Abstract
In Advice for a Young Investigator, Santiago Ramón y Cajal (1999) observes that undue deference to the work of previous researchers can stifle scientific enthusiasm. There is pessimism about the opportunities for early career psychiatrists to conduct research in the current environment (Henderson et al., 2015). There is a dearth of places for training, limited mental health research funding and lack of time to conduct research (Looi et al., 2013). It may be argued that research is too sophisticated and important for early career psychiatrists to dabble in as dilettantes. However, in the spirit of Cajal, we advocate that meaningful clinical research is still possible.
The sine qua non for a clinical research career is the passion for excellence in critical thinking and scientific enquiry (Table 1), applied through diligent skilled practice and aimed towards improving health care (Looi et al., 2013).
Elements of a clinical research career.
On beginning in clinical research as a scientist and physician
We begin discussion at the career stage of a trainee or early career psychiatrist in Australian and New Zealand.
The researcher must first find a research supervisor (ideally with additional qualities of a mentor) on whose projects the researcher may collaborate towards a new project. It is necessary the supervisor be an active published researcher, and better if they have a higher degree research qualification and experience as supervisor. Enrolling in a research higher degree at a university may provide formal research supervision and access to resources such as library access, statistical advice and courses on research methodology. Alternatively, in return for teaching and research involvement, appointment as a university clinical academic may grant similar resources.
Balancing many other roles in work and life, a clinical researcher must be extremely focused and aim for a very high standard of scientific enquiry to be relatively effective against competition from full-time researchers and large-scale project funding. There are sacrifices of opportunity, time and income that researchers will likely have to make. Early career psychiatrist researchers will not have employment that provides time for the conduct of research. There are few competitive clinical research fellowship grants for psychiatrists from various organisations (Looi et al., 2013). Researchers may choose less well-remunerated part-time employment to allow time to conduct research. Most early career psychiatrist researchers conduct work in time salvaged from other vocational activities (administration, committee service, volunteering), after family and social commitments.
On selection of research topics
Strategy is needed to frame a suitable research topic, based on a thorough understanding of a research field. As a clinical researcher it is advantageous to be supervised by a clinical practitioner because such practitioners understand the competing roles of clinical, administrative and academic tasks. Seek research topics on the edges of existing fields; there is no sense following the herd. Reading broadly, encompassing social, psychological and neuro-sciences is useful, as is discussion with supervisors and research collaborators.
Strategic research may be framed by innovations such as: investigating diagnostic criteria, developing new methodologies or synthesising approaches from different fields, applying existing methodologies to new areas, comparing two or more cognate disorders, epidemiologic mapping in specific populations or any other combinations.
A complementary approach is to consider the outcomes sought from the research, for example, to effect change in clinical outcomes in defined care pathways, to map the pathophysiology of a particular disorder or to survey the prevalence of a disorder in the broader population. This may then iteratively feedback to the intention and direction of research.
On less resource-intensive research methodologies and approaches
Efficient research may involve methods that allow the researcher to think, collect and analyse data offline in a manner accommodable with the demands of clinical practice. In this context, questionnaires, surveys, observational clinical measures and interviews may be useful for new small-scale qualitative and quantitative research.
For research in collected data, less resource and time-dependent projects may include: pilot epidemiologic studies, analysis of collected data (clinical research databases: diagnostic, clinical scales and treatment response data, biomarkers, neuroimaging), inquiries on statistical databases (Australian Bureau of Statistics) or collaboration on a study of a subset of larger funded research projects. Currently accessible advanced datasets collected by national and international publically funded research consortia are useful resources, provided the investigator liaises with those charged with dataset governance.
Small grants from hospitals, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) or research foundations may be available on successful competitive application towards costs of the purchase of measurement scales, software, accessing databases and transport vouchers for participants.
On skill and collaboration
A prerequisite to being accepted as a skilful scientist is the development of a recognised degree of expertise. This will require considerable diligence and collaborative spirit. Research skill development will involve trial and error, seeking and acting on feedback, and practising towards iterative improvements in skill, preferably with the support of a supervisor.
A reputation for mutually beneficial collaboration is an important currency that must be first diligently earned by helping others with their research. For example, helping another researcher with analysis in which you are skilled may result in reciprocal assistance from an analysis in which the other researcher is skilled. Bringing new skills to an existing study can suggest new projects on which collaboration can be sparked. Agreed goals and outcomes, usually peer-reviewed publications, are key measures of a researcher’s skill and the effectiveness of their collaborations. Collaborators and supervisors can help steer the researcher towards those with a reputation for virtuous collaboration, avoiding those with a reputation for being exploitative or difficult.
On adaptation in the research environment
Clinical research is not exercised independently of the research environment. The path to developing an independent line of research is rarely straight, short and predetermined, especially given the dual roles of a clinical researcher that incorporate the scientist and the physician. Compromises are required that depend upon cooperation and adaptability – with respect to both colleagues and the external environment. Sometimes compromises can be at the cost of one’s own initiatives and independence in order to secure the realisation of the research project, such as assisting others with their projects or modifying the aims of the researcher’s project. Hopefully, such compromises are temporary and lead to long-term outcomes aligned with the researcher’s interests.
The clinical research environment may also have constraints on the academic freedom to explore. Examples of such constraints may include: local healthcare strategy and organisation, forced alignment with pre-existing research streams and political pressures on the direction and outcomes of research.
Conclusion
The aim of a research-based scientific education is to nurture a critically reflective independent weltanschauung that encompasses improvement of clinical science underpinning psychiatric care. Considerable ingenuity will be required to conduct research in the current environment. Health services, universities, non-governmental organisations (NGOs) and the RANZCP can assist by improving access to resources, as well as providing a more welcoming environment. Access to skilled research supervisors remains a potential bottleneck. Through strategic application of diligently acquired skills, a young psychiatrist researcher can conduct significant clinical research. In this context, there is no room for dilettantes, and young psychiatrist researchers should aim to excel and, emulating Prometheus, seize the fire of knowledge from the heavens to light our scientific way.
Footnotes
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding
This paper is an initiative of the Australian US Scandinavian Imaging Exchange (AUSSIE) of which J.C.L.L. and B.L. are members. J.C.L.L. received no specific grant from any funding agency in the public, commercial or non-profit sector. B.L. received funding from Svenska Läkaresällskapet (The Swedish Society of Medicine, SLS-403101).