Mind the gap…

I did an editorial recently for the Aspetar Sports Medicine Journal called ‘divided we stand‘ you can read it here. In this piece I give my thoughts and opinions on some of the issues of trying to get research implemented into practice. In particular I discuss the barriers and divisions that I’ve encountered between academics and clinicians working together. This has created a lot of debate and discussion which is exactly the reason why I wrote the piece. However, unfortunately most of this debate has been focused around my tone and so called offensive style rather than the issues I raise, with accusations of me having an agenda, being negative, even being anti academic.

First things first I am NOT anti academic, but I am anti egotistical, anti hierarchical, and anti progressive by not being able to highlight issues, ask questions, or challenge ideas. I appreciate that my views can and do agitate some, and this is fine, but to complain about my tone or to personally accuse me and my motives is failing to stick to the points I make which is the continued gap that exists between most academics and clinicians working together better.

It appears that those who have taken the most umbrage with my editorial are those who have very enviable positions, the so called ‘clinical academics’. These individuals have managed to achieve with lots of hard work, heaps of determination, and I’m sure a little bit of luck, some fantastic job roles which are able to combine research and clinical time. These roles are usually a split between paid research/teaching time, usually attached to a university or other academic insitution and paid clinical patient contact time.

However, these job roles are rare, and the individuals in these roles do appear to have a rather skewed view on what is happening outside of their utopia. I have no doubt that they do see good, close, effective, productive, rewarding working relationships between academics and clinicians which is great, but again I will state, these are rare!

Most academics are full time!

Most academics I know don’t do any clinical work. Most academic posts focus on teaching and researching, and in my experience most academics go into teaching and researching to ‘escape’ from patients. Having talked to many full time academics about clinical work and if they miss it I usually get a reply of “oh hell no!”. Most academics I speak too are usually tired and frustrated of clinical work and have no intention of ever going back either due to the workload, financial constraints, the enviroment, or the lack of results and outcomes, and I can understand this.

But thats not to say all academics are this way inclined. Some are still seeing patients and enjoying the challenges of clinical and research work as well as helping and supporting others do the same, such as Christian Barton who describes what he does in his recent blog in response to my editorial here. And this gets nothing but my utmost respect and admiration, but again I will state that this is in my experience not common place.

Most clinicans are full time!

Most physiotherapy clinics in the national health service and in private practice employ physios to do one thing. See patients. That’s it! The ever growing demands on hospitals and physio clinics mean most employers want their clinicians assessing and treating patients when ‘on the clock’. Most employers do not want their clinicians reading, researching, or doing what is usually seen as frivolous, fruitless, fannying about with no financial gains or reimbursement during their time.

So I will say again just as I did in my orginal editorial that it is these key environmental and personal differences between academics and clinicans that are the big barriers to our future progress of trying to implement research into clinical practice. But this needs to change, and yet again this is why I also wrote the editorial. What we do need is more of these clinical academic posts, we need more paid, well supported clinical academic posts to help implement and push research further and faster into practice!

The usual clinical academic!

Currently if a full time clinician wishes to do some research the reality is they have to do it in their own time, using their own resources, without getting paid. And many, many do this. Me included. I have over the last few years been dabbling in some clinical research, and its been hard work. Now it’s not that I expected it to be easy or a walk in the park, I knew I would have to sacrifice some time, some money, and some energy to do this, I just wasn’t expecting how much. For example just to get one ethics board to review one submission was over £1500, and I estimate I’ve worked over 200+ hours unpaid, not to mention the countless late nights and weekends sat at my desk reading, researching, missing out on family and other social time.

I also wasn’t expecting many of the other barriers I came across, such as being ignored by some academic institutions as well as by some well respected academic individuals when I reached out for some help and guidance, even receiving a few short sharp flat out refusals from some.

In a nutshell

So when I was approached by Aspetar to write something on the issues around the difficulties of implementing and getting involved in research I thought this would be a perfect opportunity to highlight the issues I have faced. In a nutshell I try to point out in my editorial some of the flaws in some of the academics I have come across. Things such as being too analytical, too hierarchical, too busy to help clinicians do research. I also highlight some flaws in some of the clinicians I have also come across, such as being to lethargic to get involved in research, having poor understanding of the scientific principles, too busy to look up from constantly treating patients and realising things need to change.

I also discuss some of the barriers that these two groups have in working well together such as difficulties in communication, lack of time, resources, and funding. Finally I finish off by saying lets get our shit together, put aside the egos and hierarchy and start working together better. That’s it.

In general my editorial has created a lot of positive feedback mainly from the clinicians with many sharing their own frustrations and stories of issues and barriers they encountered when to trying to get involved in research. However, there has also been a quite a lot of complaints mainly from the clinical academics. They seem to think I have gone and created more barriers with this editorial and that the piece is harmful to generating and promoting future collaboration. What a load of crap! Highlighting issues and suggesting ways forward in my opinion doesn’t hinder progress. Bitching, moaning, and complaining about tone and offensive style whilst burying your head in the sand and refusing to accept or listen to others experiences does!

So in summary… “Rome wasn’t built in a day” is a saying that is often used to describe these issues between academics and clinicans, and I totally agree. Change and progress does take time, but we need to ensure it doesn’t stagnate by highlighting issues and barriers that some are having in trying to get involved research. So although Rome wasn’t built in a day, do not complain when someone tries to tell the builders to get a move on!

As always, thanks for reading

Adam

 

16 thoughts on “Mind the gap…

  1. Seriously another great blog, encapsulates some of my thoughts for the week. Busy on the treadmill of seeing patients, thinking how is it possible to keep up to date with everything research and evidence wise, then thinking maybe I should just move into research! Deffo need to bridge the gap, would love a strategy from the CSP to broach this.

  2. Sweet retort!! Right on the money. I chatted to a friend this weekend applying to submit a PhD application, who highlighted the barriers he’s faced getting research accepted and funded also. He’s even thinking about not doing it he’s so disillusioned with the whole process. Hope the luggage has turned up somewhere!

  3. Hi Adam,

    I’m surprised it has taken this long for me to be forced into commenting on your popular blog. If you will allow me, I would like to clarify a few things which I feel are not being given a fair crack of the whip.

    First off, no-one (well, certainly not I) was criticising your tone or your so called offensive style rather than the issues that you tried to raise. Rather, we were suggesting that perhaps the barriers that you describe are unique & individual to you, as opposed to being barriers that all clinicians would face when attempting to get into research. As evidence for this, I am yet to see anyone come forward to state that they personally have been spoken to in a condescending manner by an “academic”, or that they have been ignored when reaching out to a university for support with a project. If there is anyone else out there who has experienced such negativity, I would encourage them to come forwards.

    I cannot try to explain (nor do I condone) your experience of being belittled by an academic, but with regards to why you have found some institutions less than keen to collaborate with you, I feel there may be some reasons for this. You champion your “unique” approach to Physiotherapy (“views my own, often strong, and will eventually upset you”) and perhaps, just perhaps, this does not endear you towards certain individuals. You are vocal about your resistance to complete further academic study, how do you think a University may feel about this statement coming from someone with such a wide reaching voice? Overall, I feel if you perhaps go about things in a different way, you may experience altered results. You may disagree.

    Secondly, your comments around my utopian clinical academic role. To quote you: “these roles are usually a split between paid research/teaching time, usually attached to a university or other academic insitution and paid clinical patient contact time’. First off, my PhD is self-funded. I am grateful to Dr Dylan Morrisey for covering my tuition, and to Pure Sports Medicine for supporting me with time, but in essence, unless I secure a a research grant, 1.5 days of my week are technically unpaid. I am also a (near) full-time clinician, with a clinical diary that is open for 30 hours each week. Now I am not complaining, but I am not sure I would describe this as a utopian experience. Thank you for recognising the hard graft that goes into developing & maintaining such a role though, it is much appreciated because it is, as you correctly describe, rather hard work.

    I am not suggesting that there are not barriers to research, because there are. In my experience, the primary ones are funding and time, and these plague full time academics, clinical academics and clinicians in equal amounts. But, there are solutions that can be found and I would encourage any clinician who is considering a move into the field of research to bite the bullet and go for it. It is remarkably rewarding.

    Thanks for giving me the audience.

    Brad

    • Hi Brad, I’m honoured that you decided to lose your blog virginity on my little site! Does this mean we are dating now?

      Anyway thanks for your comments, you make some good and fair points, and yes as I said I am aware my direct, strong views and style do rile people and institutions, so be it, if it takes some tree shaking and feather rustling to stir people into action and start talking about stuff then I’m all for it!

      However I know my issues of running into academic dogma, hierarchy, pompousness, red tape etc is not an isolated experience, many have come forward to me and shared similar stories, they just don’t want it publicised due to fear or reprisals etc!

      As much as I want to believe that some senior academics are open and willing and happy for discussion, debate, critique, my experience is many are not! Just as many senior clinicians are not!

      We do seem to be focusing on one area of the gap between clinical and academic work at the expense of ignoring the other more important areas just as you mention, time, resources, funding… it is these things that we should be pushing for from our professional bodies, government, learning institutions etc.

      Let’s leave the petty squabbling aside and close this gap and get more physio’s into research, or at least reading the bloody stuff!

      Cheers

      Adam

  4. Love this blog! As a young University prof (University of the Republic, Uruguay) but willing to start doing some good quality research, I find it so difficult to find help in this issue from others academics, even from other professions. I know this is an english speaking blog but some problems are worldwide ones and maybe their solutions would fit everywhere at least partially. Also I apologise for some mistakes in orthography or sintaxis as I’m not very used to use my written English, apart from some FB chats with other collegues and friends.
    Cheers!

  5. Nothing controversial for me here Adam….I’m with you all the way. On a slight tangent, two observations I have about our profession ; 1) at grass roots it’s rarely evidence based…we talk a good game but if some research comes out that inconveniently disregards something we’re accustomed to doing then it is ignored. After the NICE guidelines for LBP no-one I know has dropped acupuncture as a treatment. In short, we cherry-pick, 2) we are culturally backward…we say ‘I prefer..’ or ‘we always done it this way…’ rather than putting the patient first…again, much back peddling when this is suggested but it’s not in a clinician’s DNA…it’s more about ‘doing things to people’…very depressing. I propose a placement at John Lewis for all graduates. That’s it. Good read as ever Adam. Cheers, G.

  6. Dear Adam,

    I’m another person who has never responded to a blog before…a total newbie at this!

    I understand you’re speaking from your own experience but it’s so different from mine that I just wanted to provide another perspective into the mix? I first became a clinical academic many years ago when I caught the research bug after my (self funded , on top of my full time job) MSc.

    I certainly didn’t/don’t want to avoid patients. I’ve worked in teaching, research and clinically in various combinations over the years. For me, I can combine 2 of the 3 pretty well but all 3 + “life” simultaneously brings me pretty close to burn out pretty quickly! I work in research on a clinical Trust site. At the moment I combine this with supervising post grad AHP research students at a Uni. But I don’t recognise the clinical academic you describe? I didn’t take this post to avoid patients and I’m lucky that my research is based at an NHS Trust and I regularly see patients as part of my research. This also means that clinicians and researchers work together at the Trust to ensure that we explore/answer questions relevant to patients, and work together to bridge the research-practice gap. This seems a win-win situation for me.

    I took this academic post because I’m really keen to help new researchers develop and to try and give them the best research training I possibly can. In the same way that I’ve previously tried to help students/staff develop their clinical skills. I earned more as a clinician too so my choice wasn’t financially driven. Like many researchers I gave up a secure NHS clinical job and continually need to bring in grant income. I’m a researcher because I wanted to be able to answer some of the questions I kept having as a clinician and to help improve patient care. I miss having a clinical caseload. As a clinician, researcher and teacher I’ve had the same aim – to continually try and improve the care for my patients, directly in 1-1 treatments, by contributing to the evidence base and to equip new/er researchers to do the same. I’ve worked with some truly outstanding clinicians, researchers and academics –and majority of physio clinicians, researchers and academics I’ve worked with have all had the same commitment to patients, students and staff. I’m sorry your experience hasn’t been the same…

    Thanks for reading this,

    Catherine

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