Academic Clinicians Research Articles

Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England

ObjectivesThis study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps...

Accessible training for academic clinicians and researchers to address the need for academic entrepreneurs.

Accessible training for academic clinicians and researchers to address the need for academic entrepreneurs.

Exploring implementation of intrapartum trial evidence: a qualitative study with clinicians and clinical academics

BackgroundImplementing research evidence into clinical practice is challenging. This study aim was to explore implementation of two intrapartum trials with compelling findings: BUMPES (position in second stage of labour in nulliparous women with epidural), and RESPITE (remifentanil intravenous patient-controlled analgesia). MethodsA qualitative interview study set in UK National Health Service Trusts and Universities. Purposively sampled investigators from RESPITE and BUMPES trials and clinicians providing intrapartum care: midwives, anaesthetists, and obstetricians, were recruited using existing networks and snowball sampling. Semi-structured virtual interviews were conducted. Thematic analysis was underpinned by Capability Opportunity Motivation Behaviour Change Framework.ResultsTwenty-nine interview participants across 19 maternity units: 11 clinical academics, 10 midwives, 4 obstetricians, 4 anaesthetists. Most (25/29) were aware of one or both trials. BUMPES had been implemented in 4/19 units (one original trial site) and RESPITE in 3/19 units (two trial sites). Access to sufficient resources, training, exposure to interventions, support from leaders, and post-trial dissemination and implementation activities all facilitated uptake of interventions. Some clinicians were opposed to the intervention or disagreed with trial conclusions. However competing priorities in terms of staff time and a plethora of initiatives in maternity care, emerged as a key barrier to implementation.ConclusionsCompelling trial findings were not implemented widely, and numerous barriers and facilitators were identified. Large-scale improvement programmes and evidence-based national guidelines may mean single trials have limited potential to change practice. There is a need to examine how intervention implementation is prioritised to optimise safety outcomes in the context of workforce restrictions, limited resources and large arrays of competing priorities including statutory requirements, that have increased in maternity care.

Online Utilization of the Nominal Group Technique to Gather Consensus Opinion Across Geographically Disparate Locations

Introduction: The nominal group technique (NGT) is a structured focus group that gathers opinion and generates consensus from groups on topics of interest. Previous studies using online NGTs (ONGTs) in health have been conducted in regions of high population density and internet connectivity. This activity aimed to determine the feasibility and utility of ONGTs in gathering opinion and reaching consensus on curriculum topics for a continuing research education program for health professionals dispersed across various locations in Southern Queensland. Methods: Fifteen clinical education academics from a range of health professions participated in 1-hour ONGT sessions from 2 University Department of Rural Health sites or their home offices. The traditional NGT was adapted for online use, using two free online platforms (Zoom for videoconferencing and Wooclap for voting and response collation). Results: The chosen platforms were effective in presenting ONGTs, allowing active and effective contributions to research topic ideas from all participants, including those with low internet connectivity. Silent generation enabled sharing, open discussion, and clarification of generated ideas. Wooclap was effective in reviewing and voting on generated responses and providing real-time feedback on voting outcomes. Outcomes were consistent with group consensus and useful in prioritizing research training topics. Discussion: The modified ONGT is effective in gathering opinion and gaining consensus from a geographically dispersed health workforce with varied levels of internet connectivity and experience with online platforms. It represents a cost-effective and time-effective alternative to face-to-face NGTs that is less likely to be affected by workforce disruptions.

Is there a sufficient supply of clinical academics for UK medical schools? A retrospective cohort study

ObjectivesClinical academics lead research to deliver medical advancements while also teaching in medical schools to maintain high-quality medical services. The objective of this project was to determine if there is...

Classroom to Clinic: Universities Need to Support The Next Generation of Clinical Academics

The General Medical Council’s current version of Outcomes for Doctors sets out three key areas of expertise for tomorrow’s doctors: professional values & behaviours, professional skills, and professional knowledge. (1) Each of these competencies further develops into numerous core skills every student should attain at medical school. While the learning outcomes set under Clinical Research & Scholarship (part of Outcome 3: Professional Knowledge) could usually be attained through numerous instances across a typical medical school curriculum, opportunities to put research skills into practice have remained relatively competitive and scarce. This represents an emerging challenge across the career spectrum, particularly in the UK as the Medical Schools Council warns that the NHS Long Term Workforce Plan 2031-32 could be jeopardised if the number of clinical academics is not maintained.(2) Facilitated by the impacts of an aging workforce alongside years of underinvestment – NHS trusts and medical schools need to work quickly to address barriers in training and retaining the next generation of clinical academics.(3) Clinical Academics are the foundation of the future of medical schools. However, much more must be done to introduce, facilitate, and encourage medical students to consider the option of training as a clinical academic. Investing in opportunities for medical students to get involved in research and teaching early on in their medical career, could be a solution not just to tackle this future workforce challenge but also to offer better career prospects. This is supported by evidence from research on matched-cohort studies conducted in Australia & New Zealand demonstrating an encouraging statistic independent of academic confounding variables. (4,5) Medical students who published research in medical student journals were significantly more likely to be associated with higher degree attainment, PubMed® indexed publications and in some cases, more likely to enter surgical training or their chosen specialty. However, getting involved in clinical research as a medical student remains challenging. Lack of opportunities, competitive funding calls, and fewer supervisors willing to take on the burden of training students are only some of the many barriers students currently face in getting involved. Recent results from a survey by the University of Glasgow’s Medical School demonstrated reassuring enthusiasm for a career in clinical research/teaching among a small sample size of 55 students. Commenting on these findings, Professor Iain McInnes, Head of the College of Medical, Veterinary and Life Sciences, said ‘.... supporting clinical academics at all stages of their career is a top priority for our college and this survey shows that the pipeline for the future of academia is in good health indeed!’. On the balance, the need of the hour must now focus on retaining this enthusiasm by investing in opportunities and offering pathways to ensure medical students can actively engage in academia. Several steps including enhancing funding, fostering stronger mentorship and networking opportunities, promoting interdisciplinary collaboration, and recognizing research efforts by medical students can go a long way in pursuing students to consider a rewarding career in clinical academia.

Lack of Integration of Research in Clinical Practice: A Qualitative Study of Clinical Academics’ Challenges in the Workplace Environment of Danish Hospitals

Lack of Integration of Research in Clinical Practice: A Qualitative Study of Clinical Academics’ Challenges in the Workplace Environment of Danish Hospitals

From Tutor to Future Educator: Investigating the Role of Peer-Peer Tutoring in Shaping Careers in Medical Education

AbstractIn the effort to promote academic excellence and provide teaching experiences and training for medical students, the University of California, Irvine, School of Medicine (UCISOM) built a novel peer tutoring program (2020), Collaborative Learning Communities with Medical Students as Teachers (CLC-MSAT). While the role of peer-assisted learning in student success on academic courses is well established, we wanted to assess the impact of our UCISOM peer-assisted learning program on tutors’ career interest in medical education. Through a mixed-methods analysis of our peer tutors’ experiences, we found 100% were overall satisfied with their positions; > 85% learned new skills; > 88% felt they were strong teachers; > 88% felt they now had a stronger grasp of the medical curriculum and most importantly, 100% of students maintained their interest and aspirations to serve in a future medical educator role after participating as a tutor. Additionally, we found a statistically significant relationship between tutors’ intentions of exploring a career in academic medicine after serving in the CLC program. Our findings suggest that our tutoring program has had a positive impact in providing authentic teaching experiences and training to medical students early in their careers at UCISOM, which may help prepare the next generation of qualified academic clinicians.

Clinical research self-efficacy in academic veterinary clinicians in the United States.

Clinical research is a growing part of the academic clinician's job, and documenting areas of low self-efficacy can inform training initiatives. 182 US academic veterinary clinicians. A survey of academic veterinary clinicians was distributed to 31 US institutions. Self-efficacy was assessed with a modified Clinical Research Appraisal Instrument-12. The relationship between research self-efficacy and completion of formal research training and years of experience was evaluated. Respondents were predominantly junior to midcareer faculty. The lowest reported confidence was in performing advanced statistical analyses (3; 0 to 10). Other low-confidence tasks included designing a qualitative methods study (4; 0 to 10), terminating a collaboration that isn't working (5; 0 to 10), describing a funding agency's review/award process (5; 0 to 10), establishing a timeline for a grant application (5; 0 to 10), establishing collaborator and consultant agreements (5; 0 to 10), and asking staff to leave the project team (5; 0 to 10). Completion of a formal research training program was significantly associated with improved self-efficacy in many tasks. Years of experience was also associated, especially in project management and interpersonal interactions. These results highlight the need for targeted training opportunities for academic veterinary clinicians in biostatistical support, qualitative study design methods, and aspects of communication and interpersonal skills that are important for developing and leading effective research teams. Range of confidence suggests that development opportunities in all domains will improve self-efficacy for some clinicians. Future studies should focus on the impact of formal training sessions on various domains of self-efficacy and on targeted mentoring in supporting confidence in more experiential learning domains.

Addressing diagnostic uncertainty and excellence in emergency care—from multicountry policy analysis to communication practice in Australian emergency departments: a multimethod study protocol

IntroductionCommunication failings may compromise the diagnostic process and pose a risk to quality of care and patient safety. With a focus on emergency care settings, this project aims to examine...

The impact of a clinical academic nurse researcher in critical care: A 1-year service review.

To outline the activity and impact from implementing a clinical academic nurse researcher in a multi-centre critical care unit. A prospective exploratory activity audit informed by the Plan, Do, Study, Act framework. Quantitative data on clinical academic activity, from 1 April 2023 to 31 March 2024, were collected in a Microsoft Excel © [2022, version 16.66.1] spreadsheet. Activity narratives were detailed in qualitative data and the impact categorized. A total of 1500 clinical academic activity hours were logged (accounting for annual leave entitlement and sickness). Of these, 973 h were directly categorized within clinical academic activity. Most frequently undertaken clinical academic activities were academic writing (17.6%), data collection/analysis (9.6%), grant and funding workup (6.8%), Intensive Care Unit service development (6.6%), clinical activity (5.2%) and local level capability and capacity (4.9%) and other supportive tasks such as administration, unscheduled meetings, critical planning time and peer support (38%). Improvements broadly mapped onto five healthcare improvement domains; organizational, process design, data optimization and utilization, evidenced-based practice, and patients/staff impact. Our data indicate system mechanisms afforded by the clinical academic role that have not been explored within the contemporary literature. A nursing clinical academic demonstrates impact across the broad organization whilst increasing the visibility of nursing work and the potential for system resilience. In conclusion, our service review underscores the transformative potential of clinical academics in shaping the future of healthcare. Utilizing their expertise and contributions paves the way for innovation, excellence and sustainability in patient care. This review has provided clarity about clinical academic activity of a nurse researcher during the first year. There is international impact of this work for both clinical academics who may be evaluating such roles and healthcare management developing similar roles locally. No Patient or Public Contribution.

Perspectives of a non-medically and a medically qualified early career anatomy academic on facilitating case-based learning sessions for undergraduate medical students.

Case-based learning (CBL) is a student-centered pedagogy where medical students are given a real-world clinical problem. At St George's University of London (SGUL), anatomy academics can volunteer to facilitate CBL sessions for pre-clinical undergraduate medical students. The major benefits of facilitating CBL sessions from the perspective of a non-medically qualified early career anatomy academic (ECAA) include exposure to clinical cases that help the academic develop an understanding over key clinical cases at the context of clinical anatomy and other disciplines including physiology, pathology, and pharmacology. Furthermore, facilitating CBL sessions assists in the acquisition of basic knowledge over history taking, the conduction of clinical examinations, the investigations performed for the diagnosis of a condition as well as how it is managed. The major benefits of facilitating CBL sessions from the perspective of a medically qualified ECAA include staying in touch with the clinical aspect of medicine and becoming familiar with the country's healthcare system and its professional standards. Perceived benefits shared by both the non-medically and medically qualified ECAA include the opportunity to become familiar with the structure and key elements of the pre-clinical medical curriculum as well as gain experience in facilitating small group teaching sessions. Overall, facilitating CBL sessions can help non-medically and medically qualified ECAAs in different contexts that may help them with their individual career goals, can encourage collaborative discussions between clinical and non-clinical anatomy academics as well as help bridge the gap between the anatomy teaching approaches employed by non-medically qualified and medically qualified anatomy academics.

Barriers and Facilitators to Teaching Anti-Racism in the Clinical Environment: A Mixed Methods Study of Academic Clinicians

Barriers and Facilitators to Teaching Anti-Racism in the Clinical Environment: A Mixed Methods Study of Academic Clinicians

Expanding the Notion of Personal Well-Being During COVID-19 Campus Closure in India: Results from a Mixed-Methods Study with Members of Higher Education

The COVID-19 pandemic has challenged lives globally in unprecedented ways. While numerous studies have discussed the impact of this pandemic on human lives, this descriptive study examined how this pandemic affected personal well-being (PW) for members of Indian higher education in the early phase of the pandemic in 2020 when there were no vaccines and remedies available. Research participants (n = 551) were faculty members, graduate students, and non-teaching staff in Indian higher education. At the time of data collection, when all campuses were closed, all participants were functioning in their roles in the academic communities via virtual platforms. This descriptive study, based on a mixed-methods research design with concurrent triangulation strategies, collected data from all regions of India. Resulting data identified and discussed the impact of the pandemic on six domains of PW in the life of participants: (a) self-care; (b) professional growth; (c) quality of interrelationship within the family; (d) relationships with significant others outside of the family; (e) process of experiencing/facing and addressing challenges; and, (f ) relationship with spirituality/transcendental dimensions. The relevance of the last domain may be unique to Indian participants’ socio-cultural context and ethos. The findings and discussion explain how PW is a composite of all these six domains, and the pandemic expanded the notion of PW for the members of Indian higher education. Further, the findings also provided a general orientation on how educational leadership teams and institutions can enhance at least three specific dimensions of their community members and thus increase the likelihood of improving the quality of their professional and personal life. The findings may also have relevance for academic communities worldwide and inform clinicians working with members of academic communities, educational institutions and policymakers.

Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management.

Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Exploratory, convergent mixed methods. Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients' lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings.

Adoption and implementation of maintenance and reliever therapy for adults with moderate-to-severe asthma

BackgroundThe use of single-combination inhaled corticosteroid and long-acting bronchodilator for maintenance and relief therapy (MART) significantly reduces asthma exacerbations and has been incorporated into asthma guidelines since December 2020, but there are limited data regarding the implementation of this approach to asthma management. ObjectiveTo determine the frequency at which MART was recommended to patients with moderate-to-severe asthma being seen at subspecialty pulmonary and allergy practices at an academic healthcare system, and the patient and clinician characteristics associated with the use of MART. MethodsWe conducted a retrospective cross-sectional study of the electronic medical records of an academic healthcare system in the Northeastern United States between January 2021 and October 2023. Patient demographic and clinician data were collected, and MART recommendation was confirmed by chart review. We assessed the relationships among patient demographics, clinician characteristics, and MART recommendation. ResultsOf 2016 patients reviewed, 293 (14.5%) were recommended MART, with 255 (87%) concurrently prescribed short-acting bronchodilators. Patients on inhaled corticosteroid-formoterol at baseline were significantly more likely to be recommended MART, whereas older patients and those on Medicare were significantly less likely to be recommended MART; 22 of 50 clinicians (44%) did not recommend MART ever, and only 3 clinicians recommended MART to 30% to 60% of their patients. Clinicians who were part of the asthma group were significantly more likely to recommend MART. ConclusionAmong academic subspecialty clinicians, there has been limited implementation of MART, with a small number of clinicians adopting MART routinely and more than 40% of clinicians not recommending it.

Core needs and diverse opportunity: A survey of academic clinical lecturers and the effects of the COVID-19 pandemic

During a clinical lecturer role, parallel clinical and academic training is undertaken. The anticipation is that a lectureship represents an exciting and expansive time. However, a national crisis has been declared at the clinical lecturer level with a leaky pipeline of clinical academics resulting in dwindling numbers. Clinical lecturers are infrequently represented as a group partly due to their distributed nature and diverse job plans. We conducted a survey of clinical lecturers in the UK. Responses (n = 107) revealed a motivated but divided workforce. A content analysis revealed core elements that sculpt an individual’s success or failure, but these were variably present. COVID-19 had a negative effect on many with various strategies reported to try and reset academic trajectories. Feelings of isolation and anxiety about a viable future in academia were significant findings. This echoes calls for a greater number of secure longer-term grants to ensure that clinical academics and their skills are retained within the research workforce. A continued effort to analytically appraise whether supportive elements are in place for all lecturers will help focus initiatives to foster excellence in clinical academic training for everyone.

Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom.

Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care. A modified Delphi approach was used; it involved an initial scoping survey and a 2-round Delphi process to identify the consensus research priorities in both adult and paediatric LRS. Participants were asked to rank approved submitted questions according to perceived importance on a 5-point Likert scale, where 1 represented lowest importance and 5 indicated highest importance. Mean scores were calculated to identify a consensus of the top ten research priorities for adult and paediatric LRS. One hundred and fifteen participants primarily from across the United Kingdom working in LRS contributed to the modified Delphi process. Participants ranked and then re-ranked the presented research topics in terms of perceived importance. This led to the identification of a top ten research priorities in both adult and paediatric LRS, respectively, based on the collective responses of LRS practitioners. The highest-ranked questions in both adult and paediatric practice related to how to best assess and record patient-reported outcome measures (PROMs) in LRS patients. Other priorities included the effectiveness of specialist physiotherapy, the use of patient-focused psychological support, and the use of various operative management strategies for infection and limb length discrepancies. We present a consensus-driven research priority study that outlines the key research topics and themes determined by healthcare professionals within LRS in the United Kingdom. These questions will assist funding bodies in prioritising where research funding may be best utilised and help drive future improvement in patient care. British Limb Reconstruction Society Research Collaborative. Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom. Strategies Trauma Limb Reconstr 2024;19(1):1-8.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data

BackgroundDespite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design.MethodsWe interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism.ResultsParticipant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism.ConclusionsOrganizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.