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Building a research career

 

Contents

1. Introduction

The National Institute for Health Research (NIHR) is the research arm of the NHS. It supports outstanding individuals working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public.The NIHR has been working for some time to understand how it can create an environment in which health care professionals are attracted to clinical academic careers. Many of the discussions have focused on how NHS managers are critical to creating an environment in which clinical academic careers can thrive.

“ Those involved in research are your prestigious nursesand therapists, they give so much more over and above the number of clinical hours they are contracted for –they will mentor people, represent you at conferences...they add value”.

Jo Cooper,University of Nottingham

This guide has been designed to assist both aspiring clinical academics and their managers to make the most of the opportunities that exist through Health Education England (HEE) and the NIHR to support health care professionals to combine clinical activity with patient focused research. In particular it will be of interest to non-medical health care clinicians applying for NIHR personal awards. It also aims to help clinicians who are interested in becoming involved in research but do not know where to begin.

2. Why is research so important?

There has been considerable investment from the Department of Health and HEE into the NIHR to encourage non-medical health care clinicians to undertake research training, alongside clinical activity. The NHS Constitution commits tothe promotion and conduct of research to improve the current and futurehealth and care of the population. The commitment features in one of sevenkey principles - the principle that the NHS aspires to high standards ofexcellence and professionalism.

“ Research is a core part of the NHS. Research enables the NHS to improve the current and future health of the people it serves. The NHS will do all it can to ensure that patients,from every part of England, are made aware of research that is of particular relevance to them. The NHS is therefore putting in place procedures to ensure that patients are notified of opportunities to join in relevant ethically approved research and will be free to choose whether they wish to do so”.

Handbook to the NHS Constitution, January 2009

Research is now considered core NHS business; this is directly associated with increasing evidence that research active NHS trusts provide better overall careto patients, including those with patients not directly involved in research.

Research is also increasingly important to patients and the public who recognise the importance of research and want access to quality research in order to benefit from new treatments, interventions and medicines. Often patients and the public who become involved in research are motivated by a desire to help others who have the same condition as they have. Patient and public involvement in research is central to the purpose of the NIHR.Research within the NHS also has direct benefits to the partners involved. Throughout this document there are a number of brief ‘research impact’ case studies that illustrate the positive benefits research can bring to an organisation, a service, the people who work in it and the patients who utilise it.

3. The Clinical Academic Role

Clinical academics are clinically active health researchers. They work in health and social care as clinicians to improve, maintain, or recover health while in parallel researching new ways of delivering better outcomes for the patientsthey treat and care for. Clinical academics also work in Higher Education Institutions while providing clinical expertise to health and social care.

Because they remain clinically active, their research is grounded in the day to day issues of their patients and service. This dual role also allows the clinical academic to combine their clinical and research career rather than havingto choose between the two.

A researcher immersed in a clinical setting is in an excellent position to identify what research questions matter to the patient or service user, to health and social care and to their profession. They are also in a position to ensure that those questions are applicable in day to day practice and care, and tointerpret and apply research findings in a practical and useful way.

Clinical academic posts are often joint appointments between health and/orsocial care and a Higher Education Institution. Both organisations support the post; with one organisation typically holding the substantive contract of employment, (with an honorary appointment in the other,) to facilitate working across the organisations.

Building a clinical academic career is an incremental andoften challenging process. Common challenges include:

  • Finding sufficiently skilled clinicians to backfill posts
  • Developing the ability to ring fence time in parallelclinical and academic roles
  • Ensuring that the financial aspects of any awardare managed well
  • Planning for the maintenance of a clinical academic positionon conclusion of any external research funding

A successful clinical academic will be able to demonstrate not only that theyare an excellent researcher but also that they can lead and inspire others intheir clinical field.

“What is a clinical academic role? To challenge existing practice working from within a service and contributing to a research-rich care environment”.

Dr. Steve Wootton, NIHR Advocate for Academic Training in Nutrition

To get started, your own service may offer you the most practical opportunities to explore research. As you develop as a researcher you may choose to expand your horizons into clinical and service areas beyond this. The important thing is to find the opportunities and support that allow you to develop and progressas a researcher.

HEE/NIHR Integrated Clinical Academic (ICA) Programme

In 2014, HEE launched the Clinical Academic Careers Framework which brings together research training programmes, including the new ICA Programme for registered non-medical health care professionals. This replaced and streamlined the previous Clinical Academic Training Programme and the Healthcare Science Research Fellowships Programme whilst also extending the eligibility criteria to allow more professions than ever before to apply and develop a clinical academic career.

Funded by HEE and managed by the NIHR, the ICA Programme offers opportunities at all levels of the clinical academic career pathway;-

  • Internships run by HEE local teams give an introduction to research to those with no prior research experience
  • Master’s Studentships provide a grounding in clinical research whilst obtaining a recognised qualification
  • Clinical Doctoral Research Fellowship – an award to enable a clinical academic to obtain a PhD
  • Clinical Lectureship – for early post-doctoral professionals
  • Senior Clinical Lectureship – award for senior clinical academics

The following examples give a flavour of the types of roles that clinical academics undertake. You will see that while there are similarities between the examples – most notably that the clinical component of the role often drives the academic component – there are also many differences in terms of how the roles are split, where the individual is based and how the individual works across organisations. Nonetheless all of these examples demonstrate how these individuals have made a clinical academic role work in practice.

4. So you want to be a clinical academic? - what you need to know

Getting started

  • Pre-formal training opportunities, such as the internship opportunities offered by HEE or gaining experience supporting a research project canhelp you understand whether this is the career for you. Talk to your patients about the ideas that you have and be receptive to their ideas too. Seek out your local research seminars programme and attend those of interest. Talk to established clinical academics – work outwho could be your research partners – can you shadow anyone?
  • Don’t be limited to those in your professional group – look aroundto find clinical academics across your organisation.
  • There are a lot of research training opportunities but HEE and NIHR personal awards are some of the most comprehensive - offering full salary and bespoke training funding. Also look out for charity awards and local opportunities. All fellowship awards are competitive, so seek advice about where you need to start. For many clinicians lacking research experience a Master’s of Research (MRes) is the best starting place. A research Master’s is designed to teach you how to undertake high quality research and most of the formal teaching will be about research, not your clinical speciality. Approximately 50% of an MRes is project work which enables you to learn from the experience of carrying out a substantial research project.

"Make your project relevant to your service so you can stay in touch with your service. It can be terribly isolating doing research but staying involved in your service helps – it is an amazing experience. Do it”.

Professor Mary Hickson, Imperial College

You need to take the long-term view of your career, with several short term goals along the way. Take the time to re-evaluate what you want and whether you are in the right place to get it”.

Professor Nadine Foster, NIHR Advocate for Academic Training in Physiotherapy

Building support networks

  • Begin to develop a clinical and academic network around you. You need to find out who the key people in your field are and who they work with. Clinically this can be your peers and colleagues and importantly your manager, their manager and the clinical service manager. The more support you can garner for your joint academic and clinical career the better. Academically you need to repeat this process with key people in your area of research. Building networks, even at this early stage, can be helpful in developing a clinical academic research career. From these networks,you may create collaborations that will build your own future research.
  • Organisations such as the Council for Allied Health Profession Research (CAHPR) are a good starting point – see section 7 for a list of others. It is really important that you let it be known that you are keen and interested in taking up research opportunities so that when opportunities arise people will think of you and offer you the chance you need.
  • To embark upon a clinical academic career it is important to become part of the wider research community. This may be within your Trust, your professional body or your clinical area. It is important to start engaging with researchers, to flag up your interest in research and your desireto progress your career.
  • Seek out examples of clinical academics in your profession and ask themfor advice. Most professional bodies have research officers who can help you. There are many who want to encourage the next generation of researchers and they can give you advice on what to do – and what not to do.Five minutes with the right academic can not only be inspiring, it can also provide a snippet of advice that might help you avoid unnecessary work.
  • Find a mentor. A mentor provides you with a wider perspective of the academic and professional world and the options available to you beyond your current studies. Ideally they should be outside your department (or even your institution). Your institution may have a formal mentoring scheme and you should use it if there is one. Do not wait for someone to find you a mentor; be proactive and brave. Find someone you respect, admire and would like to emulate and ask them to mentor you. If you are not sure what mentoring means or what a mentor does there are many resources to help you – see the resources at the end of this guide.

Developing your skillset

  • You will have to develop new skills that will be different from your clinical skills but will compliment them. A researcher has many personal attributes that help them succeed in research – tenacity, willingness to learn from critique, networking ability, curiosity, clinical experience, ability to drive forward projects, ambition, courage and openness to learning new skills – this is a new way of working and it is different but it is also exciting and rewarding and can make a real difference to your clinical work.
  • Put some time into planning how you will become skilled academically.Learn to be self-aware about the skills you have and those that need developing. Seek advice from others on what skills you need to develop. Remember that formal training is not the answer to EVERY skill gap, indeed some skills require experience to really learn them. For example, shadowing or observing a colleague can offer exposure to something you do not feel confident in or volunteering to present to colleagues can hone presentation skills. You should also routinely document all your research training.

Build your CV

  • Build your CV from the start. Publish articles even if they are not in academic journals. An article in a professional magazine demonstrates you can write well enough to be published. Submit abstracts, go to conferences and present your work as you go along.
  • Make sure you publish your master’s degree project and if possible your degree project too. A strong track record of publications is vital to succeed, so start early and keep it up.
  • Seek advice on what Master’s programme best fits with your career ambitions. Likewise take advice if you are choosing a doctoral training award.
  • Keep an eye out for bursaries and small grants. Often funders offer small amounts of money for travel or attendance at meetings. Consider local charities who may fund small projects – these awards look good on aCV as they are competitive.

Applying for funding

  • Put some time into understanding the training opportunities available: Internships, Master’s, PhD and post-doc opportunities.
  • The HEE/NIHR Integrated Clinical Academic (ICA) Programme 6 funded by HEE and run by the NIHR, is one of the most recognised routes intoa clinical academic career for many health care professionals.
  • If you are preparing an application with little or no previous experience,a successful application to a nationally awarded clinical fellowship or similar award will take at least a year to prepare. Panels are interested in you and your potential as a researcher, your project and its relevance to health care provision and the team you have bought together to support you. Your personal clinical and research training and development is an important part of the application. Spend some time putting together a comprehensive training package that is unique to you and your learning needs in relation to your research. The panel will also be interested in how you continue to develop clinically and in the research culture within your Trust. Pulling allthis together takes time and different schemes will have different criteriaby which they are assessed.
  • Seek advice early. There is lots of help available from the team at the NIHR Trainees Coordinating Centre (TCC) about the various schemes and they will advise on which schemes are best for you. Your local NIHR Research Design Service (RDS) can also offer lots of help. Approach them as soon as you have an idea. They can advise on whether your project is within the NIHR remit –if it is not then you will need to seek funding from other sources.The RDS can also advise on how to incorporate patient and public involvement and on the methodological aspects of your application.

Making a clinical academic training opportunity work

  • Talk to your clinical service manager as soon as you are thinking about taking your first steps in research. They will appreciate advance notice of your intentions and can look out for opportunities on your behalf. They can also start thinking of how to backfill your position if you are successful and about making the case to their manager to release your time. This is particularly important if you provide a specialist skill or service to your team. It may be helpful to formalise your plans for research training in your personal development plan so your manager is aware of work or staffing pressures that will be coming up.
  • Talk to your Research & Development department leads. They may be important to helping you negotiate a feasible and effective balance between your clinical and academic workload.
  • Initially you may find it practical to try and make a difference close to home by making your research expertise clinically relevant and grounded in the service you are a clinician in. However, don’t worry about becoming ‘pigeon holed’; there will be opportunities to move into different areas of research as you develop your career. In the early stages you are trying to train to be a researcher and understand what undertaking quality research entails - that could be in any specialty area.
  • Understand your manager’s (and their manager’s and the organisation’s) challenges and interests – what issues are they facing at the moment?Could your research project help and how soon? Could your project be linked to QiPP (Quality, Innovation, Productivity and Prevention programme) or quality improvement initiatives?
  • Be flexible – work with your manager to make this work for everyone. Clinical research is about making what you do better for patients,for management and for the wider NHS

5. So your staff member wants to be a clinical academic? - what you as a manager need to know

What opportunities does supporting a clinical academic bring to you and your service?

Research can benefit your service, your team and the aspiring clinical academic. It can also, if the individual is successful, bring kudos to you as a manager of a clinical academic and to your team and service. The success of a clinical academic supported by you reflects on your ability to develop a staff member. You are supporting a clinician to engage in a unique opportunity to develop their clinical skills - the service can benefit from this enormously. It also can build a culture of research that allows your service to play an active part in the wider research culture of your organisation.

There are many benefits in having a clinical academic on your team

  • To research your service or an aspect of your service. Research active environments have been shown to deliver superior clinical care.
  • To help mould the research question for a local and tangible impact.
  • To access research findings much earlier in the research process allowing you to adapt your service or processes much sooner than waiting for research to be published.
  • To offer (even small) projects that can have a meaningful impact on how you deliver your service.
  • To have clinical academics on your team who will, over time, bring new analytical and problem solving (and often clinical) skills. They will bring a more questioning atmosphere to your service – is what you are doing based on evidence? Is there evidence that something could be done better?
  • To get the service user voice into the team and enhance the quality of care provided.
  • To demonstrate new and exciting partnerships with external organisations.- To improve recruitment/retention of high calibre staff members.
  • Through support for your clinical academic you will also gain some experience in research. Meet the academic supervisor to ensure that the research is clinically relevant for you. Be interested in the findings – they may make real impact on your service. You might want to think about getting some experience in research yourself so that you understand what it is all about and what benefits it can bring to your staff members and to your own development.
  • Backfill can sometimes be a challenge especially if the aspiring clinical academic is a specialist. But it is unlikely that a member of staff will approach you about a clinical academic career and start immediately. There may be a long lead-in before any aspiring clinical academic will take up training and temporarily leave clinical practice. A nationally competitive fellowship application can take up to a year to complete - so there should be time to plan. There is also an opportunity, where a specialist clinician is aspiring academically, to use the application year to upskill another member of staff in their specialist area – potentially leaving you with a larger specialist resource in the team. Funding for research can promote workforce flexibility.
  • HEE and NIHR funding is comprehensive, covering the salary, training and research costs of the clinical academic in training. As well as keeping this staff member committed to service improvement, you have an opportunityto expand the team.
  • It is worth noting that research is a long process. It takes years to train good clinical researchers. If you can support staff along this career pathway you are far more likely to retain them in the long term. A research career offers individuals new challenges and job satisfaction and in turn they will bring a host of new and refined work skills that will enhance your service. These new skills will bring extra benefits – they will be able to support the CPD of others in the clinical team through provision of critical appraisal skills/mentoring/supervision.
  • Because research is a long process you need to be in it for the long term gain. If you can build systems and strategies to support your staff to become researchers, this will help you build a successful team, who can support each other and enhance the reputation of your service.
  • Having a strong reputation for research can attract staff to come and work within your service. Research activity could help with recruitment to both general and specialist posts.
  • Leadership capability is strongly linked to research capacity – a by-product for you may be your staff’s leadership potential developing. Make the most of the leadership skills that the clinical academic within your team will likely have; frequently, people in these roles have learned how to navigate complex situations and have developed experience in communication and leadership.
  • Gain real-time innovation for your service; often clinical academics will notice areas of practice that they believe could be improved. Their role is to demonstrate the need for improvement, find ways of doing this, and then make the change in practice. Working with the clinical academic in your team can be an excellent opportunity for you to make arguments for service development in areas that are important to you, your staff and your patients. These may be in areas ranging from service design, treatments, outcome measures, cost-analyses to commissioning support.
  • Recruitment to NIHR funded studies can attract funds into your team to undertake research support and can, in some circumstances, attract other Research Capacity Funds to support further research work. Word gets around that you are a manager that supports different career pathways and can mean you can attract further high quality staff willing to go the ‘extra mile’

What opportunities exist for your aspiring clinical academic and what do you need to know? 

Research taster and internships:

  • The most likely starting point for someone starting to have an interest in a clinical academic career is to try to get an internship or gain experience helping out on a research project. These are often based on local initiatives and may or may not include a contribution to salary backfill. Read about the Health Education England Internships at this link: https://www.hee.nhs.uk/our-work/clinical-academic-careers/research-internships
  • They are time-limited opportunities but do allow an individual to test in a real setting whether research is the career for them. You will need to free the member of staff’s time but this should not be a one-way street.You can ask for flexibility from the provider of the experience – indeed it is good to contact them so you understand exactly what is on offer - and for the experience to have clinical relevance for your service so that there are benefits for the whole team. You should speak with the person that will manage your staff member’s experience in advance of the internship.This will help you understand what they will be doing and what it might mean for you. It is also important that you understand the time commitment and how flexible it is.
  • Similarly, if you have a keen staff member and a priority area for you,why not contact the internship providers directly. The academics supporting the internship programmes are likely to be very encouraging of clinical staff bringing areas of real research need to their attention, especially if you are also suggesting a promising team member for an internship.
  • It can be helpful to encourage staff to also engage in audit and service evaluation alongside their research. This helps to develop a rounded skill-set for them. This will also help you to have ‘quick wins’ in terms of demonstrable service improvement.

Master's in clinical research:

  • Ten Universities across England offer a part or full-time formal research Master’s degree funded by HEE and managed by the NIHR. Key to this is that each post comes with salary back fill, ensuring that the candidate can devote appropriate time to developing their research skills.
  • It is important to note, that frequently staff who undertake this level of training award are keen to progress on to future awards. It is useful if you can plan to make use of their developing enthusiasm and expertise within their clinical role once they return.
  • There are a lot of training opportunities. For many aspiring clinical academics a Master’s degree is the best starting place. But your staff member should seek advice on what Master’s programme best fits their career ambitions.
  • The Master’s training prepares the individual to undertake a PhD. Because of the generous funding it is usually possible to support the individual with little impact on the clinical service which includes full salary and university fees.
  • Supporting this scheme will increase the proportion of your staff that obtain Master’s level qualifications. The courses will help your member of staff develop many transferable skills, which will improve their work effectiveness and efficiency.

Fellowships

  • If a member of staff has completed a Master’s degree and is keen to continue developing their clinical research career the next step is to studyfor a doctoral degree.
  • Opportunities for doctoral level and post-doctoral level study are available through both the HEE/NIHR Integrated Clinical Academic Programme and NIHR Fellowships Programme. Salary costs, full research costs and training and development costs are all included.
  • An application to a personal award from the NIHR Fellowships or HEE/NIHR Integrated Clinical Academic Programmes is detailed and the applicant needs to have identified and formed relationships with supervisors as well as mentors. Pulling all this together takes time. Your support in protecting some of their time for research would be beneficial to the applicant and heighten the probability of a successful application.
  • Some of the best clinical academic fellowship teams have the managers working in collaboration as part of the support team for the candidate. Get involved in the early conversations about project design. Try to remain flexible and open-minded in the design process; the project will need to have ‘fit’ with a number of drivers, however it is important that your perspective is also represented.
  • There is lots of help available from the team at the NIHR Trainees Coordinating Centre about the various schemes and they will advise on which schemes are best for your staff. As a manager there is no reason why you cannot speak with one of the team about what supporting a member of your staff means. Time is only one aspect of the process. They will need to prepare for a panel interview if shortlisted. They need academic and clinical mentoring to support them – raising these issues will ensure that the reality of what the aspiring clinical academic needs are dealt with early.
  • The NIHR Research Design Service (RDS) can also offer lots of help to the applicant. Advise them to approach the RDS early. They can advise on project remit, patient and public involvement and on the methodological aspects of the application.
  • Embrace patient and public involvement within your service. The applicant will need to liaise with patients and the public to help develop their research ideas. However, this process can also be a very useful way of getting feedback about your service in general. You may even find that there is a group of patients who are able to work with you in developing your service in particular areas. Seek advice from the RDS and organisations such as INVOLVE for support on how best to work with patients in this way.

6. Manager and aspiring clinical academic - what do you need to discuss to make this opportunity work for both you and the service?

  • Is this opportunity the right one? Is an internship or short-term project the best starting place or is it time to look at formal training opportunities?Write down research ideas to start the conversation.
  • Who does the aspiring clinical academic plan to work with? Does the manager know these individuals? Are they the right people to support this?
  • What is the career plan? It may be helpful to formalise plans for research training in the Personal Development Plan.
  • What is the mid-term plan? Will the aspiring clinical academic be expected to supervise/mentor others aspiring to the clinical academic role within the team? How will you manage expectations of others? How will you share the clinical academic research outputs internally? Will there be flexibility in both the clinical and academic workload to allow focus in one area when needed (for example during upgrade/thesis writing or if taking clinical exams)?
  • What is the long-term plan? Is there a plan for the long term inclusion of clinical academics within the team? If yes, how will you and the clinical academic work together to facilitate this? What will happen at the end of the award? Will the clinical academic seek promotion and is this viable for the service? Can the new clinical academic employ their skills across a number of teams (thereby sharing the costs and benefit of such a post)?
  • Timing: when will training start, what is the time commitment and for how long? Will the role in the team remain the same during the research training (but part-time) or does the opportunity offer the potential to develop a new role as their clinical and research skills develop? But this is not a one-way street – what can the aspiring clinical academic offer the team in return?
  • Service need: how will this impact on the service? Can the post be easily back filled? If the post is a specialist post, can another team member be trained into the post? How flexible can the aspiring academic be in the clinical component of their work? What will the split between academic and clinical work be? How will the clinical academic keep up-to-date with their clinical skills during this opportunity? How can the aspiring clinical academic help to support this process (shadowing/supporting the development of the person backfilling)? In what aspect of the service is it best to focus their clinical time?
  • Team development: The role of the aspiring clinical academic will help the team up-skill their research understanding – how will this be formalised? Will a systematic review of the evidence be part of the training? If it is, can it be clinically relevant to the work of the team? Can the aspiring clinical academic run a journal club, support audit/service evaluation or undertake other research activity with the team? The aspiring clinical academic could have an on-going role to ensure that new evidence from journals and conferences is fed quickly back to the team. Expectations need to be aligned to the level of skill development of the aspiring clinical academic – you would not expect the same from an individual undertaking an internship as someone advanced in their doctoral training.
  • Research question: Can it be clinically relevant to the service and be usefulto the day-to-day work of the team? Can a manager play a part in planning the research?
  • Support for the aspiring academic: Can there be protected time to work on training funding applications? Usually working on these applications will take place in the aspiring clinical academic’s own time – it is important that the manager is aware of this. Who will hold the budget if the staff member is successful (NHS Trust or HEI)?
  • Engaging with clinical academic supervisors: Can the manager meet the supervisor and the aspiring clinical academic to devise a project that is locally relevant? Can the academic help the manager or team in any way to understand how research can help their service in the future? Is there scope/opportunity for a long-term relationship between the supervisor’s research team and the clinical service?

7. Useful information and resources

Research training awards

  • Animation about research opportunities available as part of the Clinical Academic Career pathway

http://bit.ly/hee-nihr-animation

  • See three NIHR Doctoral Fellows talk about their experience as doctoral trainees in this video

https://www.youtube.com/watch?v=_p2lGTjgYyo

  • Health Education England Internships

https://www.hee.nhs.uk/our-work/clinical-academic-careers/research-internships