Getting started on your own project
It is unlikely – but not impossible – that you’ll leap out of the bath like Archimedes, with a brilliant research idea. Even if you did, the chances of having your idea accepted as worthy of a research project are unlikely unless you are already an established researcher. If you want to give research a go you need a mentor – ideally a senior academic in your field – working in University Departments of General Practice, Nursing or whatever your specialty. Talk through any ideas but be fully prepared to join an established project on the way to obtaining a higher degree. When you are more experienced you can formulate research questions and design studies to answer them independently. More advice is available from RDLearning (www.rdlearning.org.uk or Info@rdlearning.org.uk or 0113 392 6378). This approach is much more likely to succeed than starting out as a rugged individualist. Your trust Research and Development Department can also advise. You are far more likely to obtain funding in this way. A useful source for advice on funding and other advice is RDInfo9 and RDDirect (www.rddirect.org.uk or Info@rddirect.org.uk or 0113 295 1122) all of which are funded by the Department of Health (DOH).

Money, money, money
The NHS is one of the largest organisations in the world, but, until recently it did not invest directly in research. All this has changed now with the establishment of the National Institute of Health Research (NIHR) with an expected annual budget of £1.7 billion by 2010. If sufficient high quality applications are received, this amount could expand. The National Institute for Health Research Clinical Research Network Coordinating Centre (NIHR CRN CC) oversees the Clinical Research Networks in Cancer, Diabetes, Dementia and Neurodegenerative Diseases, Medicines for children, Mental Health and Stroke. These are priority research areas, but other important clinical problems will be funded, through the development of special interest groups.

For example, one of the funding programmes, called Research for Patient Benefit, with funds of £25 million per year, supports qualitative and quantitative research into the clinical problems you encounter everyday. The project grants are to support NHS employees’ research. As a general rule, it is a good idea to link your project with academics working at a local University, and such joint applications are particularly welcome. Charities such as a The Wellcome Trust (£600 million per year), Association of Medical Research Charities, Joseph Rowntree Trust (Social Care) and Leverhulme Trust are generous funders. If your project concerns a particular drug or device, you are more likely to secure funding from industry. The development of treatments or devices which enhance quality of life (e.g. joint replacements and pacemakers) was once the sole province of the pharmaceutical and manufacturing industries. With the identification of food supplements, such as prebiotics, that enhance health (functional foods or ‘nutraceuticals’) the nutrition industry has become part of the endeavour. When writing up research, authors declare any conflict of interest and where funding has come from. One of the common objections of industry being involved in research, either by providing funding or by doing some of the research, is that the research is biased in some way because the industry has their own agenda. To counter this view, it is important that any study is well designed and that all research is published for all to see and review.

Is it ethical?
Your research will almost certainly involve people and you will require ethical approval. When involving people in research it is important that they have a choice about participating in the study. They need to be aware of the potential risks of the treatment, to decide if they want to be involved in the research. Careful consideration has to be given to randomisation of the subjects, to ensure that the randomisation is done ethically. For example, on mainland Europe, it is recommended that infants with a family history of allergy receive hydrolysed formulae if not being breastfed. Therefore it would be unethical to randomise such infants to receive standard infant formula. The application form is a bit daunting at first sight because one form is used for all applications – as you go through it, the form ‘redesigns’ itself to the needs of your project. Much of the original application you showed to your R & D Department can be transferred to the form for ethics submission. If you are called to meet the Ethics Committee, it will feel a bit like a job interview. Try not to be put off – they are there to help you. Details of your project will already have been sorted out with your R & D Department. The part of the application they will scrutinise most closely is your patient information sheet. This should explain your project to potential research subjects in the simplest possible language. If your subjects can’t understand what you are asking them to give consent for, it will hardly be informed consent. Doctors are particularly bad at this sort of communication. Asking nonmedical friends and relations to read your information sheet often helps.

Presentations
There are other strict conventions to be assimilated if your work is accepted for presentation at a conference. These are generally 10-minute slots with 5 minutes for discussion, and are far more challenging to produce than a 45-minute lecture. As in amateur dramatics, rehearsal is everything. Presenting to your peers will be far more nerve racking than to an international audience because their questions and criticisms can be searching and personal. But they are doing you a favour by toughening you up for the real thing. Ask your mentor about the best style for slides and discuss with them the ideal number of words per line and number of lines per slide.

Learn to write well, or not to write at all’¹
Publication is important as it adds to the body of literature on a subject, shaping future research and prevents others duplicating work unknowingly. Remember when you learnt about Ohm’s law of electrical resistance in physics? This law was actually discovered by the English scientist Cavendish years earlier, but because he didn’t publish, we call it Ohm’s Law. More importantly, the best practice is based on the analysis of all published work in the area. Authors failing to submit negative studies (and journal editors rejecting them) bias this information. So, publishing work adds credibility and overcomes bias as it allows everyone to analyse the research.

Just when you thought you were reasonably proficient at the three ‘Rs’ you will have to learn a whole new language when reading research and writing up your work. Scientific articles are written in rather turgid passive prose. There are a whole host of conventions, which your mentor will be familiar with, so don’t be discouraged if one third of your prized prose is scored out. You will be amazed how much clearer your message is when you have made the corrections.

Choosing the publication
Picking the right journal (that is, the one that accepts it first time) is critical and you should take advice from your mentor. Having to redraft your paper for another journal is tedious to say the least. It is always a gamble balancing submitting to the most prestigious journal against the one most likely to accept your paper. The benefit of a prestigious peer reviewed journal (like The Lancet) is that experts in the relevant field review the paper before publication, to check things like how well designed the trial is and whether appropriate conclusions have been drawn.

References

1. John Sheffield, First Duke of Buckingham and Normanby 1648-1721