Importance of engaging physicians
Everyone in healthcare should be committed to ensuring that high-quality research becomes embedded in the core day-to-day work of the NHS, for the benefit of patients and the NHS as a whole. There is a lot of evidence to show that research-active trusts have better patient outcomes. The benefits of research apply at all levels from the individual patient, to the entire population:
- Patients who participate in research access cutting-edge treatments.
- The process of engaging in research makes doctors more informed about the literature in their field.
- Research hones many transferable skills for doctors – things that benefit all their patients, whether they are directly involved in research or not.
- A research-engaged hospital motivates staff, brings in financial income, attracts high-calibre doctors and raises the profile of an organisation.
- Research benefits the wider population and the health service as a whole, by leading to the development of more effective, high-quality, cost-efficient treatments and healthcare delivery models. With increasing pressures on the health service, promoting innovation within the NHS is essential for the future of patient care.
Although research does not usually form the core of every physician’s job, as detailed in the Royal College of Physicians’ (RCP) report, Research for all, it can be incorporated alongside clinical practice for a great many more than just those who are dedicated researchers. This should not downplay the dangers of poorly conducted research, but should instead encourage robust support for engaged physicians to deliver high quality research.
Furthermore, regardless of whether a physician chooses to integrate research into their career, every doctor has a responsibility to:
- understand how to critically appraise the evidence on which their clinical decisions are based
- interpret and clearly communicate statistics about risk to patients
- remain up to date with the evidence base
- disseminate research findings and innovations in the delivery of healthcare.
Integration into everyday work
Incorporating research into a physician’s medical career does not mean that they spend all their time in a lab instead of treating patients. There are a wide range of research activities that physicians can engage in, depending on their skills and interests. For example:
- disseminating research findings
- recruiting patients to trials*
- performing laboratory benchwork
- conducting systematic reviews
- being the lead investigator on a clinical trial
- leading a research team
- developing new research methodologies
- conducting audit reviews and health service improvement work
- collaborating with other professions including social care
*This refers both to trials where the physician is an investigator, and where the physician will be referring patients to other colleagues.
While some physicians commit to a career primarily focussed on research, it is very common to be involved in research alongside clinical practice. Clinically based researchers are well placed to identify how best to translate research into practice and to think of new research questions that arise from their clinical observations and experience.
The research process has a lot of steps and those in clinical practice won’t necessarily be familiar with all the stages and skills it requires – for example, writing proposals, designing experiments, applying for funding, seeking ethics approval, and going through the publication process. However, there are a huge number of resources out there to demystify this process. The RCP’s Research Engagement Toolkit is a useful guide to research involvement that deals with each of these areas in more detail and provides links to the relevant information and organisations. Areas that it covers include:
- finding supervisors
- developing a research question
- drafting proposals
- getting GCP training
- applying for funding
- applying for ethical and R&D approval
- research skills development and training
- patient and public involvement in research.
The National Institute for Health Research Clinical Research Network is also an important source of advice and material support for carrying out research in the NHS.
The different ways of being involved in research that are listed above all take different time commitments, and it is not reasonable to expect all research to be done in doctors’ own time. Consequently, there are a number of things hospitals need to do to ensure everyone can accommodate research engagement in their work:
- Protected time needs to be available to those who want to make research a part of their career. The Association of UK University Hospitals has guidance on research time, and the principles underpinning this guidance can be applied in all hospitals.
- Hospital leadership must foster a culture that values research. This is, in part, about the ’big’ things like protected time and funding, but it is also about small gestures that contribute to the culture of a hospital, for example:
- providing opportunities for staff involved in research to present their work to colleagues, for example in staff gatherings or on a dedicated ’research noticeboard’ in a common area
- promoting staff publications by featuring them on the hospital website or social media
- providing opportunities for staff interested in research to access mentoring from experienced senior staff
- giving priority to requests for flexibility when they are made in order to accommodate research work, or present at conferences.
- All physicians should be encouraged to see it as a basic responsibility to familiarise themselves with current trials in their field so that they can be a prolific recruiter of patients, and keep up with the literature so that they can disseminate and put into practice the latest findings for the benefit of their patients.
- Trusts must adopt employment policies that allow doctors to move between hospital and university employment without adversely affecting maternity leave rights, as this has been a deterrent to some women entering research.
There are several different approaches to how research funding is managed, both in the way funding is awarded, and the distribution of funding within a hospital. For example, there can be variation in whether funding is allocated to the hospital at large, to a broad R&D department, or to a specific research group, project or even researcher.
All approaches have pros and cons, so no single approach is endorsed. However, research carried out by the RCP (Research for all, 2016) has indicated that some researchers can feel less valued and supported by their hospital when they are not able to influence decisions about how money brought in for their research is used. This does not necessarily mean that such an approach should never be taken, as it can sometimes yield useful efficiency gains.
However, this concern should be taken into account by decision makers, and if funds are managed and distributed centrally steps must be taken to make both decision-making and communication as thorough and transparent as possible, and to ensure that established researchers are not unduly favoured over those starting out.Regardless of the approach used, there are governance frameworks that apply across health and social care research that researchers should be familiar with. Last updated in 2008, the Research Governance Framework is an example of this. This is due to be replaced, however, by the Health Research Authority’s UK Policy Framework for Health and Social Care Research, which is currently undergoing revision post-consultation.
There is increasing recognition of the importance of involving patients in the design and execution of a research project. A recent workshop with the RCP’s Patient Carer Network confirmed what those working in this area have long known – that patients are particularly well placed to help with:
- setting research questions, by helping to identify the issues that have the most impact on patients
- identifying the metrics researchers should use to measure the success of an intervention, to ensure that success is based on the things that actually make a difference to the everyday lives of patients
- giving insight into the things that make a patient willing to participate in a trial, in order to improve recruitment and retention
- ensuring that communications are easily accessible to the lay person.
- These factors mean that projects are much more likely to get ethics approval and funding if patients have been involved in their design.