Let's Talk Research 2015 - Joanna Harrison - CLAHRC NWC Internship scheme
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Collaboration for Leadership in Applied Health Research and Care North West Coast (CLAHRC NWC) Research Internship Scheme Joanna Harrison Research Capacity Delivery Manager
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Let's Talk Research 2015 - Joanna Harrison - CLAHRC NWC Internship scheme
- 1. Collaboration for Leadership in Applied Health Research and Care North West Coast (CLAHRC NWC)Research Internship Scheme Joanna Harrison Research Capacity Delivery Manager Collaboration for Leadership in Applied Health Research and Care North West Coast
- 2. NIHR CLAHRC NWC The CLAHRC NWC brings together Universities, Local Authorities, NHS organisations and the public to: ā¢ address the challenge of serious health inequalities in our region through innovative, effective applied health research ā¢ accelerate the translation of research findings into health service improvements that will reduce health inequalities
- 3. Context ā¢ Research is core to the NHS and should be used to inform planning and provision ā¢ Development of clinical academics from nursing, midwifery and allied health professions (AHPs) must be supported ā¢ High-quality clinical academic training programmes require collaborative partnerships between Higher Education Institutions (HEIs) and providers Developing the role of the clinical academic researcher (DOH, 2012)
- 4. Aim To provide an opportunity for NHS and Local Authority staff within CLAHRC NWC partner organisations to: ā¢ experience research ā¢ pursue small research projects that address health inequalities ā¢ prepare and develop fellowship applications ā¢ develop research skills ā¢ foster a research culture within their organisation
- 5. The setting ā¢ Scheme run in parallel with Health Education North West Clinical Academic Research Internships ā¢ Co-ordinated via Clinical Practice Research Unit, School of Nursing, University of Central Lancashire: -Leading provider of commissioned health education -Lancashire Initiative for Nursing and Caring research in Stroke (LINCS) project (2013) ā¢ Supervisory support from CLAHRC NWC Academic Partners āUCLan, University of Liverpool, Lancaster University.
- 6. Time and support for internship ā¢ Funding enabled ābackfillā for each intern (typically 1 day per week for 6-12 months) ā¢ Management Approval ā¢ University supervisor allocated (an experienced researcher in a relevant field) ā¢ Research Training Programme (10 days over the year) and support from UCLan co-ordinators ā¢ Small research budget for consumables
- 7. Training programme Time Agenda Day 1 Designing a research question Qualitative and quantitative research Day 2 Literature searching and on-line databases Critical appraisal Roles and responsibilities Day 3 Ethics in research IRAS and NHS permissions UCLan ethics Information sheets and consent forms Day 4 Good Clinical Practice (GCP) training Day 5 Research presentations
- 8. Training programme Time Agenda Day 6 Introduction to statistics using SPSS Day 7 Introduction to qualitative analysis using Nvivo Day 8 Principles of research dissemination Day 9 Practical research skills workshops Research funding Research careers Day 10 Internship showcase ā poster presentations
- 9. Characteristics of 2015 Cohort ā 10 Interns Trust Number of Interns Professional Group Lancashire Care NHS Foundation Trust 2 Children's Physiotherapist Health Visitor Lancashire County Council 1 Adult Social Care Co-ordinator Aintree University Hospitals NHS Foundation Trust 2 Senior Physiotherapist Senior House Officer Mersey Care NHS Trust 1 Clinical Studies Officer Knowsley Metropolitan Borough Council 2 Assistant Analysts The Clatterbridge Cancer Centre NHS Foundation Trust 2 Therapy Radiographers
- 10. Projects include: ā¢ Improving Radiotherapy Outcomes for Head and Neck Cancer Patients with Addictions ā¢ The Physical health needs of mental health service users: Exploring the views of people taking antipsychotic medication ā¢ Implementing a systemic change in Knowsley to improve mental health knowledge and build mental toughness.
- 11. Outcomes ā¢ Showcase Event 14th October 2015 (poster presentation and networking) ā¢ Written report ā¢ A research output, e.g. publication, conference presentation ā¢ Pursuit of further research training or funding
- 12. Evaluation of a clinical academic internship scheme: Bridging the research-practice divide Dr Jo Gibson Senior Lecturer, University of Central Lancashire jgibson4@uclan.ac.uk
- 13. ā¢ Funding secured fromā¦ ā¢ Health Education North West awarded funding to UCLan in 2013 ā¢ Steering Group established, including: ļ Directors of Nursing, AHP Leads, Specialists ļ Research & Development Managers ļ Trust Library personnel ļ Health Educators ā¢ The Steering Group took a collaborative approach to programme design and training provision CLINICAL ACADEMIC RESEARCH INTERNSHIPS
- 14. The Evaluation Aim To explore clinical academic internsā experiences of undertaking the internship programme in order to: ā¢ Describe the learner experience ā¢ Identify facilitators and barriers to learner engagement ā¢ Evaluate the success of partnership working ā¢ Make suggestions for improvements for future cohorts
- 15. Characteristics of 2014 Cohort ā 12 Interns Trust Number of Interns Professional Group Lancashire Teaching Hospitals NHS Foundation Trust 4 Midwife Occupational Therapist Senior Healthcare Assistant Staff Nurse East Lancashire Hospitals NHS Trust 2 Occupational Therapist Physiotherapist Blackpool, Fylde & Wyre Hospitals NHS Foundation Trust 2 Nurse Practitioner Occupational Therapist Lancashire Care NHS Foundation Trust 3 Health Improvement Specialist Health Visitor Physiotherapist/Team Leader Chorley & South Ribble Clinical Commissioning Group 1 Practice Nurse
- 16. Projects included: ā¢ Feasibility and Acceptability study of a Paediatric Asthma Action Plan with Qualitative Evaluation ā¢ Exploring staff experiences of communicating with dementia patients in acute hospital settings ā¢ Asymptomatic menās experiences of requesting a Prostate Specific Antigen Test (PSA): A Qualitative study ā¢ Are the tools used for assessing the risk of intrauterine growth restriction consistent, performed and recorded accurately, and do they effectively predict intrauterine growth restriction?
- 17. Method ā¢ Ethical approval was granted by UCLan STEMH Ethics Committee (Ref:STEMH 231) ā¢ An email invitation to participate in the qualitative study was sent to all interns ā¢ 10 of 12 interns consented ā¢ Semi-structured interviews were recorded and transcribed verbatim ā¢ Results were thematically analysed by 2 researchers
- 18. Reasons for intern engagementā¦ Meeting an unmet need ā bridging a gap I wanted to go back to study but not commit to a Masters or a Masters module. And it kind of ticked all the boxes really. Participant 4 I mean it can be quite daunting canāt it, to do research so it lookedā¦ a way that I couldā¦ check it out without actually jumping in too deep. Participant 3
- 19. Reasons for intern engagementā¦ Previous exposure to research Iāve always been really interested in research, and then when we did our degree we did a research module. And I really enjoyed it, and ever since Iāve kind of always thought itās something I could maybe get back into. Participant 5 I got involved in the [X] project, and another cognitive projectā¦ just promoting it on the ward and identifying potential participants and doing some of the cognitive assessmentsā¦ and just thought, I want to get more involved with research. Participant 6
- 20. Reasons for intern engagementā¦ Improving patient care If we can make improvements for the patients, thatās, you know, at the end of the day, itās making a differenceā¦ Participant 10 It just seemed really important to me for frontline staff to be involved with research processes and to be able to find out a bit more about things and inform their own practice. Participant 7
- 21. Learner Experience ofā¦ The UCLan Taught Programme They were aimed at somebody whoād never done research before. They didnāt go into it too academically, which is great because that would have put everybody offā¦it was kind of a working knowledge of what to do next which I thought was fine ā it was exactly the right approach. Participant 9 Honestly there wasnāt anything that I didnāt find useful. There isnāt an element of it that youād think, āWell, I didnāt need to know thatā. Participant 2 So itās been really, really supportive. I feel really nurtured actually, by all aspectsā¦ Participant 7 ā¦itās more than I expected, like youāve been more supportive than I would have expected so thatās been really helpful. Participant 6
- 22. Learner Experience ofā¦ Collaborative and Practice-based Learning ā¦trying to meet up with your mentor. Because I suppose theyāre busy with their workload, and holidays, and other commitments and stuff, so thatās been quite hard sometimes. Participant 5 The deal I sort of struck with my manager was that itā¦wasnāt to affect the serviceā¦it was up to me toā¦make sure that the quality of the serviceā¦waiting timesā¦outcomesā¦caseloads, were all covered. Participant 3 I did remind x that s/he could backfill my positionā¦and thatās what the money was forā¦āYou can catch up later in the yearā. Participant 10 My sort of struggle has been trying toā¦almost to explain to work colleagues that itās not just a university project, itās work, so they could understand why you needed protected time out. Participant 2
- 23. Learner Experience ofā¦ Colleagues Perceptions & Reactions She [colleague] didn't think that I'd get backfilled, which I didn't. ā¦ she's been openly quite negative about it. Participant 6 Our consultant, he does take the mickey, and calls me āProfessorā Participant 4 The other consultant said heās never heard anything so ridiculous as an [AHP] doing research. Participant 8
- 24. Building an effective learning environmentā¦ The challenges It takes a long time to do the off-duty and work out the shift patterns, and then suddenly you come along and then you mess it all upā¦so you do feel quite guilty in that way. Participant 10
- 25. Building an effective learning environmentā¦ The successes Iāve enjoyed listening to other people and thinking, thereās such a wealth of backgrounds andā¦people out there that want to improve the services that theyāre working in. Participant 3 At times when you felt quite isolated, around what youāre dealing with or managing is that when the interns come together, you realise youāre not having a unique experience. Participant 2 The team building, the networking was really good. And I think everybody got on very well together, everybodyās formed as a group very well. Participant 6
- 26. Legacy Effect My line manager was like, āLeave me a legacyā. Participant 6
- 27. Legacy effect ā for workpplace ā¦because I have become more interested, I am reading more literature about different things, so trying to put that into practice and say, 'Well actually we're doing this wrong, so let'sā¦ Iām feeling better about myself, that Iām performing better in my job. Participant 10
- 28. Legacy effect ā for career And the idea that now I could do a PhD. As in that...suddenly that seems so much more...accessible than it was. The idea thatā¦that was just what āother peopleā did. (whispers) That maybe I could do that. That would be exciting. Participant 6 I'm gonna apply for a PhD. Yeah, definitely [because of] the programme. Participant 7
- 29. Conclusions ā¢ Previous exposure to research, either through previous study or workplace experience, is a strong motivator for some considering a research internship. ā¢ Interns can feel isolated or āstuckā between their employer and HEI. ā¢ The cohort provides much needed support as well as opportunities to learn from each other in group teaching sessions.
- 30. Insights for future programmes ā¢ All stakeholders should understand what the intern is undertaking and ensure dedicated support is provided both within their Trust and the HEI. ā¢ Effective communication between the multiple stakeholders is needed regarding the content, delivery and outcomes of programmes. ā¢ Clinical academic internship programmes require a particularly nuanced form of support, and collaboration between all stakeholders, to maximise their impact on research engagement.
- 31. Contributors ā¢ The internship programme is hosted by the Clinical Practice Research Unit at UCLan under the leadership of Professor Caroline Watkins ā¢ The programme is run by Dr Jo Gibson and Dr Steph Jones ā¢ Colette Miller and Julie Cook Lucas provide support to the internship programme and conducted the interviews and analysis for this evaluation clinicalinternships@uclan.ac.uk
- 32. Acknowledgements The 2014 Clinical Academic Research Internships were funded by And supported by:
Editor's Notes
- accelerate the translation of research findings into health service improvements that will reduce health inequalities and improve population health
- Strategy underpinned by guiding principles. Research is not just an add-on, itās a core element. We need a well-rounded clinical research community. Clinical Academic workforce instrumental in ensuring spread of best practice and innovation. Need time, funding and support to undertake clinical academic training programmes.
- Overall, developing research capacity and supporting staff taking their first steps into research fellowship application (clinical academic, academic or knowledge mobilisation) such as the NIHR Doctoral scheme or the NIHR Knowledge Mobilisation Research Fellowship Scheme.
- UCLan --Existing links with local trusts through both education and research collaborations LINCS ā A partnership between UCLan and LTHTR to encourage any level of staff to participate in clinical research within the hospital.
- Funding from CLAHRC Ā£6000 for salary backfill, Ā£3000 for hosting the training, Ā£1500 for supervisory support, Ā£500 research budget
- Projects generated by the interns from their professional area, developed and undertaken with support from a University Researcher and Line Manager
- Several of the interns expressed reservations about the traditional options regarding professional development, which often include undertaking one off seminars or committing to lengthy post graduate study. They saw the programme as a middle ground between the existing options, which appeared to be an appropriate personal development opportunity for them. This is encouraging in terms of their perspective on the policy contextā¦flexibility
- We were interested to find that willingness to undertake the programme was often predicated on previous exposure to research, both during their undergraduate education and in their clinical capacity, where some of the interns had been involved in clinical trials or other kinds of research. Suggests importance of seeing these activities as opportunities to engage staff in research process/culture, and importance of HEI links with NHS.
- Other reasons for applying included improving patient care, thus reinforcing the clinicianās perspective of the need to deliver excellent healthcare. Some interns also discussed the need to work towards evidence based practice, indicating this approach is increasingly embedded in practice..
- It was important for us to evaluate the delivery of this new programme, and despite being in the midst of their personal projects when we interviewed them, our respondents were overwhelmingly positive about the opportunity and the structure and content of the training programme. They generally felt it was pitched at an appropriate level for NHS staff taking their first steps into active research, and appreciated the structure of the programme which carried them through their research process from design, through governance, data collection and analysis, output, dissemination, to what next? The interns had many positive things to say about the overall support they received from the UCLan team. Most had been out of education for a long time and therefore their expectations of the programme may have been different to the ānormalā student.
- But not every aspect of the programme worked out as we had hoped. We had thought that partnering each intern with a subject specific mentor/tutor would provide sufficient support, and indeed several of the interns identified this as the best aspect of the programme. However the effectiveness of our strategy of matching each individual intern with a subject expert turned out to be highly context dependent partly because some of the internsā were extremely knowledgeable in their own fields. All of the interns found the programme was more work than they had expected, and often encroached on their own time. But they identified this as less of a problem than managing their competing priorities in clinical practice. Although their Trusts received funding to cover their time, there was a wide variety of solutions to backfilling their posts (or not), depending on local priorities and contexts, over which UCLan can have no control. For some, this caused individual stress and impacted on their experience.
- It was overwhelmingly clear that managerial support was a crucial factor. Line Managers had to sign off the internship, but all the interns appreciated, or would have appreciated, ongoing line management support during the programme. In relation to this, some revealed rather negative experiences. This intern was (justifiably) concerned that this particular peer colleague, who would be crucial to their research project, might not co-operate. Some problems emerged in the context of the MDT, which seems particularly to have been an issue for some of the AHPs. Perhaps worryingly, participant 4 saw this kind of interaction as everyday ward banter. Participant 8 was otherwise well-supported by a pro-active manager and co-operative colleagues, of whom they spoke very warmly, but the personal and professional impact of this response from a very senior colleague perhaps prompts us to ask more questions about taking a localised view of the policy context, and asking where interventions need to be made in terms of delivering the āsafe environment for learnersā required by the EOF.
- As the interns began to grapple with overcoming such challenges, they inevitably needed more support from the UCLan team. Further challenges were created for us in developing appropriate responses to their feedback during the programme. We had intended our teaching and responses to be reflective, and had left space to provide additional sessions based on the needs identified by the group as the programme progressed. There were clear requests for sessions on running focus groups, and academic writing, which we arranged. However, the introduction of new dates at short notice brought their own problems for clinical practitioners. This experience has led us to respond to the initial cohortsā clarification that it is imperative for them to know their training day schedule in advance, by introducing a non-negotiable schedule for the current (second) cohort, plus introducing an attendance requirement, which is made clear to all parties from the outset, creating fewer negotiating demands on the interns. This internship cohort also struggled with some of the governance processes around their projects. The School of Health had not yet introduced the light touch ethics review for student projects from which the current cohort is benefitting, so that the our respondents experienced more delays and demands than had been anticipated. Most of the Trust R&D departments encouraged the interns to undertake projects which would sit within the domain of service evaluations and not require full NHS ethics approval, which was helpful to these time-limited projects. However, approval processes were demanding and time-consuming for all concerned, and due to a range of factors, interns had mixed experiences of R&D and higher-level Trust support for their work. This is being considered through the Steering Group to reflect on what improvements can be made.
- In terms of these struggles however, it is important not to underestimate the benefits of the group effect. The interns felt it was an inclusive group which had contributed to their positive journey. The interns were indeed a varied group, and it emerged through our evaluation that the issue of accreditation for the programme was significant for some of them. Therefore we provided the opportunity for the interns to register for a Student Initiated Module at either level 4 or level 7, if they wished. Eventually 10 of the interns chose to do this, which we are taking as evidence of an effective learning environment. For 2 of them, this is their first step into Higher Education, reflecting the potential for programmes like this to be responsive to a Widening Participation agenda, as well as to CPD issues.
- Several interns have identified a range of ways in which they are taking their learning back to their Trusts, which complements the EOF. They have identified that their new knowledge about research governance and project planning means they can be a general resource for others, using terms like sounding post and point of call. They also spoke about how they had come across more generically useful information in the course of their research that they have taken back to their teams. For some interns the results of their research project can be immediately applied to their practice.
- So what next? Widening Participation Several of the interns are exploring opportunities for study at Master level. One of these students is actively pursuing their interest in a PhD, while for the other, an empowered new world has opened up.
- has been more successful than we might have hoped in meeting many of our objectives. Challenging for them and for us Collaborative working can be successful