Tuesday 30 July 2013

Understanding how academics work: a summer crash course

Posted by Avril Rhodes

After two years of semi-undercover, ethnographic research, embedded in Teesside University, I can now reveal how academics work, for the benefit of other muggles in the world of public health delivery. I write as a muggle, struggling to hang on to my old identity so that I am welcome in previous haunts, which, is, by the way, what a knowledge broker is – someone who can still look up old friends and get an hour of their time.

The first Muggle family - The Dursleys 
Lesson Number 1 – Academics (or wizards) do not work regular hours – actually they don’t know when the working day starts or finishes.  You come in, as a muggle, after that Bank Holiday weekend, confident of a fresh start, and find your in-box full of messages from people who have blurred work and play.  And then there is a silence, when you’ve frantically caught up with the e-mails.  And then they ambush you again in the evening, in the early morning, and that old weekend trick.

Lesson Number 2 – Wizards prefer Mondays. The more the week goes on, the less likely they are to be found.  They are visible early on in the week and then start to fade away from the workplace, in favour of working at home, at night, whilst travelling, in cafes, anywhere outside the office, until by Friday lunchtime, as a muggle, you know you have the building almost to yourself. If you want to meet a wizard face to face, go for the first part of the week.

Lesson Number 3 – Wizards like casual clothes. Wear a suit, or what you think is standard business dress and you’ll stand out like a sore thumb.  Oxfam chic seems to sum up wizard dress.  But, if you want to maintain your distance, keep that muggle clothing in pristine condition.

Lesson Number 4 – Enjoy your lunch! (Calorie controlled)  Wizards like any excuse to eat lunch – properly and out of the office.  Be prepared at a moment’s notice to go off on these jaunts and don’t be deceived, they are just as likely to want to discuss work as anything else. Spaghetti and qualitative research methods are the same to a wizard.  You will also hear, “How about a coffee while we explore this further?” and before you know it you have cappuccino all over your mouth.

Lesson Number 5 – I thought I liked the written word, but I’d underestimated wizards. Everything, and I mean everything, has to be recorded, analysed, discussed, drafted, reflected upon, circulated and made into a journal article.  The absence of findings is data to a wizard.

Lesson Number 6 – and finally wizards don’t like sitting at desks and have forgotten about landlines.  As you’ll have gathered they are happiest working anywhere else apart from in the office, especially if it involves going to a conference and using mobile devices.  Want a wizard?  Ring them on their mobile and don’t flinch when they say they are in Canada.  

Tuesday 23 July 2013

And we're all wonderful

Posted by Jean Adams

I like supervising student projects. But I think I like supervising MSc projects the most. The students are a bit more motivated, enthusiastic and capable than undergraduates. The timescales are short enough that I don’t get bored. The projects are straightforward enough that I rarely have to ask (out loud or in my head) “sorry, what is it we’re trying to do again?”

Most years I supervise two or three MSc projects. Often they’re projects that I suggested, but increasingly they’re either a great idea that the student came up with, or something that we somehow worked out together. I’m lucky to have had a run of great students. One of this year’s group said to me “everyone wants you as their supervisor because they say that you get all of your students a distinction”. Unfortunately, this isn’t true – either that all my students get a distinction, or that I get it for them. Good students get themselves a distinction; and there are definitely students who have been erased from my CV (I’m not scared of massaging the appearance of the denominator).

As the weather hots up and supervisors start to long achingly for the time in August when they might get to a) go on holiday; or b) stay home and catch up with all the jobs they haven’t managed to do since last August, MSc students also start to go into overdrive. In the last few weeks, I’ve been struck by how different this year’s students are. Not just from each other, but also from me.

I’ve done Myers-Briggs enough times to know that everyone is different (and obviously this never occurred to me before someone paid to have my personality profiled and asked me to fill in an annoyingly ambiguous questionnaire). Perhaps being placed in the role of supervisor means that I am generally able to impose my ways of working on my students. After all, if they don’t fit in with me, they are likely to annoy me and not get much in the way of support or feedback. Maybe most students work this out implicitly or explicitly fairly early on in the process and just work with it.

This year I have been most bothered by the self-confessed last minute student. They’ve finished their data collection. The protocol that they submitted in January will make a perfectly good methods section. I’ve seen a first draft of their analysis. The work is not finished, but it could easily be in a week or two. Whereas I would want to get it licked so I could relax, go on holiday, maybe get the paper written up before the next academic year rolls round and flattens me, last minute student is totally calm about leaving it. It’ll take a week or two, they can start mid-August and still have plenty of time.

My logical side knows this to be true. My reflexes scream that this will lead to panic and trouble. Come mid-August I’m going to be on holiday, so it’s not like I’ll be the one who has to deal with any panic. Last minute student knows they will be on their own for the last two weeks. They just trust that things will turn out fine.

How I want them to finish their work now. How I wish I could join them in their state of ‘it’s too early to get the least bothered about this’ tranquillity.

Thursday 18 July 2013

I am not a doctor

Posted by Jean Adams

My name is Jean and I am not a doctor.

Twelve years ago this week I graduated with an MBBS (Bachelor of Medicine, Bachelor of Surgery – a medical degree to its friends). Since then I have varyingly described myself as “a medic”, someone who “trained as a doctor”, and most recently a “failed doctor”. They are all true to varying degrees. Only recently have I become truly comfortable with the reality that I am not be a doctor, without the need for qualification or explanation.

I graduated with an MBBS. But I never practiced as a doctor. I didn’t complete the early post-graduate experience you need to become fully registered as a doctor. I was briefly listed on the medical register as a ‘pre-registration’ doctor. But only as long as it was free. After that I voluntarily removed myself from the register. Which, I assure you, is an entirely different thing from being struck off.

Just to confirm...none of these people are me
For a while I kidded myself (but mostly I reassured my friends, family and advisors) that I might go back to medicine. I would indulge myself with research for a short while and complete my PhD. Then I would see the light and realise that the only true and good career path was medicine. I would become a GP or a psychiatrist. Maybe I would do a little research on the side. It was going to be fine. I was not going to be a failure.

Despite not wanting to be paid to practice medicine, for a long time I clung on to the medic label. To begin with I think this was mostly because I wanted something to show for my six years at medical school. All my friends were junior doctors. I was...still a student. I needed something to suggest that I might be a worthwhile person. For the three years that I worked towards becoming one sort of Dr Adams, I clung to the other sort of Dr Adams as some sort of confirmation that, despite appearances, I was definitely a fully fledged adult, and not ‘just’ a student.

After my mother died, my father told me that the most important thing for her, as a psychiatrist, was her dual qualification as a general physician as well as a psychiatrist. This was, he said, what gave her legitimacy during her (endless) negotiations with the rest of the hospital – no-one was ever going to listen to a shrink whine about being under-staffed, but they might listen to a ‘proper’ doctor who was playing at being a shrink for a while.

Even after I became Dr Dr Adams I didn’t quite trust that one Dr was up to the other Dr. Yeah, I had a PhD, but I was also a ‘proper’ doctor. Just like my dad said, I thought that it gave me some legitimacy with the men in suits from the rest of the medical school.

Now it all seems a bit of a joke. I can barely remember how to examine a chest, let alone suggest a differential diagnosis and management plan for your intermittent breathlessness. There was a time when I considered watching ‘ER’ to be half way between doing nothing and revising for finals. These days I struggle to work out what all the acronyms stand for.

But however much I disliked medical school as a phenomenon, I am still grateful that I went. It is a fine training in life. I’m sure I’ve forgotten more than half of what I learnt. But you don’t forget the time you held a stranger’s hand as they delivered their first baby, the hour you spent with a floridly psychotic young man trying to decipher his world, the women dignifiedly dying of malignant melanoma who still dressed like she was just about to go out for a run, or being taught how to certify someone (very newly dead) as dead.

I have finally arrived at a place where I am confident enough with the career and identify I have, that I don’t need to cling to one that isn’t really mine.

I am not a doctor.

With thanks to Lynne Stobbart, whose post on always being a nurse helped me realise that I was never going to be a doctor.

Tuesday 16 July 2013

Systematic reviewing: soporific or scholarship?

Guest post by Kathryn Oliver

For several years, I was employed by a systematic review facility which provided review evidence for various government departments. We did full systematic reviews (about 18 months), rapid reviews (about 8 month), systematic maps, papers of all of the above... I read a lot of papers and learned a lot. One important lesson was about the difference between a good quality research study, and a good quality paper. We did our quality appraisal on the reportage of a study – not the study itself. If a trial didn’t mention randomisation, we assumed it wasn’t. If it said it was randomised, but didn’t say how, it got a few more points; randomisation methods reported (tossing a coin, birthdays, researcher selection (!!!), computer-generated) got them a few more. In short, I learnt a lot about social and clinical research methods, and how to write them up....

But I started to worry that all this reviewing was having a pernicious effect on me. Apart from the effects of occasional tedium, I wondered – was it making me a bad scholar? The reviews we did were high quality and published in good journals; there was consensus that we were doing a good job. But I still worry about missed opportunities. Without criticising my excellent training or support from systematic review colleagues, I present some personal reflections on what I could have done better:

1. Not ignore everything about the papers except for the methods and findings

Since my reviewing days, I’ve gone on to do other research jobs, a PhD and a post doc – so I’ve now grappled with writing research papers myself. I now appreciate the thought and craft that goes into introductions, discussions, conclusions, implications; all loaded with high-quality academic thought and really, the parts you want other people to take notice of. But did I as a systematic reviewer? No I did not. I went straight to the methods (“another rubbish paper then”) and then to the findings (“they haven’t even controlled for income! losers”) and ignored the rest. All that thought, all those carefully constructed implications for other researchers – out the window.

2. Take the implications further

Most systematic reviews (if not most papers these days) have a section called “Policy and Practice Recommendations” or similar. A systematic review may include, say 100 papers – that’s a lot of recommendations. Now I wonder, why didn’t we - or research funders, for whom it’s probably even more important – collate these into a “state of the field” list of recommendations on which there was consensus or disagreement?

3. Collate the conclusions

“More research is needed” was probably the conclusion of most papers I read. To be fair, some did accurately describe precise research questions – and these again could (should?) have been collated into list of outstanding questions which could feed into the agenda setting for research funders, used in priority-setting with patients and the public, or just posted somewhere to inform future grant applications.

4. Draw on more types of information

Despite advances in systematic reviewing methods to develop ways to synthesise evidence from non-trial evidence, there is still a huge emphasis on empirical research data – for entirely understandable reasons. I still wonder if there are opportunities to draw on other type of research output though: commentaries and conceptual pieces, unpublished datasets (especially to answer questions raised by the review), policy pieces to give context and feed into recommendations...

I still do systematic reviews, and I still don’t do all these things, partly because of the time, lack of funding, and so on and so forth. I do try and write a commentary about the review now though, reflecting on the ‘state of the field’ which is a useful exercise for me, if no one else. These days, I try and think of a systematic review as a way to really learn about what is going on in a body of literature, and an opportunity to engage with the current debates. I think the trick is giving yourself the time to think, and not just plough through that huge pile of full-text retrieved....

Thursday 11 July 2013

The blunt end

Posted by Jean Adams

Since I’ve started this gig I’ve been responsible for my own research. By which I mean, I have (mostly and probably less than I would like to think) been the one who writes the protocol, analyses the data, writes the draft, stands up in front of people to deliver the conference presentation. I guess I’ve also had varying degrees of responsibility for having ideas, collecting data, keeping control of the budget. All research is collaborative so I’ve rarely been totally on my own. But it felt very ‘sharp end’.

Or at least, looking back it now feels that it was very sharp end. Probably at the time it just felt like what I did.
Now I increasingly manage other people who do research. This is a whole different type of responsibility. Until recently, I hadn’t realised how different having another person between me and the ‘sharp end’ of data analysis, writing and presentation can make the research experience.

I get a bit nervous before I give a research presentation at a conference. I know this and I have worked out ways to manage it pretty well. I make sure I’m well prepared. I don’t let myself think about it at all in the few hours before delivery. I check all the IT stuff in the venue works to my liking as soon as I can. If someone else is presenting the work, my normal strategies seem a bit pointless. A few times recently, I’ve found myself nervous on behalf of someone else who is presenting ‘my’ data. Obviously we can chat through what would be good to include in the presentation, and do a run through beforehand. But I can’t control everything and I certainly don’t want to fluster around someone else making sure they’re okay, when what I’m trying to do is ensure that I’m okay. I think that it’s this lack of control that makes me nervous. I hadn’t ever thought of myself as a control-freak before, but maybe I am.

Research is something that takes time and effort (and blood, sweat and tears). It’s hard not to get pretty wrapped up your research, to become attached to it. When you write about it or present it you lay out your baby in front of someone else for them to do what they will with it. It’s pretty scary at the best of times. Somehow I’m finding it a whole lot harder doing it via the medium of someone else.

Moving on from the sharp end isn’t just about shifting my responsibility from doing research to managing other people to do research though. I am also becoming responsible for other’s people careers and futures and progression. I wouldn’t want to overplay this. Genuinely, I think you’ve got to take responsibility for your own career. Other people can help you (and hinder you), but you’re the one in charge.

Given that I can now do a bit of helping (or hindering) I find myself not just being protective of my research babies, but also of my people. I spent quite a lot of time last autumn helping someone put together a studentship application. Like everything else it was a big team effort: we worked out the ideas together with some other colleagues; got lots of peer review; and did mock interviews with colleagues on the funding committee. I didn’t get obsessed with it like I do with ‘my’ grants. But it felt much more important than lots of the other co-applicant grants I’ve been involved with.

When we heard the studentship wasn’t funded, I was way more disappointed than I thought I’d be. Disappointed of course that all that good work had been for nothing. But disappointed that somehow I hadn’t been able to deliver for the would-be student. Disappointed that I’d let them down. I feel responsible.

I sometimes miss the sharp end. Over the summer I have carved out a whole bunch of time (well, maybe two weeks max) during which I will stay home, analyse data and write a paper from start to finish. In some ways it feels somehow selfish cutting myself off like that to do some research. But I promise it is definitely necessary for the wider project it is part of. The blunt end is going to take some getting used to. Maybe I’ll always need some sharp end breaks.

Tuesday 9 July 2013

What’s wrong with “Policy and Practice Partners”?

Posted by Avril Rhodes

Before entering the wardrobe and coming out in Fuse-land, I had never heard the term “policy and practice partners”, but once the door closed behind me, I never stopped hearing it, and being shortened to PPPs as well, which foxed me for a while. You may think terminology doesn’t matter, but it really does. Stay with me and I’ll tell you why it’s important. 

Entering the wardrobe to Fuse-land
As touched upon by my colleague Mark Welford in a previous post, our partners in public health do not identify with this term and at worse feel alienated from or puzzled by it. Public health managers, specialists and consultants I’ve known rarely promulgate or formulate policy – they implement it, may be consulted about policy, influence policy or advise about it, may author and coordinate a local strategy to reflect it, but don’t actually make policy. Policy is made by government departments, and to some degree, Boards and high level Council meetings. I’ve sometimes heard the phrase “our partners working in policy roles…” and that’s rarely strictly true, as it seems to be said implying that these ‘partners’ somehow make policy. More likely they’re trying to manage the consequences of policy.

When partners hear the word practice, they think of primary care, and people like your family doctor and the clinical staff working with him/her spring to mind. Using the term practitioners makes this worse, as this refers not only to people directly providing patient or client care in the GP surgery, but also people working in secondary care (hospitals to you and I), specialist units and community services. I blush to remember one occasion when a former colleague of mine who continues to support Fuse and works in data intelligence said to me “But I’m not a practitioner – I don’t see patients”, on hearing the phrase used in his presence.

Our partners are not likely to feel that they are partners unless they are directly involved in one of the many Fuse or Fuse related research projects. A partner is someone who you have a direct relationship with, for example, via a contract, or a formal statutory obligation to collaborate. We run the risk of overstating the closeness or formality of the relationship by using the word partner, and appearing presumptuous.

As I’ve been wandering around the Fuse-forest, I’ve been almost constantly thinking about alternatives and also trying to recall what phrase I would have used, before I stepped into the wardrobe and the truth is I can’t remember – and maybe there wasn’t the language to describe it. One day a light bulb did flicker briefly, and I thought about ‘stakeholders’ as an alternative perhaps with qualifying adjectives, like, “external” or “public health and social services…” or whichever sector or grouping one wished to highlight.

I fret that we’ve got too used to this PPP thing to change our ways, but I would put in a plea that we come up with something that’s more acceptable, and, at the least avoid using it when we are in our valued stakeholder’s company.

Any ideas?