Engagement in research during specialist geriatric medicine training: results of a national trainee survey

Sampling profile

The RGST survey was disseminated to 521 geriatric medicine trainees across the UK between 20 June 2019 and 30 November 2019, with responses from 36.9% (n=192). All training grades were represented in similar proportions: year 1 had 20.3% (n=39) of responses, year 2 had 18.8% (n=36) of responses, year 3 had 22.9% (n=44) of responses, year 4 had 18.8% (n=36) of responses, and year 5 had 17.7% (n=34) of responses. Forty-one per cent (76/185) held their undergraduate degree as their highest qualification, 51.9% (96/185) had a Bachelor or Master of Science (BSc or MSc), 2.7% (5/185) had an MD and 4.3% (8/185) held a PhD.

Research experience, training, support and culture

The vast majority 94.1% (176/187) of respondents agreed that research has an important role in geriatric medicine practice. Forty-four per cent (83/188) stated they had previously been involved in research. Of those who had not previously been involved in research, 59.0% (n=49) agreed they would like to undertake a period of research, and 37.3% (n=31) were prepared to take time out of training to do so (25 responded that they were willing to take over a year out of training).

Trainee perceptions of research experience, training, support and culture are demonstrated in Table 1. Thirty-one per cent (60/192) of respondents felt they had gained sufficient research experience to a level they would like (this was 41.4% (29/70) in the ST6–7 subgroup), with 18.2% (n=35) reporting an active involvement in developing or overseeing research studies. In the ‘training’ section, 52.9% (63/119) of ST3–5 trainees reported insufficient training to understand research to a level they would like; for the ST6–7 respondents, this was 42.3% (30/70). In response to the question of ‘knowledge to conduct research adequately’, 17.6% (21/119) of ST3–5 trainees agreed compared with 21.4% (15/70) ST6–7 respondents.

Thirty per cent (58/192) of respondents agreed that they had been encouraged and supported to undertake research during their specialty training; 35.1% (n=67) felt there was a strong and positive culture to integrate research into routine clinical care.

Enablers and barriers to participating in research

Follow-up questions were prompted for respondents who had not undertaken any research so far in their training to explore personal motivators (see Table 2). There were 30.1% (46/153) of trainees who expressed no desire to undertake research, half (77/153) reported that they did not want to extend their training, and 73% (109/149) agreed that they didn't have a clear idea of what topic to research. Poor understanding of research funding and developing research ideas were identified as barriers, as was supervision (74/146 reported that they had no one to supervise them).

Concepts arising from free-text responses

Responses to free-text questions highlighted enablers and barriers to research in geriatric medicine training. The coding framework with frequency of coding as an illustration of responder comments is available in the supplementary material S1.

Visibility of research and academia in geriatric medicine

The presence of infrastructure, such as academic departments and the Research Design Service, were highlighted as enablers to research engagement. However, clustered locations of these services were observed as a hindrance where ‘if you are a trainee whose home is not that close to [location of research centre], then the geography itself acts as a barrier.’ With another response reasoning that ‘academic infrastructure is developing within geriatric medicine but nowhere near the status of other specialties.’

The presence of clinical academics and other professionals engaged in research was cited as a positive force through visibility of, for example, a ‘geriatrics professor as part of the clinical team’ as mentors or ‘role models’, or through accessible supervision: ‘I had a supportive academic consultant who suggested a project and acted as my supervisor.’ However, more comments related to a lack of presence of academics (both senior and peer-trainee) and ‘not knowing who to speak to or where to get advice.’

A culture of engagement and support in research

Working in departments or with consultants engaged in research (through being ‘enthusiastic’ or ‘the driving force’) featured frequently among enablers. A part of this engagement was the perceived support and encouragement to pursue research by ‘supportive supervisors’ and ‘supportive consultants’; the most cited enabler to engage with research in geriatric medicine training. However, a lack of support was also widespread with statements of ‘apathy and discouragement’ and an ‘apparent lack of perceived importance’. Alongside these comments about the disconnect between clinical and research teams, one respondent reasoned that the minimal advice available from supervisors was the ‘lack of their own experience in the field’. Training programme directors (TPDs) were seen as key gatekeepers to research engagement, with comments including ‘TPD support to stay at same hospital to complete research project’ compared with ‘Reluctance of TPDs to actually provide assistance on how to apply for [time out of programme]’.

Opportunity

A lack of protected time was the most cited barrier to engagement: such as ‘the enormous burden of clinical work’ and a ‘lack of allocated time in training’. The effects were summarised by one as ‘trying to continue projects alongside service provision in clinical time – little time or energy’. Training logistics was another practical barrier, with the rotational and short-term nature of training placements hindering organisation of ‘meaningful projects’, as well as the effort involved applying for time out of training to undertake research; a process labelled by some as ‘inflexible’ and ‘difficult’. Comments about training less than full time (LTFT) as a barrier threaded through both time and logistics, including ‘whether LTFT research is an option’ and ‘not getting the correct pro rata amount of research time’.

Funding and financial strain were evident, with perceptions of lack of funding opportunities and reluctance to ‘spend my own time doing work with no payment or time compensation’. There was mention of impact on overall earnings, with ‘a significant financial compromise to pursue research – I could have been a consultant 3 years earlier’. This aligned with how pursuing research would mean an extension to time in training, where many were ‘not keen’.

Experiences or opportunities to participate in research when present were positive, with mention of collaboratives (such as GeMRC) or previous research experiences prior to studying medicine. However, the majority of responses described no experience or opportunity to participate in a research project. There was also the perception by some that the training requirement for regular audits takes time away from research projects, for example ‘all focus is on meaningless audits’.

The IAT was highlighted positively with a number of respondents stating it as a support by listing their role (eg academic clinical fellow (ACF)) and how they had ‘dedicated time and resources’. However, some commented how this training programme was not available to them, and one response showed potential negative impacts on other trainees in ‘having to compete against ACF trainees who have years of research experience and who are published ahead of you as they have time in their job plan for this’.

Research and evidence-based medicine in geriatric medicine training

Another commonly mentioned hindrance to research engagement related to a ‘lack of knowledge of where to start’ in developing and conducting research, including lack of formal training. This referred to a general lack of knowledge and not being ‘taught in university’, as well as to research methodology, the ‘language of research’ and topic selection. Conversely, formal teaching, such as specific research-training days and courses facilitated engagement and helped develop ‘understanding that research is something achievable by everyone’. Exposure to research during conferences and regional teaching were also factors, and a desire by some to engage in evidence-based medicine ‘seeing the knowledge gaps during clinical practice’. However, these comments in support were few in comparison to the number relating to a lack of formal knowledge about developing and conducting research.

The individual

Some commented on personal factors acting as a barrier; for example, a perceived personal ability that was ‘not academic enough’ or a ‘lack of confidence’. These views may relate to comments such as a ‘perception of “them” and “us” – either you “do research” or you don't! There does seem to be a very all or nothing approach’. These opinions also aligned with comments on perceived burden of dual clinical and academic workloads ‘balancing work life and family life. Balancing clinical and academic commitments’ and ‘burn out’ acting as an obstacle to research engagement.