CRN Wessex video transcript - British Dietetics Association (BDA) South East and NIHR CRN webinar - Dietitians’ research journeys
Contents
Transcript for the BDA South East and CRN Wessex Dieticians' Research Journeys webinar
Steve:
I'm delighted to be here, because I've been working most of my professional career supporting colleagues from dietetics to develop their research careers, their journeys.
And I can honestly say, it's not been easy for any of our speakers today. But what they're going to do is share their motivation, their experience and their lessons that they've learned to try and give you a chance to understand how you might best start your journey.
I'm not going to say anymore, I'm going to go straight into our first speaker. Each of the speakers will introduce themselves, rather than me introduce them, so our first speaker is Emma Parsons.
Emma, are you there?
Emma:
Hello Steve, yeah I'm here. Fabulous thank you very much.
Um, so as Steve mentioned I'm Emma Parsons.
I'm a dietitian by background, I'm currently a senior lecturer in nutrition and dietetics and programme lead for the nutrition and dietetics program at the University of Winchester. Um, and I also hold a visiting teaching fellowship still with the Faculty of Medicine in Southampton.
So a big thank you for inviting me along to speak today.
Next slide please.
So, I've been asked to talk about where research fits into the career journey for dietetics but before I go into that, I just wanted to share a little bit about my own career journey.
So I have worked clinically both in Nottingham and in Southampton over the years but I realised very quickly that actually my passion was exploring the quality of nutritional care across the life course.
So I completed my PhD with Marinos Elia and Rebecca Stratton around the quality of nutritional care in care homes, before progressing onto a post-op at King's College, looking at designing and developing a national clinical audit of nutritional care.
Since then I've had the pleasure of supervising a range of dietetic research internships for dietitians who wanted to start their own research journeys both within paediatric and adult aspects of dietetics.
Over the years I have worked, erm, in some teaching roles both within Kings and Southampton, and now Winchester. Training medics, people in public health as well as dietitians and nutritionists about the importance of nutritional care.
Which has been a real pleasure to help shape the future generations around their knowledge there.
Over the years I've held some leadership roles, um, which is an ever-expanding journey.
Previously I have held the chair position of the British Dietetics Association (BDA) Southeast Branch, as well which was a real pleasure to do.
If we could just move on to the next slide please?
So before we go into why research is so important within dietetics, I really just wanted to acknowledge that within the world of dietetics and more broadly across the clinical sphere of both medical and AHP professions, the last few years have been incredibly challenging.
Whenever I meet with dietitians working clinically, the strains of the last few years are evident, people are working very hard to deliver clinical care and staffing levels are challenging, burnout levels are high. But across the piece, you know one of the main drivers is ensuring that we can do the best we can for our patients and be able to provide quality care, both across acute and community settings.
Next slide please.
So one of the questions that people commonly ask is, 'what does it mean to actually be research active?' And I'd like to really stress that being research active is across a spectrum of activities.
So this could be from starting to be curious around what research actually is, um, through to actively participating in things that we might deem to be research activities.
So if you go to the council on the AHP research website, they will mention things like having research ideas, engaging in journal club activities, starting to attend or starting to present things like audits or service evaluations at conferences, through to starting to perhaps collect some data or be involved in data analysis, writing up your findings, through to implementing research findings within routine clinical practice.
Next slide please.
There are a number of challenges but also a range of enablers in terms of engaging with research within AHP professions.
Again, common ones that we hear about are in relation to service demands, meeting the clinical service demands first. Um, having time to carve out around research activities, where to go for funding, how to get started with putting in Grant applications, how you balance a research career with clinical work, and I think you'll hear some wonderful journeys um going forward in the next speaker's sessions. How you even identify a project, finding the right mentor for you, accessing peer support.
Now, I think, you know, there's a lot in the news and the literature about compassionate leadership.Finding people who will help mentor you with the kindness and compassion that you need to explore your own learning journey at your own pace, that suits your career pathway.
Um, there are plenty of people to reach out to both within the BDA or through the Local Clinical Research Network to help guide you either on your first steps or on your next steps within your research journey.
But find the right people that work for you and your learning needs, and that might be different people as you go through different stages of your research journey.
Um, there's also more formal things like postgraduate courses that you can go on to do to develop your research skills, as well as engaging with the research community and that might be the dietetic research community but also broader than that, amongst other Allied Health Professionals and the wider NIHR community as well.
The Research Design Service (RDS) is an amazing resource, as well as local clinical effectiveness teams so do speak to these people if you do have ideas about how to take your service forward.
Next slide please.
So there are also national drivers to be aware of in terms of research careers, erm, for AHPs.So the NHS long-term plan does talk at length about care quality and improving outcomes.
As a profession within dietetics, we do need to show that we are improving outcomes and that we can improve dietetic outcomes. The new Health and Care Act that came out last year, again, highlights this need and to move this agenda forward.
Health Education England (HEE) put together four pillars around leadership, education, research and competence.
If we move to the next slide please.
And the BDA from that has put together their post registration framework. Evidence-based research, evidence-based practice and research is one of these pillars, and we need as a profession to seek to extend the evidence base for dietetic practice.
Next slide please.
There are three key areas here, evidence-informed practice, looking at outcomes and also thinking about service evaluation and quality improvement. And I raised this because it's a spectrum of activities that people can be involved with, from looking at journal clubs, reading papers, to looking at the outcomes you're measuring in service to being involved with service evaluation or quality improvement.
And on the next slide, we just highlight for things like service evaluation, the competencies expected are different according to whether you're a newly qualified band five,through to a consultant level practitioner.
So at entry level, you're looking to contribute to pre-existing activities around service evaluation and audit, through to consultant level where you might be leading or influencing at national or international level.
So it's really just to raise the point through my first talk around, there is a role for everybody and, um, you know it should be looked at in job descriptions across the piece um, as to how you can achieve this.
So just, final slide.
Um, research is part of a journey, it's one part of your career pathway and it really should complement other aspects of your dietetic practice. Thank you very much.
Steve:
Hi, sorry thank you Emma. We're a little running tight for time, so I'm going to move it straight forward. Uh, Lindsey, if you're ready, would you like to take up the baton?
Lindsey:
Yes, lovely, thank you very much.
So I am just going to talk to you a little bit about my research journey as a clinical dietitian
So next slide please.
This is just to illustrate that anybody can take on scientific research, because I failed at every science exam at school and did a Bachelor of the Arts (BA) in French and Spanish originally.
So in my 30s, I went back to college, did my A levels, got my degree in dietetics. And since 2007 I've been working at the Royal Surrey Hospital, first as a band five and now as a Macmillan oncology dietitian and oncology team lead.
And the next slide please.
Will show you that actually now, as part of my role, it's a bit of a juggle but 0.5 is clinical and 0.5 is research, or thereabouts. And essentially the clinical is the clinical with clinical work, education, service development and the research takes up all sorts of different, going on from what Emma was saying, all sorts of different aspects of research including, running studies, journal articles, research ideas, grant applications and supporting other members of the department but also the wider multidisciplinary team with perhaps MSc projects and sitting on steering groups as well. So that's my day job and moving on to the next slide please.
Um, how did I get here?
I started... I've had a wide and varied career, certainly research career, I started off doing a project with my A Level, I designed and got my, um, undergraduate dissertation through ethics and, um, and as a band five, since then I've supported quite a few university students with their dissertations as a clinical supervisor which is a great way of getting involved with research.
I've collaborated on larger studies and that's again a great introduction I think if you don't know really where to start.
As are steering committees, where you're involved with other projects, um perhaps as a dietetic advisor, um I've also got my nose in with larger trials that were trying to do things without nutritional screening and I'm like well actually can we have this? And it's keeping your ear to the ground actually and seeing what else is going on. I've done some commercial research which is quite nice and easy because the legwork is done for you but you just have to run the trial, and often it's one or two patients so that's actually a really good way.
In 2017 my research journey kind of took on a different bent where I started actually really actively doing things to further the research, particularly in bowel obstruction, where I was the dietitian on the EDMONd trial and had a day a week protected time to consent patients and run them through the trial.
And, um, and then the DAIL study, um, is a dietetic assessment in lung cancer study started by a research fellow and another colleague of mine who then both left the trust and left me running the study.
Um, but it was great because it was a one-off assessment and I got all our band fives involved and anybody who was working in my team had to do their GCP training and be involved with the research so it was a really good way of furthering my career.
In 2020, I applied for an NIHR Greenshoots grant and that was my one and only little bit of formal research training with the Clinical Trials Management module as part of it. But it gave me a day a week protected time, funded time, to put in a grant application and I've just finished the bowel obstruction bounced feasibility trial as as Chief Investigator for the first time, which has given me the confidence now to think about the next step of putting in a big multi-centre grant application. And that's where I'm at at the moment.
So I've done a little bit of everything in my research journey.
So, next slide please.
I think what I wanted to do is just give you an idea of what we've got out of it. Not just me, but our team and I think the dietetic assessment and lung cancer trial proved that we were actually very research oriented in our department and we'd used our own time within our clinical time to run the study and we consented 100 patients. But then we managed to acquire a whole-time equivalent band six backfill that we've got the post that backfills the research-active members of the department, so allows me protected time.
And I think the more research you do the more other people are interested and we're constantly encouraging people to do audits and service evaluations and posters at conferences... one of my colleagues has just been awarded a Springboard award which is protected time to develop her own research and another has done some ICAP training and mentoring, um, to help with her research journey.
And I think from a practice perspective, and we're all going to be saying the same thing, it's a great way of networking, um, it improves patient care, it builds our evidence base, it's so important for us to do. Um, and when you see it happening, it's really rewarding.
Um, moving on to my final slide, I think.
So, um, I couldn't come up with three top tips, I've got lots of top tips. For anybody starting out in research, start small. Do supervise some student dissertations, come up with some projects, get the students to do the work you haven't got time to do.
And also get involved with research as part of a bigger project, even if it isn't dietetics, to have a feel for what research is about. Get on mailing lists for journals so that you can see what else is being published, so that you can see actually, maybe I would like to do this, or this needs to be done.
And also, maybe consider being a peer reviewer for journals, it'll help give you an insight into how to write.
Engage with your Research & Development (R&D) department and also the Research Design Service (RDS). They will hear about research that you might not, including commercial research.
And I think from a practical perspective, this is the biggest, the hardest thing, as a clinical dietitian doing research, is how to protect your time. Work at home, like I am today, if you can. I wear a different uniform if I'm in the office and doing research, it doesn't always work, I still get referrals, but it helps. And avoid the email because you'll get sucked in.
Um, but I think more importantly than anything else, involve everybody in the team and the department. Get people to share ideas, have journal clubs where people bring ideas. Because it actually, you know, people don't want to share because they don't think that they're valid, but actually any idea is valid and who knows what it might bring?
So, be brave and bold and talk about what you want to do.
Thank you.
Steve:
Thank you Lindsey, spot on, great timing. Um, to pick up on some of these themes as we go through in the panel, I apologise for rushing ahead but we really want to get everybody to speak to give us time for questions at the end.
So, let's take Tanya now. Tanya, would you like to share your discovering research story?
Tanya:
Yes I'm also sitting here with a slightly different hat on, I think everybody sitting on this on the panel this afternoon are all very very research active whereas I'm promoting people becoming research active. I'm a huge advocate.
Thank you, my next slide please.
So, who am I? So I have had, I've been very fortunate with my dietetic, um, career that I've had exposure to a number of, um, specialties. I loved being a bit of a jack of all trades but eventually settled down and specialised in oncology, and it is in my years as an oncology dietitian that I think I had the most exposure to getting involved with research.
Um, and from there I've then progressed to um being Head of Service for dietetics and speech and language. I'm here at the Royal Surrey Hospital and so now I have the pleasure of leading some very dynamic and Innovative services that really keep me on my toes with their ideas.
So in-between doing my day job and managing the services, um, I am trying very hard to not let go of my passion for research and trying very hard to make a difference and allow people that opportunity to take their ideas and try and integrate research into clinical practice.
Um, Emma's already alluded to the fact that that does come with a lot of challenges, um, but I think with determination and finding a way and finding opportunities, um we're taking small stepping stones, um, in the right direction.
Right, next slide please.
So, the research that I've been involved in...
Um, obviously like with most of us, we get that taster with our dissertation that's during our dietetics degree.I absolutely loved mine and from there we went on to publish it and conferences, the whole works, um I just thought this is definitely, the research avenue was for me.
But obviously, life twists and turns and takes different routes to the one I wanted. However, then it was within my, uh, time an oncology dietitian, I actually had the opportunity to do a two-year research secondment, where I could then do exclusively research. And that's really where I started thinking, do you know what? Actually I'm missing my clinical and this is where I started trying to do a little bit of having both hats on and finding my way.
So, I've come, I've had the opportunity now to be involved in multiple studies and collaborate with studies at the Royal Marsden. And also quite recently, taken on, um, a dissertation using business research methods. Which for all of us, is so completely different to scientific and that really did um challenge my skills and give me a whole different respect for research.
Um, next slide please.
So, we are research-active as a profession and I think Emma, um, introduced that really well for us.
We've all got our journal clubs, our Continuous Professional Development (CPD) groups and all of that, and within that, we've all got a lot of ideas. How often in those journal clubs do you read an article, where you think, where at the end, you're saying, 'well it could have been better if I'd included a dietitian.'
Or actually, they didn't think of that or they didn't think of this, and actually, would having us on board have made their results so much stronger? So why not do that? If we are basing our practice on evidence, surely then we should take that responsibility to try and help grow that evidence base.
But I think it is also about the culture, it's about trying to embed research into our clinical work.
Um, and I think for me, um, running and being involved with your own studies, it's just so lovely to see how your ideas are producing results.
And I think Lindsey's just explained that as well, it is so nice to see you getting really good results back and having people being consented to your studies. Um, and what's then also nice for me as a Head of Services is then to see how that impact is then spread across the department.
Because rightly so, now I've got a lot of people now generating and taking their ideas a little bit further and also doing the studies, I think it's really humbling how much patients want to be part of the process and how much they want to be able to change our practices and improve the service that we as dietitians are able to provide.
Um and I've also put there, we get noticed. I think we get noticed, not so much that we're doing the research, but I think what gets noticed is the value of dietetic input and our intervention and I think this is also why I'm such a huge advocate for us actually being involved and leading on our own studies.
Thank you, next slide.
Um, so as I've alluded to, it is a frame of mind and we've all got, we all often question things, we often challenge, we often think of different ways of doing it, we probably are already doing these sort of things where you're doing service evaluations within your department. It's already part of people's objectives, so why not take those ideas and make them matter? Why not take those ideas, seek out those support mechanisms that Emma alluded to in her slides, and try and see what you can do to actually get it off the ground and actually make it into research.
Again, it's starting small. You're going to listen to so much experience being shared today on this panel, but all of us had to start somewhere. All of us had to have that idea or were presented with that opportunity to take it further. So, if you've got something, please seek out that support and take it from there.
It does, I'm not going to hide away from the fact that it is challenging, um, it does require perseverance, it does require patience, and I think certainly the situation that we've managed to develop in our department has taken quite a lot of patience and discussions, but also again, thankfully, with the support of R&D and with the NIHR we were able to then fund that post that now provides the backfill to allow my clinicians to do their own research.
So there is a lot of, 'where there's a will there's a way'. Um, and I'm going to persevere with this and hopefully my vision is to try and see if I can build on what we've got started.
Thank you.
Steve:
Thank you so much Tanya. Spot on again for timing.
Thank you very much. Can I just remind everybody, please use the chat to give us any questions that you have, um, so that we can pick up on those questions at the end.
I'll just add a little preface to say that any questions we don't answer in the panel, we will answer and post at the, um, on the website down the line.
So our next speaker is somebody I know very well, Caroline would you like to now share your experience?
Caroline:
Thank you Steve.
Um, hello, I'm Dr Caroline Anderson and I'm a Clinical Academic Dietitian.
Next slide please.
I work across all four pillars of care of practice from healthcare, health research, leadership and education.
Next slide please.
And in terms of specialty work, I lead a clinical team for paediatric renal nephrology and I work with an MDT to provide the best care we can for children. We aim to deliver evidence-based care and we collaborate with others to find questions and gaps and implement ideas that can go into practice.
I also lead research and improvement teams to enable this and clinical effectiveness for part of the directorate. Alongside this, I provide practice-based education for undergraduates, postgraduates and wider healthcare professionals.
Next slide please.
So on a day-to-day basis, I have a split role. I have protected caseload time and to lead the clinical team. And I have protected time to do project work for research and improvement and lead research and improvement and clinical effectiveness teams.
I have been involved in many opportunities to develop grants and successful ones, both as, um, Chief Investigator and a Principal Investigator (PI) and collaborators on National and International projects.
I also deliver education to undergraduate students at Winchester University in a protected one day a week.
Next slide please.
So, how did I get here? Well I'm an ideas person and I ask lots of questions and I have a clear vision.
Next slide please.
And when I first started in Southampton some 20 odd years ago, I asked lots of questions about why there was variability in status and response to care, and why there was such poor evidence base that we were using as our basis for practice.
This led to, um, many discussions with academics including Steve Wootton, Marinos Elia and Alan Jackson.
And we, um, ended up developing a PhD that explored practice, developed, delivered, experimental science and built my network. This looked at energy expenditure, physical activity, body composition and nutritional intake.
From this I had a Health Education England (HEE) fellowship and explored systems and processes to deliver a more efficient health care, looking at digital opportunities for nutritional management with these children.
I still have the same vision and I work closely with organisation charities, all the ones that you can see here and many more, and families to try and deliver um, our vision to improve care not only for regionally but nationally and internationally, so that we have a standard that everyone gets equitable benefit wherever you are in the world.
This is not a straightforward journey and there are many challenges and you need to have the right team around you to celebrate the highs and help you through the tough times. But there are lots of little wins and if you keep looking forward for your vision and, um, your goals, you can get through any of the challenges that come across.
Next slide please.
So, what are the benefits? Well I see them across the spectrum of the pillars of dietetics but probably most importantly for me is patient experience and clinical outcomes, job satisfaction and rewarding work.
And also seeing others grow. I do lots of undergraduate support for dissertation projects and MScs and it's great to see people with their first ideas come through and some of them are subsequently gone on to get PhDs.
So what advice would I give?
Next slide please.
So you need to have some core skills. You need to be resilient, you need to be persistent, you need to work smart and you need to engage in lifelong learning and you need to build a career that's right for you. You need to have a good team, a network of support around you.
You need to work collaboratively with others that have had experience and speak to others in interesting roles. You need to think outside the box, you need to find an area that you're passionate about and take a leap of faith. You need to think critically, ask questions and appraise and review practice and evidence. Listening to people's stories, it's important to understand their experiences and that will help shape your ideas and projects. And then most importantly, you need to get a good work-life balance that helps you find a way through.
And then, last slide please.
And I wouldn't be here without these people and many more. Particularly Emma and Steve that are on the call but also Emma Redmond and lots of other people have helped me on my journey to get where I am today and going forward into the future.
Thank you very much.
Steve:
Thank You Caroline.
Um, ok I'm not going to take any questions, if you have any questions for Caroline, please post them in the chat.
I think that's really very important. And if we get to our next slides up, for our next speaker...
If we can go to the presentation, thank you.
Our next speaker, uh, is Emma Redmond. Emma, are you ready to share your story?
Emma:
Absolutely, thank you very much Steve.
So, I'm Emma Redmond. I'm the Senior Clinical Research Dietitian at University Hospitals of Leicester, Leicester Diabetes Research Centre.
I'm also an honorary Senior Lecturer at the University of Leicester and I'm the Operations Manager for the NIHR Diet and Activity Research Translation Collaboration.
I'm very grateful to be able to present today and I realise and appreciate that not everybody will have the experience of working in the research infrastructure that I do. So, forgive me if I use acronyms or use expressions that you're not familiar with.
And I hope I do explain myself. What I'd like to do is explain my research journey to start with.
I first experienced research as an undergraduate. I was very lucky, I got the opportunity to do a summer studentship. This allowed me to work in the labs at the University of Nottingham and I felt very grateful to be able to do that. It's an extra additional experience as a trainee dietitian.
When I graduated, I went to work as a community dietitian. I had opportunities at that point to do service improvement and service developmental, um, projects. I was still interested in research though and looked for an opportunity to do a PhD.
I went back to the University of Nottingham and I was very lucky, I was awarded a BDSRC studentship to do a three-year PhD in biomedical sciences, working with people with severe and complex obesity and the bariatric service at Royal Derby Hospital.
I examined the effect of the pre-operative diet in patients undergoing weight loss surgery and I felt very privileged to spend that time working with those people and those experiences.
It was hard work doing a PhD but I definitely benefited from it and I came out a very different person. At the end of that studentship, I went into research full-time and as they say, the rest is history.
So I'm kind of in a unique position here because I actually went to work as a research associate working as part of a complex intervention or health behaviour team.
Since then, um, I've been co-investigator and co-applicant on research funding. I've developed my role as a research dietitian, I'm now the Senior Clinical Research Dietitian and I lead the diet and nutrition research team at University Hospitals of Leicester Diabetes Research Centre.
We have a couple of research dietitians and recently have gone out to recruitment for three more. We work across the Biomedical Research Centre (BRC), the Applied Research Collaboration (ARC), the Patient Recruitment Centre (PRC), we deliver observational and interventional studies, we have input into protocol design and research funding submissions.
And I'm very lucky, I also have this national role. So I am the Collaborations Manager for the NIHR Diet and Activity Research Translation Collaboration. This is a network of 10 Biomedical Research Centres (BRCs) that focus their work on diet and activity, life course and ageing, obesity and weight management. And I get to work with some research leaders in that field.
My take home message really for my presentation would be, as a dietitian or a nutritionist, a nutrition professional, there are lots and lots of opportunities in research.
You can be working clinically and be able to embed some research into your dietetic practice. You can be working clinically and work on other people's research, either academically or delivering research. You could be like me or the people that work with me and you could be a research dietitian, wholly working in research. Either academically, or again delivering it. You could be a clinical lead, or you could work in the operational management and operationalising or implementing research.
And as you can see on the slides, there are lots of opportunities, from nutritional analysis, priority setting, operations, clinical trials, research planning and design. So there's lots of different things in either a big way or a small way that you can get involved in research.
My take-home message, as I say, I work now for the Diet and Activity Research Translation Collaboration. We are specialists working in research and if you're interested at all in finding out more, or you'd like some mentoring, my contact details are on the slide.
Thank you very much for giving me this opportunity to talk to you.
Steve:
Thank you very much Emma. Lovely to see you again.
And any questions, please put them in the chat, they're starting to come through thick and fast now so please put your questions in and what we'll do, is we'll sift through them as we go through and make sure that we can address as many as possible and perhaps see if we can develop some generic themes.
So Bethan is our next speaker, Bethan are you there?
Bethan:
Yes I am. Can you hear me okay?
Steve:
Yeah, loud and clear. Away you go, Bethan.
Bethan:
Okay, thank you Steve.
Um, so my presentation is again just talking a little bit about my research journey, so I am the Lead Adult Dietitian at University Hospital Southampton. Um, and I also like many of the other people that have been speaking today, have got a bit of a split role. So I am also completing an NIHR Predoctoral Clinical Academic Fellowship, which I always find a bit of a mouthful to say.
So next slide please.
So, yeah. So, who am I? So my role is, my role's split at the moment so very busy. Three days a week, um, I'm here at Southampton General managing the team of acute adult dietitians.
My clinical area is ICU and I still do some clinical work as well within that time. And then the bit that I'm going to talk to you more about today is, um, the research part of my role.
So I am currently spending two days a week completing, uh, the PCAF as it's known which is on the NIHR Clinical Academic Pathway. And I did see a question pop up in the chat a minute ago about, um, how do you get sort of funded time for masters and PHDs. And the NIHR Clinical Academic Pathway is one way of going about that.
The PCAF is a research training fellowship and it replaced the funded masters on the NIHR Clinical Academic Pathway a few years ago, and rather than just undertaking a masters in research, you're really encouraged to identify your own learning needs, and, um, you see what learning requirements you have and then you tailor the award towards yourself. You also complete some training within that and my particular area of interest is enteral feeding intolerance in adult critical care.
The next slide, please.
So, the training part of my role.
The PCAF I am undertaking over 30 months, part-time, two days a week, as I said. Um, there's various options and it's a flexible training programme so I think you can undertake it full-time for a year but I'm not sure many people do have that option. Or you can have sort of different combinations of time over different time scales,
So this is the option that I've chosen.
And as I said, at the beginning of my PCAF I had to plan what my training was, identify my own training needs and, um, identify what I needed to do. So I'd done a small amount of research training before I started the PCAF. I'd basically done one of the masters modules, so I looked at the rest of the masters at Southampton and identified which of the modules I felt I would gain most benefit from.
Um, and you can see them listed there. I won't read them all out, and also to tie in with my my current role doing more sort of management and leadership now, I thought it was really important that I looked at doing some leadership training as well and some management training so I was able to do that within my PCAF time as well.
So, next slide please.
Okay, so the research part of it. So maybe the slightly more interesting part of it, for my PCAF I had to identify at the beginning what projects I was going to undertake and I found that quite daunting to start with. Thinking, well I've got these 30 months ahead of me, what am I going to do? So I had lots of help in identifying, um, what I was planning to do from my supervisors.
And I started off by completing a systematic review, looking at the definitions and prevalence of feeding intolerance and really all the other projects that I've done have built on there, um, built on from that systematic review.
So I then went on to do a scoping review, looking at biomarkers, um, which what I wanted to do is try and tie things in with the training as well, so that was actually one of my assignments for one of my, um, university modules that I then built further on and developed alongside with my supervisors.
Um, another project that I've been working on and found really interesting is looking at how we measure feeding intolerance. So looking specifically at gastric residual volumes, um, and monitoring within the critical care units and I did a web-based survey um, across the UK ICU dietitians, which hopefully I'm submitting for publication will be out soon. And that was really nice, working with other dietitians in a similar field across critical care. And getting people's opinions and hopefully that will be able to help, my research will help to develop other people's practice and other people's knowledge as well.
And then lastly, the other project that I've done within my PCAF is a local sort of service evaluation looking at the prevalence enteral feeding intolerance according to one of the definitions we proposed within the systematic review, to see how much our patients do suffer from feeding intolerance.
Okay, next slide please.
So, my journey. I started off as a clinical dietitian as a basic grade rotational general dietitian and then quickly moved on to a clinical role within renal which I stayed in for many years. And then I moved into ICU and then more recently into leadership and management.
And I think that the common theme is across all of those, um, roles, I've always been interested in audit and service evaluation and like other people said, I really would encourage people to do that within their clinical roles and look at what's needed, look at questions you have within your clinical practice, and um, sort of start small, with small projects within the workplace which is what I was doing.
And then in 2017 I decided that I'd like a little bit more protected time to do a research project, because as we all know it's really really tricky fitting it in. So I applied for an NIHR internship which I was lucky enough to get. Which gave me one day a week, for six months, to complete a project.
And again, that was looking at an area, we were looking at the fasting practices within our Critical Care Unit at the time and I wanted to do a service evaluation looking at that and I was lucky enough to get some protected time to be able to undertake that project and do a little bit of research training as well there.
When I finished my internship, um, I kept wanting to be involved in research and I did some work-based research with one of my colleagues, Alice. We had a new, I think the way I've looked at things, is things happen within our clinical role, I have a question and I think 'oh I want to I want to answer that, I want to find out more about that', and therefore Alice and I started looking at, um, the calorie provision from citrate anticoagulation.
Um, which I think we ended up with more questions than we had answered at the end of that project. But, um, we were able to fit that in within our clinical role. But I was quickly realising that I
wasn't getting the time I wanted to be able to do all of the research in the project which is what led me to, um, applying for the PCAF.
Okay, next slide.
So the benefits of research as I see it.
Um, very much for me it comes down to the benefit to the patient and the patient care. So the research that I've done has really tied into what I've been working on clinically at the time.
So, the research I did looking at the fasting practices, we were able to review our fasting practices at UHS, similarly with our gastric residual volume monitoring practices, we've been able to review that following some of the work that I've been doing. Improving knowledge again for me, but also being able to disseminate that locally and nationally and inform others' practice as well, has been really important for me. And being able to disseminate those findings, teaching other dietitians and medical staff.
Okay, next slide.
So, top tips. For me, I think allow plenty of time. Everything always takes a lot longer than you think it's going to take, especially the planning for these projects. Thinking about what you're going to do, chatting it through with people and then for grant applications, papers, re-drafting, resubmission... redoing things again.
You've got to build in time for that, everything takes a lot longer than you're going to think. So if you are thinking of something like a PCAF, you need to be sort of thinking about it a year or so in advance and really planning that in, planning that time in. Build your research networks, so on the NIHR Clinical Academic forms there's a little box about your research network, so you really need to think about that.
Talk to people, meet people, um, reach out to people who are research active locally and just build those networks. And then, take feedback. So people will tell you that, um, what they think and you need to take it on the chin and redraft, resubmit.
Okay, that's me.
Steve:
Thanks Bethan, thank you very much, particularly for introducing the PCAF stories, I think that's something for people starting out. It's a really important first step.
Uh, I think we have one more.
Now then, okay I thought we were done. Right okay, thank you Bethan.
So we now move to a round table, where we have the opportunity to ask questions.
I wonder, uh, whether it's worth putting all our speakers up onto the screen?
Can we do that?
Okay everybody, thank you very much indeed.
Um, if you're not one of the speakers, could you just take your camera off, please?
Lovely, thank you very much.
Um, we've got lots of questions have come up in the chat. We have about 15 minutes and I know various members have to go off as soon as possible, straight after that, back into service activities. So what I suggest we can do is… um, take some things that have emerged over the course of this and then invite different people, can just put their hand up and, uh, offer a view.
I think one of the things that's come up is very much around protected time and getting an agreement with your service lead to actually start investing time in developing these activities.
Uh, any advice to having that conversation with your managers about getting that time to start your journey? Anybody have a view? Tanya, do you want to offer a view from the manager's position?
Tanya:
From manager's position, I think this is this is a challenging one because it's invariably, it's going to require investments and I think what we are not very good at doing is, um, we tend to just absorb and I think there is, we have to be so careful that if we are going to embark on trying to do more, be more research active in the department, that we're not absorbing it into our clinical practice that's already under a lot of pressure. So it does require, and this is where it does require thinking through and being very sure and very clear how we're going to approach it.
And again, um, and off the experience of Lindsay and other researchers in my department, we've had to be very disciplined with how we define, it's a research day, it's a clinical day. Um and again starting off, it wasn't easy because the the roles are still merged and blurred, so it just it does just require working out exactly how you're going to do it. Um, but we have to be careful we don't absorb, um. Because then it just makes it... I think it's it's not fair on either end. You don't get a chance to concentrate on the research properly but then it also to the detriment of your clinical service.
Steve:
Thank you. Uh, Lindsey, do you want to add a comment?
Oh, you are muted.
Hang on, one second. Could be on mute, Lindsey, please?
Lindsey:
There we are. Can you hear me now?
Steve:
Yes.
Lindsey:
I think from a from a clinical perspective,
Um, the way I've approached it is very much, um, you know I do see that we do need to have a little bit of time each week to do some sort of CPD stroke other things and it's very easy to continue to absorb patients, like Tania says.
I think, I'm not a manager, I'm a team lead but I think I always try and and protect a little bit of time each week to build that in. I see audit and service evaluation as part of a dietitian's role and I think we are going towards job planning um, I think in practice it's harder to put it into place, but I think this sort of thing needs to be perhaps built into job planning as we move forward, so that we can actually protect a bit of time.
I will say, I have done a lot of things in my own time as well. I want to be realistic about that.
That actually if you've got a lot of ideas, I've had to invest some of my own time as well. It's not easy.
Steve:
Thank you, I think that's a very important point to make.
Emma, you've got your hand up there as well?
Emma:
Thanks Steve, I just wanted to come in, I've been looking at the other questions as well, so this may be relevant to some of the other questions, but if you're a dietitian in clinical practice and you're wanting to make your first steps, it doesn't necessarily have to be around your clinical practice as such.
And if you're looking for backfill time, it may be worth approaching your R&I or R&D office, so if you're working for a primary care trust, acute trust, they should be in the Research & Development or Research & Innovation department.
They should have a contact and they can put you in touch with whoever is working in research in
your area, whether that is an academic group, an institution, a link to a university. They can tell you if there's studies or trials running, which you might be able to get involved in, which they can then be funded to backfill part of your time.
So if you're wanting to reach out for the first time, for instance if you have, um, we have a Patient Recruitment Centre (PRC) who run clinical commercial trials.
I know it's mentioned in some of the other presentations, and they will actually fund some of your time to deliver, if it's a diet or nutrition intervention. So you might have a few hours a week
or a month which can then pay for that time.
And also making those connections with your R&I or R&D departments means that you also have a little bit of experience that you can ask about, 'how do I embed this within clinical practice?' or 'who do I go to for things like the standard templates of documents?' like the protocol writing or writing funding submissions, or advice in those sort of areas.
Steve:
Thank you. Caroline you've got your... I think we're going to have one question and about four, five, answers.
That's really good.
Caroline?
Caroline:
Um, it's about starting small. And as Bethan said, planning in advance.
You need a year, two years, lead in. You know, build it into your, um, appraisal reviews, you know take opportunities where they come up to get involved in other teams, you know as Lindsey said, you will, you know, there is some work that you end up doing in your own time.
You do need to find that balance. Um, but you know, you can't just have an application that's in three months time and put it in and expect to be backfilled because there are so many different balancing measures and so many effects of you coming out of service that will affect other people. So it's about planning things and having that long aim plan.
And you also may not get things the first time you do them, so it's about having those systems in place to be able to have the backfill to be able to then, to do that. So it's training other people in your area so there's people that want to come in and backfill you.
You know, the other extreme option is changing your practice so you have set clinical days and you have days that you can then get pots of money, but that doesn't suit everybody.
Steve:
Also noted Lindsey's comment about wearing a different uniform on the days you're doing research, so that you don't get this blurring of responsibilities Um, I think that's really important and I think one of the things that's come across for me is how important inquiry is professionally.
Research is a bit of a dirty word for many people, particularly if it seemed to take away from the clinical service.I think everybody has a responsibility professionally to develop an inquiring mind and to look and ask the questions and I noted Bethan's comments around how she started, particularly in actually being full of questions out of our own experience, identifying things that need to be addressed.
And service evaluation and audits are research. It doesn't have to be a large, fully-funded, multi-centre study that's ultimately going to get published in the New England Journal. And I think one of the things that's really most important is how do you start?
So I'm going to, we've got a few minutes, I'm going to ask for top tips to start.
How do you start this journey?
Any offers? We said start small but move on from that
Emma, give us a top tip to start.
Emma:
Talk to people, be curious.
Have an ideas book and write things down. Things pop into your head at the strangest of times in terms of developing your ideas. Write them down and find supportive people to have those early discussions with. Whether that's your colleagues, whether it's your local universities, um, it could be other AHPs where looking at MDT research.
Steve:
I'll take Emma, I'm sorry, Bethan, you've got your hand up there?
Thanks Emma.
I've got Bethan and then I'll do Caroline then I'll do Lindsey and then I think I can squeeze one more in.
Bethan:
For me, I was just going to say, I think when you're seeing your patients and you think, well why do we do it like that? That doesn't make any sense.
Then, just think, well how could I test that? How could I investigate that? Go away and read about it, talk to your colleagues. Is that just historical practice that we've done forever more?
Um, and then think about well, how can I question that? So, relate it back to the
things you're doing every day. And then it's not taking away from the clinical practice and taking away from the clinical world, it's adding to that.
Steve:
Sorry, I'm just trying to manage several things at once and a bit of juggling.
Uh, Caroline? Quick response.
Caroline:
Yes and when you, so yeah, it's really following on from what Emma and Bethan said about knowing the literature.
You know, have a look and see what's going on in the literature and understand that and get people to help you to understand that literature if you're new to appraising papers. Because then when you go to someone with your questions and your ideas, you can see what's already been done and you can build on that to develop your project but you need to find that team that are going to help support you. Your clinical teams, if you have the opportunity of academics and reach out to people, email people you know, there's lots of us in research that are more than happy to help other people start their journey or let them come along with our experience, so that they can find their feet.
Steve:
Thank you, Caroline. Lindsey?
Lindsey:
Um, I think my top tip would be, find out who else is doing research around you, where you're working. So it could be in your department or it could be in other departments and to find out you can go to your Research & Development department and then just ask whether or not you can lend a hand so that you can be involved with somebody who's already doing active research, so that you can learn from that experience because that's what I've done with all my band fives and they've been involved with a little bit of research that I've been doing and as a result are now starting to develop their own ideas and have the confidence with which to do that. Um, so I think try and see whether you can ingratiate yourself with an existing research project or service evaluation.
Steve:
I think that's a really helpful suggestion. I think asking, inquiring, challenging, they're all parts of what we do in our ordinary daily lives but sometimes it gets a little bit lost in a research story.
Um, we have time for perhaps one more question...
Um, and that's, how do you get yourself a Doctoral Research Fellowship? What do you think you need to do in order to get your first opportunity to do a PhD?
Any comments or thoughts? Bethan, do you think a PCAF is a good route into getting a PhD?
Bethan:
Yeah, I was holding off answering because I actually haven't got a PhD yet, so I didn't know someone with a PhD wanted to answer.
Um, but yeah no a PCAF is a really good opportunity. Um, the NIHR funded routes are really good. But they are really competitive so, um, talk to other people that have gone through them, if people are happy to share old applications with you, um, that's what I did. Spoke to other people that had applied and learned from their experiences.
And like Caroline and I both said, if you are applying for something like a PCAF. Um, or the Doctoral Clinical Academic Fellowship, you'd need a year or two's lead in time to it, you can't just sort of think on a whim, 'I'm gonna do this' and apply next month. You need to spend a long time planning for it. Um, but yeah the PCAFs are an excellent route, um, and they're a really good opportunity to work up that PhD application.
Steve:
Thank you. I'll come to Emma in just a second, can I just add,
I mean people like Gary Frost, uh, myself, Kevin Whelan... there are a lot of people who've been involved in the NIHRfor a long time.
There is a lot of support for dieticians. Dietetics is a very good route when you look across AHPs. I think the important thing is, you want to ask around to see different people's journeys and put the effort into preparing your thinking.
It has been said, it takes a year to prepare a proposal, sometimes two.And there's nothing worse than submitting a half-cocked proposal. We've got people on the panels who want to support you, you've got to work with them to try and get the best applications in.
Uh, Emma? Quick final response?
Emma:
Thank you Steve.
Um, I would say that a PhD is not for the faint-hearted. Not wanting to put people off, but there is absolutely no reason that you have to have a PhD to work in research.
And just to say to everybody out there who's working clinically, you can go in and work in research in a small way, in a big way, it doesn't have to take over your entire clinical role or life, you can dip your toe in and see how it goes.
Um and there are lots of people out there, like ourselves who are working in it, who would be happy to have a chat as to how we started and what we were doing and as I mentioned before, go to your R&I or R&D office. There should be people who will specialise in supporting Allied Health Professionals working in research.
A PhD is fabulous for the people that it works for. I would say in preparation for that, you definitely need to have some form of research experience, usually through a master's dissertation project, audit or service development project, which you could be doing clinically beforehand.
But just be prepared. A PhD is very different, it can feel very lonely and isolating and you come out a bigger and better person at the end of it but it's a lot of work and a lot of commitment, part-time or full-time, so just bear that in mind.
Steve:
Thank you, Emma. It's interesting watching people nod for that.
Um, they share that experience.
Um, we're up for time, time has beaten us.
Um, can I start by thanking our guests who presented today, I think you've done a fantastic job laying out, not only your experience but giving some good advice in terms of helping people start.
Uh, Natasha and the team, I'm sure we are going to have resources available for you in due course. Um, Natasha, will we be posting all that on the BDA website?
Natasha:
Yes, so yeah thank you again everyone and Steve as well for, um, chairing this webinar.
Um, so yeah the BDA Southeast branch does have its own website as part of the BDA website, I've put the link in the chat function. So if you are a member of the BDA Southeast Branch um, we do have an events and previous events section there so we will put the link to the recording and the slides and it will be made available on that website.
There is also a discussion forum on our website, so if you do have lots of questions and maybe you know as a way of linking in with other people that might be interested in research, we have got that discussion forum and function, so please do see that on our website as well.
Um, and obviously you can email us and as our presenters have kindly, um, offered their support as well, um, obviously you can contact them. But thank you very much everyone for joining,
Steve:
And thank you guys for organising it and having the opportunity to share our thinking.
Thank you everybody.
Natasha:
All right. Thank you all, bye for now.