SKILLS & LEARNING
CLINICAL RESEARCH IN DIETETICS Kaylee Allan Registered Dietitian ICU dietitian, Southmead Hospital Bristol Kaylee works as a Critical Care Dietitian in Bristol as well as undertaking a MClinRes part-time with Plymouth University. Her interests are ICU, research and sports nutrition.
This article will discuss how to get involved with research and develop a research career within dietetics. When I was graduating from University nine years ago, had someone told me that “research will be your future,” I would have laughed. Yet, for the past seven years, I have been part of a small research team of dietitians within critical care. Although small, our team produces multiple papers each year, focusing on topics which impact on our daily practice. My research journey started with an interest and an opportunity. Fortuitously, I was able to shadow someone with significant research experience who encouraged me to get involved. In the initial stages I helped with data collection and then developed skills in writing patient information sheets, organising research site files and obtaining consent. AN INTEREST AND AN IDEA
It might sound obvious to have an interest in the topic you wish to research, but I believe it’s essential to be interested enough to undertake a project in the first place. Accept that the journey, from planning to publication, can be challenging. Developing a potential research question from a small idea can be difficult, but it is a good starting point. Here are some suggestions to help your ideas flourish: Talk to colleagues If you find someone who is interested in the same area, team up and start the ball rolling. Having a mixture of professionals can give an extra dimension, so don’t be afraid to ask. Use Twitter The power of social media can connect you to experts and like-minded indi-
viduals who can signpost you towards useful papers, websites and resources. The Critical Care Specialist Group Twitter account is very active and extremely useful (@BdaCare). Twitter can be used for following along at conferences and can alert you to new ‘hot off the press’ publications. There is often some inspiring dialog between experts which may trigger ideas. Use a notepad Keep this with you at all times, from wards and meetings to bathroom and bedroom. You never know when that idea might pop into your head. Additionally, keep minutes from research meetings. Not only does this keep you on track, but it also acts as a useful list for establishing the next steps. Utilise resources In addition to social media, speak with colleagues who are research active, find out about in-house training which can boost your research career. Also, look further afield, discuss with your specialist group or the British Dietetic Association (BDA) research officer. For me, the specialist group has been fantastic for collaboration and also for those important discussions. If inspiration is what you need, find those like-minded colleagues. Keep your eye out for study days Take a look at the BDA research symposium and sign up to receive the Research Ezine: www.bda.uk.com/ professional/research/symposium Consider the time the project will take, including developing the idea, undertaking a literature review, data www.NHDmag.com March 2018 - Issue 132
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SKILLS & LEARNING collection and disseminating your findings. Research is not a quick process; to do it right, consider if your caseload will allow for the additional work you intend to do. Don’t set yourself up to fail.
If funding is what’s stopping you, start with the BDA. There are small grants worth applying for within the BDA, but also elsewhere, often the challenge is knowing how to access the money pot.
KNOW THE LITERATURE AND EXPLORE METHODOLOGIES
THE ART OF WRITING
If time is limited, ask your hospital or university library for help with searching for the current literature. Read around your topic. Know what the current literature is within your area. What is known and unknown? What does your question add to the body of evidence? Then consider what methodology will answer that question. Avoid jumping in with a randomised control trial (RCT) if you’ve never undertaken research before. Be realistic, start small and learn from the process as much as from the findings. I’d suggest writing a review of the literature; undertake a service evaluation, or a snap-shot audit of current practice. Explore current practice and how this compares to local and international guidelines. Test your protocols: are they being adhered to? Collect the data and immerse yourself in it. In my experience, even small audits can be good enough to change practice. To help with writing a literature review or selecting the appropriate methodology, use your Research and Innovation department (R&I). My local R&I hold research evenings to showcase local work and offer small grants for projects. Of course, events like this are excellent for networking! Make sure you are on the Trust email distribution list, so you hear about the grants and how to apply for them. Attend a Good Clinical Practice session (GCP) - this is an absolute must for anyone looking to becoming more research active. Furthermore, I have spent time with my local Research Design Service (RDS). The National Institute for Health Research (NIHR) funded RDS is free to access. Personally, I have gained a great deal from using the experts on hand (face to face and via email). The RDS is available throughout the UK (more information opposite) where the team can help set up studies and projects. There is even support with refining and perfecting the research question, to ensure the project aim and outcome measures help answer it. 52
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Whether it’s an assignment or a review paper, often writing can be the most challenging aspect to master. I’ve gained a lot by volunteering to write articles and asking my colleagues for feedback. Additionally, reading more will enable you to adopt a style which suits you. I’ve been fortunate enough to attend sessions on writing for publications within my University taught lectures and externally. Here are some useful tips on writing: Get the right writing environment This will vary depending on your own personal learning preferences. If you need absolute silence, then a busy café may not be conducive for you. Find a space that allows you to be relaxed and comfortable to start writing. Give yourself time Set aside time to write. Whether that’s 20 minutes in the evening, or an hour at lunchtime, make time. Protect that time and use it wisely. Some people work better under the pressure of a deadline, but a suitable workspace and time to produce good work is essential. Set an alarm, every 20-30 minutes, to take a break from the computer, but make sure the time sat in front of it has been constructive. Five- minute free writing On day one of my MClinRes, a lecturer made us write on our subject, non-stop for five minutes. This was a worthwhile task to do for two reasons: firstly, it gives you the time to put pen to paper and secondly, you’ll start to write! I was amazed how much I could write in only five minutes and how useful this process was to focus my mind. Get someone to proof read your work This is beneficial, particularly if you are writing a lay summary or participant information sheet. Having someone else proof read often leads to constructive feedback and can pick up on grammatical errors and flow. Don’t be offended,
Table 1: Valuable twitter accounts to follow if you are finding writing difficult Name of account
Twitter name
Write for Research
@write4research
Write that PhD
@writeThatPhD
Fast Track Impact
@fasttrackimpact
Explore Style
@explorestyle
Table 2. Key websites
British Dietetic Association (BDA)
www.bda.uk.com/professional/research/home www.bda.uk.com/about/trustfund/home Twitter accounts: @BrDieteticAssoc (British Dietetic Association) @bdaprof (BDA Education and Professional Development Team) @JudyLawrence7 (BDA research officer) Permission gained to use this twitter account For ICU (non-twitter people) use the Facebook group and search for the BDA Critical Care Specialist Group. Twitter: @BdaCare
National Institute for Health Research (NIHR)
www.nihr.ac.uk/funding-and-support/funding-for-training-and-career-development/ training-programmes/ www.nihr.ac.uk/patients-and-public/how-to-join-in/ www.nihr.ac.uk/about-us/how-we-are-managed/our-structure/research/researchdesign-service/
try and use the comments to improve your work. Remember, your audience might not know the technical terminology you use, so make it clear. Mind maps Write down key points under each of the main headings (such as; introduction, results, conclusion). Bullet points will help you to plan your paper and can focus the mind, should it start to roam. PURSUING A RESEARCH CAREER
For me, I needed to find the next step after we published our RCT. I enjoyed the whole process (and although stressful), I particularly enjoyed disseminating our findings at conferences and publishing results in academic journals. To gain a better understanding of health research, I decided to embark on an NIHR funded MClinRes course with Plymouth University. This was the perfect opportunity to have the time to undertake a project that I’d been meaning to do. Additionally, the resources and support from academic supervisors is invaluable. The MClinRes has not only improved my understanding of setting up and undertaking a project, but has refined me as a clinical dietitian.
This is the first step on the ladder in terms of a career in research, and the NIHR offer multiple pathways to becoming an independent, active researcher. LEARN FROM YOUR MISTAKES
I would encourage you to reflect and learn from mistakes made. I can recall moments early on in my research journey where I had made mistakes such as, missing data and stumbling over my words when trying to consent a patient. Mistakes happen, but try to learn from these and be resilient. Learning the hard way often makes you a better researcher. I always encourage people to ask questions, it might prevent mistakes from occurring. CONCLUSION
I would encourage any dietitian to become more research active and publish work. Research will boost your learning and development, benefit your patient groups and promote dietetics within your remit. Start with small ideas and build on them, volunteer to help out with data collection and access free resources available to you, if inspiration is what you need. Ask as many questions as you can, to anyone willing to hear your idea. Research is an excellent string to a dietetic bow. www.NHDmag.com March 2018 - Issue 132
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