Ranjita Dhital is a Community Pharmacist and PhD student at King’s College London and is currently writing up her part-time mixed methods PhD investigating the feasibility and effectiveness of alcohol brief intervention in community pharmacies.
I recently attended the National Institute for Health Research’s (NIHR), One-day meeting for Current and Aspiring Nursing, Midwifery, Allied Health Professions and Pharmacy Researchers, in London and I was encouraged by colleagues at the Royal Pharmaceutical Society to share my thoughts on the day. I’m currently writing up my part-time mixed methods PhD investigating the feasibility and effectiveness of alcohol brief intervention in community pharmacies which has became a rather large PhD (three exploratory and feasibility studies followed by the first RCT http://www.biomedcentral.com/1471-2458/13/152).
I left the meeting with positive thoughts and ideas for the future. I was particularly struck by the presenters’ stories of, ‘how I got here.’ These stories were vivid accounts of their personal journeys and the challenges they experienced and I found they resonated with my own experiences. Most had become pioneers in their field and had overcome a range of hurdles along the way. Interestingly there was a common thread which linked most of their accounts; they had embarked on research whilst working in clinical practice. They had questioned current practice and identified, though research, solutions to improve patient and public health. In other words they were passionate about improving the well being of the public through research.
The meeting stimulated many ideas for me and I’ve listed a few points below, some are based on my own experience:
The challenges of combining research with clinical practice
A few presenters at the meeting expressed they didn’t have a choice to combine clinical work with research. They instead had to give up their clinical careers in order to pursue their research interests. This also holds true for me. A few years ago I had to give up my permanent post at a mental health trust (even though I had secured funding for my time whilst I was going to be involved in research). It’s depressing this is still happening. I hope NIHR are able to do more to change culture within middle management? So NHS clinical teams have more understanding and awareness of the important impact of research. Especially as a lot of NHS services and professional/clinical training are not evidence based.
Clinicians are close to the research ideas
I believe the best health research ideas often come from clinical practice, especially through working with patients and the public. This was my story. I had the idea for community pharmacists to deliver alcohol brief interventions to their clients whilst I was working as a newly qualified community pharmacist and undertaking a post-graduate primary health care diploma. I thought this intervention could potentially prevent alcohol problems in the future and create a new public health role for pharmacists. I was able to develop this idea into a piece of course work for my diploma and a couple of years later a research project for a masters degree. I later embarked on my PhD to develop this idea further. So for me it all started whilst I was in clinical practice and linked with a research institution.
Overcoming personal challenges and harnessing what is unique about me
Whilst on my PhD programme I’ve experienced many challenges. Only a couple of years ago I found out I was dyslexic (with some dyspraxia symptoms). I’m almost severely dyslexic. I decided to get a diagnosis with the disability team at my university as I found academic writing difficult. I have most difficulty with sequencing information when trying to write. But, since my diagnosis, I’ve received ongoing support from my dyslexia tutor and PhD supervisors. I’m still trying to understand more about my learning difference. Research funders, like the NIHR, should be aware that individuals who are beginning their research journey through a clinical route may have undiagnosed learning challenges, such as dyslexia. For me this remained hidden for many years and made the early stages of my PhD more painful than they should have been. All dyslexics have unique learning profiles and being dyslexic has nothing to do with intelligence. I would personally find it very helpful if more academics ‘came out’ about their dyslexia or if there was a support network. I’m now finding there are also unique advantages to being dyslexic and undertaking research, despite challenges I face with this every day.
Having heart, tenacity and a thick skin!
Early on during my PhD, especially when presenting at pharmacy related conferences and meetings, members of the pharmacy academia and pharmacy professional education teams would sometimes be baffled by my ideas. Some did not think the public nor pharmacists would be interested in alcohol brief intervention. In spite of this I persevered and this forced me to find allies outside my ‘group’. This was a good thing, as I became part of an international network of alcohol brief intervention and became linked with diverse groups of academics/clinicians (but initially I had to do some convincing work with them too). I know this networking has benefitted my PhD. However, I hope that in the future professional groups (from academia and practice) are able to more readily embrace new ideas; are able to see the big picture. This would have been particularly helpful during the early stages of my PhD, as I’ve now developed a thicker skin! Yes, I didn’t know if my pharmacy intervention would be feasible or effective, that was why I was undertaking a research degree.
Widening the opportunities for clinical-research careers
I also think funders, such as the NIHR, should further consider the unique challenges faced by clinical practitioners (which invariably differ from those embarking on research after their first degree):
- Permit those with Doctorates in Health Care or Professional Doctorates (e.g. the DPharm) to enter NIHR’s Clinical Academic pathway (not just those with PhD’s or going through a conversion route). Those who have chosen to undertake a DHC are involved in research and practice – I would have thought these would be individuals the NIHR would want to support?
- Currently the NIHR award competition is held once a year. Maybe increasing the frequency to twice a year to encourage those working in clinical practice to manage their work and research with less uncertainty; allowing individuals to plan their time more effectively.
- Regularly consult with those who are newly involved in research and clinical practice to share their experiences and ideas. Especially if NIHR plan to make changes to the funding schemes, for example, forming a working group to collect experiences and ideas would be helpful.
I’ve recently started working as a part-time community pharmacist, after a gap of a few years, and am finding clinical practice enjoyable. Seeing, first hand, how my research could be implemented in practice is particularly rewarding. This was how I originally became interested in research, through observing clinical practice whilst working as a pharmacist. I feel optimistic about the future and support the values and ideas expressed by the NIHR at the meeting. In addition, I’m enjoying my research journey and have found it to be a transformative experience.
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