As characterised by the symptoms presented by the geriatric patient, my reasons for going into research are inevitably multi-factorial.

I have never considered myself “academic” in the broadest sense of the term, but my research interests have slowly evolved over a period of time. For some of us, the desire to pursue research is born early on – the intercalated B.Sc and so on, but I was not one of the driven!

Humble beginnings
Opportunities to engage in research presented themselves at different stages of my career, and I opted to seize these. My first glimpse into the world of research involved simple surveys looking at the impact of patient information leaflets. Fairly basic stuff, but it at least allowed me to realise that ‘research’ was not some ivory tower phenomenon, but something tangible and achievable. I think that such humble beginnings were useful in reducing any feelings of intimidation when contemplating research later on.

In some respects it might be easier to look at reasons why I didn’t pursue research at an earlier stage, as I have really only become more involved in the latter stages of my SpR training. Of course there are always time issues and research does demand considerable time and effort, but these can be overcome through effective time management. I think that one has to be quite selfish in some respects - demand and command protected time. I didn’t enter research at the traditional stage, post membership, mainly because of financial concerns – I was bringing up a young family. This may sound naïve, but it is increasingly a real issue with more trainees starting families early in their career. Traditionally, family used to take second place to a career. The advantage of coming to research later is that I have been able to develop my own interests, rather than pursue the next allocated MD thesis from the beneficent professor. Of course in the ‘good old days’, this was the eminently sensible and preferred route – basic training as a registrar followed by ‘finishing school’ and research as a senior registrar. There is little doubt that the Calman reforms have made it harder to combine clinical and academic medicine.

Case reports
Later, my entry into the world of publications was though case reports. Mundane maybe, but a good way to learn about writing for the medical audience, understanding how the journals work and performing basic literature searches. More recently, I have been trying to focus on Advance Directives, end of life care, and community issues. As part of my PhD thesis, I will be looking at Advance Directives (ADs); the aims are to see if they may have a role for patients nearing the end of life. We will be focusing mainly on patients in care homes or sheltered accommodation, determining if ADs are acceptable and workable, and then looking at how best to implement a program promoting awareness and use of ADs. There are many questions in this field and it will be exciting to try and find some answers!

Growing on you
It is important to have enthusiasm for the topic which you are researching, as there will be many challenging times and plenty of self doubt – if your heart is not in it, then these will be all the harder to overcome. For me and I suspect many others, there was no blinding flash of inspiration, but ideas were suggested and grew upon me. I think this is different from having a project thrust upon you – few of us will have truly original ideas and the reality is that projects need to be nurtured in a supportive and sympathetic manner. The environment is clearly important – if there is no research ethos in the area where you are working, then it makes initiating projects much harder. However, most trainees will pass through a research orientated setting at some stage, so keep alert to opportunities. Being in an active research unit does make a big difference – familiarity with methodology, grant applications and so on, make life much easier than trying to do it all on your own. I have been fortunate to be appointed as a clinical lecturer in geriatric medicine, which combines the best of all worlds – an active research unit, clinical training, teaching responsibilities, and access to the university and training in research.

The benefits of research/academic work are several; not least of these is the selfish notion of professional pride and satisfaction. These may not be ‘PC’, but there is a real pleasure in seeing one’s name in print! Of course, there is the notion of contributing to the greater good of mankind, but in truth few of us will be privileged to contribute on such a scale. The reality is more a steady chipping away at a target, during which more questions are asked than answered!

Staying inspired
Working in an academic environment does keep you on your toes – teaching commitments, multidisciplinary working and cross field collaboration all help to keep you thinking and inspired. This is not to say that such matters cannot happen outside an academic setting, but if it is all on your doorstep, it does make life easier! The impact of the Internet should not be underestimated – the ability to access articles, review literature and so on has been made much easier. It is amusing to see that colleagues on the other side of the world are facing similar situations to home – or where there are differences, to look at the underlying reasons.

A good reason not to enter research is because you need it for your CV – this will only lead to dissatisfaction and frustration, unless you are very lucky. The downside of research is the tedium of repetitive form filling – 10 copies for this, 15 copies for that grant application or ethical committee. However, these are the facts of life and one has to accept such - it may become easier in the future! Learning to work independently is a major challenge, but I trust that the rewards will make it worthwhile.

The true aims of research, to my mind at least, are to ask questions and try to find answers. Achieving this can be a source of great satisfaction. A spirit of inquiry, open mindedness, flexibility and patience will be of benefit, but many attributes are acquired ‘on the job’.

Of course, research does not mean a career in academic medicine, but it does open the door of opportunity, should one wish to take the plunge! Keep your options - that is key.

Simon Conroy
Clinical Lecturer in Geriatrics
University of Nottingham