Sustaining Clinical Academic Leadership and Excellence (SCALE): protocol for a mixed‑methods international consensus

<ns3:p>Introduction Clinical academics drive research, education, and innovation in health care, yet global reports highlight attrition, funding instability, and under-representation of primary care and community-based disciplines. Despite recognition of the problem, there is no internationally endorsed, prioritised strategy to strengthen this workforce. Objective The SCALE (Sustaining Clinical Academic Leadership and Excellence) study aims to develop a stakeholder-driven consensus statement that identifies and ranks actionable strategies to attract, retain, and advance clinical academics across specialties and career stages. Methods SCALE adopts a four-stage, mixed-methods approach: (1) a rapid scoping review of literature published since 2015; (2) an ethics-approved, REDCap-based pre-workshop survey gathering international stakeholders' ratings of draft statements and free-text feedback; (3) a Nominal Group Technique (NGT) session at the 2025 International Conference on Residency Education (ICRE) in Québec City with 18–22 purposively selected participants; and (4) a single-round electronic Delphi to validate and, where needed, refine the consensus outputs among the wider survey cohort. Consensus is pre-defined as a median rating ≥7 and an interquartile range ≤2 on a 1–9 importance scale. Quantitative data will be analysed descriptively; qualitative data will undergo reflexive thematic analysis. Reporting will align with ACCORD and CREDES guidelines. Impact This work will generate a globally relevant, context-sensitive roadmap to support clinical academic careers, with an emphasis on primary care and underrepresented disciplines.</ns3:p>