Research (week 5 of 8)

The classic scientific research career is possibly based (unconsciously at least) on the work of individuals such as Newton, Einstein, Darwin or Freud, involving extended periods of research, reflection and writing in a broad range of areas leading to an increasing focus on some key novel and overarching principals and findings. In the case of Charles Darwin, for example, he famously spent five years in his late twenties aboard the HMS Beagle travelling the oceans of the world. He collected huge amounts of data from his observations of animal life and geology, in the form of writing, drawing and animal specimen collections. On returning to England he went on to spend several years longer studying humble little molluscs and other organisms in his own home-made laboratory. He wrote up, published and presented his findings all along. Ultimately, his careful scientific scrutiny, classification and writing, combined with an unintended push from Alfred Russel Wallace (who independently co-discovered the ‘theory of evolution’) led Darwin (together with Wallace) to together publish their grand theory in 1859 and assume their places in the great scientists' hall of fame.

Charles Darwin (1809-1882), English naturalist and co-discoverer of the theory of evolution by natural and sexual selection

Darwin's voyage aboard the HMS Beagle (1831-1836)

Alfred Russel Wallace (1823-1913), Welsh Naturalist and (sometimes overlooked) co-discoverer of evolutionary theory

Map combining the research travels of Darwin and Wallace 

In contrast to the heroic careers of Darwin and Wallace, involvement in modern psychiatric research tends (for most Psychiatrists) to be brief, painful, tedious, trivial and both unrewarding and unrewarded. Starting from this assumption, I would advise that you take a humble and pragmatic approach to engaging in psychiatric research. Think of the end results before you begin, i.e. you may be lucky enough to end up with a few lines of publications in your CV or, at best, an MD or PhD.

If you want to have a research career like Darwin, then stop reading this blog and go to a good university where you can do a very sciencey PhD and then start off on a pathway of several decades of poorly paid post-doctoral research with a university or (better paid) similar work with a pharmaceutical or medical devices company. Please note that you are still extremely unlikely to enter the stratosphere of Darwin, but you will at least be doing full-time ‘proper’ research away from the pragmatic world of clinical Psychiatry.

'I've done NO research!'

In preparing for movement up the different rungs of the medical career ladder, perceived weakness in the area of research causes a lot of undue anxiety among NCHDs in Psychiatry, as already alluded to in the blog on the CV:
https://psychiatry7trainingtips.blogspot.com/2020/04/your-cv.html

And while it is an advantage for interviews to be able to report a successfully completed piece of research or a postgraduate research degree such as an MD or PhD, the importance of research tends to be overemphasized by NCHDs and by Consultants who have been successful in and hence enjoyed this aspect of their career. In fact, in interviews for senior clinical posts, an overemphasis on research at the cost of neglecting to emphasize clinical aspects of career development may be detrimental. And interviewers for particular posts (some of whom are your potential new colleagues if your interview is successful) may be less than impressed at the prospect of working with someone who seems to be preoccupied to narcissistic levels with research to the detriment of good old fashioned honest and collegial clinical work and service development.

Also as already mentioned in the blog on your CV, while some experience of clinical research is helpful for overall career development, it has been my experience that research achievements rank low down in the priority list for interviewers for standard Consultant posts, but there will obviously be much more emphasis on your research record if you are applying for a senior academic post.

I have also alluded in the CV blog that for any research in which you have been involved, make sure to emphasize the ultimate outputs and remember the maxim ‘no research without action; no action without research’, i.e. your research should have important clinical implications and your clinical work should be 'researchable' or at least 'auditable'. Outputs should include academic products such as posters, oral presentations, papers, grant applications and grant awards. You should be able to describe the new skills you have developed from the research journey, such as the use of medical statistics, and the development of skills in literature review and critical appraisal of medical evidence. On the research journey you should also learn how to write clearly and ‘scientifically’ (perhaps for the first time) and learn how to communicate your ideas through poster and oral presentations. Most importantly, you should be able to highlight the clinical relevance of your research and how it has helped to improve patient care and clinical services. Finally, you should describe briefly how your research may have helped in the development of your clinical skills and everyday practice. For example, you may have used diagnostic tools or questionnaires in your data collection that have proven useful in your clinical practice.

So the next time you’re asked in an interview or on a plane journey about the relevance of doing medical research, go above and beyond the ‘bottom line’ and key findings from your particular project and list off the above additional ‘incidental’ learning from being involved in research.

Levels of exposure to research vary widely, from brief and peripheral involvement in a single small project right through to completion of an MD or PhD with associated publications in the medical literature.

The traditional MD or indeed PhD used to involve a Trainee taking a break from their usual clinical training posts and working as a full or part-time Researcher or Lecturer for a period of 2-3 years. Such positions often involved a number of clinical sessions during the week combined with the research project. The MD or PhD was ultimately achieved (or not) in a semi-structured way, through one of two ways. In the more conventional approach, the Trainee would write (and hope to publish) papers based on a literature review of the area of research interest, followed by a proposal for MD or PhD and any necessary application for ethics approval followed by an extended period of data collection (through e.g. clinical interviews, biometric assessments, etc.) and ending with a hurried write-up and submission to the university of their final thesis. The three hardbound copies of the thesis would then serve as dust gatherers on the shelves of the research supervisor, the researcher and the proud mother of the researcher.

In contrast, in more ‘structured’ MD and PhD programmes (traditionally more associated with training in Clinical Psychology), the research project is carefully planned out from literature review through to ethics approval, data collection, analysis and write-up, with the candidate submitting sections of their overall thesis in stages and thus avoiding the last minute rush. Each stage of the research project must be approved by a formal meeting with the research supervisor and relevant individuals in the awarding institute. These meetings serve as useful milestones and prompts for all involved, especially the researcher and the research supervisor. The intensity of the researcher-supervisor relationship is thus diluted and ‘chaperoned’ by the research board meetings, with the responsibilities of both individuals highlighted in the process. Therefore, the research project becomes less a vanity project for the supervisor and/or the researcher and more a collaborative piece of work with a beginning, middle and end. A disadvantage of this type of approach is that there is less flexibility on how the project is completed and less available ‘shortcuts’ for the candidate to take.

So when it comes to planning that ‘research’ part of your career and CV, consider your purposes for engaging in research and your estimated likely outcomes from the process. Consider whether you would like to be a ‘real researcher’ and aim for Darwinian heights or (like most of us) aim to do just enough to have a few paragraphs and discussion points for your CV and for interviews, while also learning some new analytical and clinical skills that will make you a better doctor in the longer term. I would then advise that you consider an area that you are interested in researching and link up with an established researcher or research institute and try and collaborate with them on a current research project or programme that relates to your interests.

Collaboration with an established researcher or research institute means that you may have the opportunity of coming in at a particular and discrete phase of the project (e.g. ethics application, literature review, data collection, analysis or write-up) and not have to plan and execute an entire project on your own from beginning to end. You will also have the benefit of supports from a multidisciplinary research team (e.g. different medical specialties, psychology, medical statistician, librarian support, IT support, etc.). Trying to embark on a big research project on your own or in a service setting that has no tradition or track record of research is likely to lead to a long, lonely and endless voyage (using the HMS Beagle analogy again) with a shipwreck before you get even close to the finish line. In contrast, being involved with an established research team means that you can have a limited but focused input into a project with maximal support and the opportunity to be credited on papers and other research outputs for years after you have finished working with the group.


So that's the research section done - next week, I will be writing about the importance and relevance of teaching experience in your development as a Psychiatrist...

And the upshot of all their travels, research, reflections and writing - 

the joint presentation of Darwin and Wallace at the Linnean Society meeting in 1858