Article by Simon Fletcher, Cheryl Whiting, Annette Boaz, Scott Reeves,
Faculty of Health, Social Care and Education, Kingston and St George’s, University London
Research is hard, but that’s the reason we do it. Research should be challenging shouldn’t it? How else would it push the boundaries of knowledge and open up new lines of enquiry without warranting a few late nights and early mornings, resilience in the face of constant rejection and the turbulent waters of peer review? There is, however, an important difference between how difficult research is and how difficult it is to get into research. Our study explores this, by engaging with the experiences of clinical practitioners who have taken time out to undertake postgraduate research training.
Drawing on 29 interviews with graduates from the Masters by Research in Clinical Practice (MResCP) at Kingston and St George’s, University of London, the Implementation and Improvement Science MSc at King’s College London and attendees at a two day Implementation Science Masterclass organised by NIHR CLAHRC South London, we began to see how and why some clinicians struggle to gain entry into an environment which is both complex and exclusive.
While we anticipated that there would be practical barriers to undertaking research in addition to full or even part-time clinical practice, the interviews revealed that these difficulties were overshadowed by negative managerial attitudes, professional insecurity and various forms of inter- and intra-professional tension.
Physiotherapy and nursing staff described problematic managerial encounters, saying:
From what she [manager] said, she was worried that if I became more involved in research that could perhaps lead to a promotion over her. (Physio #1)
There can be resistance definitely within certain professions. If your manager isn’t research active, then that’s very difficult. I’ve had to experience a lot of barriers. Like when I did my MRes, my manager did everything in her human power to stop me doing it. She didn’t want me to do it at all and it was only for the fact that I went to a different MDT [multidisciplinary team] member who was research active was the only reason I got it [sic].(Nurse #3)
Although these are individual cases, the lack of support in the first instance and professional insecurity in the second, reveals that deviating from convention in these environments can prove to be deeply disruptive.
There was also evidence of the long-established perception surrounding a power imbalance between medical professionals and almost all other healthcare workers. While these are perceptions, and should be judged as such, the way in which the comments below reflect a complex and self-sustaining barrier to clinicians entering research is cause for intervention. A physiotherapist commented:
I think there is this professional silo mentality to some extent now. I think that if you look at our medical colleagues some of them would be reluctant to engage in research that was genuinely multidisciplinary, because they wouldn’t see it as having the kind of status that straightforward medical research gets, and they’d be concerned where it might be published. (Physio #4)
Although these examples are perhaps disheartening, determination and focus can often overcome negativity. However, the interviews did uncover a more troubling contradiction at institutional levels. There was evidence of an organisational push to benefit from appearing to encourage research, while at the same time no provision had been made. The comments below support this:
If I’m meant to be doing this [research] in the same hours that I’m meant to be doing my clinical role, I have been given NO time, NO resources, NO change to my pay structure, NO change to my job description, NO change to my banding, and NO allowance of my caseload or duties in order to be able to do the research project. [Since returning to clinical practice] nothing has changed in my job description and although the personal annual reviews might set me goals where I’d engage in more research activity, there’s nothing been changed about my job plan in order to allow that to happen, and no targets or goals have been set by anyone.(Physio #2)
It’s not in my job description to undertake research as it were, building a research culture – yes, that’s part of my job, but I must say I don’t have any set time to do that. (OT #3)
The way in which research is theoretically but not practically supported, and the way in which the term itself is perhaps being exploited for superficial gain, brings us back to what we said at the start. Research is and should be hard, but it is impossible if it’s not facilitated. Our findings should encourage the opening up of discussions on the way in which perceived barriers and institutional culture can block entry to research for enthusiastic cohorts of clinicians year after year.