CONFERENCE CALLS

Research: Getting that can do attitude

uring parts of this conference I felt I was being beaten with a stick. A constant voice in my head asked, What exactly is the point of being a speech and language therapist if nothing that we do works? Scenes from past clinics floated before my eyes and set me wondering. Where are these clients now? How are they coping? Even with all the effort and self-questioning poured into every session, did anything I had to offer actually make a difference? But, while Paul Carding was fairly scathing about the professions fitness for the evidence race, he was also keen to stress that no evidence is not the same as no use. In our favour, we are a young profession, we are willing to act and we are far from being the only discipline facing tough questions about its very existence. By the end, Rosalind Rogers, incoming chair of the Royal College of Speech & Language Therapists, sensed delegates were leaving with a much more can do attitude. So, what are we going to do differently? Matthew Hallsworth from the UK Clinical Research Collaboration said there will be no new money, so we need to be creative with what we have. Some practical suggestions and recommended reading from presenters and participants are in table 1, but I also wanted to find out what impact contributors thought their sessions had. Paula Leslie hopes those attending realised that real, onthe-job clinicians are capable of instituting evidence based practice and that they have a responsibility to do so, even if its just making an informed decision about an aspect of received wisdom intervention by critically reading a paper, or writing an objective case report. Joan Murphy, Lois Cameron and Mary Turnbull got across that speech and language therapists have the skills to do research, can be involved at different levels, and can even have fun doing it! Importantly, they say we need to build our confidence in partnership with academic institutions as therapists have pertinent clinical questions to ask and the academic institutions need us as much as we need them. While Elspeth McCartney is happy that participants understood we have some good ways of evaluating practice, and that we can show some practice is effective, she was aware of anxieties about the process that we will have to address. I think some participants in my session were concerned that measuring intervention and trying to pin down best practice might impede a therapists flexibility, and impair on line clinical responsiveness. But, as one attendee remarked, when the East Kent Outcomes system was introduced to her area, there was an initial resistance because you dont want to lose the creative buzz. This turned to a more positive attitude when people realised the benefits: After all, why would you want to keep doing something that doesnt work? Looking to the future, Elspeth McCartney has a vision of phased clinical trials of many aspects of therapy intervention, moving as far as evaluation of real therapy practice in a variety of centres and contexts, with results showing very good effects for clients. While action is needed on many levels to bring this about, individual clinicians are key to this vision becoming a reality. For James Law, this starts with people being driven by the right questions about their practice, a skill that has to be embedded in speech and language therapy training. He would like people to have relatively easy access to research support, whether that is through a university or other body, and to be realistic about what research entails in terms of the time and support needed. He wants managers to be creative about encouraging practitioners to see research as a career option
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2006

How is the profession going to increase its evidence base? Looking back on a recent conference organised by the Royal College of Speech & Language Therapists, editor Avril Nicoll considers what practical steps we can all take.
THE ROYAL COLLEGE OF SPEECH & LANGUAGE THERAPISTS HELD A CONFERENCE IN EDINBURGH ON 28 SEPTEMBER 2006 TO CONSIDER THE THEME PLUGGING THE EVIDENCE BASE GAP: IMPORTANT RESEARCH IN SPEECH AND LANGUAGE THERAPY. SPEAKERS INCLUDED PROFESSOR PAUL CARDING AND DR PAULA LESLIE FROM THE UNIVERSITY OF NEWCASTLE, PROFESSOR JAMES LAW, QUEEN MARGARET UNIVERSITY COLLEGE, ELSPETH MCCARTNEY, UNIVERSITY OF STRATHCLYDE, AND JOAN MURPHY (UNIVERSITY OF STIRLING) WITH MARY TURNBULL AND LOIS CAMERON (FORTH VALLEY PCT).
Table 1 Developing an evidence base: What can we do? All Familiarise yourself with the UK Clinical Research Collaboration (www.ukcrc.org) Read: Lewison, G. & Carding, P. (2003) Evaluating UK research in speech and language therapy, International Journal of Language & Communication Disorders 38(1), pp. 65-84. Pring, T. (2004) Ask a silly question: two decades of troublesome trials, International Journal of Language & Communication Disorders 39(3), pp. 285-302. Reilly, S., Oates, J. & Douglas, J. (2003) Evidence Based Practice in Speech Pathology. London: Whurr. Student Learn to ask the right questions Therapist Provide RCSLT with basic evidence to lobby Parliament Judge the quality of papers, and read more widely before you accept the evidence Develop critical appraisal through journal clubs / networks / special interest groups / peer support opportunities Get formal training in research skills, eg. systematic decision-making Keep a reflective diary Join local research and audit committees Academic Address pay differentials to encourage more clinician researchers Build partnerships with clinicians Management Make research as much of a priority as number of level contacts Give senior clinicians protected time for clinical research as part of their career structure, expect them to publish, and actively support them through individual performance review Maintain new graduates enthusiasm for research by protecting time and limiting caseloads Recognise that time is needed even more than funding Seek out and take advantage of funding opportunities (investment in Scotland means the next 3 years is the time to act; regional funding has been reintroduced in England) Research Build strong collaborations leaders Focus on quality Ensure a locus of responsibility to see the project through Start from a thorough understanding of professional knowledge Encourage applications and publicise schemes, eg. those designed for small scale developmental research Improve IT systems Streamline form filling Increase part-time opportunities Help the Allied Health Professions find a unified voice Broaden the medical evidence hierarchy to include qualitative research Give extra support to proposals for relatively under-researched fields Royal College Develop a research strategy that facilitates a of Speech & research attitude, sets priorities and promotes our Language involvement in multidisciplinary research Therapists Outline research competencies Facilitate better support for postgraduate education Support research applications Provide extra input to areas that dont have natural links with universities Build on the advice offered in Communicating Quality 3

L-R Jan Broomfield, Elspeth McCartney, Jen Reid and Mary Turnbull have much to offer as the profession plans a research strategy.

that they can support in practice, rather than assuming that people will disappear off into universities. Paula Leslie is passionate about the need for more clinician researchers to build a robust evidence base. The clinician researcher is sometimes more clinician: evaluating practice with a researchers robust and beady eye. And sometimes more researcher: with a clinicians understanding of the frailty of the human situation and the questions that need answering to more directly improve patient care. Joan Murphy, Lois Cameron and Mary Turnbull know from experience that this can only happen if research time is seen as an essential part of our career, rather than an added extra, with protected time given. There is clearly a fair level of agreement on the way forward, and many small things we can all do to get things moving, whether we are individual clinicians or in a leadership role. It seems that opportunities have been missed for example, one delegate commented that Agenda for Change could have been used to build a research attitude into job descriptions. And, though the conference largely chose to pass over this, we must not underestimate the challenge of building research capacity, particularly in parts of the NHS in England at the moment. The point, however, is that we want to make a real difference to people with communication and swallowing needs, now and in the future. We need to have confidence in our clinical decision-making and information giving. We have to develop the professions resilience. Cant do is simply not an option. SLTP

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