Contents

Routes into Research

Applying to do OOPR

During OOPR

Completion of Research/Transferable Credit Time

Other Options of Some Involvement in Research

Top Research Tips from Trainees/Potential Contacts

Trainees are strongly encouraged to get involved in research of some kind, whether this is by conducting local projects that can be presented at meetings, completing research methods courses or conducting full time research as part of an MD or PhD. The NorthEast Thames rotation has a strong track record for supporting trainees to pursue PhDs and there are many research-active groups locally. At the bottom of this section is some specific advice for how to organise research within NorthEast Thames and some relevant contact details, dependant on your research interests.

Relevant to all trainees, Section 4.5 of the curriculum states:

“Research is central to the provision of high quality health care, contributing significantly to a culture of continuous improvement in quality, safety and clinical effectiveness. The Respiratory Medicine SAC considers properly supervised research to be an important component of training. It allows trainees to acquire and develop a whole range of skills including, in particular, the ability to think and reason critically and to appraise the literature. These are essential skills for any Consultant and a prerequisite for leading the implementation into practice of new developments in their specialty. In originating, planning, and executing a research project, the trainee will have the opportunity to develop and hone a range of other abilities, including leadership attributes, organisational skills, time management skills and presentation skills and will also learn about the economic and ethical aspects of research and practice. The role of research in developing professionalism in the trainee, and its benefits for the wider NHS, cannot be over-stated.”

All trainees must achieve research competencies. These can be achieved by:

• applying for appropriate ethical research approval and demonstrating the ability to write a full scientific paper
• the attainment of a higher research degree
• giving a national/international presentation and undertaking an assessed research course
• pursuing research/ a research degree (eg. MA/MSc) in medical education

Routes into Research

There are a number of routes into research. Which one you should pursue will depend on your long term career aims, your previous experience, and what opportunities currently exist. When it comes down to it, in order to do research you need money – both for your research costs and to pay your salary.

• Academic Clinical Fellowships are funded by NIHR. Posts are allocated to institutional partnerships of University, NHS Organisations/ Trusts and Local Education Training Boards (LETBs) and academic trainees are recruited by the LETBs through open competition via a nationally developed process for academic recruitment. They are not an option for many trainees as they are ST3 entry only. They are also restricted to specific groups/supervisors/projects. However, Prof Jerry Brown usually has an ACF, so if you’re interested in infection, particularly Strep. Pneumoniae, and plan ahead this is a great route in.
• ‘Soft funding’ is funding that a PI has which is not attached to a specific person or project. It can be used to fund entire projects or, often, to fund someone for a short amount of time whilst they get pilot data that they use to apply for more money to a major funding body. The only way to know about the existence of such funding is to speak to research leads/PIs. Going OOP on soft funding gives you dedicated time to get pilot data which can be invaluable, but is precarious if the money won’t cover the whole duration of your research and can be stressful whilst awaiting other funding decisions.
• Pre-existing fellowships are posts that are already set up in an institution/group and already funded. Trainees then apply competitively to the post and, if successful, can register for an MD/PhD. This route has the advantage of avoiding the pain of completing funding applications, but has the disadvantage of arriving to a project which you have not designed/written and is not ‘yours’. They may be funded by a legacy grant and be quite predictable, or be from a specific initiative and come up sporadically. There is an element of luck of being ready to go out on OOPR at the right time. A recent example are the Crick/NIHR fellowships. Large project grants often have a fellowship written in, and then are advertised competitively. Again, showing enthusiasm, asking around and talking to PIs is the best way to find out about these.
• Personal Research Training Fellowships are provided by major funding bodies such as MRC, Wellcome and NIHR. They are competitive and prestigious and require a lot of planning. They are probably the best route into a long term career in academia. In order to gain a personal research fellowship, you need to persuade the funding panel that: you are personally worth their investment; your supervisor and group has the expertise and experience to support you in developing research skills; and your project is important and worthwhile. Although writing a grant/fellowship proposal is long and painful, it is good experience. It forces you to really delve into your research question, immerse yourself in the literature and justify your methods and costs. By the time you get to interview, you really feel you own the project. You will need to find yourself a supervisor who will support you in the entire process so plan ahead and talk to lots of people.

Applying to do OOPR

This is a multi-step process so plan as far ahead as possible. You should informally alert your TPD as soon as possible that you are considering OOPR. Once you have a supervisor and project confirmed, you should formally request OOPR. If you are awaiting a funding decision then include the date you expect to hear the result, and whether this is essential for you going out. Please remember that you can only leave the programme in October or April and must give 6 months notice. Steps in applying for OOPR include:

• Applications to research bodies for fellowships/funding (eg MRC, Wellcome, NIHR)
• Application to the deanery/LETB (via an OOPR form)
• Application to the JRCPTB (via a Research Application Form), accompanied by a job description and an up to date CV

Much of the paperwork is to ensure that you can ‘count’ part of your research time towards your CCT date. Once you have submitted all the forms, the JRCPTB will submit applications to the Respiratory SAC for review of the research content including an indicative assessment of the amount of clinical credit (competence acquisition) which might be achieved. This is likely to be influenced by the nature of the research (eg entirely laboratory-based or strong clinical commitment), as well as duration (eg 12 month Masters, 2-year MD, 3-Year PhD).

On approval by the SAC, the JRCPTB will advise the trainee and the deanery of the decision. The deanery/LETB will then make an application to the GMC for approval of the out of programme research. All applications for out of programme research must be prospectively approved. Therefore you must apply before your OOP starts, and the LETB will then apply to GMC for time to count.

Guidelines for amount of time to count:

• Maximum overall 12 months credit – you will need to do regular weekly clinical sessions
• 6 months credit – some significant clinical interaction
• 3 months credit – no major clinical interaction to take account of the transferable skills achieved

During OOPR

Whilst you are out on OOPR, it is wise to attend some training days to keep in touch with trainees, stay up to date with other areas of practice and stay up to date with changes to the curriculum and ARCP requirements.

You must submit a research report each year to the ARCP panel and keep your TPD up to date on your plan to return to the programme. You may wish to attend a ‘returning to practice’ one day course – a great example is the course co-designed by Dr Sophie Vergnaud-Wiseman, which includes refreshers in ALS, and clinical specialities so you can return to the Med Reg on call rota with confidence.

Programmes/sites to make your research/life easier:

• GraphPad Prism – draw lovely graphs .
• PubCrawler – get relevant newly published research delivered to you to keep up to date with your field.
• Mendeley or Zotero – free and fantastic reference managers (as good as Endnote but free). Essential for writing your literature review, or any paper, ever.
• Twitter – a great way to get yourself known, link up with people in your field, and get access to breaking info/new papers. Don’t underestimate the value of interacting online before meeting people (including ‘big names’) in person.

Completion of research

Upon completion of the research period the competencies achieved will be agreed by the OOP Supervisor and the Educational Supervisor and communicated to the SAC, accessing the facilities available on the JRCPTB ePortfolio. The competencies achieved will determine the trainee’s position on return to programme; for example if an ST3 trainee obtains all ST4 competencies then 12 months will be recognised towards the minimum training time and the trainee will return to the programme at ST5. This would be corroborated by the subsequent ARCP.

Trainees need not count research experience or its clinical component towards a CCT programme if they do not wish to do so, but must decide whether or not they wish it to be counted on application to the deanery/LETB and the JRCPTB.

Up to 3 years out of programme is the accepted normal, but consideration of a longer period may need to be made on a case by case basis. The SAC will usually recognise up to 12 months of the OOPR as educational credit towards the minimum training time. However, it is the SAC’s prerogative to decide just how much educational credit should be granted. For OOPR that involves relevant clinical experience, additional educational credit of up to a further six months (ie total of 18 months) may be allowed on a case by case basis but, again, this is at the discretion of the SAC.

Other options of some involvement in Research

All trainees not wishing to undertake a higher research degree should undertake supervised research during their clinical training and should also consider attending a course on research methodology. The ARCP decision aid, section 5.5 details the requirements as:

• End of ST3: Evidence of critical thinking around relevant clinical questions
• End of ST4: Evidence of developing research ideas and questions, participation in journal clubs, able to critically review the literature.
• End of ST5: Evidence of preparation for ST6 requirements
• End of ST6: One or more of: higher degree/ or full publication/ or national/international presentation (abstract) and assessed research course/ or research/research degree (MSc) in medical education

All trainees should demonstrate understanding of research principles and methodology and also of statistical methodology. They should be able to show that they are able to critically appraise research literature, including both individual research papers and systematic reviews. One way to assess the attainment of such skills is by the production of short papers and/or case reports. Another is via an assessed course on research methodology. Trainees with an interest in medical education can be encouraged to undertake research in teaching methodology (see Teaching and Training).

Good places to start which will help you read and critically appraise research papers of all types, are the series of articles written by Trisha Greenhalgh for the BMJ (also available as a book), and various authors for JAMA. The best thing to do is google “BMJ How to read a paper” and “JAMA Users’ guide to the medical literature”. Examples are:

• Murad, Mohammad Hassan, et al. “How to read a systematic review and meta-analysis and apply the results to patient care: users’ guides to the medical literature.” Jama 312.2 (2014): 171-179.
• Greenhalgh, Trisha. “How to read a paper. Papers that report diagnostic or screening tests.” BMJ: British Medical Journal 315.7107 (1997): 540.

In addition, and helpful if you are presenting at a journal club, are a number of structured checklists to guide you through appraising specific types of study/paper such as a cohort study, an RCT, an economic evaluation, or a systematic review. These are free, on the Critical Appraisal Skills Programme site.

Top tips from trainees

• Know why you want to do research and what you expect to get from it. Be honest with yourself and your supervisor.
• Choose the right supervisor – you need someone who you respect and trust, who will be around, and can give useful feedback. It’s a major commitment to spend three years working with/for someone and you need to have compatible ways of working.
• Make sure the department you are joining can and will support you. It needs to have the right experience/expertise and a good setup for making you part of the team. Make sure you have somewhere to sit!
• Be prepared for your concept of time to change. You will need patience, as results are not achieved instantly, and many things you try will probably fail.
• Look for additional opportunities that appear once you are in research such as writing educational articles, getting a position on a BTS committee, courses on public engagement etc. Make the most of your time.

If you’re thinking of applying for OOPR and want some advice from current trainees, these people are happy to be contacted:

• Jess Potter, MRC Research Fellow, conducting a mixed-methods (although predominantly qualitative) study exploring the experiences of recent migrants to the UK with TB of accessing UK healthcare services, with Dr Victoria White (Year 2).
• Matthew Burman, working on the CATAPULT study, a cluster RCT looking at the delivering of TB care to migrants. It compares the Newham model of care vs the national model of care. The primary outcome is treatment completion. Matt is funded by Barts Charity.

Chatting informally after training days will also often give you an insight into the research groups in our region and the type of work that current trainees are involved in.

Professor Jerry Brown has provided some additional information on: the benefits of doing research; the practicalities of arranging research; considerations in choosing a supervisor and project; funding opportunities; and information on research active groups within North East Thames, which you can download here: How to Organise Research.

Also, please read our ‘spotlight on research’ post.

Potential research opportunities at UCL in interstitial lung disease, lung cancer, lung infection, and airways disease. UCL Respiratory can offer research opportunities for clinical, translational or basic science research projects into a wide variety of lung diseases, including interstitial lung disease, pulmonary oncology, bronchiectasis, pneumonia, COPD and asthma. UCL Respiratory has an excellent record in obtaining clinical training fellowships from the MRC and Wellcome Trust (approx. 70 – 80% success rate) and providing a high quality research environment for clinical academics.

If you are interested in doing a period of research and perhaps applying for PhD training fellowships, please contact Professors Rachel Chambers (ILD, r.chambers@ucl.ac.uk), Sam Janes (pulmonary oncology, s.janes@ucl.ac.uk), or Jerry Brown (bronchiectasis, airways disease, lung infection, jeremy.brown@ucl.ac.uk) so you can discuss further what opportunities there are at UCL.