From placement to PhD? – A Manchester BRC research placement story

A new viewpoint

Entering my third year of working on hospital wards, I increasingly thought about the background to my daily clinical decisions. As a clinical pharmacist, I’m required to use evidence-based practice when reviewing a patient’s medications. But how is clinical research carried out and how does this affect everyday practice?  These are the questions that led me to pursuing a Manchester BRC research placement. As it’s through research we can help to improve patient care.

Why COPD?

COPD is a term that’s used to describe a group of lung conditions that cause the airways to become permanently narrowed, and therefore causes breathing problems. Inhaled and oral medication can help to open them up to some extent.

Working as a clinical pharmacist I’ve found that I’ve been able to make an impact on this patient group. From assessing inhaler technique, advising on smoking cessation and checking annual flu vaccination status.

The research

We know that antibiotics and steroids are often overused in COPD ‘flare-ups’ (exacerbations) and are not always the most appropriate treatment depending on the cause. However, all flare-ups are generally treated in the same way, with steroids to treat inflammation and antibiotics, to treat infections.

The TRACE-COPD trial looks at using procalcitonin (an infection biomarker) and eosinophils (an inflammatory biomarker), which are found in the blood to predict if a patient would benefit from antibiotics or steroids for  their flare-up and so avoid giving them these medications unnecessarily.

The expected

Meeting with BRC respiratory lead Professor Jørgen Vestbo and Dr Alexander Mathioudakis, the Clinical Fellow running the study, we planned my time to provide insight into all aspects of clinical trial design. This included patient recruitment and data collection, data management and analysis, pre-stage clinical trials development and training on the methods of conducting a systematic review (a study which groups together information from currently published research to produce a summary of evidence). Plus, weekly attendance at the BRC Research study days which are led by academics and industry professionals.

The unexpected

Before starting the placement I didn’t expect to be so involved within the development stages of clinical research.

I've been able to produce the groundwork for a systematic review of the outcomes evaluated in clinical trials on COPD treatment. With this, I'll be named as an author in the published article. Also, the results of this systematic review will be used in the development of a core outcome set for future clinical studies evaluating COPD treatment. A core outcome set could improve the quality and comparability of future clinical research studies.

I was surprised to find that a patient-centred approach to clinical trial design was so integral to the studies I’ve been exposed to. I had the pleasure of meeting a patient expert aiding patient recruitment by developing understanding and awareness of the clinical trials within the COPD patient population. The patient expert helps to ensure study design is patient-focused to ensure the results have meaningful impact on patient care.

What have I learnt?

I have developed skills of extracting data from published research articles to be included in a systematic review. By doing this, I have a new understanding of the importance of good research design to ensure the data produced reflects the patient population. Ensuring good research design will improve the impact a study has on patient care. I have refined the skill of critical analysis and appraisal of research articles. This means I can read research articles and decide how trustworthy and relevant they are to the COPD patient population.

I will use these skills day-to-day as a clinical pharmacist when reviewing patients’ medications and the evidence-base for the choices behind them. I will critically analyse the literature to decide how relevant studies are for my patients and how they have helped form national guidelines for COPD.

Training opportunities

The “BRC NIHR Early Career Research Seminar” was a highlight of the placement as I learnt about the various NIHR Fellowships that are on offer at pre and post-doctoral level. The event also gave me an insight into current PhD student projects within the BRC.

I attended a lecture by Professor Vestbo on the interactions between clinicians, academics and pharma within experimental medicine. As a pharmacist, it was interesting to learn about how researchers and the pharmaceutical industry interact to produce clinical trial research. In addition, I’ve been able to complete Good Clinical Practice (GCP) training in which the principles are transferable to any other clinical and/or research environment I work in.

The clinical trial experience

I’ve observed patient visits with the clinical team at NIHR Manchester Clinical Research Facility and commercial trials within the Medicines Evaluation Unit such as looking at identifiable factors to help early diagnosis of COPD and how the cold virus affects these patients. I learnt about the breathing assessment techniques used in respiratory research such as spirometry and sputum induction. In my practice as a clinical pharmacist, I can use this experience when interpreting diagnostic measures in patient’s medical notes to assess their respiratory disease.

What does the future hold?

I would like to continue to work with Dr Mathioudakis and Professor Vestbo to help with clinical study development in my own time. I hope this will form the basis of a research background while continuing as a clinical pharmacist. Once I’ve built more experience and confidence in research – who knows, maybe a PhD application is on the horizon?

How you can get involved

Placements are aligned to the BRC themes and are open to nurses, midwives, pharmacists and allied health professionals. If you’d like to apply; choose a project, get the backing of your line manager, then fill out a short application form – it’s that easy! This could be the start of a career in research or simply give you a new insight of evidence-based practice in your role.

Thanks to all staff who have been involved my research placement; for their amazing support!