1. Developing and Supporting Clinical Academic Research Careers
Mental Health, Health and Social
Care (MH2aSC) research group
Developing and Supporting Clinical Academic Research Careers
for Nurses, Midwives and Allied Health Professionals: the UK Experience
September 22nd 2018
Faculty of Dental Medicine and Health Osijek
Dr Ros Kane, Reader in Healthcare; Dr Ian McGonagle, Principal Lecturer; Dr Christine Jackson, Visiting Professor, University of Maribor, Slovenia and Honorary Fellow.
University of Lincoln, UK.

2. Aims
To provide a short history of the Clinical Academic career pathway for Nursing, Midwifery, Health Visiting and Allied Health Professionals (AHPs) in the UK
To provide an illustration of a regional development in the UK
To provide the context and challenges for Clinical-Academic Careers in nursing/AHPs

3. Principles Research is core business of the NHS.
Research clinicians required in all professions.
Strategy delivery will require partnership between HEI and service.
The process will need to grow.
Clinical academics will need to be a feature of NHS workforce planning, nationally and locally.

4. The Strategic Learning and Research Human Resources Plan (StLaR) Project
Problems to address
Poor labour market intelligence
Capacity building the next generation(s) to
meet increased demand and succeed the present ‘ageing workforce’
Increase investments in research training and scholarly activity
Build clearly identified career pathways
Poor contractual arrangements
Develop support and mentorship
Develop inter-professional alliances
Work internationally/globally

5. What is a Clinical Academic?
A nurse, midwife or allied health professional who engages in both clinical practice and research, providing leadership in the pursuit of innovation, scholarship and provision of excellent evidence-based healthcare.
A central feature of their research is that it aims to inform and improve the
effectiveness, quality and safety of healthcare. They focus on building a research led care environment including the development of capacity and capability.
They challenge existing practice as well as working within, and contributing to, a research rich environment that leads the way towards achieving excellence in healthcare and health outcomes (DH 2012 page 3).
DH (2012) Developing the Role of the Clinical Academic Researcher in the Nursing, Midwifery and Allied Health Professions London Department of Health.

6. What is a clinical academic?
In the UK the following definition is generally agreed as –
‘Clinical Academics are clinically active health researchers. They work in health and social care as clinicians to improve, maintain or recover health while in parallel researching new ways of delivering better outcomes for the patients they treat and care for. Because they remain clinically active, their research is grounded in the day to day issues of their patients and the delivery of service. This dual role allows the clinical academic to combine their clinical and their research career rather than having to choose between the two’.
NIHR 2016

7. Organisational and personal benefits for clinical academic roles (AUKUH, 2016)

8. ‘Developing the best research professionals’
Qualified graduate nurses:
recommendations for preparing and supporting clinical academic nurses of the future
Report of the UKCRC Sub Committee
for Nurses in Clinical Research
2007
in collaboration with
Modernising Nursing Careers

9. Producing the ‘Finch Report’
Analysis of reports and policies, UK and international - on research capability and capacity (1)
20 key stakeholder interviews plus expert reference group discussions across the UK (2)
Data from (1) and field notes from (2) were analysed using NVivo software
Inductive and deductive analyses – propositional themes/recommendations generated for testing
Tested on a national focus group of stakeholders

10. Finch report recommendations (2007) The clinical academic training pathway10

11. National funding of the Finch Report recommendations
Each of the four UK countries funds their own programmes
For England this is through the National Institute for Health Research (NIHR)
Funding allocation includes salary replacement costs, tuition fees and additional research costs

12. Our regional Clinical Academic Pathway
‘Platinum’
award ?
Gold award
Spend a bit of time on this slide talking through the specifics of each level

13. Successes

14. Doctoral Training Programmes
Point of discussion

15. Challenges (feedback from national awarding panels)
Professional clinical development
Personal development
Research design and methods
Institutional support for development and sustainability
Contribution to research capacity building in the NHS

16. Service challenges
Building a clinical academic career is an incremental and often challenging process. Common challenges include:
Finding sufficiently skilled clinicians to backfill posts
Developing the ability to ring fence time in parallel clinical and academic roles
Ensuring that the financial aspects of any award are managed well
Planning for the maintenance of a clinical academic position on conclusion of any external research funding
NIHR Trainees Coordinating Centre (2015) Building a research career: a guide for aspiring clinical academics. (excluding doctors and dentists) and their managers. NIHR. Leeds.

17. Collaboration
The issues of new ways of working and new roles (such as a clinical –academic) are not straightforward in terms of employment.
This is despite the fact that workforce planning and development for medical personnel appears to present few challenges!
Key features of challenges include:
Grading
Supervision
Time and
Focus of the role
In responding to these challenges it is essential that active partnership takes place between University and NHS providers.

18. Future: centralised applications
ICA HEE/NIHR Integrated Clinical Academic Programme for non-medical healthcare professions
ICA HEE/NIRH programme

19. Key documents
Building a research career

20. Key documents
The Association of UK University Hospitals (AUKUH) guidance

21. Contextual Policy
Butterworth, A., Jackson, C.S., Orme, M., Hessey, E., Brown, E., Ferguson, J. (2005). Clinical academic careers for educators and researchers in nursing: Some challenges and solutions.  Journal of Research in Nursing (2005) Vol 10 (1) 85-97
Clinical Research Network (2012) Five year strategic plan for research delivery
London. NIHR.
Department of Health (2012) Developing the role of the clinical academic researcher in the nursing, midwifery and allied health professions. Department of Health. London.
Jackson, C and Butterworth, T (2007). Everyone’s business, no-one’s responsibility: reporting clinical academic research activity by nurses in the United Kingdom.  Journal of Research in Nursing, Vol.12, (3), pp
Medical Research Council (2015) A Cross-Funder Review of Early-Career Clinical Academics: Enablers and Barriers to Progression. A Review led by the Medical Research Council in collaboration with the Academy of Medical Sciences, British Heart Foundation, Cancer Research UK, National Institute for Health Research and Wellcome Trust.
UKCRC Subcommittee for Nurses in Clinical Research (Workforce) (2007) Developing the best research professionals qualified graduate nurses: recommendations for preparing and supporting clinical academic nurses of the future: The ‘Finch’ report. London: UKCRC.

22. Web links

23. Aims
To present a brief history of the development of clinical academic careers in England and describe current provision
To present findings from a qualitative study exploring the experiences of clinical academic nurses and allied health professionals after a tailored training programme
To give examples of barriers encountered and strategies to overcome them
Present an innovate intervention to support research among newly qualified nurses

24. Clinical Academic caReers Pathway AnaLysis.
What is CARPAL?
Clinical Academic caReers Pathway AnaLysis.
An impact analysis of the experiences of the Clinical Academic Careers (CAC) pathway for health care staff previously and currently in receipt of a HEE-EM Bronze and Silver award.

25. Methods 1:1 semi-structured interviews (n=20)
Topic guide developed from the national CAC work profiles and desired outputs from the developing CAC roles strategy (DH, 2012) and UKCRC (2007)
Each interview minutes in a convenient location
Have undertaken Bronze, Silver or both

26. The Clinical Academic Pathway
‘Gold’
award
‘Platinum’
award
Masters in Research Methods

27. The Clinical Scholar Bronze scheme
Our East Midlands Bronze Scheme is open to Nurses,
Midwives, 16 Allied Health Professions
The programme is aimed at aspiring clinical academic health care professionals
12 funded places per programme
Released for scholarly activity for 48 days over 6 months (Nov start)
Training programme minimum of 6 teaching days (front loaded) - database searching; academic writing skills; research design; evidence and values in clinical practice; data analysis plus additional sessions as necessary.
Mentoring system
Training Needs Analysis
Action Learning Sets
The programme will prepare each scholar for successful participation in a Masters Research degree.

28. The Clinical Scholar Bronze scheme
Assessment process (UoL short course programme)
Assessment 1
A combined 6,000 word assignment. A literature review plus either a research proposal or results from a small pilot study.
Assessment 2
A personal reflection log on career development and future research and clinical training needs
Presentation and assessment of this work at the end of year Celebration Event for Bronze (and Silver) Scholars

29. The Bronze Award For those without formal Masters qualification
Structured 5 day educational programme
Support from experienced Clinical Academic Mentor
5 facilitated Action Learning Sets-delivered by an academic
Enhance ability to compete successfully for the next stage of the Clinical Academic Pathway e.g. MRes

30. The Bronze Award Outputs
6,000 word dissertation (80%)
1,000 reflective piece (20%)
Presentation

31. Benefits: Feedback from Bronze Scholars
The Bronze Award ignited my passion for research and gave me the confidence to apply for a masters.
It changed my career and opened doors for me and has given me a chance to focus on something different.
The award has definitely given me more confidence and I have more motivation to achieve. I think I have become more evidence based and less afraid to look into the evidence for whatever I am doing.

32. The Silver award For those with Postgraduate Masters qualification.
Bespoke educational programme and development plan based on training needs assessment.
Support from experienced Clinical Academic Mentor.
Enhance ability to compete successfully for the next stage of the Clinical Academic Pathway e.g. NIHR PhD.

33. Silver programme outputs
5,000 word literature review.
A fully worked up PhD proposal in line with the NIHR requirements.
Ethics approval.
Presentation (formative)
Mock Interview (formative)

34. Benefits: Feedback from Silver Scholars
It has allowed me to shape my career and has given me the opportunity to develop clinical practice and make it better.
I found the Silver programme really rewarding and I felt very privileged to be on it. It has enhanced my confidence.
I’ve used the skills and knowledge that I’ve gained to try and do something and to help move practice forwards. I always try to evaluate what I do and then roll that out to the team; to check that we are doing as well as I hope and see where we may need to change things.

35. Recognised challenges
Lack of research culture in nursing and the AHP’s
Academic pressures
Clinical pressures
Funding
Time

36. Management and Structures
Interim findings
Management and Structures
Patient Care
Confidence
Leadership
Personal development
Spread

37. Passion and drive for improving patient care.
Personal development
Passion and drive for improving patient care.
“I question why it’s done the way it’s done. I begin to realise that unless you naturally find evidence to show what’s beneficial or how to do things to make outcomes better, then it’s really hard to get anywhere or develop service without that sort of evidence.”
“It’s given me a new passion for what I am doing”.

38. Given time to reflect, develop, and translate
Personal development
Given time to reflect, develop, and translate
“All of these programmes give time out of the clinical workplace. Thinking time. Time to consider where you want to go. Time to consider what your skills are. How you develop those.
“It’s given me the time really to be able to integrate findings into clinical practice”.
“It’s given me the time to look into my clinical field. Find out what best practice is…what the current evidence base is. That’s made me more confident in doing.

39. Approach practice and own abilities with more confidence
“If there is a new project that’s happening, I feel like I’ve got the skills now to help evaluate that project”.
“It’s made me feel up-to-date in my current area of practice by just having a chance to read and reflect. I’m more confident in my every day interactions”.

40. A more inquiring practitioner
Confidence
A more inquiring practitioner
“I was never confident enough to say….. ‘well actually why are we doing it like this? That’s what my seniors told me to do, so it must be right’. It got to the point as I became more confident, I would go off and do things on my own. That’s when I started to question why things are done the way they are.”
Promotes resilience
“[you] just need to keep going. You have to get over those hurdles and learn from them to improve”.

41. Broadened skillset to become expert
Leadership
Broadened skillset to become expert
“[it’s] opened my eyes to different things. I hear what’s going on in the wider world of things”.
Experts within teams/depts.
“I’ve got lots of experience and knowledge about things which a lot of the clinicians here haven’t”.
A new identity
“I never thought research was possible for me because I thought it was for the clever people”.
“The new initiatives have opened research to lay people like me”.

42. Consulted by colleagues “Things within the Trust do come to me now”.
Leadership
Consulted by colleagues
“Things within the Trust do come to me now”.
“They are always asking me about research things that I wouldn’t have felt competent to answer before”.
Discovered networking opportunities
“[it’s] opened up a network of people that I didn’t know was there”.

43. Importance of early adopters initiating spread
“It has only taken one or two interested people to actually steer it in a different direction and making those links to the Research and Development team”.
Others interested in their work
Encourage others to undertake awards

44. Improved team confidence and ability
Spread
Improved team confidence and ability
“The team is probably more confident with treating that type of patient…the service is better and the team are more confident in their clinical work with those patients”.
“That knowledge has been shared and asked about in my team”.
Established learning groups within their trust/field

45. Management and Structures
Understanding benefits: Cost-saving
“Sometimes people can see the rational[e] for cost saving agendas more clearly than they can for a research agenda”.
“Even thought it’s beginning to get more evidence based, and we’re getting some really good feedback from the wards. That needs to translate somewhere into financial contribution to increase the staff”.
“Colleagues thought “they were just taking time out on a jolly”.

46. Management and Structures
Research as an ‘add-on’
“It was there: research. It was talked about but it was mainly thought about being done in your own time rather than in organisational time”.
‘We haven’t got time for research’
“The biggest barrier I have in terms of improving the services…is time”.
“We’ve got very good links with the therapy team now…which has developed which doing the…award. I’ve had the time to go and visit them”.

47. Management and Structures
Management, structures and roles: lack of opportunities and pathways in NHS
“Even though it would be ideal to have someone in a dual post, there is no money for it”.
“My influence only goes so far. I can put forward suggestions and case studies about what I think would be useful but ultimately other people make that decision”.

48. Management and Structures
Importance of supportive individuals/leaders
“If I was in any difficulty explaining it to my boss, [the head of research] would have been happy to support and help out”.
“The medical director…is very forward thinking…comes from a Trust where research was very high profile”.
“When I presented to the Trust, my boss came along… now [they] can see the value in it. [They’re] supporting me to do other things”.
Normalisation
“It’s about having people with those skills based within a clinical environment. To change it from within…you are just making that how things are. That takes ages”

49. A new initiative: Clinical Academic Fellowship
Clinical practice
Academic practice
Newly qualified nurses
Substantive posts in local trusts (LPFT, ULHT)
30 hours per week contracted to clinical practice
7.5 hours per week
Secondment to the University of Lincoln
Engagement in research activity and teaching opportunities
Opportunity to contribute towards papers for publication and presentations for national conferences
Establishing links between research projects and clinical practice

50. Clinical Academic Fellow profiles
Trish Tsuro
Emily Scott
Staff Nurse on a vascular inpatient ward - United Lincolnshire Hospital Trust
Contributing to work around a values based project on dignity in clinical practice and a project on self-management living with and beyond cancer.
Student liaison link nurse.
Staff Nurse on a male acute inpatient ward – Lincolnshire Partnership Foundation Trust
Contributing to work around Mental Capacity and DOLs standards and monitoring and assessing the physical healthcare needs of patients in inpatient settings.
Diabetes link nurse.

51. Being a Clinical Academic Fellow
Exciting, challenging and rewarding.
Opportunity to be part of a team that nurtures the development of good research skills.
Develops communication and organisational skills.
Networking opportunities.
Enhances the ability to become evidence and value-based practitioners.
Clinical practice enhanced because we think around our activities, the reasoning behind them and how they can be improved.
Opportunities for continued personal development. `

52. Challenges of being a Clinical Academic Fellow
Time – being a newly qualified nurse and managing the workload
Gaining managerial support and the support of clinical team
Travelling
Progression after the secondment year has ended

53. The research team www.lincoln.ac.uk
Dr Christine Jackson Dr Ros Kane Dr Ian McGonagle Emily Scott Trish Tsuro Heidi Green Holly Hamer Shona Maclean Funded by Health Education England: Working across the Midlands and East