I wrote an editorial for the Aspetar Sports Medicine Journal called ‘divided we stand‘ you can read it here. In this, I discuss barriers and divisions that I’ve encountered between academics and clinicians working together. This has created a lot of debate and discussion and is exactly the reason why I wrote the piece.
However, unfortunately, most of this debate has been focused around my so-called offensive style and tone rather than the issues I raise, with accusations of me having an agenda, being negative, even anti-academic.
First things first, I am NOT anti-academic. But I am anti-egotistical, anti-hierarchical, and anti-progressive with those who try to prevent others from highlighting issues, asking questions, or challenging ideas. I do appreciate that my views agitate some, but to complain about my tone or to accuse me of ulterior motives is a diversion from the main point I am making 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 academics and so-called ‘clinical academics’. These individuals have managed to obtain some fantastic job roles which are able to combine research and clinical time.
These roles are a split between paid research and teaching time, usually attached to a university or other academic institution, and paid clinical patient contact time.
However, these roles are rare, and the individuals in these roles appear to have a rather skewed view on what is happening outside of their utopia. I have no doubt that they do see 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 don’t do any clinical work. Most academics 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!” or “not at all”
Most academics I speak too are usually tired and frustrated of clinical work and have no intention of going back either due to the workload, financial constraints, the environment, or the lack of results and outcomes, and I can understand and empathise with this.
This is not to say all academics are this way inclined. Some do still see patients and enjoy the challenges of both clinical and research work as well as helping and supporting others do the same. And this gets nothing but my utmost respect and admiration, but again I will state that this is not common.
Most clinicians 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 or fruitless with no financial gains or reimbursement during their time.
So I will say again just as I did in my original editorial that it is these differences between academics and clinicians that are some big barriers to the future progress of trying to implement research into clinical practice. This needs to change, and yet again is why I also wrote the editorial.
What we need is more clinical academic posts, we need more paid, well-supported posts that 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. Myself included. I have over the last few years been dabbling in some clinical research, and its been hard work.
It’s not that I expected it to be easy or a walk in the park, I knew I would have to sacrifice time, energy, and some money to do this. I just wasn’t expecting how much. For example just to get one ethics board to review one submission of a trial I was working one last year it was £1500. 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 wasn’t expecting many of the other barriers I also came across, such as being ignored by some institutions as well as by some well-respected academics when I reached out for some help and guidance, even receiving a few short sharp 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 what I have experienced.
I try to point out 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. But I also highlight some flaws in some of the clinicians I have also come across, such as being too lethargic to get involved in research, having a poor understanding of the scientific principles, and being 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. And I finish off by saying let’s get our shit together, put aside the egos and hierarchy and start working together better.
This has created a lot of feedback 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 quite a lot of complaints mainly from academics who seem to think I have created more barriers with this editorial.
I just think this is nonsense from a few bruised egos. 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!
Summary
“Rome wasn’t built in a day” is a saying that is often used to describe issues that take time to resolve. Change and progress takes time, but to move forward we need to highlight issues and barriers. And although Rome wasn’t built in a day, there is also another saying “there are many ways to Rome” to highlight that if current progress is stalled, take a different route!
I don’t know about you, but I’m ready to move forward and take another road because the one we are on doesn’t seem to be going anywhere.
As always, thanks for reading
Adam
Did you get challenged by academics ?
Sent from my iPhone
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Yes!
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.
Thanks Kaye, and yes I do think the CSP should be doing more to support clinicians looking to do/get into research!
Don’t be scared of contacting researchers. http://semrc.blogs.latrobe.edu.au/united-we-stand/
No one should be scared… but they should expect either no reply or refusals! But hey this is no different than anything in life hey Chris?
No reply I would consider rude. Refusals may not be best term. Take good ideas and willingness to work together and likely response will be positive
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!
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
Nailed it!
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!
Hi Rodrigo
Thanks for your comments and your English is perfect, better than mine!
Cheers
Adam
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.
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
Thanks for sharing your views and insights Catherine!