Widening access to clinical research

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SUE CARR: Hello and welcome to this one-off podcast episode from the General Medical Council. I’m Sue Carr, I work as a Consultant Nephrologist and Deputy Medical Director at the GMC. 

Throughout my career I’ve been lucky enough to be involved in clinical research projects, which have brought a wealth of benefits to me, working as a doctor, and to my patients.  

But we are aware that not all doctors have the same opportunities. In this podcast, we’ll discuss how we can widen access to clinical research for doctors and talk about how taking part in research projects can equip doctors with skills, knowledge and experiences that can improve patient care.

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FARHAD PEERALLY: My name is Farhad Peerally, first of all. I'm a final year gastroenterology and general medicine registrar in the East Midlands. I’m currently working at the University Hospitals of Leicester, but I also hold an honorary contract as a research fellow with the Department of Health Sciences at the University of Leicester.

Between 2015 and 2019 I took some time out of programme to do research in patient safety. And I was given the opportunity to use different methods to look at how healthcare could improve its responses following serious incident investigations. 

SUE: Thanks, Farhad. I wonder if you could just tell us how you got involved in being a clinical research fellow. And just, how, what motivated you to do that?

FARHAD: I think the first thing to say is that as doctors, especially doctors in training, we are quite lucky to have a particularly structured clinical academic pathway. And I was lucky enough to secure a clinical academic post throughout most of my postgraduate training, which undoubtedly opened a lot of doors and lead to my eventual appointment as a research fellow.

I suppose I cannot understate the importance of three particularly important factors, which ensured I made my initial steps into academia smoothly, and I suppose with confidence. And these are adequate supervision and mentorship, getting time to carry out research, because doing it alongside clinical commitments, especially if you're doing postgraduate exams, can be very hard, so you need that time. And you need to believe in yourself and that particular belief can only be instilled by your supervisors and mentors.

SUE: So, you’ve described your involvement in research through the clinical academic training pathway. What do you think doctors can do who want to be more involved in research, who perhaps don't go through the clinical academic training pathway or decide later, later in their training that they've got an interest in research – what could they do to get more involved?

FARHAD: I suppose the first step would be to speak to your educational supervisors about your interest in research. They will know people who will know others who might be doing other research projects. And, there's a beginning to everything and you'll have to tag along to a team to start off with, I suspect. And even if it's a minor role, in terms of data collection, there's always a beginning to these kind of longer projects and getting involved first thing, as potentially just collecting data, would be a particularly good starting point. 
I also think that there are a lot of academic jobs around that people may not be aware of, and they're often advertised on NHS jobs and BMJ careers. So, just this willingness to just potentially inquire about the jobs in and around the region where you’re based at is a particularly good first step. It’s breaking the ice really, so contacting your educational supervisors, contacting local research teams, and most teaching hospitals have a clinical trials unit who, from my own experience, have been quite reciprocative [sic] to enquiries for interested trainees to get involved.

And I think I need to mention this scheme, which I was made aware of last year – the NIHR Associate PI scheme. This one is actually a structured pathway into research for people who don't want to take time out, and it's sponsored by the NIHR, the National Institute for Health Research. And it allows trainees, in particular registrars early on in their registrar year to get to know the ins and outs of clinical trials unit. And, they are assigned the task of recruiting patients and they get dedicated training into research methods.

SUE: So, some good ideas there for doctors who might want to get involved, you know, without going through a formal academic training pathway. 

I wonder if you could just tell us, you know, what you think about patient benefits from doctors engaging in research. You know, do you? Does the patient becoming involved in research, does that help with patient safety? Do patients benefit from being involved in research at all?

FARHAD: I think patients benefit from research in a number of ways. So, we do know – and this has been shown in numerous studies – that research active units tend to have better patient outcomes. That’s one. 

The second is the fact that simply being involved in research means that clinicians are more inquisitive in nature, and being inquisitive means that, simultaneously, you're adding on to that particular step of the ladder in terms of a bigger picture of one particular question. So, whilst it may seem that your particular bit of research isn't contributing directly, it's adding on to that bigger picture. 

SUE: It certainly keeps doctors knowledge and skills at a really high level, doesn't it? And patients benefit from that. Do you think being involved in research has sort of helped you progress in your clinical training?

FARHAD: I've got to say the bit that I think has particularly been beneficial to me is the amount of collaborations I’ve made, the amount of new people I’ve made… I've got to know and the new networking opportunities that research has brought to my career. 

It has benefited to my clinical training as well in terms of the fact that it's opened doors that wouldn't have opened before. So, from my end, it’s allowed me – I haven't reached the stage where I need to apply for a consultant job just yet – but it certainly opened my eyes in terms of how other clinical units work through the collaborations that I've made.

Because within your own clinical training pathway, you can get very stuck to your own region, but through research you get to know others from other areas and what they're doing and whether you would fit within their own team. You get a better idea of this as well.

SUE: So, Farhad, do you think you could give us your thoughts on how you think we might encourage more doctors at different stages of their training and careers to take part in clinical research opportunities? 

FARHAD: So, I, I think flexibility within the training pathway is an absolute first step. Linking up trainees from smaller teaching, from smaller district hospitals which may not have a particularly active research profile with researchers within tertiary centres or universities would be another step. Medical schools are particularly good at this, but I think as soon as trainees hit the post graduate training pathway, they tend to be alienated from universities. This is not the case in America, in a lot of European countries, and I think a tighter link between, in particular smaller hospitals and universities would be useful.

SUE: I think that’s a really interesting idea you put forward there about linking between smaller hospitals and bigger teaching hospitals or universities. 

FARHAD: Yeah, well, I suppose just to summarise the most important point I think that has allowed me to progress throughout my clinical academic training pathway. It's the enjoyment of learning and, and I’d say carrying on contributing to new knowledge and knowing that eventually and hopefully it will benefit both the centres I’ve worked in and patients directly. Even if you're not seeing the benefit straight away, you’re adding on that particular block within the bigger scheme of things.

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SUE: Can I just ask our clinical fellows to introduce themselves and the roles that they’re undertaking at the moment? 

VALMIR SELIMI: My name is Val and I’m a clinical fellow at the General Medical Council, working in the Strategy and Policy directorate. 

CHUN LIM: My name is Chun Lim, I’m one of the clinical fellows based at the General Medical Council as well, at the Education Policy department. 

NATASHA MATTHEWS: I’m Natasha Matthews, I’m a clinical fellow currently at the GMC working in Fitness to Practise. 

SUE: That’s great. And, can I just ask you about your experience in your previous clinical roles or other roles, about how you’ve maybe been involved in research projects. 

VAL: Thanks for the question, Sue. I feel really fortunate. I’ve been involved in a few research projects and that's ranged from lab-based work, examining immune cells, which I was able to undertake during the intercalated portion of my medical degree, to examining new ways of teaching students how to use diagnostic surgical tools. So, I have had a somewhat varied research experience.

NATASHA: I'm a post-foundation year two doctor and I finished that in August just gone. And I previously undertook an academic foundation program in the northern region and the research I did was mainly in the field of global health.

CHUN: So, being a transfer student from my home country to the UK medical system, I personally found it difficult to get embedded into any research projects during my medical school years. I've done some small projects in the past and have those results written up as a paper as well, but during my medical school years here as well as my clinical training, opportunities have been more difficult.

SUE: Thanks, Chun. That’s really interesting. Having heard what you said, what do you think we can do to encourage or enable more medical students or doctors in training to take part or to have the opportunities to take part in clinical research during their education or training? 

CHUN: I think to, to know research one has to understand what is research and what is the benefits? I personally don't think I have been formally told or taught about this when I was a student. If you have not had the basis of research quite early on, it's really difficult to sort of find opportunities because the standards that's been set for, to be involved in research has been quite high. 

NATASHA: I think there's a really big market for those doctors who don't necessarily see themselves as having a long-term research career or doing loads of research, so they wouldn't necessarily choose to do a clinical, an academic clinical job, for example. But, they want to try some research or do a, you know, a smaller project if you like, and it would be good if there was a greater focus on creating and enabling research opportunities for those individuals. 

Because, at the moment I feel like there's a risk of research being a bit of an elite opportunity, and I think passionate individuals might struggle for like, ridiculous reasons, like they didn't get the top mark at medical school, or they don't have enough previous publications. I'm exaggerating a little bit, but I do think there's a risk of that, and research should be about passion and potential and not grades and prestige. 

SUE: And what do you think in terms of benefits to patients? What? How do you think research brings benefits for patients?

VAL: For me, doctors being involved in research can lead to a variety of patient benefits. I would say that being involved in research is one way to develop or even build upon one's ability to really critically assess research-based literature, which we as doctors use to guide patient treatment. And that can really help doctors communicate the origin of management decisions that have been presented in the literature, both between ourselves but also to patients, which is a great benefit.

But also, I would say that involvement in research is one way in which you can acquire a toolkit of skills that can be applied in various clinical situations, when you identify areas for improvement that may better the patient experience. So, that toolkit includes things like how to produce a hypothesis, develop a framework to approach a problem that may go on to better the patient experience, and both, how to best analyse and present that data.

CHUN: I think it also helps doctors to improve on the service that they can provide by a number of ways, such as, with good evidence they can change their personal practice,  they can influence the practice in the department by, you know, setting up guidelines to make patient care more standardized as well, and that this sort of practice can even be spread regionally or nationally as well. 

NATASHA: Essentially, it's looking into… research is looking into what does and doesn't work. And, as a patient, you want your doctor to do what works. So, the more research we do, the bigger the evidence base and patient care will be better. So, by contributing to research, you're contributing to that whole process so we can offer the best patient care. 

And it helps broaden your mind and your skills in a way you wouldn't expect. So, particularly, I think, my communication skills. Because it's made me think about how when I've done a project and I have to condense my ideas and my findings into a research poster at a conference or an oral presentation, or even summarising it into a research paper, which if you want in a journal, often has to be quite limited number of words, and I think that that idea of, having to do that, is a really useful transferable skill to when you're actually communicating to patients your thoughts and ideas about different things. 

SUE: So, I think that’s really interesting to hear all of your thoughts about how being involved in research can benefit our patients. Do you think there’s benefits in being involved in research projects for doctors? 

VAL: Yeah, I think that there’s an ability to improve your knowledge to go on to apply to, kind of, the patient setting. But also, in addition to that, I think research allows doctors to develop a niche in an area outside of their clinical practice, sometimes ranging into very uncharted waters – and we've seen that with the COVID pandemic. And I think that that can be really fulfilling for doctors, providing them something different alongside that clinical practice, which they can really go on to call their own and their own, kind of, contribution to healthcare in a wider sense – and I think that can really energise people. 

CHUN: I think doctors who are more well versed in research will, again, like we say, has better clinical knowledge that's more up to date, so people will look towards you for the latest evidence. 

NATASHA: So, the benefits to patients and doctors are kind of inextricably linked, in my mind at least. So, I think it's helped me a lot with my… be a better doctor, because I'm more able to critically evaluate other people’s work and new evidence that comes out, and that's been especially important when we're operating, as we often do in medicine, but in a much more pronounced way at the moment, in a context of uncertainty. And so, having that skill ultimately means you can provide the ‘most good’ patient care, I’ll say, when you’re operating in a context of uncertainty. 

Also, the skills that a doctor gets from research have a lot of overlap with the skills you need to design and implement patient safety and quality improvement studies, which ensure essentially that our health system processes and policies continue to improve. Often those things are separated as two very distinct things, but I think there's a large amount of overlap. 

SUE: So, when we’ve heard there about some of the benefits that research can bring both for patients and for doctors, in terms of their knowledge and skills and motivation, but what do you think about how we can encourage more doctors to take part in research opportunities? And how we can make those opportunities available at different career stages and make sure that they’re, sort of, available for all trainees?

CHUN: This is a very important question, I think, that needs to be addressed. So, just based on personal experience, being quite a senior trainee now almost near to consultant level, opportunities haven’t been easy to come by. And the more senior you become it feels like, you know, a bigger mountain to climb to, even to get somewhere with research.

And I think that's that, and almost research becomes very much luck-based depending on on where you work and what specialty you are in, and certainly compared to my peers I know that my rota is more intense, being in paediatrics, where it is a lot of long days, 13 hour shifts at the day or night, there’s very little extra time for your professional development sessions compared to other specialties. So, I think it is a very system-wide issue, and almost the opportunities, the time, the opportunities, the teaching needs to be built in the system.

VAL: From my perspective, I think that positive role models are key to encouraging doctors at all stages to partake in research, but also understand how to engage with it. I was very fortunate at an early point in my career as a student to have a doctor act as a mentor, advising myself and a colleague how to conduct a piece of work. I think it's important to recognise that not everyone will have that opportunity at a medical student phase of their career. And, in turn, it's really important that doctors involved as, in research, act as role models to all doctors at all stages of their careers. 

NATASHA: We need to actually value research in our training systems, which at the moment I think is lacking. Even, like, in day-to-day normal life before, before the pandemic, it was almost seen as a bit of a luxury to be taking time off the wards to go and do your research project, and really you should be on the ward seeing patients and that's what you're paid to do. And actually, we need to see research as an important part of a doctor’s development and, if they want to do it and want to pursue their interests further, we should celebrate that. 

SUE: I think we've heard there your thoughts about how research brings benefits to patients and benefits to doctors, and I think some really interesting thoughts about the importance of mentoring, role modelling and sponsorship in terms of enabling trainees to access research opportunities. I think really important to hear from you about making sure that opportunities are available at different career stages. So, I think there's some really important points you've made there, so thank you very much for that.

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SUE CARR: This has been a podcast from the General Medical Council. Thank you to our guests, Dr Farhad Peerally, Dr Natasha Matthews, Dr Valmir Selimi and Dr Chun Lim for taking part in the discussion and for offering such excellent insights with us. 

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