Guest post by Michael Sykes. I ask myself, ‘OK, so you have had your NIHR Fellowship interview; regardless of the outcome, what have you learnt over the last couple of years that might help others?’. It is likely that I will look back at this in a few years and think how little I knew. Just as I now look at who I was when I first started my clinical academic journey all those years ago!
Nevertheless, here are some of the things I have learnt. Some are about the mechanics, some about the realities as I experienced them, and some about the more personal side of starting to thinking of myself as an early-career researcher.
Get clear about what drives you: As someone in a senior NHS management role with over 15 years of healthcare experience, I had many questions about the best way of providing care. Many of these could be easily addressed as quality improvement projects. The problem was that I was aware of the ‘fads and fashions‘ literature and knew enough about research to understand the limitations of simple quality improvement. But did I really want to become a researcher?
I sounded a few people out about this. Some were of the view that researchers live in universities not in the ‘real world’. Others were clinicians researching real-life clinical issues. The conversations with clinician researchers were great.They helped me on a practical level about the steps to take. Importantly, these conversations felt really supportive and encouraging. Whilst challenges were mentioned, the researchers spoke with passion about what they did, they described working collaboratively, and they universally demonstrated a burning ambition to improve care. This was enough to encourage me to apply for a Masters studentship and gain the support of my employer.
Even before starting my Masters, I had decided that the next step towards leading high-quality studies was through a PhD (and ideally a fellowship which supports development activities around the PhD). At this point I met a wonderful mentor who helped guide me through the application, including narrowing the focus, identifying a supervisory team, gaining appropriate support and generally being a supportive critical friend.
Decide what you are willing to invest: I had decided that I was willing to invest personally, both time and lost income through going part-time, in order to give myself the best possible chance of succeeding. I am not sure whether this is necessary, certainly there are successful clinician academics that haven’t gone part-time to get where they are. That said, for me balancing significant time to develop the fellowship application with family and with working full-time was fine; it’s just that I needed to sleep and eat too!
Choose your research area: Identifying broad areas of research in which I was interested was easy. That said, the research areas I identified were like fractals. It was possible to pull away from them and see new categorisations, or focus in closer and see further distinctions. I needed to decide between my areas of interest, so the question was, ‘what would I like to spend the early chapters of a clinical academic career focussing on?’. This was difficult because the cost of focussing was not getting following other research interests. But, the cost of not focussing was a lack of progress!
Choose your career direction: Reference to the early part of an academic career belies an earlier consideration. That is, whether I wanted to be a trained clinician academic leading my own research, or a clinician who works with academics to answer research questions. Both are needed and they are not necessarily mutually exclusive. After heart-searching and reviewing my self-concept, I went with the former. But it wasn’t an easy decision!
The next question was how to reach that goal? For me the steps to achieving that were proposed within the NIHR Clinical Academic framework. This meant building upon previous experience of being involved in studies by completing a Masters in Clinical Research.
Narrow your focus: Time to be blunt, can you name a PhD study which has changed the world? My early ideas were about finding the “truth” and making things better. Of course the goal should be to make things better, but realistically the PhD study will be one of a number of studies within a particular area which are indicative of something.
My advice would be to write down what it is you want to find out. Then file that under ‘career aspirations’… Or put it another way, come up with an idea for a study, half that idea, half it again, then break that question down into 3 or 4 studies, then take one of those studies and refine it into a PhD!!
Oh, and don’t become frustrated by this. Don’t think that people are being unambitious and don’t lose sight of the initial big career aspiration. These are the foothills you are walking in, the mountain is still to come! That said, the foothills are a good place to get ready for the mountain. So think, what are the skills you will need to climb it?
Decide what your PhD training is for: What type of a clinician academic do you want to be? One of the many pieces of guidance my mentor gave me was to ask myself this question. She illustrated it with the example of a technical expert who is brought onto a project for their specific skills (for example, in a particular method) and asked me if that was who I saw myself being, and if not then who? What role would I want to have in a team, what expertise would I bring? The answer to this shapes the focus of the PhD training. It also helps with the application narrative about where you are trying to get to and how the Masters / PhD supports this.
Make good use of the advice: As I shaped the proposal I got support from a large number of sources, including user and carer groups, the local NIHR Research Design Service (RDS), the NIHR Clinical Research Network (CRN), the Clinical Trials Unit (CTU), peer reviewers within the university, the university’s enterprise team in relation to intellectual property, and the university’s grant support staff.
All this advice is unquestionably invaluable, but so is a mentor’s guidance about when to seek it. Too late and the application won’t be submitted in time, too early and the advice may be over-whelming or not focussed on the later application. Also, when seeking advice, including with a supervisory team, be clear what it is that you are asking from them.
Keep going: Through the process of developing the application there were some real highs. For example, I was awarded funding to present my Masters dissertation at a couple of conferences (which also looks good on your application) and I got to present the proposal at a different university (which helped me look at the proposal afresh).
But there were also some lows. Getting drafts back with hundreds of comments can be a challenge and at times I confess to thinking that this suggests there is one correct answer when there are many different routes to solving an issue. Get over this, of course this is your application and if you don’t agree you should say so, but try not to be disheartened! Getting lots of comments shows that supervisors are willing to invest time in you, they see potential in you, and are helping you to produce a better application.
And I should mention another low. Being told that the application wasn’t ready for this submission deadline was unquestionably right, but let’s be honest, it didn’t feel ideal at the time. You may need to find a constructive way to channel that, I recommend taking up running!!
Seek to actively learn from your supervisors: As I worked with my potential supervisory team, I learnt a huge amount about how to shape a good application. Here is an outline of some key tips I picked up:
- Have clear aims in the PICO-style (population, intervention, comparison, outcome) and make the objectives specific and outcome focussed (as opposed to describing the method). The methods will fall out of these, so spend time getting them right. What is it you are really seeking to find out? I note that this can be a challenge when balanced with the PhD as a training vehicle which might well be training in a particular method.
- When writing the background, this is not about educating people, so choose the correct tone and avoid long quotes.
- Make the protocol coherent, from background through aims to method and analysis… and don’t introduce surprises later on. Specify and justify the methods, for example, say how many interviews, with whom, how they were selected, the content of interview, the type of interview, and the method of analysis and why this is how it should be done.
- Be consistent with the language within your application, basically always call the same thing the same name.
- Make the Plain English Summary PLAIN! Using a Flesch score or similar will help, as will getting others to read it.
- Have a timetable describing different stages in the application process. Set deadlines for when drafts will be distributed, and have realistic and agreed timescales for response. Be clear on when you’ll need statements or input from others, as well as the steps and dates in the sign-off process.
- The sign off process has many steps, some hidden. Speak with your Trust and the university to make sure you know what must be done. Be realistic about timescales for each step, your application is one of a hundred other priorities that people are dealing with.
Keep going some more: Remember why you are doing this and, as the cliché goes, don’t forget that nothing worthwhile is easy. Thank anyone who helps you, and then WHEN you succeed, help others.
So there it is, my best advice. A document to make ‘future me’ cringe! And in case you were wondering, somehow I managed to succeed at interview. I am tempted to say it was the bringing together of wool and eyes, but actually it was the result of a lot of hard work, perseverance and a great deal of wonderful support!