Date: 24 May 2019
“I graduated from the University of Edinburgh in 2001 but couldn't afford to do the extra year for a BSc so I started my registrar training in 2004 without any previous involvement in research. I moved to the Royal Surrey County Hospital in Guildford for my house officer role and then worked in A&E for my first year as a senior house officer (SHO). I loved working in A&E and decided my career path would be set within an A&E setting.
“In 2008, I was two-thirds of my way through specialist registrar training and I was thinking about quitting emergency medicine. I look back now and can see that this was because I was experiencing burnout. Fortunately, I saw an opportunity to do some research as part of a medical degree (MD) and somewhat landed on my feet when I was assigned to Professor Charles Vincent, an expert in patient safety and Ruth Brown, who was my supervisor, at Imperial College in London.
“The MD inspired my love of patient safety and I discovered that I also loved research – something I wouldn’t have known, because, as with many people, you do not know unless you try it.
“I like the intellectual challenge of conducting research; it is very different from clinical work. Working out statistics is something we do not generally do in our clinical work. It helps you switch off from the usual stresses that come with clinical work and gets you involved in something purely intellectual.
“My MD thesis was entitled “Assessing non-technical skills in the emergency department”. I looked at assessing non-technical skills (NTS), in particular leadership skills, for emergency department (ED) registrars and created an assessment framework to help identify and rate skills as a workplace based assessment. I’m aware only a small proportion of research is put into practice so I was delighted when I heard the Royal College of Emergency Medicine wanted to implement the assessment tool I had developed. This is now known as the ELSE tool and is the main assessment method for all trainees in the UK.
“As I started my consultant job at Frimley Park Hospital in 2014, I was interested in doing a safety survey. I looked at the college website which has a safety toolkit with various resources for ED to improve safety – but the safety survey referenced was from the USA. There wasn’t one from the UK – and the USA one was not quite right for the UK. As Professor Vincent always said, there is no need to reinvent the wheel if someone has already done the bulk of the work. So, with him in mind I went about adapting the safety survey for use in the UK. I got in touch with the College who were aware of this gap and they gave me some funding to carry out this work.
“The study was titled ‘SECUre: A Survey of the Safety of Emergency Care in UK EDs’ and aims to enable ED leaders to assess or diagnose the Patient Safety Culture within their departments and offer a framework for improving or changing this culture. We also looked at whether attitudes towards safety culture in the ED differ between doctors and nurses.
“The survey was sent to all Royal College of Emergency Medicine registered Safety Leads in the UK, which numbered around 200, and we managed to recruit 1,060 participants (60% Nurses, 40% Doctors) from 18 sites across the UK.
“I spent some time making sure SECUre was on the NIHR Portfolio. Having a study on the portfolio means that other sites want to get involved. The research department knows that studies on the portfolio count towards their accruals and that – from a practical point of view –having a study on the portfolio means you are given a research nurse. This then allowed it to be independent of the local ED person who was going to be the local collaborator. This was important for confidentiality of survey results and for participants’ confidence in this.
“CRN Kent, Surrey and Sussex helped identify sites but in the end we had far more sites than we needed. Having CRN support meant all I had to do was find an ED consultant at each site that had enough time available to be Principal Investigator (PI) for the study. The research nurses do the bulk of the work and we’d never have been able to recruit those sites without knowing we had sufficient research nurse support because ED consultants are extraordinarily busy. We didn’t want to do the survey in only research active ED departments as we wanted to get a full spectrum of data; this was only possible through research nurse support.
“I’ve become a fan of encouraging people to try out research and become more involved. My advice to others is to give research a try. I get great satisfaction from my research work. You need to be willing to be patient and persistent, but it is doable outside of an academic centre. I’m keen to encourage those not in academic jobs to do research, or as a consultant, envisage you will be involved in research in some way.
“In five years I hope to be doing much the same work, including the continuation of our own projects as a department, recruitment into national trials, and increasing the numbers of people who get involved. I imagine I will still be involved in qualitative research as I find it really interesting and it can be done relatively easily in a district general hospital.
“I’m very grateful to my department who has supported me in being able to devise and run SECUre. Fortunately, I got a consultant job in a department that was forward thinking and appreciated the value of research, even in a district general hospital.
“We’re currently recruiting into three studies. It’s useful to always have a study on the go for when a new doctor or trainee doctor joins the department – because they are usually interested to know what research is going on. And this way, we always have something for them to work on, get GCP-trained and to start recruiting. Now ten people in the department are trained to recruit – two consultants are involved in delivering research, one research nurse and one military research nurse”.
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