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Building ahp capacity for research an example from an nihr research professor
- 1. Building AHP Capacity for Research: an example from an NIHR Professor Nadine Foster NIHR Professor of Musculoskeletal Health in Primary Care
- 3. • Context – Of physiotherapy research development • Personal experience – My story • Tips – For career planning
- 5. Context – in physiotherapy ‘Emergent profession’ First degrees - 1979 2 physiotherapists with PhDs All degree entry – 1993 Idea of a ‘research career’ is relatively new Many PhDs conducted through other more academic disciplines
- 6. Context – in physiotherapy ‘Punching above our weight’ Working at all levels Assisting research Carrying out research as an individual or team member Conducting research projects Leading research teams Developing and managing research programmes 1st meeting of UK professoriat 46 professors in 2011 53 professors in 2016 0.1% of profession
- 9. Personal experience • 1996 – my first year of change – Early disappointment – Opportunity ‘abroad’ • 1996-2000 - early post-doc years – Wearing many hats
- 11. Highlights from this time
- 12. Personal experience • 1996 – year of change 1 – Early disappointment – Opportunity ‘abroad’ • 1996-2000 - early post-doc years • Strategic collaborations and another move – Realising where I needed to be • People • Institution
- 13. Keele University Teaching and research Professional activities Research Increasing involvement in research with the Primary Care Research Centre
- 14. Personal experience • 1996 – year of change 1 • 1996-2000 - early post-doc years • Strategic collaborations and another move • 2000-2004 - Increasing focus on research – Number of projects, PhD students, grant writing, publications... – Increasing involvement with a dedicated research centre • Visionary leadership • Great infrastructure for research • Excellent teams
- 15. 2004 – year of change 2
- 16. Personal experience • 1996 – year of change 1 • 1996-2000 - early post-doc years • 2004 – year of change 2 • 2004-2009 - Dedicated research role – ‘Galvanised’ success • Research activity • Publications • Grants • Collaborations • Building AHP research capacity
- 17. Highlights from this time
- 18. Building AHP capacity Clinical academics AHPs, nurses and doctors Academics AHPs and methodologists Clinical research facilitation AHPs and doctors Local MSK CAT group Hub and spoke model
- 19. Personal experience • 1996 – year of change 1 • 1996-2000 - early post-doc years • Strategic collaborations and another move • 2004 – year of change 2 • 2004-2009 - Dedicated research role • 2009-2016 - Further growth and success – Promotion to Professor – Increased leadership roles – NIHR Research Professorship 2012-2017
- 20. NIHR ‘hats’ • NIHR supports > 360 personal fellowships and > 4,000 NIHR trainees • NIHR Health Research Mentor, Deputy Chair of HEE/NIHR ICA panel • NIHR Academic Training Advocates – a cohort of proactive researchers working as ambassadors for health research careers, supporting and advocating for non-medical professions a.forster@leeds.ac.ukn.foster@keele.ac.uk caroline.alexander@imperial.ac.uk l.c.roberts@soton.ac.uk sally.singh@uhl-tr.nhs.uk
- 21. NIHR Advocates • NIHR Academic Training Advocates – http://www.nihr.ac.uk/our-faculty/academic-training-advocates.htm Psychology Lead: Professor Richard G Brown, Neuropsychology and Clinical Neuroscience, Institute of Psychiatry, Maudsley Audiology Lead: Dr Melanie Ferguson, Honorary Associate Professor and Research Lead, NIHR Nottingham Hearing Biomedical Research Unit Physiotherapy Lead: Professor Nadine Foster, Musculoskeletal Health in Primary Care, Keele University Dietetics and nutrition Co-Lead: Professor Gary Frost, Professor of Nutrition and Dietetics Imperial College London. Co-Lead Dr Steve Wootton, NIHR Biomedical Research Unit, Southampton Podiatry Lead: Professor Anne-Maree Keenan, Assistant Director NIHR Musculoskeletal Biomedical Research Unit, Leeds Nursing Lead: Professor David Richards, Mental Health Services Research, University of Exeter Midwifery Lead: Professor Jane Sandall, Professor of Social Science and Women’s Health, King’s College London Occupational therapy Lead: Professor Marion Walker, Stroke Rehabilitation, University of Nottingham
- 23. Tip 1 Find out what you really want to do.... and be tenacious about doing it...
- 24. Tip 2 Work with good people.... in terms of - their ability (of course!) but also - their willingness to support you
- 25. Tip 3 Write papers & grants - Important ‘indicators’ of research Enables - you to develop - you to develop others
- 26. Tip 4 Secure dedicated time for research (eg. a fellowship) - with a unit that matches your needs Facilitates - Dedicated time to focus - Further knowledge and skills - Networking
- 27. Tip 5 Work with a mentor - External to your team/Institution Facilitates - Periodic reflection on your career - External benchmarking of your CV and future plans
- 28. Tip 6 See your career as a continuum It needs to be - ‘Sufficiently focused’ yet ‘flexible’ - Taking ‘the long view’ yet with a series of ‘short views’ - Interspersed with ‘years of change’
Notas del editor
- The NHS Constitution commits to the promotion and conduct of research to improve the current and future health and care of the population. Research is a core part of the NHS…..and this is directly associated with increasing evidence that research active NHS Trusts provide better overall care to patients…. But to deliver on this aspiration, we need a strong infrastructure to support research, with the right people at the heart of that who have the knowledge, skills and networks to deliver high quality research to underpin clinical practice
- Context Of physiotherapy academic development and the challenges in terms of clear academic career paths Personal experience my story so far, as a physiotherapist who followed a research path early and has developed a strong clinical research career Tips practical tips – including some tough reflections
- My research has focused on the field of musculoskeletal pain, such as…. And my research has in particular focused on the development, testing and implementation of complex interventions delivered by AHPs, such as…. Physiotherapist-led exercise interventions for knee osteoarthritis Models of stratified care that subgroup MSK pain patients and match them with different treatments Physiotherapists working as vocational advisors in general practices, providing work and occupational focused support for adults with MSK pain
- Physiotherapy has been described in the past as an ‘emergent profession’ with respect to academic development and research Degrees were first awarded to British physiotherapists in 1979 and around that same time a couple of physiotherapists became the first to be awarded PhDs Since Sept 1993, physiotherapy in the UK became an all degree entry profession In reality thats only just 23 years ago, and its fair to say that research careers for physiotherapists, and for all AHPs are not yet well established and indeed I would argue have been insufficiently flexible - but this is changing In the last 20 years the most typical pattern within the profession is to see PhDs being conducted by physiotherapists through other more traditional academic disciplines such as medicine, physiology, psychology and social science
- The good news however is that more recently our context is more likely to be described as ‘punching above our weight’ With physiotherapists and AHPs working at all levels of research activity from... In addition we are now seeing greater flexibility than ever before in terms of AHPs combining research with other roles, through for example educational roles as lecturers and senior lecturers, consultant posts and a small but very welcome group of true clinical academic roles And just in 2011, Prof Ann Moore galvanised us through a first meeting of the physiotherapy professoriat in the UK, and mapped the total number in that group, which we believe was over 46 and rising to about 53 this year, There are just under 50,000 physiotherapists in the UK, and with about 50 professors – that about 0.1% of the profession (Compared with over 370,000 nursing staff)
- My personal experience, started in N Ireland Despite the bad press, this is the magnificent Ulster coast, and thats where the University of Ulster is. In an ahead of its time physiotherapy school that developed the first degree course, I got my first taste of research - a study collecting patient data within a hospital setting. Does anyone else remember those days, when undergrads could actually do research with patients? That early experience with clinical research caught my attention and shaped my decision to take a risk - to later apply for funding for a doctoral research programme at the UU. It was a risk because at that time there was no clear career path for a physiotherapist wanting to get involved in a research career. My PhD was based in the Faculty of Science and I shared rooms with cell and plant biologists ! My doctorate set me on the path of MSK research, focused on treatments for back pain and gave me the opportunity to learn about different research methods, including surveys, laboratory based research and clinical intervention studies
- I would particularly like to thank my DPhil supervisors, Profs David Baxter and James Allen, for supporting my early research training and academic development. Given the lack of clinical academic career structures in physiotherapy at that time, they were really visionary in their collaborative research programme between laboratory based physiological studies and applied health research – and their support of AHPs in particular.
- I moved to Coventry University in 1996 to the School of Health and Social Sciences, and took up a lecturing position gaining experience in shared teaching and learning across health disciplines., organising clinical placements for undergrad students, teaching undergrad and Masters students, writing up papers from my PhD and beginning those first steps in terms of post-doctoral research grant applications and collaborations. Hence, the notion of wearing many hats...
- The key highlights from this early postdoc period ... Seeing my research being published in the journals I admired as a PhD student, Being invited to participate in international conferences by others in the field – this shot is of Eilat in Israel, where I was an invited participant in the 4th International Forum for back pain research Starting to supervising others in research. Supervision of others research particularly MSc and PhD students continues to be one of the most rewarding aspects of my work And I began to build collaborative networks, several of which have been very fruitful bringing together clinicians and researchers from general practice, physiotherapy, social science, psychology, osteopathy and chiropractic. Given I was based in a largely education focused University, I built both internal and external collaborations for research.
- In 2000 I moved to Keele, to a post that was half teaching and half research. This was just the type of post that I was looking for, supported then by Profs Marilyn Andrews and Julius Sim. During this period I worked with the Chartered Society of Physiotherapy’s research and effective practice committee, and represented research on their governing council. Over a period of 4 years, I gradually became increasing involved with the research programme within the Primary Care Musculoskeletal Sciences Research centre, led by Prof Peter Croft. I had met Peter at that international conference in the late 1990s in Israel and was very impressed and I still consider it a real privilege to be working in the research institute that he has been so instrumental in building at Keele University
- In 2004 I moved full time into what has now become the Arthritis Research UK Primary Care centre. I was able to do this through an NCCRCD Primary Care Career Scientist award, providing full time funding for 5 years. This was a risk because I was giving up a permanent academic post in the Department of Physiotherapy and moving to a 5 year post in a research centre and to some extent therefore an uncertain future. In those 5 years, I worked closely with many excellent researchers, who provided support and inspiration in equal measure. I love being challenged in research and here I had found a group able to both challenge and inspire me. The combination of research expertise and research infrastructure, makes our centre a really inspiring place to work, because we are able to deliver the kind of research that I believe can make a real difference to decisions about patient care. For me, this is largely focused on large high quality clinical trials in the NHS developing and testing treatments and services for MSK
- This 5 year period of dedicated research funding through the Primary Care Career Scientist award was pivotal for me, across many indicators of research ‘success’: --- -Research activity – increasing PI role in large clinical studies Publications – in the 8 year period between my PhD and 2004, I had published 18 peer reviewed papers, that increased to 36 papers in the 5 year period from 2004 to 2009 Grants – in the period between my PhD and 2004, my grant track record was in the region of £700,000, but in the period from 2004 to 2009, this exponentially increased to over £9 million and a similar increase in research Collaborations, including international collaborations and a step change in building AHP capacity for research; in the period between my PhD and 2004, I had supervised 3 PhD and 5 MSc students, this rose to a further 6 PhDs and 6 MScs from 2004 to 2009; the number of AHPs involved in my research (delivering interventions) rose to over 250 from a previous 80…
- The key highlights from this period ... Beginning to see my research being published in the top general medical journals, Being able to provide jobs for other earlier career AHP researchers, who had worked with me as MSc or PhD students and help them to develop their own careers as part of successful clinical academic teams Greater success with grant applications – the notion of success breeding success – that you wait for ages for your first few successful grants (like waiting on a bus) and then they seem to come along at the same time! Invitations to be involved in international and national activities including Conference organisation, research funding panels, expert panels, and guideline panels
- Key highlight – capacity building in others Clinical Academics – nurses, AHPs and doctors Academics – AHPs and methodologists Clinical research facilitations PT and GP research facilitators CAT group – local group of clinicians and academics coming together to ask and answer important clinical questions (in MSK research) – through CATs Now a hub and spoke model across West Midlands With 7 spoke groups Over 70 folks involved…
- For me, the last 7 years have been a period of further growth and success. In 2010 I gained a Chair at Keele through internal promotion and with that came increased leadership roles, including the role of Director of CTU. In 2011 I applied for and was successful in obtaining one of the first NIHR Research Professorships (to support a large programme of MSK research in primary care – focused on stratified primary care for MSK patients and large NHS based clinical trials). There were 8 awarded in the first call, there are now 27, 20 are women, 5 are non-medics, and I am the only physiotherapist… To date, I have published over 100 papers and contributed to over £23 million in grant income Clearly my research career is nowhere near over, and I am current busy with several large grants – an NIHR programme grant and several HTA trials….
- The NIHR award has also meant me taking on several NIHR hats and other roles Including mentor role, ICA panel NIHR Advocates: Dr Caroline Alexander, clinical specialist physiotherapist at Imperial College; Prof Sally Singh, head of cardiac and pulmonary rehabilitation at University Hospitals of Leicester NHS Trust; Dr Lisa Roberts, consultant physiotherapist at University Hospital Southampton. Prof Ann Forster, head of stroke rehabilitation at Bradford Teaching Hospitals I have included their email addresses for you to make contact with them….
- The NIHR Advocates cover 8 clinical professions, summarised on this website With leads and advocate teams across psychology, audiology, physiotherapy, dietetics, podiatry, nursing, midwifery and occupational therapy If you need support in taking the next step in terms of develop a clinical research career…..contact them….
- Dont think for a minute that my research career has been smooth all the time, Prior to my NIHR Primary Care Career Scientist award I applied for another personal fellowship and got through to the interview – but I didn’t get it and that was really tough – felt so personal – but ultimately its about getting up and dusting yourself off and getting back on track and not giving up You might decide what you really want is a combined clinical and academic career as a true clinical academic, or a predominantly educational role, or indeed to spend concentrated time in clinical practice again. Other options are contract research, research management, an AHP consultant path or indeed a research orientated clinical manager! The reality is that if you love what you do, then it will show and you will be more successful.
- You might be really fortunate, because you might work with the best people in your field already – if so, stick with them and help them develop further But the reality is that many of us will work with people and in teams that cannot support us well and you may need to either make tough decisions about moving to get that next level of support and experience OR make strong collaborations with the folks who you admire – dont be afraid to ask – its remarkable how generous many very senior people can be with their time Good indications of a unit for clinical research development will obviously be their track record to date in supporting doctoral students and post-docs into funded fellowships, shared NHS / HEI posts, and their retention and promotion of staff into more senior roles. Ask yourself – does your current institution look like that?
- If you wish to pursue a research career then tip 3 is... It may well be that in the beginning of your grant writing career you are not the lead of the grant, or indeed that your salary will depend on getting that grant – but you need to start here in order to begin to develop a track record in successful grant application. Academic papers and grants are important indicators of research – and are inevitably used to judge your ability to progress further in research They will help you to develop, address the most important clinical questions in your field, and open up collaborations, And they will also help you to develop others – by gaining grant money to support others to work with you
- Tip 4 is to seriously consider how you might secure dedicated time for research for example through a fellowship research requires a new skill set and this takes time to develop and new experiences that challenge you. clear dedicated time will really help you make this transition There are now more opportunities than ever for AHPs to apply for this type of funding or role within established units – still not enough in my view – but definitely better than 10 or 20 years ago. Of course – the NIHR is a very good example If you have not yet applied for a fellowship, then do it - If you have a current fellowship, start planning for the next one…
- My final tip is to see your career as a continuum, This is a whole life’s career – perhaps 35 or 40 years long! I think you need to Be both sufficiently focused so you are answering the priority questions in your field and producing the best quality research possible BUT also sufficiently flexible so you can respond to fit with institutional, national and international research priorities – my PhD and passion started off in LBP but over the years my research has taken a broader view of other musculoskeletal problems, and now includes a wider spectrum of interests. Its about taking the long view – where are you headed and what might you want to be doing in 5 or 10 years time? Whilst realising that this is of course made up of a series of short views – the next project, the next grant, the next clinical service change Watch out for those years of change – we all have them! You might not see them coming, but they can be very helpful to reflect on to help you see what you want to be doing