Thoughts from the frontline of NHS research

Like many psychology graduates, I found myself unsure of my career options after I left university. I wanted to work in a clinical role but wasn't sure of how, or where, to start. Research had always interested me but I didn't want to sacrifice clinical opportunities in order to work solely in research. So, after several support worker roles and some voluntary research work, I decided to try something a bit different and applied for the post of clinical studies officer.

For anyone who hasn't encountered a clinical studies officer (or a research nurse) before, we facilitate NHS research in whatever way possible. The role focuses on finding participants for NHS research studies, but we also do a lot of behind the scenes work to ensure projects run smoothly. So what exactly does the role of a clinical studies officer look like, and how does it link with clinical psychology?

A day in the life of a clinical studies officer

As a clinical studies officer my main role is consenting people to research studies and helping with any concerns they might have during studies. My role often involves other tasks of course, such as screening potential candidates, completing psychological assessments, and helping local lead researchers (Principal Investigators (PIs)) to ensure their studies run smoothly. Making sure studies run smoothly can involve all manner of tasks. A few particularly unexpected examples for me include: running healthy lifestyle intervention sessions; learning how to take blood; and promoting research at a local shopping centre. Because of the flexibility required by the role, a colleague recently described my role as "You don't do research; you make research happen".

An important consideration of the clinical studies officer role is that studies often recruit from several NHS Trusts. Recruiting participants from multiple Trusts ensures a study's results are consistent across factors impacted by geography such as socioeconomic background and service provision differences. Working on nationwide projects means that clinical studies officers must communicate effectively with our counterparts in other parts of the country. Open two-way communication helps to identify recruitment techniques which work well at other Trusts, and we use this information to maximise recruitment for the study as a whole. However, recruitment strategies often work better in some Trusts than others due to differences in terms of policies and service configuration. Therefore each Trust's research team will have to tailor their research strategies for each study to account for these differences.

Although my role varies based on the studies I'm supporting and the stage each study is in, a typical day might look like this:

• 8.30am: Get into work and answer my emails.
• 9.15am: Leave the office for my first appointment – visiting someone at home for a follow-up assessment.
• 10.30: Attending a trial management meeting for a study. I update the trial managers with our local progress and address any concerns. I also use the opportunity to see what challenges and solutions have been identified at other Trusts.
• Midday: Lunch and a chance to gather my thoughts from that last meeting.
• 1pm: I go to a clinical team's weekly meeting to present a new study that's opening for recruitment soon. They have a lot of questions about the study, e.g. "Who's the main point of contact?", "How will this research benefit service users?". This is good because it means they're engaged!
• 2.30pm: Running a "recruitment clinic". This involves me sitting in a clinic and having a chat with anyone who the clinicians think might be eligible for one of the studies I work on. I provide information, answer questions, and receive consent from anyone who wants to participate. Between seeing people, I input the data from my earlier visit onto a secure database.
• 5pm: Home time!

As you can see the role can cover a range of tasks. Although some days are less intense than this one, there are also days when I feel pulled in too many directions at once, and the work from several different projects seems to pile up on me (clinical studies officers and research nurses often work on multiple studies). However, I'm fortunate to have supportive managers and colleagues who can help me to manage the work load when it gets particularly heavy.

The challenges of recruiting to studies

As I mentioned before, recruiting participants to studies is my primary role. Although recruitment to a study is ultimately the responsibility of the PI, this responsibility is often delegated to clinical studies officers and research nurses for reasons of practicality (e.g. we have closer links with local clinicians than the PI).

There are lots of challenges to recruitment, which cause many studies to fail to meet their recruitment targets. Here are some of the most common challenges I've come across, and how my colleagues and I tackle them.

• Initial identification: Initially identifying potential participants can be difficult, mainly because the information needed to confirm someone's eligibility for a study is often confidential or absent (e.g. diagnosis, current treatment, age). One way to tackle this problem is to advertise research projects in the waiting areas of services that potential participants might visit. Some studies are also advertised in other public places, such as patient and participant involvement events, shopping centres, or even in the media. Another way we try to identify potential participants is to ask for referrals from the clinicians who work in relevant services. Sometimes clinicians take a more active role and work on studies too. Engaging with clinical teams is really important, as we often can't approach potential participants directly.
• Engagement: Some studies focus on populations who can be described as "difficult to engage", such as people with communication problems or people who display challenging behaviours. Personally, I prefer to think of people described in this way as simply having a different experience of the world, which researchers (and clinicians) must try to understand. To overcome issues with engagement, we often present information in different ways (e.g. using simplified information leaflets, having information translated, using several communication methods). We also work closely with staff members who already have a good rapport with individual service users, as well as anyone else who supports them (such as family, friends, or third sector representatives). Engaging people who support potential participants ensures that we're sensitive to any specific needs an individual may have, and can accommodate for their needs.
• Eligibility criteria: The eligibility criteria for a study can sometimes feel somewhat constricting (e.g. a study might aim to recruit people with a diagnosis of schizophrenia, aged 18-25 from a Bangladeshi background). However, studies that have highly selective eligibility criteria often have lower recruitment targets. Further, before an NHS Trust takes on a study, the study's central team meet with representatives from the local Trust's research department where any concerns about recruitment targets are discussed and solutions are explored. These discussions between Trusts and central research teams mean the problem of eligibility criteria being too restrictive is usually encountered during the feasibility phase of a study (i.e. before recruitment starts).

Personal reflections

One of the things I most enjoy about being a clinical studies officer is the variety the role offers. I work with service users from a range of backgrounds, and my work covers different mental health problems so I never feel like I've 'overspecialised'. My role on a study can vary greatly as well so I get the chance to experience many different roles, including: training staff to work on a study; conducting assessments with participants; safeguarding; and delivering clinical interventions. This variety gives me experience in different aspects of research and its implementation, whilst also giving me clinical experience with a multitude of mental health problems and the issues connected with them.

I also enjoy working on cutting edge research which investigates contemporary issues that seriously affect people's mental health and overall wellbeing. For example, I've worked on the STEPWISE and SCIMITAR+ projects, which both consider ways to help people experiencing severe mental illness (SMI) to improve their physical health through accessible lifestyle intervention programmes. These projects are important because people experiencing SMI live an average of 10-15 years less than the general population, mainly due to preventable physical health problems (such as cardiovascular disease). It is hoped that projects such as STEPWISE and SCIMITAR+ will inform NHS treatments for SMI in the future, and it's a great feeling to know that I've had input into that.

As with any job, there are aspects of my role that I occasionally struggle with. For example, the work can feel lonely sometimes because research teams are often small and each team member may work on different combinations of projects. Having to juggle competing demands independently can be quite stressful at times but I'm fortunate to have supportive colleagues who help me to handle problems when they arise. As with many healthcare roles my role also requires me to reflect on my experiences which can be challenging at times, especially if I feel that someone has been disadvantaged by my actions. For example, I may have to inform an eager potential participant that they aren't eligible for a study due to their score on a screening assessment that I've done with them, which could then lead me to reflect on my competence with that particular assessment tool.

Despite the challenges I face in my role, I find that working in NHS research is very engaging and can be a lot of fun. I'm a naturally curious person, so working in research means that I'm always coming across something new. I've learnt a great deal about the world of research and how research connects with good clinical practice. I've also been able to try my hand at a range of tasks and I really enjoy the day-to-day variety that comes with that. Most importantly though, I've gained a greater appreciation of the impact of cutting edge mental health research, e.g. how the link between physical and mental health can potentially be implemented to improve the lives of service users.

Thinking back on the last couple of years, taking a job in mental health research was the right choice for me. It's not the path I had originally envisaged when I left university, but it's provided me with invaluable experience and also given me the opportunity to do something a bit different. In fact, it's a career option that I believe graduates should be told more about and I certainly recommend becoming involved with research in whatever way you can! It may be the path less travelled for some, such as those wanting to go down a clinical route, but the work is incredibly rewarding and can offer a fresh perspective on mental health problems. Whether or not research is your dream career, everyone can learn something from working in the area!