Nightingale J, Fowler-Davis S, Grafton K, Kelly S, Langham C, Lewis R, Bianco B, Harrop D
Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK.
University of Lincoln, Lincoln, UK.
Health Res Policy Syst. 2020 Oct 19;18(1):122. doi: 10.1186/s12961-020-00638-1.
Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme.
A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model.
Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition.
The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration.
在不同的国际环境中，培养医疗行业的研究能力都是一项挑战。在英国，国家卫生研究院旨在通过针对护士、助产士和专职医疗人员的综合临床学术（ICA）研究职业晋升阶梯来应对这些挑战。尽管此前尚未对从早期进入点（实习）开始的晋升情况进行调查，但已发现在该晋升路径的后期阶段学术进展不佳。对四个已完成实习的队列进行了全国性评估，以探讨利益相关者的观点以及实习项目之后的进展情况。
一个混合方法项目采用了定性和定量数据收集的顺序阶段，首先是两个利益相关者焦点小组（n = 10）；研究结果为向以前的实习生队列（n = 104）、他们的经理（n = 12）和学术导师（n = 36）分发的在线调查的开发提供了信息。随后进行了八次半结构化访谈，以探讨实习带来的挑战和机遇。主题分析用于审查焦点小组和访谈中的定性数据，调查数据则使用描述性统计进行分析和展示。来自每个阶段的数据综合展示在新世界柯克帕特里克培训评估模型中概述的四级评估框架内。
存在重要的地区差异，但实习受到所有利益相关者的高度重视。不同职业之间的代表性各不相同，护理和一些基于服务的职业代表性较差。所有实习生都成功完成了该项目（n = 104），有证据表明对实习生、同事和患者护理产生了积极影响。平衡研究任务与临床活动具有挑战性；中层管理人员被视为项目成功的把关人。进入ICA路径下一阶段的竞争非常激烈，只有四分之一的实习生能够实现；在资助项目之外获得导师指导对于成功过渡至关重要。
实习项目成功地提供了一系列重要的早期研究经验，尽管在项目之后的进展具有挑战性，部分原因是实习与ICA框架下一级之间的差距不断扩大。弥合这一差距所需的关键指导支持因时间和资金不足而受到威胁；因此，对于许多护士和专职医疗人员来说，追求临床学术职业仍将难以实现。需要在机构层面采取合作方式提供临床学术支持，有几种国际模式提供了可供考虑的替代策略。
