“It’s the duty of every doctor to get involved with research”
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6329 (Published 27 November 2015) Cite this as: BMJ 2015;351:h6329
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We read with interest the article by Anne Gulland and very much support the assertion that involvement with research is important for all doctors. This has become of increased significance given the recent evidence that patients admitted to research active institutions have better outcomes [1], and the commitment in Principle 3 of the NHS Constitution [2] “to the promotion, conduct and use of research to improve the current and future health and care of the population.”
Whilst we are in agreement that all doctors, and indeed all healthcare professionals, must be encouraged to both understand and participate in research to deliver this goal, we also feel it important to ensure that there are sufficient numbers of doctors developing a clinical academic career and taking up principal investigator roles. In the last decade the National Institute for Health Research (NIHR) has made great progress in this direction with the development of a clinical academic career pathway, complementary to the schemes run by the MRC, Wellcome Trust and other research charities. Nevertheless, despite all these efforts the issue of dwindling numbers of clinical academics [3] is not fully resolved, and must continue to be addressed. This is critical as doctors make significant contributions to the formulation of research questions and the translation of outcomes to patient care, contributing to this country’s international reputation for research excellence.
An area of particular concern is post-doctoral progression. Indeed, Clinical Lectureships, which enable post-doctoral clinicians to develop research independence, seem to have lower numbers of applicants than expected and, despite gradual progress nationally, each year an appreciable number of posts go unfilled. The reasons for this must be investigated and rectified where possible.
To tackle this question in 2013 we, in the Oxford University Clinical Academic Graduate School (OUCAGS), established a longitudinal study of career decision-making amongst medically qualified doctoral students registered at our institution. One of the study’s preliminary findings indicates that, 51% of UK doctors undertaking a DPhil (PhD) at the University of Oxford intend to mainly work in clinical academic posts in their long-term career. However, only 66% of these are extremely or very likely to seek a Clinical Lectureship in England (unpublished data from OUCAGS’ 2013 census).
The fact that only two thirds of this group of medically qualified doctoral students are likely to apply for Clinical Lecturer posts is somewhat surprising given their stated intent towards an academic career. The underlying issues are complex, arising, for instance, from tensions from divided time between clinical and research commitments, as Anne Gulland mentions in her article. Our study continues to explore these factors and will develop proposals on how to make post-doctoral clinical academic careers more attractive.
Given the need to support post-doctoral clinicians on the clinical academic career path, we would encourage other higher education institutions to also examine factors influencing career decisions amongst their own clinical doctoral students. UCL have recently decided to investigate this question amongst their students and are basing their questionnaire on the OUCAGS’ study, which will enable us to compare data. We would encourage other institutions to do likewise, to allow the creation of: a comprehensive national picture; evidence-based strategies for the further enhancement of clinical academic careers; and monitoring the effects of proposed contractual changes.
Denise Best, PhD
Academic Clinical Careers Manager,
Oxford University Clinical Academic Graduate School,
Room 3600 Medical Sciences Divisional Office,
Level 3, John Radcliffe Hospital, Oxford, OX3 9DU
denise.best@medsci.ox.ac.uk
Joana Lopes, MSc MBPsS
Research and Professional Development Officer,
Oxford University Clinical Academic Graduate School,
Room 3600 Medical Sciences Divisional Office,
Level 3, John Radcliffe Hospital, Oxford, OX3 9DU
Chris Pugh
Professor of Renal Medicine
Director, Oxford University Clinical Academic Graduate School
Associate Dean Academic Affairs, Oxford Deanery
Oxford University Clinical Academic Graduate School,
Room 3600 Medical Sciences Divisional Office,
Level 3, John Radcliffe Hospital, Oxford, OX3 9DU
1. Ozdemir BA, Karthikesalingam A, Sinha S, et al. Research activity and the association with mortality PLoS One2015;10:e0118253
2. Department of Health. NHS Constitution for England. 27 July 2015. www.gov.uk/government/publications/the-nhs-constitution-for-england
3. Medical Schools Council. A survey of staffing levels of medical clinical academics in medical schools as at 31 July 2014. 2015. www.medschools.ac.uk/SiteCollectionDocuments/MSC-survey-2015-web.pdf.
Competing interests: We are all involved in clinical academic training
People have different interests and skills. It is not possible for most to both practice and do what is generally considered 'proper' research in any real depth, with knowledge of all the legal and ethical considerations. Or possibly attracting critiscism from those whose primary job it is. One of the individuals who has been influential in describing what most practitioners do in every day practice, or should be encouraged to do, is Donald Shon (1930-1997) (Web sites describe his work). He describes the need for conscious 'reflection in practice' especially because it can reveal unconscious motives and biases. His teaching also includes 'reflection in knowing', which is what we all do as a result of successful practice without consciously thinking. Maybe his theories have influenced the emphasis on reflective practice now but how it can be shared or even tested is more unclear. Shon's emphasis on examining the unconscious may not be popular amongst researchers rather than practitioners - I do not know - but it would be useful in research projects which impinge on individuals' personal lives. Usually this is qualitative research, although there are some studies by individuals interested in psychoanalysis into the impact of the researcher on the study and therefore on whether it will impact the data used to write up studies (See several Web sites re Research and Transference).
One rather shocking series of articles proposing research into use of the internet by practitioners is published in BJPsych Bulletin December 1, 2015. 'Special Articles' 'Should We Google our Patients?' The revision was received last year but despite a suggestion that the public/users should be involved in decision making no reference to their participation in drawing up these articles is made. There is also reference made to a proposal to tackle the negative posts about psychiatry made by services users by another contributor, who suggests a counter campaign to post positive messages. The articles are too long to describe in detail here but the idea of conducting research into giving the right of health and social workers to google individuals' twitter and facebook and other internet accounts (which has been worked up pretty comprehensively) is very dubious. Human beings being human there will already be some who google clients they have an interest in, and it will be almost impossible to stop when sites are open access - the suggestion that guidelines and ethic approval will make it more acceptable is sugaring a very unpleasant use of the internet. It actually sounds very much like 'stalking' under the cloak of 'professional need to know'.
Competing interests: No competing interests
The article by Anne Gulland emphasises on the importance of doctors conducting research as part of their routine clinical practice.No one disagrees about the importance of research in improving and developing care to patients including having better clinical outcomes.As former executive lead of reserach and deveopment in my Trust I wish to make the following relevant comments;
• There are two types of research conducted in healthcare organisations; one which is service oriented and the other which focusses on advancement of medicine and improvement of care in general.
• Organisations such as hospitals will be focussing on service directed research in line with local service need priorities as stipulated in their research strategies and action plans.
• In order for doctors to carry out research and innovation they must be enabled to do so by allocating the necessary time within their job plans to i.e. by having sufficient supporting programmed activities (SPAs).The problem doctors face is that their organisations may not identify time for them to do so as this entails resource and money which is best used for direct programmed clinical activities which are more likely to generate income as opposed to reserach which may be perceived as a luxury whose benefits are not readily tangible to the employing organisation.Therefore, in many occasions SPA time to conduct reserach is simply not approved by Trusts for the doctors to pursue research.
• Each Trust has staff that manages reserach and development and ensure compliance with research governance and facilitate the strategy or direction of reserach within them, however the money allocated to support research is generally not sufficient and varies between hospitals. In contrast, companies and other businesses invest millions of pounds to carry out research as the return is very beneficial.
In conclusion, although it is important for every doctor to have the desire and effectively doing research but equally the employing organisation has a big role to ensure this happens tailored to patient and service needs locally and nationally.
The Rotherham NHS Foundation Trust
Moorgate Road, oakwood, Rotherham, S60 2UD.
Competing interests: No competing interests
Research is a skilled activity, and exceptionally time-consuming - full ethical approval, patient involvement, statistical expertise are nowadays essential, and exclude most practicing doctors from authorship or design of studies.
Research should be considered when an opportunity presents - and it is unethical for doctors to put unreasonable barriers up to valuable research. But every doctor? Surely not!
Among doctors in training all too often it is a compulsory, box ticking exercise. Good research is not designed and executed by conscripts. However, early in training doctors might discover an aptitude for research.
There is a value in practicing careful and diligent medicine too; service doctors will rarely gain fame or honour, but they do as valuable a job as a lollipop lady or a white van man.
There is also some professional skill in delivering services to patients well, which is diluted by and not aligned to being a research assistant.
If helping out with research planned, managed, analysed and written up by others for no remuneration becomes a duty it becomes a compulsory tax on practice and a heavy and usually unwelcome burden to bear.
Maybe researchers are from Mars, and physicians from Venus - of course there is some overlap, but we should celebrate the value of the different skills and aptitudes.
Competing interests: No competing interests
The opportunity every doctor has to get involved with research
Many doctors reading this article will be feeling daunted by the demands on their time that they perceive from this duty. Anne Gulland mentions the National Institute for Health Research and its portfolio but she misses the opportunity to give the link to its associated portfolio http://public.ukcrn.org.uk/search/
The first step to direct involvement in research for many clinicians will be to recruit into a UKCRN-adopted study. This brings about the benefits for engagement in research that Gulland mentions. It also facilitates continuous professional development both formally from points awarded through trial meetings and in reality through involvement in trial groups. Designing projects to develop one's own ideas can come later; being involved in a trial group will help.
I worked as a consultant medical oncologist in this acute general hospital, starting at a time when this specialty was very rarely represented in the workforce of such hospitals. I was able to assure colleagues of the quality of the service by commitment to clinical research through trial recruitment, always core to oncology practice. I have now retired from that post but continue to work part-time in the Trust to promote precisely the approach that Gulland and Fiona Godlee advocate.
I find that there are consultants who are enthsiasltic about research; in fact this culture was established from when the hospital opened in 1970, particularly in gastrointestinal medicine and surgery. Others are concerned that erosion of time for supporting professional activities in contracts precludes them from research. In reality the reseach infrastructure that a hospital with significant UKCRN portfolio activity can develop makes this much easier. An enthusiastic research nurse makes all the difference.
Competing interests: No competing interests