Introduction
The ICA Programme supports registered graduate clinicians belonging to the ICA eligible professions to develop clinical academic careers by providing training awards that combine continued clinical practice and clinical development with clinical research and research leadership.
The HEE/NIHR Integrated Clinical Academic (ICA) Programme’s Personal Award Schemes; the Clinical Doctoral Research Fellowship (CDRF), Clinical Lectureship (CL) and Senior Clinical Lectureship (SCL) offer the opportunity to undertake fully funded clinical research, research training and tailored professional development whilst maintaining clinical practice and salary.
The fifth annual ICA Programme CDRF competition launched on the 1st March 2019 and closed to new applications on the 30th April 2019.
The numbers of applications received and awards made are detailed in the table below.
ICA Programme CDRF Scheme – Applications and Awards
| Application status | Round 1 (2015) | Round 2 (2016) | Round 3 (2017) | Round 4 (2018) | Round 5 (2019) |
|---|---|---|---|---|---|
| Applied | 84 | 81* | 91 | 83 | 77 |
| Interviewed | 49 | 46 | 53 | 51 | 53 |
| Recommended** | 28 | 26 | 34 | 31 | 29 |
| Awarded | 24 | 20 | 30 | 24 | 24 |
* The proposal detailed within one application was deemed to lie outside of the NIHR’s remit. As a result, this application was not assessed by the Selection Committee.
** The number of candidates deemed by the Selection Committee to meet the minimum standard for funding through the scheme
The ICA Programme CDRF scheme is assessed by a single selection committee. The six members of the selection committee’s chairing team made the following observations on conclusion of the Round 5 competition.
The Chairs’ observations
The Chairs agreed that applications received in 2019 were again, on the whole, very competitive. Applicants took full advantage of the chance to simultaneously propose comprehensive professional development plans and research projects of excellent quality and value.
Having noted some common weaknesses within unsuccessful applications (both in the written application and at any subsequent interview), the Chairs would like to remind prospective applicants of the following:
The need for full methodological consideration and justification
Whilst most applicants underpinned their proposals with the relevant theory base, the Selection Committees again observed a number of themes and common weaknesses within applications. The ICA Programme welcomes applications utilising any scientific methodologies, but these must always be justified and evidenced as those most appropriate to answer the research questions raised:
- A number of predominately quantitative research proposals also included a qualitative research element; although often warranted, this element was often weakly or poorly developed by comparison.
- The Programme does welcome wholly qualitative research proposals, but the theoretical grounding, methodologies and project design of qualitative or mixed methods proposals must be of the same high standard as is expected of quantitative research proposals.
- Confusion between pilot and feasibility trials was common, as was a tendency for applicants to propose a full RCT, despite lacking the justifying data and, importantly, the requisite personal experience of undertaking a trial of any kind.
- There is a current prevalence of intervention development proposals. Such proposals remain welcome, but the selection committees would equally welcome diagnostic and prognostic research proposals.
- There is a tendency to overlook the different stages of prognostic research and research developing new interventions. Several proposals aimed to develop and apply empirical or theoretical models without due consideration of the need to validate them. Such applicants should consider specific training in model development and validation, and ensure that their supervisory team includes specific research expertise in this area.
- Several applications involved the analyses of existing large epidemiological data sets. It is recommended that such applications show clear inclusion of supervisors with expertise in the analyses of such data.
- A number of applicants incorporated patient reported outcomes into their proposed studies, but did not have a clear rationale for the choice of measures. They seemed not to have given sufficient consideration to instrument selection or the implications for the collection of high quality data.
The need for advanced planning and proposal development
It usually takes between 6 months and a year to work up a competitive application. Successful proposals have, at the very least, been under development for a couple of months prior to the competition launch, during which time they have benefited from the support of the supervisory team members and prospective host organisations.
The considerations that should be made if proposing a linked project
Research projects can link with broader, existing research programmes, but applicants must demonstrate a consideration of both the advantages and disadvantages of this approach. In addition, applicants must describe how ownership of the project will be achieved (e.g. will the awardee take on PI responsibilities?) and detail the contingencies in place to ensure the success of the project if issues arise with the linked research and/or its funding.
The need for strong statements of support from the hosting organisations
The supporting statements submitted by an applicant’s proposed hosting organisations are often weak and generic, and fail to convey a reassuring level of support for, and understanding of, the proposal and the aspirations of the applicant. Given the vital importance of organisational support to the development of a clinical academic career, the Selection Committees fully expect (and at the CL and SCL levels, require) these statements to clearly articulate an ongoing and post-award commitment to the applicant’s academic career.
The need to be ambitious whilst remaining realistic
When formulating the scope of the research proposal, prospective applicants need to ensure that the research project can be completed within the period of the award, predominantly by themselves with a view to maximising personal development. Early identification of, and guidance from, an experienced PhD supervisor or mentor will be invaluable to this.
Using training awards to develop new methodological skills
Applicants to research training awards are encouraged to take advantage of the opportunity to gain experience of methodologies that they have not used previously, and to always propose the most appropriate methodological approach rather than merely one that is familiar.
The Selection Committee will still, however, expect applicants to possess sufficient understanding of the proposed methodologies to justify their choice and, following appropriate timely training, to lead their research project (demonstrating ownership of the proposal in its entirety). The training plan should incorporate sufficient support and training to ensure expertise will be demonstrable at the end of the award as they commence the next step towards being an independent researcher.
Whether to propose a part-time or full-time award
There is a tendency for applicants to propose part-time awards in order to continue within their existing clinical posts. These awards all contain protected clinical elements, and so it should not be necessary for applicants to make such a concession in order to maintain professional practice. Applicants proposing a part-time award purely to undertake additional clinical activity should consider the impact of this on their academic career trajectory. This is not, obviously, a consideration that individuals proposing a part-time award for any other reason are expected to make. Applicants who, for personal reasons, already work part-time (or, indeed, anticipate working part-time in the near future) are more than welcome to propose a part-time award.
The need for PPI
The selection committees were disappointed to observe very poor PPI in a number of applications. Applications that have paid lip service to Patient and Public Involvement but not effectively incorporated it are easily identifiable as such, and are invariably weaker as a result.
Common issues noted:
- Confusion between Patient Engagement and Patient Involvement.
- PPI proposed for one specific element of the project (e.g. research development) but neglected elsewhere, most notably within the data analysis and dissemination phases.
- Extremely poor PPI costing. Applicants are reminded that the NIHR takes PPI very seriously. PPI is one of the assessment criteria used by the Selection Committee when reviewing all applications and PPI members sit on the interview committees.
Applicants are referred to the comprehensive resource available from the INVOLVE website, which includes guidance on writing Plain English summaries and budgeting for PPI involvement.
Plain English Summaries
The Plain English summary submitted as part of the application will be assessed by the selection committee. If the summary does not provide a clear explanation of the proposed research to clinicians and researchers who do not have specialist knowledge of your field, as well as to members of the public, this will impact on the competitiveness of the application when shortlisting decisions are made.
Applicants are advised to use the support available from NIHR INVOLVE and the Research Design Service in the development of their Plain English summaries.
Frequent weaknesses in the Plain English Summaries submitted to the Round 5 competition:
- Poor structure with large blocks of text and a lack of headings
- Poor explanations of terminology
Further guidance on writing in plain English is available.
For further support and advice on writing a plain English summary, please contact your local Research Design Service.
The cost of the project, including any NHS support and treatment costs
Proposals are required to be fully costed before shortlisted applicants attend for interview. Whilst inappropriate or erroneous costings within successful applications will be amended with the support of the NIHR during the subsequent contracting process, they are noted by the Selection Committee during assessment. Such mistakes are indicative of poor planning by the applicant and, particularly if relating to NHS support and treatment costs, of limited engagement with/from the hosting organisations.
Support from the NIHR Research Design Service (RDS)
The Selection Committees noted that several applicants are not accessing the support available to them through the NIHR RDS. RDS staff regularly observe Selection Committee meetings and they are well placed to provide advice and helpful feedback on applications prior to submission.
The opportunity for personal development as a clinician, academic, and clinical academic leader
Finally, prospective applicants are reminded that an award represents an opportunity to undertake training and development that will further their career as a clinical academic and the service that they afford their patients. Whilst the principal purpose of the proposed training and development plan should be to afford the fellow with the skills needed to successfully undertake the fellowship, it is permissible that limited elements of the plan serve primarily to support their wider and longer-term career aspirations as an academic, clinician and clinical academic leader.
Useful Resources
The Selection Committees have identified a variety of resources that prospective applicants might find useful in relation to some of the weaknesses identified above.
- Mixed Methods Study Designs: Prospective applicants are advised to consider the following article, and particularly the 10 resources highlighted within it.
Oxford Journals Health policy and planning 10 best resources on … mixed methods research in health systems
- NIHR Clinical Trials Guide: The NIHR has produced a Clinical Trials Guide, and recommends that prospective applicants intending to propose a trial consult it at the earliest opportunity
- Feasibility and Pilot Trials and the value of each:
NIHR definitions can be found here:
NIHR Additional guidance for applicants including a clinical trial, pilot study or feasibility as part of a personal award application
See also:
Whitehead AL, Sully BG, Campbell MJ. Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemp Clin Trials. 2014 May; 38(1): 130-3. DOI: Cotemporary Clincial Trials - Pilot and feasibility studies: Is there a difference from each other and from a randomised controlled trial?
- MRC Guidance on Complex Interventions:
The MRC's standalone guidance document is more detailed than the often cited BMJ paper.
- The University of Birmingham - Patient Reported Outcomes:
The University of Birmingham’s Centre for Patient Reported Outcomes Research has a freely available NIHR funded information resource on PROs of potential use to prospective applicants, and more broadly, to those involved in PROs.