Dual nationality as a clinical researcher.

(Image from http://www.europealacarte.co.uk/blog)

 

So just to clarify- I do already hold dual nationality. As I was born to a German father and a British mother I hold two passports. So being both researcher and clinician should be a breeze right!? I’ve been used to dealing with identity crisis since some football World Cup final when I was still at primary school (not sure which year or who won – so can’t have been that traumatising!).

However, I do sometimes wonder if being a research clinician makes me a bit of a pain for both researchers and clinicians alike. On the one hand I am a speech and language therapist who has worked with people in the NHS for yonks so I consider all research through these tinted spectacles. I ask questions of my research colleagues such as:

What are the clinical implications?

Is it going to have a direct impact on people and the health service?

Will it improve service provision?

How is this important in the ‘real’ world?

On the other hand I am also an SLT doing research- I have gone to the ‘dark side’ and am concerning myself with research methods and technical things. I am no longer in the trenches, nor on the front lines of the NHS. I am at UCL trying to push the mission from behind, to strategise with the other researchers. This also means I ask SLTs questions such as:

Could you write that piece of work up?

Have you thought of doing some research on this?

Would you consider helping me with my research?

Would commissioners look at that as useful?

I am frequently aware of my ‘dual nationality’. And although I may be annoying I have also realised the doors that can open much more easily with this status. I already carry a title of SLT. It gives me some credence in a health research arena. I have been able to transfer many skills- learning to communicate with consultant medics, nurses, administrators and family members can be applied to professors, lecturers, administrators and participants. I am also able to explore my future dynamically. I am missing my clinical work (I currently have small children and have decided to focus on juggling studies with home and not adding clinical to the mix for now). However I am looking forward to exploring a future where I can be both researcher and clinician. How exciting to have this other avenue of my career to explore- a world of different opportunities.

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Seizing the day (and the blog post)

I was recently reminded of the fact that at some point my NIHR doctoral research fellowship funding will finish. I am just shy of being half way through my PhD – I have just over two years left and after that I’ll be done. That seems like a long time but really the first 22 months have flown by so I am sure the next 26 months will too. I started thinking about my NIHR application around 2 years before I commenced my studies. Per se I should probably be starting to consider my  post PhD future around now.

I have a couple of friends who have just finished their NIHR fellowships. They have almost completed their PhDs (wow!) and are heading back to clinical roles. Their advice? Well they recommend seizing all the opportunities you have – going back to an old job can be tricky. But going back to an old job with new ideas, new skills and projects can enthuse, invigorate and rejuvenate you, your colleagues and your future research prospects. They have recommended I do this by seizing any opportunities offered on my PhD journey. On this journey there are many interesting and exciting opportunities – some rather scary and new. But their advice has been jump in.

The opportunities I have encountered have included networking with amazing people, speaking and presenting, attending conferences and training and blogging. There have been other opportunities too but I am going to focus on blogging for a second.

Now I do enjoy blogging. It took me a while but I’ve realised that my skills as a verbose speech and language therapist have translated quite well. And in fact have cascaded – creating new opportunities, spreading the word about my research and broadening my networks. This is a blog post I wrote for the NIHR:

https://www.nihr.ac.uk/blogs/using-my-clinical-training-to-drive-my-research-ideas-and-my-research-skills-to-change-clinical-practice/6371

For me blogging is about  writing as though I am having a conversation. It’s a very different style when compared to any other academic writing activity. I feel it is much less rule bound than many other types of writing. And yet people have asked me about how to do it. So I have jotted down a couple of tips:

  • To read a blog people need to stay hooked so write in a easy, accessible manner (by this I mean plain English, think about how you chat to your colleagues)
  • Don’t write too much most people can’t be bothered to scroll very far down
  • Apparently google is more likely to pick something up if there are more than 1,000 words in it- might be worth bearing in mind!
  • Include an image at the start- this can be included in any tweets and people are more likely to click through or look at an image on twitter (just make sure the image is labelled for non-commercial reuse or it is your image).
  • An image can summarise an idea in your blog and convey a key message (the old a picture can convey a thousand words theory)
  • If you are writing a guest blog check out other guest blogs on their site- I wouldn’t necessarily recommend referencing in a blog post but some sites may like a reference or two
  • It is important that you don’t give away the results of your research- these should be saved for peer reviewed publications- draw people in with other ideas or talk about processes. Tempt them and they may follow or look up your peer reviewed publications!
  • Blog regularly – then people will follow you more reliably. People like a routine.
  • Enjoy it! I quite like to think about what I will blog- it’s fun and you can chat about most things (carefully).

So seize the opportunity to expand your skills and happy blogging!

 

 

Please ask questions: Investigating your own future PhD ideas.

Doing a PhD is an interesting experience – not least because lots of people (including myself pre-starting to have any real interest in research) do not really know what it is! In fact I would say I didn’t really know how research worked and am still finding these things out. But since starting my PhD I have had a number of people asking the same questions, including:

“How are your assignments and exams going?” (There are none)

“Is your course longer than one year?” (Yes I am doing it part time for 4 years)

“Do you get a student discount?” (Yes in some shops!! yay)

“So what days do you actually work?” (My PhD IS my work- and I work Monday, Tuesday, Thursday and the occasional Wednesday)

“Who is paying you?” (The NIHR- the research arm of the Department of Health, and they pay my annual leave, sick leave and pension contributions)

“What about your clinical skills- do you miss patients?” (I remain HCPC registered and I am using clinical skills with research work with participants in my research: win-win!)

“Who’s idea was it?” (Eh mine- but it has evolved with advice from my supervisors)

These are actually all very valid questions.

I really feel there are a pool of potential researchers among the allied health professions who just don’t know much about how to get involved with research or even who to ask. And when I answer these questions they frequently lead to more questions. SLTs are often investigating their own options – they have great ideas and would love to realise them as a PhD! It can be valuable to share experiences to buoy others up to have a go. So many people gave me advice and I am always keen to pay it forward. I would always encourage SLTs to come along to the annual doctoral information session at UCL (just passed but keep an eye out on the RCSLT Bulletin mag in April/May next year). Also come along to an event at UCL- such as the Aphasia Research Group at UCL. This is a great place to network and meet academics. You will need to be supported by an academic who is somewhat interested in your project so they can support and advise you. This type of networking is key. The next Aphasia Research Group meeting is tomorrow at UCL from 3-5pm. Come along and hear some inspiring talks from research SLTs and network. They run 4 times a year and are free to attend. There are also opportunities to discuss any of your own budding ideas and get feedback at our regular research generator workshops:

https://aphasiaresearch.wordpress.com/

On the other hand My friends and family are simply fascinated by this apparent torture (in their eyes) I have let myself in for! They are more likely to ask:

“You’ll be how old when you finish?” (FYI I won’t yet be 40 when I finish so I’ll be really really young still ok!!!!)

“Do you seriously think that a PhD is more flexible for childcare?” (Yes I do! I can make up my hours around my children’s needs and I don’t have to cancel patients so often when they get sick!)

“Are you actually really enjoying it?” (YES I really do love it! I am 21 months in and I still love it)

Do we have to call you Doctor Volkmer when you finish? (Eh YES! But not when there is an emergency hence I will not be using Dr on any airplane ticket purchases!)

These are also all valid questions: And YES seriously I do enjoy it- I feel incredibly lucky to be doing something I enjoy and I feel is going to make a difference to more people’s lives (I hope).

Hearing from people with PPA

So yesterday I ran a focus group with people with Primary Progressive Aphasia and their families. Focus groups are a qualitative research method. They are a means of collecting valuable opinions on a topic or an issue (Wilkinson, 1998). The group discussion allows ideas to unfold and develop in response to the research question. The group can enable individuals to say things in the safety of a group that they might otherwise not say. The researcher acts as facilitator- trying to avoid unduly influencing the discussion but supporting and encouraging everyone to contribute.

Although this isn’t my first rodeo (group) it certainly felt a bit like that in the run up. Recruitment was slightly more tricky then anticipated- hampered by a delay in getting ethics approval due to the unforeseen complexities of this altogether tricky process (refer back to previous posts on this topic as I really don’t wish to bend your ear on this delicate subject in this post!). But really I don’t know why I was surprised. Groups are often harder to recruit to than anticipated – even clinically. Either you have too few (they all take holidays that week or they just DNA) or the next time there are just too many clients. Or the clients don’t gel or they gel too well and you can’t get the work done!

As with any good group, however, I should have trusted in the group milieu. For while I completed the travel expense reimbursements and checked all the consent paperwork was in order the group was already forming, morphing and taking shape. People introduced themselves to one another, they shared diagnosis, experiences and made connections. They shared opinions on the refreshments- what sandwiches and crisps they preferred or whether the weather was too hot for traveling distances across London or via train.They even prompted one another to repair upside down name tags!

As always I am reminded of the importance of the little things. The things I feel are not that significant can have a much bigger impact. Refreshments are a little reward and a thank you, but also a great neutral way to relax and start chatting. Name tags make things a lot easier- especially for people with PPA who may find it easier to read aloud or have difficulties with word recall. And really we are in England- whatever your age, nationality or background the weather and a cup of tea are scripted social conversations that can break down any barrier. And as the group came together to discuss the topic I had introduced the conversation seemed to flow and grow. And well, the content of that conversation is something I will share with you in future publications…..

 

My wonderful consensus group! (and by that I mean the wonderful participants)

I am writing an extra special post this week to thank all the amazing speech and language therapists (SLTs) who participated in my consensus group on Tuesday afternoon. The group was hosted by the Dementia and Mental Health Clinical Excellence Network. I was lucky enough to have 36 extremely enthusiastic and interested SLTs who attended the session.

The meeting used Nominal Group Technique- a method of gaining consensus without undue influence from one particular person or a couple of people. This involves asking people to generate ideas to a question (in silence) and writing these down. Then going round robin style to share ideas, clarifying and discussing them briefly before individuals silently choose their top 8 ideas and write them on separate cards. Participants are then asked to rank the ideas individually. 8 being most important, 1 being least important (putting the cards away as they make decision), then 7& 2, 6 & 3, 5 & 4. These are then collected and collated for analysis. The ratings can be reviewed for further rating and ranking to refine the consensus process.

Prior to the meeting I had felt anxious that the SLT participants may find it boring and tedious and generally a methodological blah! But to my surprise I had really positive feedback. Not only did people highlight that being involved in research made them feel they were being heard but also that the process itself was clinically useful. People described feeling that they had really reflected on their practice and what the key components of the intervention are that they themselves deliver. They felt they refined their motivation and rationale for this activity. A number of people also reported enjoying the process of hearing others opinions and felt this was a great way of learning.

I hadn’t necessarily anticipated the clinical sharing and learning component of this exercise –  of sharing knowledge and developing skills. The committee of the CEN suggested they may even use this type of method again for workshop tasks! What a great experience. I am so grateful to have had this opportunity to integrate a real breadth of clinical expertise into my research project. Now to analyse the data! Argh!

The next hoop- getting research off the ground.

https://commons.wikimedia.org/wiki/File:Girl_twirling_Hula_Hoop,_1958.jpg

Big news:
Me: I have been successful – my research project has been given ethical approval!
You: Fantastic, congratulations, so when does your study start?
Me: Well…hmmm…yes… did I mention R&D approval?
You: Huh? What’s this?

So let me explain- having been awarded ethical approval by the Health Research Authority to conduct research in the NHS I am now in the process of communicating with each of the individual Research and Development departments within each NHS Trust. This should be moderately straight forward as the appropriate paperwork such as the mysterious and complex “schedule of events” has also been approved by the HRA. Having said that I am slightly dreading negotiating the details. In general the trusts I am working in have tiny weeny speech and language therapy departments that don’t necessarily sit where the research is happening – for instance in one trust (as in many) the SLT is managed by the physical health trust next door to the mental health trust where the research is happening. Not an unusual arrangement for us. I wonder if these awkward arrangements disadvantage us in research- we will see.

I am pondering the future- anticipating obstacles so I can be more prepared! I am continually liaising with stakeholders (such as the amazing SLTs who are enthusiastically preparing to host the study) and persevering. In keeping my chin up I am able to view things more broadly – I feel I am developing my skills and learning heaps and am sharing all this with anyone and everyone who will listen. I hope that sharing these experiences and unforeseen challenges can support more SLT researchers to conduct more research in the NHS itself. The NHS is a great resource and patients can directly benefit from research happening within the organisation. I heard somewhere that patients seen in a trust where (NIHR) research is happening have better outcomes. And better outcomes are the reason I am ploughing determinedly onwards!

When the man from Monty Python shares his tale.

https://www.flickr.com/photo/brizzlebornandbred/14391022818

On Easter Sunday my husband thrust his iPhone in my face  happily yelping out; “It’s the Monty Python man, the one with dementia, he is in the paper again”.

Dementia, fronto-temporal dementia and the language variant; primary progressive aphasia, are not diseases I would wish upon anyone. In fact I would never ever wish illness on a person. And yet when a famous person such as Terry Jones suffers this disease it provides a great platform for raising awareness amongst the public.

The article my husband brandished under my nose describes fantastically how people with PPA can lose their ability to communicate, whilst remaining otherwise fit and able to undertake other activities such as walking, watching familiar movies, going to restaurants and maintaining relationships. The article highlights the close relationship that Michael Palin has with his old friend; the value of non-verbal communication and the pleasure of continuing to partake in normal social relationships. The journalist also flags the pitfalls- Terry is now unable to express his opinions, he has changed – no longer able to lead a conversation. In addition he is rather impulsive and he may not have full insight to his condition. This is the nature of PPA. I am so impressed his friends continue to maintain contact, having regular catch ups in restaurants and so forth. Not everyone has that supportive social circle. I suspect it is still rather difficult for him and his family and friends- they may not be sure they are doing the right things, that there is not some other conversation strategy that may work better. Not knowing what someone is actually thinking and feeling is, according to many of my patients and their families, one of the hardest things.

The family have made public their wish to share his tale in order to increase awareness. What a fantastic family. I am always amazed and humbled by how keen people are to help future generations – to contribute to the research and spread the word. These are people who inspire me!

https://www.theguardian.com/society/2017/apr/16/monty-python-terry-jones-learning-to-live-with-dementia