When I was at medical school, someone asked me what I thought I would be doing in twenty years’ time.

I remember thinking that I would like to be doing a mixture of clinical work, teaching and research, perhaps with some management work as well. Not long afterwards, I started housejobs, and any thoughts of research soon became well and truly lost in the maelstrom of clinical practice.

Five years later, after having taken six months off to go travelling, I found myself working as a medical registrar in Australia, where the pace of clinical life slowed enough to allow me to start reading journals and remembering that I had been quite keen on the idea of research at one time. I introduced a new adverse incident audit to the medical unit, and wrote up the results for publication.

Following my wife back to the UK, I was lucky enough to obtain a research fellow post in Dundee, running a randomised controlled trial of exercise training for older heart failure patients. Everyone needs a lucky break or two in life, and this turned out to be one of mine! The project was funded and had ethics approval before I started, and I was able to get straight down to work. The project was due to last for three years, so I was able to register it for a PhD.

The project was a randomised controlled trial of exercise training for older heart failure patients, funded by The Health Foundation. I was responsible for screening and recruiting patients, as well as attending every exercise session to ensure safety. I worked alongside a research nurse who performed the outcomes evaluations, and a physiotherapist, who co-designed and delivered the intervention. I was also responsible for database management, data analysis and report writing, as well as giving regular update presentations to the project team.

Whilst the day-to-day running of the project was busy, I also had time to run a separate retrospective casenote review, examining the tolerability of beta blockers and spironolactone in older heart failure patients. I got stuck into writing the PhD and managed to publish a review article on exercise training in heart failure.

Going back for more
Did I enjoy it? I enjoyed it so much that I applied for, and got, a clinical lecturer post in Dundee in 2003, with an eye firmly on a clinical academic career. Since this time, the project has finished, the PhD is written (the viva awaits), and I have become involved in a series of other projects and collaborations. New directions for research have been suggested by the results of the exercise trial, and I have been part of several successful grant applications. Teaching plays a prominent part in my new role, both of undergraduates and postgraduates, and on top of everything else, a clinical workload gets fitted in as well.

What lessons have I learned, both from my experience and from watching others?

• Pick a project that you are interested in. Two or three years is a long time to be doing something you hate.
• Don’t do research just because your career or CV needs it. Do it because you want to.
• Try and imagine what the final published papers from a project will look like. If you can’t, it may be that the project has not got clear enough aims and outcomes.
• Pick a supervisor that you get on with. Talk to other people to get a broad range of opinions
• Research working is very different to clinical work. Clinical work is reactive; research is proactive. If you do nothing, nothing will happen! It usually takes several weeks to adjust to this new way of working
• Be very wary about agreeing to any clinical workload whilst you are researching. Clinical work has a nasty habit of displacing everything else, and the time evaporates quickly.
• Be ruthless in your time management. It is your job and your life – you decide what takes priority. Do not come in early or leave late; this is a sign of poor time management, not hard work. Accept that there is only a certain amount that you can do in a single day.
• Start planning your research in your first SpR year. I was lucky to drop into a ready funded project, but most projects are not like this, and the lead time for getting ethics approval and funding is at least a year, and often longer.
• Pick an established research unit with an area of expertise that you are interested in; they are most likely to help you create a project that is right for you, give you high-quality research training, high-quality supervision, and if you run into problems (e.g. with ethics or recruitment) they are most likely to be able to dig you out of a hole.

Has research made me a better clinician? Maybe. A research training certainly equips one to critically appraise evidence, and encourages one to translate evidence into practice. The more I research, the more I realise how little evidence underpins our daily practice, and the more determined I become to do something about it. On a personal level, research has made me a more reflective clinician – it gives a different perspective to clinical practice and has allowed me some time and space to think about what I am trying to do when I look after patients.

Miles D Witham
Clinical Lecturer in Ageing and Health
Ninewells Hospital and Medical School
Dundee