Out of Programme Time: Maintaining Clinical Skills
There are many reasons why trainees choose to take time out of programme (OOP). Examples include the pursuit of further education and scientific research or to take advantage of teaching opportunities. This benefits the profession by enriching the experience and aptitudes of trainees, ensuring we have a diverse range of skills in our future consultant body. However, anyone who has taken time out of clinical training will know how quickly the routine of hospital life and work becomes unfamiliar. Additionally, medical practice is constantly evolving with new pharmaceutical products and clinical guidelines regularly introduced.
The provision of excellent, up-to-date, safe and dignified medical care to older people should always be at the centre of our working lives, however diverse our future roles may be. Thus, the potential decline of clinical competency whilst out of programme may concern some trainees and present a barrier to considering a PhD or other project. To enable trainees to overcome this barrier it would be useful to have a clear idea of what the national training colleges and post-graduate medical deaneries expect of trainees, who need to maintain clinical skills whilst focusing on academic or other non-clinical interests. It would also be informative to have an idea of the strategies adopted by others who have taken time OOP.
Keeping to a research timeline
By the time trainees come to conducting a research project or undertaking a full time research position the chances are they will have been effectively managing their time for a number of years. So why does time management, efficiency and keeping to schedule become such an issue for those undertaking research? We often hear about fellowships terminating without the candidate having written up the project and the problems of attempting to complete a thesis having returned to full time clinical work.
With the inevitable freedom that comes with full time research also comes the considerable likelihood that time will be wasted! This can be due to numerous factors but working in an organised and efficient fashion will pay dividends in successfully completing any research project, no matter how big or small.
In any research project there will always be factors beyond our control. This is inevitable. However, trying to anticipate and mitigate against such delays is part of successful project management. People will develop their own ways of working, which will depend on other commitments, the type of project, the culture of the host institution and personal preferences. However, there are generic skills that can help when trying to stick to timelines. These skills are invaluable when combining clinical work with research, teaching and other commitments in future careers.
Increasing participation of older people in research - cmRCT
Andy Clegg, Senior Lecturer at Leeds University and Consultant Geriatrician at Bradford Royal Infirmary, describes how use of the innovative cohort multiple randomised controlled trial (cmRCT) design may help increase participation of older people in research studies.
There are many challenges involved in recruitment of older people to research studies, particularly randomised controlled trials. Study exclusion criteria and refusal rates are a major issue and the presence of cognitive impairment and ethical decisions adds complexity. Concerns with study information and consent procedures are the most common reasons given for not participating in clinical trials. Understanding and weighing up the complex information about randomisation and control groups is not easy, particularly in the presence of sensory and cognitive impairment.
An extra problem in many randomised controlled trials is that it is not possible to achieve blinding of participants and assessors. This can mean that participants randomised to the control arm may be disappointed and perform less well in assessments or may be more likely to drop out of the trial. Additionally, if assessors are unblinded this may influence decisions when performing assessments.
Getting off to a good start
This article is for those who have secured funding to do a research project (e.g. for a PhD) or who have dedicated time to spend on a project. Here we look at looks at the kinds of challenges you will be faced with and offers advice on how to get off to a good start.
You may be lucky and have a desk, computer, filing cabinet, email account, and so on, all set up when you arrive. But if not, ask. Supervisors' secretaries and even your supervisor will be happy to help you with the practical side of things, but probably won't come looking for you to tell you. The key here, as with research life in general, is that you need to be proactive.
Understanding your project
At the beginning it can be tempting to plough straight into the practical setting up and data-gathering part of your project. However, in parallel with this it is also extremely important to spend time getting a full understanding of your project. This means ongoing reading around the field such that you are familiar with the main studies, the methods used (including advantages and disadvantages of each), the controversies and the unanswered questions. Although some of this will have been covered in writing the funding application (if there was one for your project), the depth required for the thesis is greater than this.