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Abstract
Research is vital to paediatrics; however, many trainees feel there is a deficit in their opportunities, experience and exposure in this area. Three training regions in the UK, the West Midlands, Wales and Peninsula, have recently started region-wide, trainee-led research and governance collaboratives aimed at improving trainee access and education in research, undertaking good quality, multicentre audit, quality improvement and pilot projects in collaboration across the regions and implementing change. We report on the experiences, benefits and challenges of these trainee collaboratives (Paediatric Research Across the Midlands, Wales Research and Education Network and Peninsula Trainee Research Audit and Innovation Network) including a trainee survey looking at how these initiatives have improved skills in conducting multicentre prospective studies, team working skills, leadership, understanding of statistics and manuscripts and presentation skills. We also describe how collaboration with colleagues and participation in projects can benefit trainees in a wider sense of purpose and help to encourage morale, as well as what can be learnt as paediatric training moves forward.
- audit
- evidence based medicine
- general paediatrics
- neonatology
- paediatric practice
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Introduction
Although audit is mandatory, most paediatric trainees generally have limited exposure to multicentre projects or research. The proportion of academics within the UK paediatric consultant workforce fell from 11.3% to 5.9% between 2000 and 2011,1 and <10% of senior trainees now have a higher research degree, compared with 1/3 of consultants >50 years old.2 Both reported and personal experience indicate most paediatric trainees are both interested in and wish to perform research. The new Royal College of Paediatrics and Child Health (RCPCH) curriculum, Progress, encourages paediatric trainees and trainers to seek out research (domain 11; research),3 with previously elicited barriers being a lack of academic culture, diminished opportunity and time constraints in training programmes and work schedules.4
In recent years, increasing focus has been placed on collaborative, team-based audit and research. Other specialities have set up trainee-led collaboratives, providing a framework within which motivated trainees can deliver better audit and research projects.5 Examples include the West Midlands Research Collaborative (surgical network) and the South West Anaesthesia Research Matrix (anaesthetic network).5 6
We report the experiences, benefits and challenges of three newly formed paediatric trainee collaboratives (Paediatric Research Across the Midlands [PRAM]; Welsh Research and Education Network [WREN]; and Peninsula Trainee Research Audit and Innovation Network [PenTRAIN]), including a survey exploring how these initiatives have improved skills in conducting multicentre projects, team working, leadership, understanding of statistics and manuscripts and presentation. We also describe how collaboration with colleagues and participation in projects benefits trainees in a wider sense, helping to encourage morale, and lessons learnt. Interestingly, despite forming separately, these collaboratives have common motivations, aims and challenges.
How we work
Table 1 shows the aims and structures of the three networks. Online supplementary appendix 1 demonstrates a sample programme from a WREN study day.
Supplemental material
Aims and objectives of the three networks
Table 2 demonstrates the topic breadth covered and projects undertaken so far by the three groups. All groups currently have ongoing projects, with planned journal submissions for completed projects. Projects so far have been:
Multicentre, prospective clinical audit.
Quality improvement projects including creation and implementation of guidelines.
Surveys of practice.
Completed projects across WREN, PRAM and PenTRAIN networks
Research is a project designed to gain new knowledge and usually requires ethical approval. A service evaluation is a way to define or measure current practice in a service but does not have specific standards to compare with. However, audit compares practice with known set standards to measure how well practice measures up.7 These results can both be used to define areas of good practice and areas of improvement. These possible improvements may be undertaken as part of a quality improvement project (QIP) and the service or practice remeasured to quantify the impact made by the QIP. Audits and QIPs are usually registered with the governance departments of local trusts.
Trainee experiences
To date, PRAM and WREN have each involved 50 trainees in projects, of estimated totals of 240 (21%) and 140 (35%) trainees, respectively, while PenTRAIN has involved 21/82 (26%) Peninsula trainees.
A ‘Google Forms’8 snapshot online survey in July 2018 targeted 120 PRAM, PenTRAIN and WREN members (those signed up for emails, project participants or attendees at an education day). We received 35 responses (29% response rate); 18 (51%) from PRAM, 14 (40%) from WREN and 3 (9%) from PenTRAIN. All were trainees of ST3 grade or above; 6 (17%) were ST3 trainees, with the rest evenly split between ST4-8 registrar levels. Furthermore, 31 (88%) trainees had no formal research experience.
Of those surveyed, 29 (83%) had attended a teaching session or meeting, 27 (77%) had participated in data collection, 20 (57%) had been involved in a project steering group, 15 (42%) had been a project leader at some time, 11 (31%) were committee members and 4 (11%) were currently or had been the organisation chair (where multiple roles could be selected).
In response to ‘to what degree has your involvement in a network increased your confidence in the following domains’, the percentage of trainees responding with ‘moderately’ or ‘significantly’ (on a rating scale of ‘not at all/slightly/moderately/significantly’) was as follows: conducting a multicentre prospective study: 26 trainees (74%); team working skills: 25 (72%); leadership: 17 (48%); understanding of statistics: 16 (46%); critical appraisal skills: 16 (16%); understanding of writing a manuscript: 15 (43%); and presentation skills (poster or oral): 13 (37%).
Free-text positive responses included: improved awareness of research opportunities, reading articles, networking and camaraderie, enthusiasm within training and for quality improvement, feeling like collaborative projects have more impact and achieving a common goal.
The level of trainee involvement indicates that most trainees wait until finishing their membership (membership of the Royal College of Paediatrics and Child Health, MRCPCH) exams before considering such projects. Many consider positive skills gained (especially in teamwork and leadership) are useful for all aspects of career progression, as referenced in the new RCPCH curriculum (domain 6: leadership: domain 8: quality improvement).9 10 Those who did not respond, however, may have been because they did not identify with any of these positive traits, although the response rate is representative of online surveys.11
Challenges
Shift work and trainee commitments over large geographical areas challenge efficient communication and project coordination, and all networks use email, social media and video-conferencing to address these.
One region (the West Midlands) provides a 1-day good clinical practice training course as part of protected regional teaching for ST4-8 trainees every 2 years, as this has been perceived as a barrier to participation in clinical research.
Sustainability is key, as founding trainees move towards consultant posts or other demands take precedence, so it is important to have in-built continuity. Involving junior trainees and having coleaders of projects encourages a non-intimidating environment, equipping them to lead on future projects. A rolling committee structure is another way to address this.
Getting buy-in from trainees at all grades, when much of this work is done in their free time, is essential and has been addressed by using regional teaching days, a blog and demonstrable support and promotion by the local deaneries.
As project ideas evolve, ethical approvals funding may be required, and identifying sources and supporting applications will require senior input. Making the step to research activity and implementing change is key. Involvement from local schools of paediatrics and consultants has helped establish the networks with advice on designing and leading an achievable project. Support from bodies such as the Clinical Research Networks or potentially the RCPCH are also areas to explore.
Future directions
We are currently undertaking a joint prospective multicentre audit of hypertension detection in children and PRAM are applying for funding for a mixed-methods project evaluating presentations of self-harm. WREN is involved with developing a paediatric research network funding bid for Welsh Government, and a novel research project is under development. Further work could include involvement in trial-related research activities, embedding these groups into local schools and ideally within national paediatric training. This will hopefully empower and encourage trainees to develop their interests and experiences in research, audit and clinical governance.
Websites
PenTRAIN: https://sites.google.com/a/nihr.ac.uk/pentrain/home; @UKPenTRAIN.
PRAM: www.pramnetwork.com; @PRAMNetwork.
WREN: www.wrenpaediatrics.com; @WRENpaeds.
Footnotes
Contributors HM and KCH created initial idea; HM wrote for PRAM, coordinated and completed the article; CWC and SL wrote for WREN; TM wrote for PenTRAIN. HV, KCH, RB, AG and CWC reviewed drafts. JK kindly supervised and reviewed.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.