Research

Introduction to the Research Pillar

WHAT IS LEVEL 7

WRITING AN ABSTRACT

CASE STUDIES

What is a clinical audit?

How to get published

Service evaluation  

Introduction to the Research Pillar

What is the Research Pillar?

The research pillar of advanced clinical practices specifies that advanced practice clinicians should be able to critically appraise and engage with research, evaluate and audit their own and others’ clinical practice, as well as develop and implement governance systems, disseminate research findings, and quality improvement projects and facilitate collaborations… However, many of advanced practice clinicians struggle to meet this pillar.

“Yes, but I am a clinician! How can I manage this within my caseload?”

“I don’t have the time or training!”

We recognise that many advanced clinical practitioners do not have formal research training, but this pillar demonstrates the importance of understanding how to apply research to the clinical setting. This may take many shapes or forms, and often does not need a formal course to be able to provide you with the skills needed. The research pillar requirements may be met through service improvement projects, developing new or better ways of working, reporting on case studies of interesting or rare cases seen in clinical practice, or auditing your and your peers’ clinical work to ensure you are acting in line with recommended guidance (for example, auditing number of diagnostic imaging requests and justifications, and judging whether these were appropriate or not). It is important to remember that some of the basic research skills, such as appraising an article, will help you to: write your own article, provide inspiration (hopefully) on what may be possible for you or your service to repeat or do better, or may provide a standard to compare against.

We have included a few ways that may be helpful to provide evidence of meeting the research pillar within the Research section of the website, and you can have a look at the research webinar which goes over different advanced practice research options.

How do I perform in the ACP research pillar ? (appn.org.uk)

WHAT IS LEVEL 7

Level 7 relates to a level of practice; it is not related to the Agenda for Change banding systems.

Level 7 equates to Masters level education, however, it is not necessary for you to have completed a Masters to work at level 7. In order to fulfil the criteria outlined by HEE to work as an Advanced Practice Physiotherapist, you need to evidence that you understand what Level 7 is and demonstrate how you meet it in the four pillars of advanced practice.

Please see the Level 7 Webinar hosted by the APPN for an interactive discussion as to what level 7 is, and how this level of practice and be met across the four pillars:

What is a Level 7 portfolio? (appn.org.uk)

Individuals working at level 7 should demonstrate:

 Subject specific:

• In-depth knowledge & understanding – informed by current research
• Critical awareness of current issues/developments
• Complex clinical reasoning
• Critical thinking
• Research understanding – ability to review and carry out

A range of generic abilities and skills that include the ability to:

• Use initiative and take responsibility
• Solve problems in creative and innovative ways
• Make decisions in challenging situations
• Continue to learn independently and to develop professionally
• Communicate effectively, with colleagues and a wider audience, in a variety of media.

Level 7 is described as:

A systematic understanding of knowledge, and a critical awareness of current problems and/or new insights, much of which is at, or informed by, the forefront of their academic discipline, field of study or area of professional practice

A comprehensive understanding of techniques applicable to their own research or advanced scholarship

Originality in the application of knowledge, together with a practical understanding of how established techniques of research and enquiry are used to create and interpret knowledge in the discipline

Conceptual understanding that enables:

• to evaluate critically current research and advanced scholarship in the discipline
• to evaluate methodologies and develop critiques of them and, where appropriate, to propose new hypotheses.

In order to demonstrate Level 7 practice, you will need to show how you:

• Deal with complex issues both systematically and creatively, make sound judgements in the absence of complete data, and communicate their conclusions clearly to specialist and non-specialist audiences
• Demonstrate self-direction and originality in tackling and solving problems, and act autonomously in planning and implementing tasks at a professional or equivalent level
• Continue to advance your knowledge and understanding, and to develop new skills to a high level.

Clinicians demonstrating this will:

• Have qualities and transferable skills necessary for employment requiring:
• The exercise of initiative and personal responsibility – decision-making in complex and unpredictable situations
• The independent learning ability required for continuing professional development.

WRITING AN ABSTRACT

Abstracts are a really useful means of showcasing your work to the wider clinical and research community in a concise way. They can be an opportunity to submit your work to a conference, or used at the start of a journal article to allow others to decide whether they want to read your article.  Typically abstracts can range from a 200-word count to a 500-word count, with typical headings (depending on the target audience) including background, aim, methods, results, conclusion.  Abstracts are an opportunity to get your work into the wider world. They need to be to the point, include the most important information, and sell your story!

The goal is to communicate:
1. What was done?
2. Why was it done?
3. How was it done?
4. What was found?
5. What is the significance of the findings?

It is really important when writing your abstract to think of the audience you are writing to. This will change if you are writing for a conference of physiotherapists or a conference of NHS managers (who may not all be clinical) or for non-content specialist teams. So keep this at the forefront of our mind as you write, especially if you are including condition specific jargon or abbreviations like SLR (Straight leg raise) or LBP (low back pain).

Links to useful articles/ videos: https://study.com/academy/lesson/how-to-write-a-scientific-abstract.html

https://www.southampton.ac.uk/sias/resources/howtoseries/howtoabstract.page

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136027/

CASE STUDIES

We all see interesting cases in our practice. Depending on where in the pathway you are situated, this may happen daily, weekly or monthly! What is important to identify is what were the key features that made you sit up and take note of this case. Was it because they were an unusual age group for this condition, or was it more subtle than expected or was it a differential you hadn’t considered? I have used a recent case study I wrote as an example to help you understand the steps to take in writing or preparing your own. This was a case study about Guillain Barre-Syndrome that masqueraded as a suspected large disc presentation seen on our emergency pathway. It is important if you plan to publish your work in a peer-reviewed journal that you obtain consent for the patient’s story to be shared. This may require written consent, or verbal consent depending on the journal.

When writing a case study, the first thing to do is to go back to the literature to understand more about the condition in question. This becomes your background section. We look at the epidemiology of the condition by trying to understand how common is the condition, and who it is most likely to affect including risk factors or subgroups. It is also the justification for why this is an important case study –what features were important that fell into the ‘masquerading’ pathology and which are distinctive? So in my case, it was important to understand that GBS is uncommon, but may be increasingly prevalent due to COVID-19. The background should provide a short summary of why this case is important and some facts about the condition of interest and typical features.

Next, is the description of the case (case presentation). Who the patient is (demographic, non-identifiable information), and how they entered your pathway. What were the key features of their subjective examination? What were the key features of their objective examination? And what happened next? My case had bilateral leg pain in a posterior (S1) distribution. This was typical of a large disc pathology but apparently also typical of GBS. My case also presented with progressive peripheral weakness – bilateral foot drop. Again, it may be an unusual case of a very large disc but a clear sign that something else was going on. Absent reflexes are characteristic of GBS, but if I was suspecting a higher cord compression this would have been unexpected. It may be helpful to provide some differential diagnoses of what you were thinking and what diagnostics were requested to help confirm or refute these. Include any diagnostics ordered, investigations, treatment and outcome if relevant.

Finally, the discussion should include a review of other published cases in the literature (briefly), and how your case compared to other cases. Any clinical guidelines around this condition should be mentioned with mention of how this case was managed in comparison to the guidance. Finally, it should provide a summary of what the learning points/ take home message is for the clinician reading the case report. In my case, this was that with the increase in potential post-viral conditions like GBS, my subjective questioning needed to include vaccine dates, and COVID sickness dates to ensure I considered all other pathology apart from spinal conditions.

https://www.bmj.com/content/350/bmj.h2693

What is a clinical audit?

Clinical audit is a way to find out if healthcare is being provided in line with standards and lets care providers and patients know where their service is doing well, and where there could be improvements.

It’s not just a data collection exercise, and involves measuring current patient care and outcomes against defined audit criteria or standards.

There is an expectation that audits are useful clinical tools and that changes may be implemented following the results from an audit.

Audits are a way of identifying areas for improvement and by continuing the audit cycle you are able to measure any improvements in changes that have been implemented following on from the results of a previous audit.

The main stages of an audit include:

• Choose a topic or an area of practice to audit
• Define set criteria or standards that you are auditing against
• Collect Data
• Analyse the data against the standards
• Feedback the results
• Discuss possible changes
• Implement agreed changes

In order to complete the audit cycle, a re-audit would be required

• Allow time for changes to embed before re-auditing.
• Collecting a second set of data.
• Analyse the re-audit data.
• Feed back the re-audit results.
• Discuss whether practice has improved.
• Discuss further changes as required – implement as required
• Reaudit / close audit cycle if objective has been met.

Evidence of leading clinical audit would contribute to fulfilling the research pillar as part of the Advanced Practice role.

How to get published

• Look at your work and classify it. Is it a service evaluation, a case study, an audit, primary research etc? You can find a description of different publication types online.
• What type of publication is your work most appropriate for? Would it fit best in a research journal, or is there a theme that you could adapt for an editorial piece?
• Look at the most popular journals in your area of work. What sort of publications do they accept? Some journals will not accept service evaluations but some will accept case reports.
• Look for less popular, but perhaps easier-to-publish-in journals. Start by searching a journal database or looking at your reference list and where those articles were published.
• Pick a number of journals and read their articles to get a sense of their house style. Look at their website and see what types of submissions they accept. What would be the best fit for your piece of work?
• Consider the authorship of your work. Could you write your piece in collaboration with a colleague who was involved in the work? Could you contact another researcher who has authored similar work and see if they would consider co-authorship? This will give you support in your writing style and publication process but will also give your work more authority. Otherwise, seek out a mentor and discuss the process with them.
• Contact the editor of the journal you feel would be the best fit for your work. Set out a summary of your work and ask for their feedback and if they would be interested in this type of submission. If you can arrange a brief phone call with the editor or any of the peer reviewers this will be helpful in aligning your writing to their journal style and interests. You may not get a response but you may get some helpful feedback and advice.
• Make your submission. Sometimes this can be done using an online portal or sometimes this will be an email directly to the editor. Try to stick to the house style, be clear about what type of piece you are writing and stick to the brief for that piece and stick to the word count.
• Resilience, patience and persistence are the key from here on out. Keep going back to step one and keep submitting and re-writing.

Service evaluation  

The service evaluation is not an audit as we are not benchmarking it against a gold standard, neither it is research. The service evaluation is a process that helps us to measure the current practice and identify whether we achieved the aims and objectives which were set up while designing the service.

The service evaluation is usually conducted to assess the current service so it can’t be generalized to other services. The participants are usually those who use the service or deliver it.
Generally, service evaluation does not need ethical approval however you should always discuss this with your team leader or service manager.

The knowledge gained from service evaluation can be utilized to improve the service, provide a recommendation, and demonstrate the achievements.

While conducting service evaluation you should consider following

1. What is your service evaluation question?

2. What are the aims and objectives of the service?
3. What resources you may have and what you may need to complete the evaluation?
4. Who are your key stakeholders?
5. Data collection and analysis
6. Dissemination of the results
7. An Action plan