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|The Path to Research|
What’s the attraction of research?
There has never been a more exciting time to be involved in neurology research. As clinical trainees we are entering the profession at a time of unprecedented progress. There has been an explosion in the number of treatments we can offer, including disease-modifying drugs in MS, thrombectomy in stroke, and gene silencing in spinal muscular atrophy and potentially in Huntington’s disease (to name just a few). This is the result of both basic scientific and clinical trial research, much of which has been pioneered in the UK by clinical academics working alongside basic science colleagues. As a consequence of these and other high-profile studies, neurology patients are better informed about novel treatments and participating in research; as a treating clinician, you are likely be approached with questions relating to these and other research-related issues.
Spending time in research is valuable regardless of your ultimate career path. Learning these techniques as well as the immersion in cutting edge research and critical thinking directly benefits clinical practice throughout your career. An understanding of research governance (including “Good Clinical Practice” in research) is essential when providing guidance for patients interested in participating in clinical trials, including those co-ordinated by other clinicians and centres. Your clinical practice will also drive the formation of research questions, ethical study design and implementation.
Do I need to do research?
Neurology has always had a high proportion of trainees taking time out of training to pursue higher degrees. The 2017 ABNT census showed that 64% of trainees have completed or are undertaking a post-graduate degree; a fifth had completed or are undertaking an academic clinical fellowship and more than one in 10 pursue further academic training in an academic clinical lectureship. The overwhelming majority (88%) found these experiences valuable.
However, with changes in the demographics of the medical profession, changes in the models of service delivery (particularly a need to have more general neurologists outside of neuroscience centres) and changes in post-graduate medical training, it may not be as crucial to have a research degree in order to secure a consultant job.
Without detracting from the value of being the consummate neurologist, becoming an expert in a particular neurological condition or investigation technique (for example neuroimaging, or body fluid analysis) through a period in research is richly rewarding and benefits your colleagues. Acquiring generic research skills has further benefits for patient care, for example being able to critically interpret clinical trial data relating to treatment or prognosis.
Not everyone who undertakes research will go on to lead their own group. The core personality trait for the successful clinical academic is a deep sense of curiosity and a passion for finding things out. As a clinical academic consultant, there is a far greater degree of personal autonomy compared to a full-time NHS contract. However, in order to maintain your academic contract there is often a need to secure personal funding for your role through grant applications, and a secure (tenured) position may take longer to achieve. Conversely, modern service pressures mean it is no longer realistic to anticipate ring-fenced time for research within the job plan of a standard NHS consultant contract. It is not impossible to carve out meaningful time for research from an NHS post, but undoubtedly rare.
What kind of research is available?
There is a huge variety of research. It is typically disease-focused (e.g. MS, dementia, stroke), but there are opportunities to engage from “bench” (laboratory-based neuroscience, for example at the cell biology or genetic level) to “bedside” (more directly applicable clinical research, for example participation in multicentre therapeutic clinical trials or biomarker studies). Recently, there is growing interest in using artificial intelligence and other computational techniques to analyse “big data” in neurology (for example, data from whole genomes or large population-based epidemiological studies). Being drawn to a particular technique primarily is fine, but the disease area will define the wider perception of your later career expertise to a large extent.
When can I do research?
If you are interested in a period of dedicated research time, this can be done as an Out-Of-Programme (Research) venture, or can be done between CMT and ST3. The routes into research on the new (post-Shape of Training) pathway will become clearer as the Internal Medicine Training programme takes shape.
Research can be done for short periods or as a dedicated period of post-graduate study. MPhil (usually 1 year), MD (usually 2 years) or PhD (usually 3 or more years) of full-time equivalent study are available. It often possible to augment your clinical training by spending time in (sub)specialist clinics throughout your research time. Many clinical academics are able to travel widely attending and presenting their work at international conferences.
It is also possible to do research as part of the NIHR Integrated Academic Programme, which funds Academic Clinical Fellowships, usually at ST1 and ST3. These are training posts that include 25% protected research time, and provide an opportunity to try out different research groups.
If you are not sure about committing to a period of dedicated research time, there are other “on-the-job” ways of getting involved in research to see if it is right for you. Is your hospital participating in any clinical trials, and can you be involved (specialist research nurses are often a good source of information on these)? Is there an opportunity to answer a research question that has come up during your practice (for example, by looking at clinical data, or by systematically reviewing data that has already been published)?
How is a research degree funded?
Typically, a research fellow is paid an un-banded salary commensurate with their NHS scale point. This might be through an existing grant held by a Principal Investigator, being employed by a university as a clinical research assistant, or through a personal grant award. Remember that you will need funding for your salary as well as “consumables” (i.e. money to do the research itself).
The ABN is proud to support several Clinical Training Research Fellowships every year. In addition, there are schemes through the Medical Research Council, National Institutes of Health Research, Wellcome Trust and other funding bodies (for example, disease-specific charities such as the Stroke Association, or Alzheimer’s Research UK).
What should I look for in a research job?
There are a range of posts available, from 1 year clinical research fellow posts (these are often attached to established clinical trials) to 3 to 4 year posts designed for achieving a higher degree (MD or PhD). It is useful to have an idea of what you hope to get out of the post - for example, are you looking for an introduction to a particular technique, research group, or clinical trial type - or a period of formal study? Shorter 1 year posts can sometimes lead to longer studentships. If there is a particular area of research that interests you, it’s often a good idea to approach the group leader or principal investigator (PI) - they can speak to you further about their research, and give you a sense of what opportunities are available. It may also be possible to shadow current clinical fellows, which can help you get an idea of what your working day will involve.
If you’ve found a position that you think sounds interesting, there are several factors you should explore before you apply. Meet the proposed supervisor face to face. It is very hard to succeed if you don’t fundamentally gel with them, no matter how eminent they appear. Other questions to consider are:
What’s the process for applying for a clinical research post?
First of all, decide if you want to join an existing study, if you want to join a studentship programme (a more formal programme through a university, usually 4 years where the first year consists of rotation round different labs), or if you want to gain a fellowship that would allow you to develop your own research interest under the supervision of a senior researcher.
Universities often have a jobs website which will advertise positions in that institution. Speak to colleagues, especially other academic registrars or consultants, as they may know of current or impending vacancies. The ABN annual meeting has a dedicated session showcasing research activity across UK centres and is a great place to network. www.jobs.ac.uk has a search function for PhD positions. Most funders now have social media accounts (for example, Twitter) and may make announcements about upcoming posts using these.
If you are considering applying for a fellowship, look at the research pages of the ABN website, as well as other funders such as the MRC, NIHR and others. For this you will need to find a supervisor who may be able to guide you through the application process.
Gargi Banerjee: firstname.lastname@example.org - ABNT Research Representative.
Martin Turner: email@example.com - ABN Research Chair