Research topics – the benefits of an eternal outsider?

I meet with a lot of NHS clinicians to talk about research questions and study design. Our region covers many different Trusts and the level of clinical expertise is immense. These meetings are always interesting and challenging. I have to confess, however, that I don’t usually have the first clue about the specifics of the topic area we’re discussing.

When I first started as research adviser, this bothered me greatly. It was what made me most nervous about meeting a clinical researcher for the first time. However, I’ve now learned that there is actually benefit in not knowing all the ins and outs of the topic area. After all, it’s the clinician who is the expert and it’s not clinical expertise they need.

Far better to let the clinician explain the research topic to me. I can then ask the simple and obvious questions that help elucidate the research question. This discussion usually forms the basis for the argument for why the research needs to be done. And determining the priority of the research topic is the very first thing a funder will do. For NIHR commissioned calls, this prioritisation process has already been at least partially done. However, for the plethora of researcher–led funding streams – both NIHR and otherwise – the argument about the importance of the research topic is the first one you must make.

The fact that I’m at a distance from the research topic means that I can play devil’s advocate. I have a tendency to cover draft protocols in comments and track changes and send emails full of questions to researchers who send me initial project proposals. It’s much better for me to be the one to do it than a funding panel who will ultimately reject a proposal if there are too many unanswered questions.

It’s difficult to know exactly who will be present at a given panel meeting where the funding decision will be made. Even though lists of members are available – and they are definitely worth a look – actual attendance varies. And, when it comes to RfPB, which panel will assess your application can vary too. Relatively recently, a bunch of ‘South East’ applications where discussed at a panel meeting in a different area entirely.

When it comes to the day of the actual meeting of the funding panel, there may be someone there just as experienced, or even more experienced, than the PI. But, then again, there may not. You also can’t predict which direction the discussion will take. Will the panel be focusing more on the priority of the topic area or will it be the design or the plan of analysis that takes up the bulk of time during the discussion? The discussion time will be tiny relative to the time that has gone in to preparing the application and so there’s simply no way of knowing which aspect in particular will capture the panel’s attention.

It’s my job to try to cover every possible angle.

Many RDSs offer researchers the opportunity to put their application forward for a ‘dry run’. At the RDS SE, we hold a regular ‘pre-submission panel’, where we all get together and try to replicate an NIHR funding panel meeting. As a group, we cover a range of specialities, both methodologically and with regards to specific health topics. We have lay representatives who attend and even use the RfPB programme’s assessment criteria to rate each submission. It’s a useful exercise for both the adviser and the researcher. From my perspective, I find it fascinating to see how my comments fit in with those of my colleagues and it’s reassuring to have actual proof that we’re all pretty much on the same page when it comes time to assess the proposals. And, from a researcher’s perspective, they get a lot of feedback on their proposal, far more than the few bullet points of doom that accompany the formal NIHR letters informing PIs about funding decisions.

I’ve come to embrace my role as the eternal outsider when it comes to the majority of specific health research topics. I believe it allows me to offer researchers a far more honest assessment of their research proposal and gives me the tools to push researchers to improve the quality of their applications. It’s also a strength of the RDS as a whole, allowing us to attempt to replicate funding panels for researchers.

If you are preparing an application for NIHR funding, it is worth talking to your local RDS and benefit from our expertise… and our lack of it.

Top tips from the RDS National Training Day!

I attended the NIHR Research Design Service National Training Day recently. I believe it’s the second one that’s been held, but it’s the first one that I’ve been able to attend.

Even within the Research Design Service South East (RDS SE), it’s fairly rare for members from our 3 sites to get together in person. We do it perhaps a handful of times a year – mainly for our thrice annually Pre-Submission Panels and our annual Away Day. So, the prospect of meeting up, with not only the other RDS SE people, but with those from all the other 9 RDSs was an exciting one.

Attendance was good, even from RDSs for whom the trip to London was considerably more arduous than my own one and a half hour direct train trip from Brighton. At my level – that of a general research adviser with no overarching strategic role – there’s basically no formal opportunity to contact people from the other RDSs. It’s one of the reasons that I’ve embraced social media to the extent that I have – it’s a great way of talking to other advisers in RDSs whom I wouldn’t otherwise meet. So to have this opportunity present itself, and for it to be face-to-face, was great.

I have to say the experience didn’t disappoint. There must have been about 150 of us there – a good representation across the board. And, for the most part, we were able to share experiences and reflect on the fact that, despite the regional variations across the country, we face the same issues and challenges when it comes to supporting researchers design fundable projects. The take-home message was that we are doing a good job, but that there is always room for improvement.

I’m not going to do a formal report of the day – that would, I imagine, be fairly dull. But I did want to share some of the things I found most valuable in terms of research advice. Hopefully this will resonate with anyone reading who works for an RDS – and perhaps some of you were there too? – and also be useful to any researchers reading, regardless of whether your located in an NHS Trust or an HEI.

One of the opening plenary talks was by Prof. Tom Walley, Director of the HTA programme and of the other NETS programmes. In terms of things changing, he was able to tell us that the HTA programme are piloting a new Expression of Interest form, which will take the place of the longer and more detailed outline application form currently being used. The goal is to make this first step in the application process easier and faster, both to write and to be reviewed. You can find out more about this here.

I was also able to pick out four top tips from Tom’s talk.

The first was about making very clear to funders the importance the research question to the NHS and its users. Determining the priority of the question is the first thing a funding panel will do, before they even look at who is on the team or how they’re proposing to address the question. This explanation needs to be explained clearly and convincingly to a non-expert reader.

The second point was about clearly defining the evidence gap, as defined by systematic reviews. Tom quoted the figure that half of studies are designed without reference to a systematic review of the evidence that already exists. This raises the question of whether, if a systematic review doesn’t exist in the area in which you work, should this be the first thing you do? Indeed, the RfPB programme has recently issued new guidance around applications for systematic reviews with a suggested funding limit of £150K. You can find out more about that here.

The third point was the observation that there are too few NHS applicants, especially acting as principle investigators. We RDSs need to be proactive about engaging with clinical researchers. We have work to do in liaising with Trusts and demonstrating the benefits engaging with us will have for their clinicians interested in research.

The final point was around value for money. Tom observed that we have likely reached, or are very soon to reach, a funding ceiling. This fact makes clearly describing the importance and relevance of your research question all the more important. Funders will increasingly only be funding ‘priority’ questions. There is a drive for efficiency, in terms of both study design and in making use of data sets already in existence and routinely collected data. The recent HTA call for ‘efficient study designs’ is a nice demonstration of this. Such studies also need to be pragmatic, to reflect the realities of care in the NHS. This drive for value will also mean fewer extensions and a greater monitoring of milestones and targets. Studies are more likely to be closed down if it becomes apparent that they will require a big extension in time and money in order to succeed. There will be more importance placed of having feasibility and pilot data in order to demonstrate that patients are out there and are willing to be recruited into, and remain in, clinical trials.

I found these messages helpful and will definitely be referring to them in my advising in the future. I was gratified to see a very clear role for the RDS in facilitating high quality research and hope that this is a message we can get out to researchers.

That is, in essence, the aim of this blog.