Unofficial Guide to Medical Research, Audit and Teaching (Unofficial Guides) - Softcover

Tang BA(Oxon) BM BCh MRCGP, Ceen-Ming; Fischbacher, Colin; Qureshi BM BSc (Hons) MSc MRCPCH FAcadMEd MRCPS(Glasg), Zeshan

Softcover

ISBN 10: 0957149980 ISBN 13: 9780957149984

Publisher: UGTM (Unofficial Guide to Medicine), 2015

Synopsis

This book follows 'The Unofficial Guide to Passing OSCEs'. It teaches all the skills expected of today's graduates, but omitted in the curriculum. It provides a systematic approach to teaching, research, and audits, including seizing opportunities to undertake these highly competitive activities. It contains checklists for analyzing research, tips for effective teaching, and guidance for portfolios, giving it relevance beyond examinations, in post graduate further education, and as a day-to-day reference.

About this title

About the Authors

Dr Ceen-Ming Tang BA(Oxon) BM BCh MRCGP is based at the University of Oxford, with an interest in pharmacology and translational medicine. She is a qualified GP.

Zeshan Qureshi is a Paediatric Registrar, London Deanery, UK

Excerpt. © Reprinted by permission. All rights reserved.

The Unofficial Guide to Medical Research, Audit, and Teaching

By Ceen-Ming Tang, Zeshan Qureshi, Colin Fischbacher

Zeshan Qureshi

Copyright © 2015 Zeshan Qureshi
All rights reserved.

ISBN: 978-0-9571499-8-4

Contents

1. GETTING INVOLVED IN RESEARCH (Ceen-Ming Tang, Heather Chester, Tung On Yau, Sze Kan Cecilia Cheuk, Zeshan Qureshi), 
2. LITERATURE SEARCHING (Ceen-Ming Tang, Zeshan Qureshi, Heather Chester), 
3. STATISTICS AND KEY EPIDEMIOLOGICAL CONCEPTS (Colin Fischbacher, Zeshan Qureshi), 
4. BASIC SCIENCE RESEARCH STUDIES (Tung On Yau, Ceen-Ming Tang, Sze Kan Cecilia Cheuk), 
5. QUALITATIVE RESEARCH (Colin Fischbacher, Zeshan Qureshi), 
6. ECONOMIC EVALUATION (Tim Colbourn), 
7. COMMUNICATING AND PUBLISHING RESEARCH (Ceen-Ming Tang, Zeshan Qureshi), 
8. CRITICAL APPRAISAL (Ceen-Ming Tang, Colin Fischbacher, Zeshan Qureshi, James Brooks, Sze Kan Cecilia Cheuk), 
9. CLINICAL GOVERNANCE (Ceen-Ming Tang, Rayna Patel), 
10. TEACHING (Ceen-Ming Tang, Debbie Aitken, Janet Skinner), 
11. HEALTHCARE INNOVATION AND ENTREPRENEURSHIP (Ceen-Ming Tang), 
INDEX, 

CHAPTER 1

Getting Involved in Research

Opportunities To Do Research

Finding The Right Project

Finding The Right Mentor

Defining A Research Question

Designing Your Research Study

This chapter will introduce you to research. It will give you an idea as to what opportunities are available to develop as a researcher, and how to take advantage of such opportunities when they arise.

OPPORTUNITIES TO DO RESEARCH

Academic medicine is a broad term for a variety of career paths with differing degrees of clinical and research involvement. Opportunities are wide-ranging, from writing a case report to obtaining an academic medical post or completing a PhD. Broadly speaking, those who want only occasional or relatively short-term involvement in research should focus on finding an appropriate small project and mentor. Many people will just approach a mentor and work on a small research project in their spare time. For those with an ongoing interest in academic medicine, finding a way to obtain allocated time to engage in longer-term research may be best. This chapter considers the more formal opportunities to engage with research.

There are many different opportunities to do research at various points throughout your career, and many questions are asked about the "ideal" time to do research. Unfortunately, there is no simple answer to this question. The answer varies considerably between countries, and it also depends on taking advantage of opportunities as they arise.

COURSES AND RESEARCH DEGREES

Table 1 below summarises different options for formal research qualifications. It is important to explore and consider these carefully as they are a significant commitment and will slow your progression through clinical training. Nonetheless, they are valuable opportunities that may allow you to gain skills and experience throughout your career.

POST-GRADUATE MEDICAL TRAINING

Post-graduate medical training varies considerably between different countries. Opportunities for doing research during this training vary even more, and entry into academic medicine has often been described as a convoluted and unstructured process. Here, we will explore the research opportunities available to trainees and interns around the world, including in the UK, the USA, and Canada. Similar principles apply to other countries across the world, like Australia and New Zealand.

United Kingdom (UK)

Once qualified, UK career pathways allow for academic work to be integrated into clinical training from the first year as a junior doctor until a substantive (consultant) post is gained. These academic training pathways have considerable flexibility and account for those who may discover their aptitude for or interest in research only later in their career (Figure 1). Similarly, it accounts for those who had an early interest but have come to realise that the pursuit of academia is no longer appealing.

At the time of writing, this integrated academic training pathway consists of the academic foundation programme (AFP), academic clinical fellowships (ACF), and clinical lectureships (CL) before attaining the certificate of completion of training (CCT). After the CCT, a joint clinical and academic senior post may be applied for. Candidates may enter or leave this pathway at any point to return to full-time clinical training.

The AFP is designed to give interested junior doctors an opportunity to experience academic medicine. Officially, previous research experience is not required. Unofficially, applicants for the AFP are expected to have extensively engaged with and enjoyed formal research as an undergraduate. Therefore, students without any formal research training should seek out their own opportunities throughout medical school to gain experience before applying for the AFP. The structure of the AFP varies between deaneries, but generally consists of either a 4-month block allocated to research in the second year, or dedicated academic day releases scattered throughout the year. In the research world, this is a fairly limited amount of time. Ideally, the AFP should help you identify your research interests, and allow you to present your work or publish a paper. Many deaneries also provide a teaching or management-oriented AFP. In summary, the AFP gives junior doctors an opportunity to explore their interests in research, and will serve as an indication of interest and commitment for those who wish to apply for an ACF.

ACFs are open to anyone who has completed foundation training in the UK. This does not have to be an AFP. The ACF is a 3-year post (or 4 years for trainees in general practice), and includes allocation of a national training number (NTN), meaning that successful applicants are simultaneously enrolled in specialty training. During an ACF, 25% of your time is allocated to research, and the remaining 75% to clinical training. These posts are usually specialty specific, but can be tailored according to your particular interests. Again, the division of research time varies significantly from post to post, with some allocating 1 day per week to research, and others blocks of 2 or more months at a time. There are advantages to each approach. For example, a cohesive stint of research time may allow for a more uninterrupted focus on your project and greater involvement in the laboratory, whilst increased division of the time may allow less disruption of clinical training.

The primary aim of an ACF is to identify a suitable project and gather preliminary data for a PhD. During the ACF, the majority apply for a Research Training Fellowship to complete a higher research degree, such as a Doctor of Medicine (MD) or Doctor of Philosophy (PhD). Those who are unsuccessful at obtaining a research fellowship at the end of an ACF post, or those who wish to continue with their clinical training before undertaking a higher research degree, will return to the standard specialty training routes. Higher research degrees may also be undertaken as an out-of-programme experience anytime during clinical training.

After completing a PhD, trainees may apply for clinical lectureship posts. The posts last for 4 years, during which trainees are expected to balance postdoctoral research commitments with completing specialty clinical training. The amount of time allocated to research is usually around 50%. After clinical lectureships, clinician scientist awards are available as an intermediate to applying for more senior research positions, such as senior clinical lectureships and honorary consultant posts.

United States of America (USA)

Many medical schools require medical students to participate in small research projects. After graduation, trainees enter residencies in specific fields such as anaesthetics, internal medicine, and surgery. At academic institutions, many of these residencies will also have short, required research components. Interns with a particularly strong dedication to research and desire to become a clinical investigator may apply for integrated programs that combine training in research with training in clinical medicine and its subspecialties. One example is the American Board of Internal Medicine Research Pathway (Table 2). Broadly speaking, the period of research training must be mentored and reviewed, with trainees working towards a graduate degree (if not already acquired) or its equivalent.

Canada

Following completion of medical school, graduates may become physician scientists through Clinician Investigator Programs (CIP). These programs are offered by many academic institutions. There are 3 pathways for CIP training, namely continuous training, distributive curriculum training, and fractionated training pathways (Table 3). Collectively, these programs provide research training for residents who wish to pursue an academic career.

Other Countries

It is difficult to generalise about the opportunities and routes into academic medicine around the world. The principles are broadly similar. For countries lacking integrated training programs, trainees may still take time out of their clinical training to undertake higher research degrees, such as an MD, Master of Surgery (MS), and/or PhD. It is also possible, albeit more difficult, to acquire degrees such as a PhD by publication alone. This requires no specific allocated time for that higher degree, only the completion of a series of related publications and the write-up required for the research degree. Any short blocks of research may be supported by research fellowships.

OBTAINING FUNDING

Funding is increasingly difficult to obtain, and the pressure of finding funding has become notorious in deterring clinicians from the academic route. As an undergraduate or early stage researcher (e.g. Academic Clinical Fellow), funding for any project will rest with your university department or laboratory, and you are unlikely to be required to obtain funding for yourself. Nevertheless, a plethora of awards and grants are available to those in these positions. These should be sought out as they will not only expand the possibilities for your research project, such as giving you opportunities to present your work internationally, but will look excellent on future applications for grants and academic posts.

Higher research degrees, however, often involve a need for you to find funding. A variety of sources are available for such work. Organisations and/or schemes of interest in the UK include:

• National Institute of Health Research (NIHR) Fellowships

• Wellcome Trust Fellowships

• Medical Research Council

In addition to these sources, a number of fellowships are awarded by university departments and research-based charities. You may also get funding from private healthcare providers in exchange for doing part-time clinical work with them. For those not undertaking an integrated academic-clinical training post, these are important sources of funding which will allow you to develop a PhD proposal without the help of allocated research time.

FINDING THE RIGHT PROJECT

When choosing a project, you need to keep in mind your areas of interest and goals whilst being realistic about what you can achieve with the time available. Some academics will have only a limited block of dedicated research time, in which the experiments and write-up must both be completed. Others will be balancing research with their clinical commitments. If you have a limited amount of time to complete the work, it is important to cover the groundwork in advance of this time period. This may involve applying for ethical approval, recruiting patients, or applying for relevant licences related to animal work.

The bottom line is that you need data to complete a project. Do not involve yourself in projects where the first data will be generated a year after you begin, unless you can justify this (e.g. by doing preliminary work in the interim). The project is right for you only if it fits within your timeframe.

There are several other factors that you must bear in mind. Firstly, the project needs to be simple and manageable. If you need to learn several new complex skills to complete the project, this is probably not suitable for a short-term project. An ideal project would also include a contingency plan which allows you to partially fulfil your goals. More importantly, the project should involve more than just grunt work. It needs to encourage critical thinking, facilitate your learning, and help you achieve your goals. Be wary of getting involved when there is no clear goal at the end.

IDENTIFY GOALS FOR YOUR PROJECT

The first step in getting involved in research is to identify your goals. It is important that you do this early on, since projects can be tailored to meet your needs. If you want to be a full-time academic, or a clinician in a very academic specialty such as oncology, then your career trajectory will likely involve working towards a PhD. It is important for you to gain experience, present, and publish your work. For those with other career aspirations, it can be difficult to justify committing large amounts of time to research unless you consider academia to be very interesting in and of itself. Nevertheless, undertaking short research projects may help you to identify areas in which you would like to specialise. It will also teach you to think critically and evaluate the research behind evidence-based medicine.

Broadly, your goals may include:

1. Exploring different areas of interest

When you first start out in research, you may have many areas of interest, or not know whether you are interested in research at all. Spending short amounts of time (2 – 3 months) on different projects in different groups will not only give you a feel for life as an academic, but also help you narrow down your interests. This will serve as a guide when choosing longer-term projects.

2. Gaining experience and developing skills

The aim of your project may be to learn a particular skill. This can range from common skills such as designing a search strategy or pipetting, to more specialised skills such as cloning. Gaining experience should be a priority if you are interested in pursuing a career in academia. Even if you have no interest in academia, a basic understanding of the research process is valuable.

3. Completing course requirements

If the aim of your project is simply to fulfil course requirements, choose a supervisor that has experience working with students and understands your curriculum. Ensure that the project is clear and fits within your timeline.

4. Presentations and publications

Both presentations and publications are valuable additions to your curriculum vitae. They not only demonstrate your interest in a specialty, but also add points to your job applications. If your aim is to present or publish, this often necessitates a long-term commitment to a project.

WHAT TYPES OF PROJECTS ARE AVAILABLE?

A wide variety of projects are available, such as basic science studies on cell biology, immunology, neurobiology, biochemistry, pharmacology, microbiology, and genetics in organisms from bacteria to man. Research in basic sciences is focused on expanding the knowledge of the scientific community in relation to fundamental biological mechanisms. As a medical professional, you have a greater understanding of the clinical relevance of such findings and are well-placed to take this knowledge from bench to bedside. Furthermore, being medically qualified enables you to participate more actively in studies involving human participants. Participation is also possible in numerous other types of studies, including epidemiology, literature reviews, and meta-analysis, as well as non-research projects such as audits and quality improvement projects.

FINDING THE RIGHT MENTOR

Finally, you need to choose a good supervisor who will take an active interest in your work and career – and, if everything goes wrong, they must be there to support you. It may seem desirable to find the most senior professor to work with, but keep in mind if they do not have time to commit to you, or an appropriate project, then their seniority counts for nothing.

Knowing who to work with is a hard and daunting prospect for a student. Interactions with senior doctors are usually framed around you as a student trying to prove yourself, and them as a supervisor assessing whether or not you are good enough to work on the project. You need to remember, though, that you are investing in the relationship as well. Just having a supervisor agree to work with you does not make a project good for you.

Ideally, you should choose several potential mentors to speak to. You may be surprised by how much, or how little, they can offer you.

When choosing a supervisor, here are few things that you should consider:

• Is your supervisor somebody that you find approachable? You need to be able to come to them when problems arise, and know that they will listen and work together with you to design a plan to solve the problem. They will also need to have the patience to explain things to you, since you are new to the field.

• Is the research group the right fit for you? It is often helpful to visit the lab or talk to PhD students and students working on the project to see if the working environment is right for you.

• Ensure that your supervisor understands what you have to offer, in terms of time and expertise. My BSc project was a 4-month block, and it was really helpful when my supervisor told me, "You have to be realistic about what you can achieve. We need to come up with a small management project that can be done in the timeframe." He had realistic expectations about what could be achieved, and we achieved it.

(Continues...)

Excerpted from The Unofficial Guide to Medical Research, Audit, and Teaching by Ceen-Ming Tang, Zeshan Qureshi, Colin Fischbacher. Copyright © 2015 Zeshan Qureshi. Excerpted by permission of Zeshan Qureshi.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Edition details

• Publisher: UGTM (Unofficial Guide to Medicine)
• Publication date: 2015
• ISBN 10: 0957149980
• ISBN 13: 9780957149984
• Binding: Paperback
• Language: English
• Edition number: 1
• Number of pages: 400