\u0026rdquo;, \u0026ldquo;The department's openness to research and development\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Good mentoring and guidance on how to enter psychiatry academia\u0026rdquo;, \u0026ldquo;Hand holding by native graduates\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Mentoring to do projects jointly\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;More information on the options along with clinical work\u0026rdquo;, \u0026ldquo;Easy access\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Training on how to write academic writing\u0026rdquo;, \u0026ldquo;Help with research methodology\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Barriers\u003c/h2\u003e \u003cp\u003eTheme 1: Cultural Barriers\u003c/p\u003e \u003cp\u003eParticipants commented on cultural barriers in academia and their own cultural backgrounds, including two subthemes: a) Academic culture, and b) Discrimination.\u003c/p\u003e \u003cp\u003eSubtheme: Academic culture\u003c/p\u003e \u003cp\u003eParticipants described the academic culture as unwelcoming and difficult to access. A participant noted that \u0026ldquo;\u003cem\u003eOpportunities (are) only for the research colleagues\u003c/em\u003e\u0026rdquo;, highlighting an implicit favouritism towards psychiatrists already involved in research. Similarly, another participant expressed the need for a more welcoming academic environment: \u0026ldquo;\u003cem\u003eWe also need a welcoming attitude from those in academics\u003c/em\u003e\u0026rdquo;. Moreover, two psychiatrists characterised academia as competitive but also unimpactful, suggesting a perceived irrelevance of clinical practice.\u003c/p\u003e \u003cp\u003eSubtheme: Discrimination\u003c/p\u003e \u003cp\u003eA greater number of participants identified their cultural background and education as factors that hindered their academic involvement, stating \u003cem\u003e\u0026ldquo;Cultural factors like migration\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;Feeling skills from other countries would not be recognised in the UK\u0026rdquo;.\u003c/em\u003e Participants reported \u003cem\u003e\u0026ldquo;racism at workplace\u0026rdquo;, \u0026ldquo;colour\u0026rdquo;, and \u0026ldquo;stereotyping\u0026rdquo;\u003c/em\u003e, while \u003cem\u003e\u0026ldquo;IMGs carry the burden of services while local candidates are prioritised for research opportunities\u0026rdquo; and \u0026ldquo;IMG trainees are implicitly discouraged to take up academic training\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eTheme 2: Structural and Navigational Barriers\u003c/p\u003e \u003cp\u003eParticipants highlighted the structure of academia and its accessibility. Two subthemes emerged: a) Lack of opportunities, and b) Support and guidance.\u003c/p\u003e \u003cp\u003eSubtheme: Lack of opportunities\u003c/p\u003e \u003cp\u003eParticipants reported lacking a research network that would allow them to engage in research activities. They mentioned feeling disconnected from where research is occurring and attributed this to physical distance and a lack of networking opportunities: \u003cem\u003e\u0026ldquo;no contact with universities; no effective research network\u0026rdquo;, \u0026ldquo;working in rural community settings, lack of local networks\u0026rdquo;\u003c/em\u003e. Furthermore, some participants reported limited funding opportunities, with one participant mentioning \u0026ldquo;\u003cem\u003eResearch funding issues\u003c/em\u003e\u0026rdquo; as a barrier to their involvement in research.\u003c/p\u003e \u003cp\u003eSubtheme: Support and guidance\u003c/p\u003e \u003cp\u003eNavigational barriers were highlighted. Specifically, many participants reported that accessing the academic environment is challenging without adequate encouragement and guidance: \u0026ldquo;lack of support from the employer or research department\u0026rdquo; and \u003cem\u003e\u0026ldquo;less guidance on teaching and research in (the) UK\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, some participants expressed feeling uninformed about the process of getting involved with research. A participant stated: \u003cem\u003e\u0026ldquo;Right information, current lack of ease of access to right programmes, better awareness of how one could take an academic career and still progress to complete training\u0026rdquo;\u003c/em\u003e. Participants found that there is a general lack of knowledge on how to get started, \u003cem\u003e\u0026ldquo;Lack of understanding/knowledge of what is available or possible\u0026rdquo;\u003c/em\u003e, which creates a vague picture of whether clear procedural entry routes exist. Additionally, some participants mentioned difficulties in publishing and applying for grants.\u003c/p\u003e \u003cp\u003eTheme 3: Capacity and Resource Barriers\u003c/p\u003e \u003cp\u003eThis theme centred on resource availability, namely, time and personal resources. Participants identified a range of resources and capacity limitations that hindered academic participation. The emerged subthemes were: a) Limited time, and b) Lack of resources.\u003c/p\u003e \u003cp\u003eSubtheme: Limited time\u003c/p\u003e \u003cp\u003eMost participants reported feeling unable to pursue a research activity due to time constraints. They stated they that their job arrangement was dominated by clinical practice, leaving little room for other pursuits, and that they felt they had been working at full capacity. One participant described it as \u003cem\u003e\u0026ldquo;Full-time \u0026amp; arduous clinical work\u0026rdquo;\u003c/em\u003e, while another mentioned \u003cem\u003e\u0026ldquo;lack of allocated time\u0026rdquo;.\u003c/em\u003e Another participant referred to \u003cem\u003e\u0026ldquo;personal/work life balance\u0026rdquo;\u003c/em\u003e, further emphasising the demands of clinical work. Additionally, two participants commented on bureaucracy and administrative procedures as time-consuming, preventing them from engaging in research: \u003cem\u003e\u0026ldquo;Too much administration, bureaucracy\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSubtheme: Lack of resources\u003c/p\u003e \u003cp\u003eIn this subtheme, participants primarily referred to personal resources. Specifically, they identified a lack of training as a barrier to their involvement. A participant noted: \u0026ldquo;insufficient knowledge\u0026rdquo;. Another cited a language barrier: \u003cem\u003e\u0026ldquo;English is not (the) first language\u0026rdquo;\u003c/em\u003e. Three participants also felt less confident in undertaking research: \u003cem\u003e\u0026ldquo;anxiety about outcome and imposter syndrome\u0026rdquo;.\u003c/em\u003e In contrast, others showed no motivation at all: \u003cem\u003e\u0026ldquo;Not relevant as I don\u0026rsquo;t want to get involved in the first place\u0026rdquo;.\u003c/em\u003e Finally, three individuals highlighted financial barriers, such as \u003cem\u003e\u0026ldquo;needing to concentrate on bills\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Facilitators\u003c/h2\u003e \u003cp\u003eTwo themes emerged from questionnaire item Y: a) Creating evidence-based practice and b) Institutional and resource facilitators.\u003c/p\u003e \u003cp\u003eTheme 1: Creating Evidence-Based Practice\u003c/p\u003e \u003cp\u003eThis theme included participants\u0026rsquo; aspirations to develop practice supported by an evidence base. Two subthemes emerged: a) Applied research, and b) Dissemination and personal development.\u003c/p\u003e \u003cp\u003eSubtheme: Applied research\u003c/p\u003e \u003cp\u003eSeveral participants expressed their desire to innovate as a reason for pursuing academic involvement. Quotes included \u003cem\u003e\u0026ldquo;Innovation, new treatment\u0026rdquo;\u003c/em\u003e, \u003cem\u003e\u0026ldquo;improving clinical care\u0026rdquo;, \u0026ldquo;patient outcomes\u0026rdquo; and \u0026ldquo;Contributing in research conducting surveys Nd evaluation for service development\u003c/em\u003e\u0026rdquo;. They would also pursue a research project that would be personally relevant and applied: \u0026ldquo;\u003cem\u003eReal research which is applied\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eSubtheme: Dissemination and personal development\u003c/p\u003e \u003cp\u003eThis subtheme reflects participants\u0026rsquo; desire to share their knowledge and expertise. Participants mentioned \u003cem\u003e\u0026ldquo;sharing of knowledge\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;creating small groups to scaffold others to write papers\u0026rdquo;\u003c/em\u003e. Many participants emphasised the importance of teaching as illustrated by this quote \u003cem\u003e\u0026ldquo;Practising specialist skills I achieved over years would be helpful for next generation\u0026rdquo;.\u003c/em\u003e This may suggest a view of teaching as an active form of participation that promotes personal growth and the dissemination of evidence-based knowledge. Additionally, two participants referred to publishing papers, with one specifically alluding to the difficulty of the process: \u003cem\u003e\u0026ldquo;Easy to do publications\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eTheme 2: Institutional and Resource Facilitators\u003c/p\u003e \u003cp\u003eThis subtheme includes three subordinate themes: a) Balance between clinical work and research, b) Availability of opportunities, and c) Culture. It reflects themes two and three of the barriers, but it differs structurally due to the size of the subthemes.\u003c/p\u003e \u003cp\u003eSubtheme: Balance between clinical work and research\u003c/p\u003e \u003cp\u003eParticipants identified facilitators in this subtheme that share similarities with the subtheme from the barriers analysis: \u0026lsquo;\u003cem\u003eLimited time\u0026rsquo; (from the overarching barrier theme \u0026lsquo;Capacity and Resources\u0026rsquo;).\u003c/em\u003e Unlike the \u0026lsquo;\u003cem\u003eLimited time\u0026rsquo;\u003c/em\u003e subtheme, the \u0026lsquo;\u003cem\u003eBalance between clinical work and research\u0026rsquo;\u003c/em\u003e subtheme explicitly referred to a more balanced job arrangement that allows for both clinical and academic responsibilities, as demonstrated by this quote: \u003cem\u003e\u0026ldquo;Job plan changes to allow more academic involvement\u0026rdquo;\u003c/em\u003e. Clinicians mentioned that undertaking research is impossible without allocated time within the job plan and argued that it should not be expected of them to do it in their own time: \u003cem\u003e\u0026ldquo;Paid release days - clinical duties during that time need to be covered rather than left for me to deal with on my return\u0026rdquo;.\u003c/em\u003e Apart from designated time, some clinicians expressed that a reduced clinical workload would enable academic involvement: \u003cem\u003e\u0026ldquo;Time in job plan with corresponding reduction in clinical workload as well\u0026rdquo;.\u003c/em\u003e However, it was noted that this should not endanger their financial stability: \u003cem\u003e\u0026ldquo;financially well remunerated for taking up academic role\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eSubtheme: Availability of opportunities\u003c/p\u003e \u003cp\u003eThe identified facilitators in this subtheme centred around the availability of opportunities. Participants noted that forming partnerships would enable academic engagement. This might include a supportive peer group, \u003cem\u003e\u0026ldquo;Peer group support\u0026rdquo;\u003c/em\u003e, or a broader research network wherein opportunities for collaboration are more likely to arise: \u003cem\u003e\u0026ldquo;better relationship with academic departments, developing relationships with researchers\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;Link with academic/ professorial units\u0026rdquo;\u003c/em\u003e. Moreover, clinicians stated they would consider involvement if more teaching opportunities were available, demonstrating a comprehensive view of the profession that encompasses practice, research, and teaching. Participants responded: \u003cem\u003e\u0026ldquo;Honorary roles\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;clinical or practical teaching\u0026rdquo;.\u003c/em\u003e Finally, one participant stated that there is a need for \u0026ldquo;\u003cem\u003emore funding opportunities\u003c/em\u003e\u0026rdquo;, while another quoted \u003cem\u003e\u0026ldquo;recognition by the employer\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSubtheme: Culture\u003c/p\u003e \u003cp\u003eThis subtheme encompassed facilitators related to the broader work culture. Some participants referred to institutional culture and expressed a need for a more inclusive and open academic environment: \u003cem\u003e\u0026ldquo;Inclusive culture is needed in academic circles, which are currently closed up and non-inclusive\u0026rdquo;.\u003c/em\u003e They also highlighted the need for equality of opportunity and fair access to academia: \u003cem\u003e\u0026ldquo;access to opportunities for all consultants not just clinical academics\u0026rdquo;.\u003c/em\u003e Psychiatrists also expressed the need for more support. They shared comments such as: \u003cem\u003e\u0026ldquo;Friendly supportive environment\u0026rdquo;, \u0026ldquo;organisational support\u0026rdquo;\u003c/em\u003e, and \u003cem\u003e\u0026ldquo;support from Trust\u0026rdquo;\u003c/em\u003e, highlighting the significance of support from various parties. Additionally, participants underscored the value of mentoring and guidance to enter, \u003cem\u003e\u0026ldquo;Good mentoring and guidance on how to enter psychiatry academia\u003c/em\u003e\u0026rdquo;, and to navigate the academic realm, \u003cem\u003e\u0026ldquo;Happy with following the advice from established academics\u0026rdquo;\u003c/em\u003e. Participants also identified the need for research methodology training and academic writing: \u0026ldquo;\u003cem\u003eGuided research methodology workshops, daily clinical and academic discussions\u0026rdquo;\u003c/em\u003e. Lastly, two psychiatrists mentioned the need for a clear pathway and knowledge of available resources.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis mixed-methods study explored interest in and barriers and facilitators to academic engagement among UK-based psychiatry IMGs of Indian origin. Barriers to academic involvement were cultural (including perceived discrimination), structural and navigational (limited opportunities, support, and guidance), and capacity and resource constraints (both time and personal resources). Facilitators included motivation to support evidence-based practice, balanced clinical and research roles, accessible opportunities, and supportive academic cultures on both an individual and institutional level. Interest in academia was high on UK arrival and broadly unchanged over time, though patterns differed by gender and prior research experience: men and those with research experience reported higher initial interest, while women and those without experience showed greater increases over time.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.1 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInterest in academic psychiatry\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eDespite the considerable barriers identified in this study, Indian IMGs in psychiatry reported high levels of academic interest upon entering the UK to work, and this interest generally persisted over time. This indicates that lack of interest itself is not a pervasive barrier among the group surveyed, consistent with previous findings from the broader UK medical workforce.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Given these consistently strong levels of interest, addressing cultural, structural, and institutional barriers could facilitate greater participation in academic psychiatry among IMGs.\u003c/p\u003e \u003cp\u003eParticipants without prior research experience showed greater increases in academic interest from UK arrival to the time of survey (p\u0026thinsp;=\u0026thinsp;0.013). This reflects previous research indicating that newly arrived IMGs often focus on \u0026ldquo;surviving\u0026rdquo; before they can begin to \u0026ldquo;thrive\u0026rdquo; in their new work environment.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) This adaptation period may reflect both growing awareness of academic opportunities and increased confidence as clinicians become more established in UK practice.\u003c/p\u003e \u003cp\u003eOn commencement of clinical work in the UK, female IMG psychiatrists self-reported lower levels of interest in academia compared to males (p\u0026thinsp;=\u0026thinsp;0.034). This aligns with research highlighting that women in medical training express lower interest in academic careers than men, particularly at senior levels.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Structural inequities may contribute to this pattern: even after adjusting for factors such as time in practice, specialty, and the number of publications, men are significantly more likely to be professors.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) As of 2022, only 35% of UK clinical professors were women, revealing a persistent gender imbalance at the highest levels of medical academia.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) These disparities could reduce early academic aspirations among women due to a lack of visible role models and mentors.\u003c/p\u003e \u003cp\u003eHowever, our findings also indicate that female IMG psychiatrists experienced a greater increase in academic interest than males from the start of their UK clinical practice to the point of survey (p\u0026thinsp;=\u0026thinsp;0.043). These gender differences among IMG psychiatrists may reflect inter-group differences in experiences upon arriving and working as psychiatrists in the UK healthcare system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.2 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCulture and discrimination\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eSurvey respondents described the academic environment as unwelcoming, exclusionary, and difficult to navigate. There is a sparsity of literature focusing on discrimination of IMGs in academic psychiatry. However, in clinical roles, existing research demonstrates that IMGs feel greater discrimination from colleagues and institutions.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Furthermore, almost a third of locally employed doctors, the majority of whom are IMGs, reported having been bullied, undermined, or harassed in the work place in the General Medical Council\u0026rsquo;s (GMC) 2019 workplace experiences survey.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) One study of IMGs in academic plastic surgery in the US found that, despite IMGs having comparable Hirsh indices, number of publications and citations, they received almost seven times lower research funding from the National Institutes of Health compared to domestic graduates.(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) Although outside of the UK, it reflects an institutional discrimination against IMGs in academia that was similarly highlighted by the participants in our study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.3 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNavigating research and structures\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eMany of those surveyed reported limited awareness of academic career routes within the UK, challenges in accessing opportunities, and limited contact with universities and research networks. Structured pathways such as the Academical Clinical Fellowship (ACF), which provides joint clinical and academic training over three years, along with support for doctoral funding, appear to be access disproportionately by White, British doctors. In 2022, fewer than five General Practice ACF posts were accepted by doctors of Asian or Asian British Indian ethnicity.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) For IMGs, who often begin NHS work outside formal training pathways, these disparities may be compounded by a lack of tailored guidance and limited institutional support. Mentorship is recognised as highly important in developing academic clinicians. However, minoritised groups often receive less mentoring than their non-minoritised peers.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) This underrepresentation and lack of parity in mentoring suggests systemic inequities in access to academic medicine at early career stages.\u003c/p\u003e \u003cp\u003eOur study did not find any regional differences suggesting that those with more academic interest gravitated closer to established academic centres.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.4 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCapacity and resources\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eTime constraints and job arrangements being dominated by clinical practice emerged as key barriers. In contrast, having dedicated research time formally included in job plans and paid release days were identified as important enablers of academic involvement. This reflects findings from the Royal College of Physicians\u0026rsquo; (RCP) \u003cem\u003eResearch for\u003c/em\u003e All report, which highlighted lack of time as the predominant barrier to research participation among doctors working in the UK.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eParticipants also raised concerns about the impact of research on work-life balance, suggesting that academic activity would likely have to occur outside of working hours. This also aligns with a report by the Royal College of Physicians, where respondents described research as overwhelming home life, often being conducted during evenings and weekends.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) This pattern is also true among psychiatry registrars specifically.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurther personal barriers were identified, including insufficient research knowledge, imposter syndrome, and English not being a first language. Some IMGs may find it difficult to conduct research due to language difficulties although Indian graduates are trained in English, dialects may create difficulties. These issues are consistent with existing literature showing that IMGs are more likely to experience self-doubt and feelings of intellectual inadequacy.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Language challenges, especially during the initial stages of clinical work, are also described in the literature, further connecting with our observed increase in academic interest over time for some groups surveyed.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.5 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eImplications for policy and practice\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eResearch experience is becoming a necessity for career progression in psychiatry in the UK.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) For entry into higher specialty training, candidates are awarded points for completion of research degrees, publication of academic manuscripts, and presentations delivered at national and international conferences.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) However, not all clinicians have equitable access to research opportunities. Mentorship, cultural, and discriminatory barriers are particularly important among IMGs. To prevent inequality in academic psychiatry, national training bodies and trusts could ensure protected research time is embedded within job plans, even at the core training level. Particular effort could be made to support those IMGs who arrive \u0026ldquo;pre-loaded\u0026rdquo; with academic qualifications or experience.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Clearer guidance, improved opportunities for mentoring, and enhanced institutional support could help to cultivate a research-active psychiatric workforce that reflects the diversity of the UK medical profession.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.7 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStrengths and limitations\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eTo our knowledge, this is the first study to explore interest in, and barriers and facilitators to, academic engagement among UK-based psychiatry IMGs. The concurrent mixed-methods design, combining quantitative survey data with thematic analysis of free-text survey responses, provides both breadth and depth. We recruited IMG psychiatrists across multiple UK regions, grades and years of experience, and included clinicians with and without prior research involvement. The credibility of our qualitative analysis was improved through independent double-coding of qualitative data, discussion of conflicts, and adjudication by a third researcher. Partiality was reduced as the qualitative analytic team had diverse professional backgrounds, including a medical doctor, a PhD candidate in education research, and a senior lecturer in intellectual disabilities. The detailed reporting of participant characteristics also allows for greater assessment of the transferability of our findings.\u003c/p\u003e \u003cp\u003eHowever, a relatively small number of psychiatry residents responded, and academic interest was self-reported at a single time point; retrospective ratings of past interest are vulnerable to recall bias. Although multiple comparisons were performed, we did not apply a formal correction for multiplicity. This was because these analyses were exploratory and intended to generate hypotheses. Additionally, strict family-wise error control (e.g. Bonferroni) can be overly conservative, particularly in studies with modest sample sizes and correlated outcomes, increasing the risk of Type II error. We therefore report exact p-values and place greater emphasis on effect sizes. These findings should be interpreted cautiously and warrant confirmation in larger studies.\u003c/p\u003e \u003cp\u003eAdditionally, IMG psychiatrists responding to this survey may not be representative of the wider pool of all UK-based Indian IMG psychiatrists. This may limit the generalisability of our findings to IMGs from other regions, although the majority of UK-based IMGs trained in India.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Finally, this study lacks a non-IMG psychiatrist control group to act as a comparator; this would be valuable in determining which barriers and facilitators are specific to IMG psychiatrists (and to what extent), and which, if any, are experienced by the psychiatric workforce more generally.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study used a concurrent, mixed-methods approach to explore interest in and barriers and facilitators to academic engagement among UK-based psychiatry IMGs. Despite significant structural and personal barriers, participants expressed strong interest in pursuing academic work. Importantly, this interest was sustained or increased over time, particularly among those with less prior research exposure and female IMGs, suggesting that early barriers may ease with adaptation.\u003c/p\u003e \u003cp\u003eOur findings suggest that the level of academic engagement is not driven by disinterest, but by access to research infrastructure, mentorship, and institutional guidance, as well as other cultural and discriminatory factors. Targeted strategies, such as integrating research time into clinical job plans, expanding mentorship schemes, and offering structured academic induction for all doctors, including new IMGs, could enhance inclusion and progression in academic psychiatry. Addressing these barriers is not only important for supporting IMG clinicians, but also for building a representative and innovative academic workforce in UK psychiatry.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements and Declarations including competing interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSM and SM serve as trustees for the British Indian Psychiatric Association (BIPA). SJT is on the editorial board of the BMC psychiatry but was not involved in the editorial or review process. He holds grants from the NIHR and Baily Thomas Charitable Fund outside of this work. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Neuraxpharm, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from various national funding bodies all outside this work. No other author has any declared conflict of interest related to this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that we have read the journal\u0026rsquo;s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Institutional ethics was obtained from University of Kent, School of Psychology ethics committee\u0026nbsp;(ref:2026177635357210551). Informed consent from participants for participation and publishing data is obtained\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors satisfy the ICMJE guidance by substantially contributing to the design, analysis and interpretation of the work, drafting of the manuscript, final approval of the manuscript and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003eMD - Data curation, Formal analysis, Investigation, Methodology, Visualisation, Writing (original draft); MM - Formal analysis, Methodology, Visualisation, Writing (original draft); SSM - Conceptualization, Investigation, Project administration, Supervision, Validation, Visualization, Writing \u0026ndash; review \u0026amp; editing; SM -Investigation, Project administration, Writing \u0026ndash; review \u0026amp; editing, DS-Investigation, Project administration, Writing \u0026ndash; review \u0026amp; editing; VZ - Investigation, Project administration, Writing \u0026ndash; review \u0026amp; editing; PT - Formal analysis, Validation, Visualization, Writing \u0026ndash; review \u0026amp; editing; \u0026nbsp;SJT - Formal analysis, Validation, Visualization, Writing \u0026ndash; review \u0026amp; editing; DM- Conceptualization, Validation, Visualization, Writing \u0026ndash; \u0026nbsp;review \u0026amp; editing RS- Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing \u0026ndash; \u0026nbsp; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll data supporting the findings of this study are available within the paper and its Supplementary Information.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSinclair LI, Ajram L, Seneviratne G, Tracy D, Critchley H. 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Indian psychiatry: Research and international perspectives. \u003cem\u003eIndian journal of psychiatry\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(Suppl 1), S38\u0026ndash;S42. https://doi.org/10.4103/0019-5545.69205\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eRoyal College of Physicians. Research for all: Building a research-active medical workforce. 2016. \u003c/li\u003e\n\u003cli\u003eAl-Haddad M, Jamieson S, Germeni E. International medical graduates\u0026rsquo; experiences before and after migration: A meta-ethnography of qualitative studies. Med Educ [Internet]. 2022 May 1 [cited 2025 Dec 16];56(5):504\u0026ndash;15. Available from: /doi/pdf/10.1111/medu.14708\u003c/li\u003e\n\u003cli\u003eLeonard JC, Ellsbury KE. Gender and interest in academic careers among first- and third-year residents. Acad Med [Internet]. 1996 [cited 2025 Dec 14];71(5):502\u0026ndash;4. Available from: https://pubmed.ncbi.nlm.nih.gov/9114871/\u003c/li\u003e\n\u003cli\u003eLi B, Jacob-Brassard J, Dossa F, Salata K, Kishibe T, Greco E, et al. Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis. BMJ Open [Internet]. 2021 Nov 2 [cited 2025 Dec 14];11(11):e050322. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8565568/\u003c/li\u003e\n\u003cli\u003eStaffing levels of medical clinical academics - Medical Schools Council [Internet]. [cited 2025 Dec 14]. Available from: https://www.medschools.ac.uk/what-we-do/championing-clinical-academia-and-research/clinical-academic-survey/\u003c/li\u003e\n\u003cli\u003eChen PGC, Nunez-Smith M, Bernheim SM, Berg D, Gozu A, Curry LA. Professional Experiences of International Medical Graduates Practicing Primary Care in the United States. J Gen Intern Med [Internet]. 2010 Sep [cited 2025 Dec 14];25(9):947. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2917670/\u003c/li\u003e\n\u003cli\u003eGeneral Medical Council. Survey of Specialty and Associate Specialist (SAS) and Locally Employed (LE) Doctors. 2019. \u003c/li\u003e\n\u003cli\u003eEgro FM, Lai J, Muthiah N, Smith BT, Nguyen VT. Characteristics of International Medical Graduates in Academic Plastic Surgery. Plast Reconstr Surg [Internet]. 2022 May 1 [cited 2025 Dec 14];149(5):1263\u0026ndash;71. Available from: https://pubmed.ncbi.nlm.nih.gov/35311804/\u003c/li\u003e\n\u003cli\u003eHowe A, Orkin C, Apea V. The under-representation of racially minoritised doctors in academic general practice training: a retrospective analysis. BJGP Open [Internet]. 2024 Jul 1 [cited 2025 Dec 14];8(2):1\u0026ndash;8. Available from: https://bjgpopen.org/content/8/2/BJGPO.2023.0136\u003c/li\u003e\n\u003cli\u003eMorzinski JA, Fisher JC. A nationwide study of the influence of faculty development programs on colleague relationships. Acad Med [Internet]. 2002 [cited 2025 Dec 16];77(5):402\u0026ndash;6. Available from: https://pubmed.ncbi.nlm.nih.gov/12010696/\u003c/li\u003e\n\u003cli\u003eHelm EG, Prieto DO, Parker JE, Russell MC. Minority medical school faculty. J Natl Med Assoc [Internet]. 2000 Aug [cited 2025 Dec 16];92(8):411. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2608609/\u003c/li\u003e\n\u003cli\u003eKoelkebeck K, Andlauer O, Asztalos M, Jovanovic N, Kazakova O, Naughton S, et al. Research by Psychiatric Trainees and Early Career Psychiatrists\u0026mdash;Results of a Survey From 34 Countries in Europe. Front Psychiatry [Internet]. 2021 Sep 10 [cited 2025 Dec 16];12:718669. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8461014/\u003c/li\u003e\n\u003cli\u003eLegassie J, Zibrowski EM, Goldszmidt MA. Measuring Resident Well-Being: Impostorism and Burnout Syndrome in Residency. J Gen Intern Med [Internet]. 2008 Jul [cited 2025 Dec 16];23(7):1090. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2517942/\u003c/li\u003e\n\u003cli\u003eClinical researchers in the United Kingdom: Overview Clinical researchers in the United Kingdom. \u003c/li\u003e\n\u003cli\u003eSelf-assessment verification process | Medical Hub [Internet]. [cited 2025 Dec 16]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/psychiatry/higher-psychiatry-training/self-assessment-verification/self-assessment-verification-instructions/domain-breakdown\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Immigrant doctors, immigrant psychiatrists, Indian psychiatrists, Academic psychiatry","lastPublishedDoi":"10.21203/rs.3.rs-9531516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9531516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eAcademic psychiatry in the UK is in a precarious situation with diminished academic to clinical posts. There has been a growing reduction in psychiatrists engaged in academia in the last 25 years. This has coincided with increased growth of International Medical Graduates (IMG) particularly from India working in UK psychiatry. IMGs may face unique barriers to involvement in research which might be contributing to the academic gap. IMGs from India form the largest ethnic minority group among the UK psychiatrists. This study explores interest, barriers and facilitators to academic engagement among IMGs of Indian origin working in psychiatry in the UK.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA questionnaire with 14 questions was developed with the British Indian Psychiatric Association (BIPA) members. It was disseminated online among IMG psychiatrists of Indian origin. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to distribute the survey in electronic form. The survey was disseminated via a convenience sampling approach, including through local professional networks. The questionnaire covered professional characteristics, past non-UK academic involvement and perceived interest, barriers and facilitators to UK academic engagement. Quantitative analysis used Wilcoxon signed-rank test and Chi-square with significance taken as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Thematic analysis of free-text responses was undertaken using Braun and Clarke\u0026rsquo;s methodology was undertaken.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOf 89 respondents 61% reported prior non-UK academic involvement. Being male and prior academic experience was significantly associated with greater academic initial interest. Identified barriers were cultural and discriminatory, structural and navigational, and capacity and resource related. Facilitators included motivation to contribute to evidence-based practice, improved balance between clinical work and research, increased opportunities, and a supportive research culture.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eIMG psychiatrists of Indian origin are motivated to engage in research but face challenges and barriers of cultural, discriminatory, and job planning factors. Similar surveys are needed to capture the unique experiences of other diaspora groups working in psychiatry to address the glass ceiling of clinical- academic engagement.\u003c/p\u003e","manuscriptTitle":"Finding a Voice in UK Academic Psychiatry: Barriers and facilitators to engagement among Indian International Medical Graduates: a mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 16:45:05","doi":"10.21203/rs.3.rs-9531516/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"200114532359285200122201499255708029790","date":"2026-05-08T13:06:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-08T05:57:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-08T05:56:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-05-07T04:14:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-04T18:14:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-05-04T17:38:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c469d2b-aca5-4216-b0c9-30a52652b555","owner":[],"postedDate":"May 18th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"200114532359285200122201499255708029790","date":"2026-05-08T13:06:49+00:00","index":29,"fulltext":""},{"type":"reviewersInvited","content":"10","date":"2026-05-08T05:57:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-08T05:56:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-05-07T04:14:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-04T18:14:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-05-04T17:38:32+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T16:45:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-18 16:45:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9531516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9531516","identity":"rs-9531516","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}