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Should Fellows do Research?

Why should you do research?

Research is a general term that covers all processes aiming to find responses to worthwhile scientific questions by means of a systematic and analytical approach. Research is crucial to drive development and innovation in patient care. Cardiology is a highly competitive speciality with translational and clinical research at the core of the evidence-base we use in day to day practice. In Cardiology there are several examples showing how practice has rapidly changed as a result of several key research findings. For example, the use of primary percutaneous coronary intervention for an acute ST elevation myocardial infarction has replaced fibrinolysis over the past decades in view of accumulated evidence on its benefit for patient outcomes and this has become standard practice. The current trend in Cardiology to use cardiac computed tomography (CT) for the investigation of stable chest pain is a relatively recent example of how constant research worldwide improves everyday clinical practice. There is no doubt that research is necessary to shape our clinical practice and the decision to pursue research during higher speciality training needs to be considered by every trainee. The important question is why should you do research and what does it add to a cardiology speciality trainee?

Every clinician is responsible for evaluating their own clinical practice and to do that you need to use the tools of research and must be able to review research done by others. This is perhaps best demonstrated by guidelines such as National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) that we use in everyday clinical practice. These are based on meta-analyses, systematic reviews and clinical trials and it is important to understand the evidence that drives changes in guidelines and clinical practice and leads to improvement in patient care.

An important aspect of research, which, is often overlooked is the opportunity to learn new skills. This may be directly related to cardiology such as multi-modality cardiac imaging, lab based practical procedures or more general skills such as leadership, teamworking, and personal development. Personally, for me, undertaking an imaging study has allowed me time to develop my interest and improve my confidence in cardiac imaging so that I can better understand cardiac magnetic resonance (MR) and cardiac CT from basic principles, this in turn complements my clinical training. Though, we are all taught research skills during undergraduate training, often during clinical training (Foundation Programme, Core Training, Specialty Training) the focus shifts towards clinical and practical skills. Even for trainees who are not interested in an academic career, understanding the research process helps them to develop their scientific and clinical skills. The ability to critically appraise other research and understand the differences in methodology to enable us to draw conclusion is essential to developing analytical thinking and decision-making processes.

When most trainees think of research they may have a certain idea, however, research is flexible and you can create your own opportunities, discover and develop new interests. Research gives flexibility but also diversity, you can involve being part of a large research group or setting up a smaller pilot study. This can be qualitative or quantitative, a lab-based study, pre-clinical or clinical study or involving data science and can be tailored to specific interests. Undertaking research does not mean that everyone must become a clinical academic. Most trainees who undertake research will not become clinical academics as consultant Cardiologists, however, without being involved in research it is difficult to ascertain whether it may be an area of interest. For those who are interested in clinical academia, there is significant flexibility as to the type of research you want to conduct and the amount of time you want to give to academia. Clinical medicine is a high pressure working environment and often consultants will be involved in other aspects of work such as training/teaching, management and public health to diversify their roles. For many being involved in research allows for variety in their day to day clinical work and gives an opportunity for continuous development ultimately shaping their clinical practice. There is scope to continue academic work alongside clinical work and supervise future academic trainees.

Lastly, an important aspect that drives innovation and change is the ability to collaborate with other centres and leaders in research. Medicine is continuously changing and as clinicians we not only learn from our past experiences but also from that of our colleagues. Furthermore, it is important to develop research units in hospitals, so that it becomes accessible to a wider range of trainees who may not be able to move geographically to pursue academia. Being involved in research can provide an opportunity to network, learn and work with others in the same field. There is an opportunity to gain recognition in your area of interest which can further help and develop your clinical and academic career. It is however important to remember that despite the highs of research there are also the lows. Research may not be for everyone and you must decide what is best for you, however, you should make that decision after being well informed of the possibilities it may provide.

Research is important and all relevant components of the research engine should co-operate to achieve scientific progress that will help to drive evidence-based medicine and ultimately provide best patient care. The process of conducting research brings new opportunities and challenges and can be highly rewarding.