Clinical academic careers

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Summary drawing of the CAHPR/NIHR event in London on December 8th 2017

The Unspoken Voices Project is funded by a HEE/NIHR clinical doctoral research fellowship. This training programme aims to support allied health professionals (AHPs), nurses and midwives to develop as clinical-academic researchers. That is, to be able to continue to work as clinicians in the NHS whilst carrying out research that is relevant to NHS services and patients. One of the reasons that it is thought to be a good idea for clinicians to be engaged with research is because research-active health organisations get better outcomes for patients. The fellowship programme has already provided me with some fantastic opportunities to network with other clinical-academics and to learn about how research can have an impact on healthcare (see TEDx NHS, Conference season). One of the challenges facing the NHS is that there currently aren’t established career frameworks within health organisations that enable clinicians to combine clinical practice with research. I have been reflecting recently on what is happening both locally and nationally, and what more needs to happen, in order to change this so that I (and other trainees like me) can continue in a clinical-academic career after the fellowship has ended.

I attended a meeting with colleagues at the University of Gloucestershire (UoG) at the beginning of December. They are looking to broaden their research portfolio, to work more closely with healthcare providers, and to develop the teaching and training programme that they offer social- and health-care workers. Although UoG don’t currently have AHP trainees in their student population, the health and social care team are keen to expand their offer as well as to find areas of overlap with local research-interested clinicians. It was a really positive experience to be in a room of people trying to find common ground and to build relationships that will expand horizons for all parties. I was reminded how, within healthcare, we often embed ourselves within clinical areas, teams or specialties. It can be difficult for some people to see beyond the opportunities provided within their immediate work environment. The same could be true in trying to develop a clinical-academic career. I am in the fortunate/unfortunate position that my host University is 200 miles away and there are no local Higher Education Institutions (HEIs) with Speech and Language Therapy training courses. This has the potential to be both a barrier to developing a clinical-academic career, and an opportunity to look beyond my immediate milieu. My UoG colleagues and I focused on areas of shared interest (e.g. research methods, building bridges between health research and healthcare providers) and possibilities for future collaboration that will benefit all parties (e.g. teaching, building training courses). I was grateful to meet people who recognised the skills that I am developing as a research fellow and saw beyond my professional label or clinical background.

I was invited to present my clinical academic journey to a meeting in London in December. The aim of the day was to consider how the NHS can develop sustainable AHP research careers. We heard presentations about how the National Institute for Health Research (NIHR) and their Clinical Research Networks (CRNs) are developing the support that they provide AHPs to enter into a career as a clinical academic. A podiatrist collegue and I were interviewed about the highs and lows of our paths into clinical-academic training. Representatives from Solent and from Sheffield health communities provided some possible frameworks for developing clinical-academic pathways, about which the delegates discussed the strengths and limitations. The over-arching theme of the meeting was that, currently, clinical-academic careers are ‘non-linear’. AHPs move between clinical and academic opportunities and there is no standard framework for a career that bridges healthcare provision with research activity.  Clinical-academic careers frequently depend on tenacity and courage of an individual. There are heartening developments within strategic NHS bodies to bolster clinical acaedmic careers in future. Significant hurdles continue to be the financial pressure on middle-managers and the lack of a mandate for them to develop such posts.

One of my concerns on entering the NIHR fellowship programme was that I couldn’t see where it would lead me. My modus operandi is as a goal-focussed planner, so I found the lack of a clear pathway post-fellowship was unnerving. As a clinician in the NHS, there is a route you follow when developing clinically, followed by a route into management. There was no obvious job in the existing clinical-managerial NHS career development framework that having a PhD would qualify me to do. Neither is there a clear clinical-academic career framework. What my experiences with UoG and at the workshop in London have taught me is that I need to seek out opportunities, build relationships, look beyond traditional boundaries and expectations, learn from those who have forged their own paths ahead of me and, ultimately, build my own clinical academic career. And then to help others to do the same.

 

 

 

 

 

 

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Engaging the experts

Group members
Some of the motley crew who make up my expert group

Follow an engaging day at the Lab4Living one day conference Sheffield in September, I considered whether I could take a more creative and collaborative approach with my expert advisory group. I was inspired by the methods of co-design that were presented at the conference as well as the imaginative mechanisms that people used to interpret their experience of healthcare, research or both.  This post features some of the methods  I am adopting to develop a co-design approach to my research project, specifically managing my expert group meetings.

During my inaugural expert panel meeting in July, one of the main themes that emerged from group discussions was that all the information I provided – relating to both the group meeting and the research – was too wordy. As a speech and language therapist, I am acutely aware of reducing my language dependence during clinical sessions and often use pictures and drawing to support explanation, information sharing and therapy. Outside of the clinic however, and arguably in healthcare in general, there is still an over-reliance on the written word – note keeping, report writing, appointment letters, information booklets, worksheets… etc. I used some of the methods that I learnt about at the Lab4Living conference, along with feedback from the group, to shift the focus of my most recent expert group meeting away from the written word towards other media used for communicating.

Pictures: I used images to annotate the agenda, I produced some pictures to support the development of a logo for the project and we took pictures of people present so we can add them to the minutes (see some of the smiley faces at the top of this post!).

Agenda_Pg1_PDF                 Drawings_PPI

Videos: I produced a “talking-head” of me reading a summary of the minutes of the last meeting. I also used a programme called “Screencast-o-matic” to create an audio-visual participant information sheet. This can be uploaded to YouTube and shared as a link.

Activities: Rather than relying on people’s verbal responses, I developed activities that enabled people to use other means of communicating preferences. I used lego to enable people to vote for images that they liked for the logo and rating scales to gather their opinions about the recruitment resources that I had produced.

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As a result of these changes, the meeting had a very different energy with less focus on me talking and more on the expert’s opinions. The experts were better able to engage in providing feedback through practical activities and were very positive in their responses to the materials I had produced. They were able to provide both specific and general criticisms of the participant information materials as watching the screencast gave them time to prepare responses. One participant was very positive about the screencast and felt that my slow and clear commentary of the images resulted in him having a good understanding of the information provided. He stated that he wished all information could be presented like this. I enjoyed being creative in the methods that I used during the group and look forward to preparing for future meetings by building on the successes of this one.

How do you like to digest information? What do you use to engage people’s opinions in a creative way? Should we be aiming towards a paperless, word-light health service? Let me know your thoughts.

Conference season

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I am sat at my desk following the activity of the Royal College of Speech and Language Therapist‘s conference on Twitter. There is a great energy being projected from the attendees and the organisers and I can’t help but feel sad that I’m missing out. I have connected with many therapists and researchers via Twitter over the past year, several of them whom I know will be at the conference. It would have been a great opportunity to meet up in person and put faces to names and Twitter handles. Watching the proceedings from a distance does provide me with the opportunity to reflect on my own conference-going experiences of the last month however. I was fortunate to attend both the AAATE (Association for the Advancement of Assistive Technology in Europe) and a Lab4Living one day event in Sheffield. There is much that conference attendance offers an aspiring clinical-academic, but I wonder how the learning outcomes are translated to professional practice and academic development?

The AAATE conference, held in Sheffield in mid-September, gave me the opportunity to share my research plan with professionals working across assistive technologies (AT) in healthcare, from around the globe. During the conference I became much more aware of the research activity of the healthcare community in Sheffield (my academic home) and was also able to connect with people from other countries. There is some really interesting work happening in Canada within the Agewell group looking at using AT to support rehabilitation and ageing. AT encompass connected healthcare, digital technologies, environmental controls, wheelchairs, robotics as well as AAC. The conference was an opportunity for me to view my project through a much wider lens and to understand where there are areas of overlap between  research in the field of AAC and that happening in areas concerning other AT. I was becoming very focused on the detail of my own research project towards the end of the summer and the AAATE conference was an opportunity to look up and around at the bigger landscape in which I am working. The level of interest in my project during the conference was reassuring, I was asked questions which have helped me reflect and refine aspects of the research and I learnt a lot about developments in the field of AAC specifically and AT more broadly.

I went back to Sheffield the following week to attend a day conference called ‘Intersections of practice’ organised by Lab4Living, which is a collaboration between Art and Design and Health and Social Care at Sheffield Hallam University. This event provided a different perspective on healthcare and health research, more specifically the benefits of co-design. I learnt that the design process is intrinsically collaborative; ideas, concepts, and prototypes evolve through a process of discussion amongst stakeholders, modelling and then remodelling. Presentations from a range of people demonstrated where creativity has transformed aspects healthcare at either an individual, service or an organisational level. I reflected on how a more creative, collaborative approach could improve the way I organise my expert group meetings. The day inspired me to make the group more active in order that we could all get more out of the process of working together and ‘co-designing’ the research project.

Conferences are a fantastic opportunity to network with people, to champion my research project and to understand more about the research field in which I am operating. They are energising and exhausting in equal measure. They have helped me focus on my research and they have blown open a world of possibilities and potentials. I have been able to learn a lot from following the RCSLT conference proceedings on Twitter too. It doesn’t replace the experience of being there in person but Twitter does enable me to catch up on the highlights and participate in some of the discussions from a distance. Conference attendance is for a small and privileged minority, however. I am acutely aware, from years of clinical experience in the NHS, that attending conferences is rarely an opportunity many clinicians enjoy.  Much of the content of conferences is concerned with cutting edge research, possibly years away from being a clinical reality. Sometimes having a view on the bigger picture can help provide a context for our existing reality however, and that insight into that context should be available more widely. As a clinical academic, I feel responsible for communicating my conference experience into a form that is useful and engaging for my clinical colleagues. Ultimately, the knowledge, skills and inspiration shared at conferences needs to be translated into clinical practice in order for it to be of value to our patients, clients and service users.

I’d welcome any thoughts on mechanisms for conference transference!

 

TEDxNHS – Inspired by people

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I was lucky enough to be successful in securing a ticket to attend this year’s TEDxNHS event in London on 15th August. The event is designed to bring together people who work for the NHS; to share stories, experiences and innovations that both celebrate and inspire the workforce. And inspire it did.

The event was held at Wilton’s Music Hall in East London; a fabulously restored theatre styled with worn-plaster walls and vintage decor.  The organising team had secured a variety of sponsors who provided a range of refreshments both during the breaks and in the ‘goody’ bags. It made a refreshing change to attend an NHS event in a stylish venue with good food and drink as appose to the usual hospital training room with BYO sandwiches and lukewarm tea. Easy as it is to condemn such details as frivolous during the current period of austerity – I welcomed the effort of organising team to find a beautiful and unique venue. It really enhanced the overall feeling of the event being a celebration of the attendees.

The programme was arranged into three sections, each with its own theme: ‘Rising to the challenge’, ‘Empowering the mind’ and ‘Embracing the unknown’. Themes consisted of a range of speakers, performers and videos, each representing a unique experience of healthcare in the NHS. Speakers had 10 minutes for their presentations, which maintained the pace of the day and kept the audience engaged. Performances of music, poetry and magic by people who either had professional experience in the NHS, or were people with disabilities and had therefore relied on NHS care, provided opportunities to reflect or relax during the energetic programme. Videos of previous TED talks also offered moments of light-hearted diversion from what, at times, was some quite emotive content.

The speakers represented an impressive portfolio of skills and experience. They consisted of medics, service users, a nurse, an NHS CEO, a parent, a designer and a police sergeant. Their presentations each told a personal story. Some speakers shared tales of developing health services, others offered accounts of intimate and at times heart-rending health events that had affected them. It was hard not to be both moved and inspired by the events that they described but also in their resolve to share their stories to improve the experience of others. The resounding theme amongst the speaker’s narratives was their passion and how this fuels them either professionally, personally or both. I most certainly left feeling #inspiredbypeople.

What really stood out for me about the day was the range of healthcare issues, experiences and innovations that were showcased. In such a large organisation it is easy to loose sight of what is happening outside of individual departments and teams. There is a fantastic array of activities happening in any one Trust on any given day but as employees we rarely get the opportunity to learn about them, let alone celebrate them. There are also many similarities in the challenges that face groups of professions, teams and services. There is much we can learn from the innovations of others but we can also learn from their adversity.  My only disappointment about the event was the lack of Allied Health Professionals on the programme. I would like to see representation from AHPs in future events as I know that we would have much to add to such a dynamic and inspiring programme. I would highly recommend this event to anyone working in the NHS; it certainly achieves, and at times surpasses, what it sets out to do.

 

 

 

Asking the experts

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The inaugural meeting of the expert advisory panel for the Unspoken Voices Project was held at the National Star College (NSC) in July. During this project I aim to put user experience at the heart of my enquiry, so the expert group are a critical lintel in the framework of my research. As such, the success and integrity of this and future expert group meetings are vital to the overall project.  I stumbled upon many logistical barriers whilst planning the inaugural meeting. These included coordinating busy calendars, accommodating long journeys and a seeking suitable and available venues. This resulted in a lot of uncertainty surrounding the viability of the meeting. As late as the week prior to the meeting, unforeseen events cast doubt over whether all the group members would be able to attend. It was therefore with great relief and joy that my supervisor, four group members and I could gather on a sunny day in the beautiful grounds of the NSC in mid-July.

The experts brought a range of life experiences to their role as advisors. Two retired professionals, a speech and language therapist (presenting feedback from two of the students at NSC), and a communication aid user with experience of supporting AAC services and product developers came together to offer their advice on conducting research with people with communication difficulties. Three group members had experienced communication difficulties from childhood and two had acquired difficulties during their adult life. One group member had experience of being involved in health research but for the others, this was their first role within an advisory group for a research project.

Practicalities 

Members of the group experienced a range of communication difficulties. As a speech and language therapist, my instinct was to try to predict the communication needs of the group and to try to make accommodations for any potential difficulties in advance of the meeting. As a researcher, I took a step back and handed the authority for such decision-making over to the experts. I asked the group how I should conduct the meetings, in what form they would like to receive information and how I should manage communication with all members. As a group, we agreed that meetings should be face-to-face to facilitate communication (although many experts were happy to join the meeting via video-conferencing), in the afternoons to accommodate those who have to travel and should last no more that 2 1/2 hours. Members wanted to receive information about the group via email and many expressed interest in receiving information via a web-based information sharing site, such as this blog. Group members generally felt that information needed to be provided in simple language, may benefit from pictorial support and that it would be useful to have short video summaries of agendas and minutes.

Recruitment 

In order that the project is carried out ethically I need to complete a very detailed form, which summarises exactly what I plan to do during the research, how I plan to do it and how I intend to safeguard the participants, to a health research ethics committee. I must be transparent about how I aim to recruit people to the project, ensuring that potential participants are fully informed about what their involvement will entail and what will happen to the information they provide. The standard way of doing this is by providing a very detailed, text-based participant information packs and then securing written consent for each specific element of the project process. I presented drafts of the type of information packs commonly available to research participants. All the experts in the advisory group felt that the level of written information in the draft documents was far too detailed for people with communication difficulties. The consensus was that text needed to be bigger with fewer words and more pictures. The experts also suggested that information should be available on a video that people could access via a link in an email.

I sought the group’s advice about how to make the project attractive to potential participants. We discussed how to encourage people to be involved in the project and the group felt that a strong image might help. The experts reflected on what motivated them to be involved in the group. One individual said “I want to give something back” and another described how communication aids had helped them to overcome the frustration of not being able to say what was on their mind. Promoting the opportunity to get involved and being part of something that could influence change were considered to be key drivers for participation. There was a feeling that too much written information could put some potential participants off and that being able to contact people by email rather than post may be more successful. This feedback will help me to shape my recruitment strategy to fit the needs of people with complex communication disabilities but will involve significant creativity. I have a list of skills I will need to seek out if I am going to realise these suggestions and make my project resources attractive and accessible.

Next steps

I am already looking forward to meeting with my expert group again in the autumn. In the meantime I have plenty of work to do. I need to find a balance between presenting enough information to people involved in the project that they are suitably well-informed, without overwhelming people for whom written text is difficult to decode. I will delve into the dizzying world of vlogging and YouTube to learn about producing engaging and informative videos for both my expert group and for potential participants. I must also develop my skills in presenting complex and dense information in simple language and use strong images to support my expert advisory group in understanding an appropriate level of detail about the project.

One of the aims of the clinical doctoral research fellowship, the funding grant that supports this project, is to develop clinical-academic leaders. Fellows have a responsibility to develop or to maintain their clinical skills while developing academic and research competence. Working with my advisory group over the course of the project will provide an invaluable opportunity to work in direct partnership with people who have communication difficulties. I will also be able to learn directly from the experts how best to support their participation in this project specifically and more broadly in roles outside of their homes and families. This will be one of the ways I build on my clinical experience, enhance my clinical skills and establish new horizons for my clinical practice.

 

Reviewing reviews

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Image courtesy of: http://www.cochrane.org/what-is-cochrane-evidence

I have been reading about systematic reviews recently. They are a useful starting point for any research project as they enable a researcher to scope-out what is already known about their research subject and therefore provide a foundation on which to build the research study. Systematic reviews use defined methods for exploring the literature in a consistent way, and reviewing the results in order to draw conclusions. They must be explicit, comprehensive and reproducible. Methods for conducting systematic reviews frequently, but not always, start by identifying a question that needs answering. They then require a clear framework for identifying suitable research papers: who are the focus of the papers, what intervention is being investigated and what outcomes are important? Systematic reviews also necessitate the reviewer to clarify the types of literature that will be searched, how information will be extracted from that literature and how the results of the search will be analysed in order to draw conclusions. It all should be quite simple. Identify a question, choose a method, carry out a search, evaluate the findings, report. Boom! And yet I am now on week two of reading about systematic reviews and I don’t appear to be any closer to step one: finding a question.

The aim of the review for this project is to find out the words, themes and narratives are used by people who rely on communication aids to define the outcomes and impact of using them. This does not, however, seem to be a very systematically reviewable question. Systematic reviews evaluate the effects or the implementation of interventions. I need a clearly defined population (adults, children, young people, people with acquired communication difficulties, people with communication difficulties from birth), a specific intervention (e.g. AAC in general, low-tech communication aids, high tech communication aids, picture based communication aids, text-based communication aids,), a control group (e.g. other people with speech, language or communication needs, or non-disabled peers) and an outcome (e.g. quality of life, satisfaction, access to work/education, improved relationships). I am reluctant to limit the parameters of my search as I am aware that there is a limited amount of information available on the topic of AAC (The case of the missing perspective…). Yet if the question for the review is too broad, the search will produce too many results to manage, most of which will almost certainly be irrelevant.

My lack of clearly defined question has led me to consider carrying out a ‘Realist review’; a specific method of systematically reviewing information which builds an understanding of the underlying mechanisms at work within an intervention rather than producing an overall review of the results of other studies. In theory, it is an obvious answer to my dilemma. I don’t need a pre-defined question; realist reviews do not focus on the effects of interventions specifically rather they explore what works for who and why; all types of literature can be used to strengthen the theory, not just academic literature of which the pool for AAC is limited. They also allow for the integration of number-based data (quantitative studies) and descriptive data (qualitative studies), and can result in narrative and figurative findings. My review of reviews so far does indicate that this particular method does not have strong presence in healthcare research and I have yet to find any examples of its adoption within either the fields of AAC or speech and language therapy. There are a small number of very well established academics using this method but it still appears to be on the fringes of systematic review methodology. I am not sure that I have the confidence or the experience to blaze this trail at such an early stage of my academic journey. I think I may need to re-read some reviews of reviews and head back to the drawing board.

Communication is key

Image courtesy of: https://wisconbio.org/tag/science-communication/

If I could create a personal word cloud, ‘COMMUNICATION’ would scream out of the middle of it in huge letters. I have spoken, typed, written, drawn and gestured this word multiple times a day in my professional life. During speech and language therapy training, I studied communication in its many forms: spoken, written, non-verbal, dance (well, I remember the bees waggle dance featuring in one first year lecture). It then became the bread and butter of my work as a speech and language therapist; supporting people who have difficulty speaking or writing to communicate effectively is one of the fundamental skills of my trade. More recently, I found ‘communication’ taking more prominence in my life outside of work. Where once day-to-day communication was something I did without much thought – usually face to face, occasionally in writing –  new platforms emerged; each requiring attention to style, with an individual set of interaction rules and an expectation of regular updates. Social media, text-messaging, emails, and blogging, to name a few. “How shall I phrase that?”, “Which emoji best represents how I feel?”, “Does this picture sum up my experience here?”, “How can I write this in 140 characters?”. There were so many novel ways to express opinions and experiences, communication suddenly required consideration in my personal as well as my professional life. Although fascinated by communication (hence my career choice) and able to support others to communicate, I found adopting these new modes of communication challenging. I have learnt to engage with social media platforms, but it has been a slow process.

And now I find that a new set of communication skills is required. One element of my academic training is developing and implementing an effective communication strategy. In order to share my learning, research and to build collaborations for the future, I must connect effectively with stakeholders: my supervisory team, the project advisory group, professionals working in the field of communication aids, my speech and language therapy department and colleagues, participants, recruitment sites, funders, sponsors, the university,… the list goes on. I need to be proficient at communicating with academics, clinicians, experts and members of the public with experience of using communication aids. I also aspire be able to engage and interest people who aren’t aware of communication aids, to raise their awareness of the challenges that people who rely on them face. Twitter has opened up the possibility of networking with people who I don’t know and may never meet but with whom I share a professional interest. I find it difficult to judge what, where and when to tweet however, and am still learning how to precis my thoughts into 140 characters. This blog is my attempt to articulate my research journey to a wider, non-expert but interested audience. Writing for an unknown reader is another communication challenge. How much knowledge should I assume? How do I come across in writing to people who don’t know me? Is my writing clear and accessible? Academic journals are a key mechanism for sharing research, especially within professional and academic communities, yet require a different style of written expression again. Having spent over a year writing one paper for submission to a journal, I then found myself spending days, weeks even, formatting the document so it meets with the journal-specific style requirements.

I started this journey thinking that I was an expert in communication but the terms of reference have shifted. Communication is key to sharing my project with the widest possible audience, to develop a network that will support me on my clinical academic journey and to build a profile as a researcher. But I am no longer the communication specialist; I am a student again.