Research productivity and the medical radiation sciences: what do we want?

Lake O'Hara Dreaming

This is a blog mash-up! I usually talk about EdD stuff on here, and over on the #MedRadJClub we host guest blogs that relate to the monthly paper up for discussion. This month’s paper (A Review of Individual and Institutional Publication Productivity in Medical Radiation Science by Ekpo, Hogg & McEntee), looks at research productivity in the medical radiation sciences (MRS) and who is doing what and where. The paper draws some important conclusions from this data – and the accompanying blog (by Peter Hogg) speculates about the paper as well as the role of doctorates (among other things) to encourage productivity. I had a few thoughts that ran more than 140 characters – both the blog and the paper resonated with many of the themes from the last few months of work in my EdD so here we go….

Is “productivity” all we want?

Ekpo et al’s paper and Peter’s blog both start from the standard viewpoint of most papers dealing with MRS research and one that we usually take as an irrefutable truth – that medical radiation technologists/radiation therapists/radiographers “must develop our evidence base for practice” and, conversely, that our practice must be “evidence based”. I have been thinking about this lately – and while I don’t disagree, I might point out that what we usually mean by evidence (and research itself) and the idea of a unique MRS evidence base are concepts that merit further discussion. When we talk about research, we almost always mean that which is influenced by the prevailing ideology of the natural sciences. What we read, value, publish and discuss is almost always quantitative. There is no doubt that this improves patient care in the long run, but the journey to where the impact is felt for the individual patient may be both protracted and convoluted and this is currently a very hot topic! There is also the contentious issue that EBM itself is not value free. As for our “evidence base” – it has long been a source of complaint that this has traditionally been developed by other professions. In fact, it is hard to pinpoint what it is we mean by our own research base.  In my field (radiotherapy) for example, there is a lot of detailed and useful research in highly technical aspects of radiotherapy that is indistinguishable in many ways from that being carried out by radiation oncologists (physicians). Does that matter? Isn’t it all evidence? So “productivity” is an easy metric, but is it a meaningful one?

Go Canada!

From my local (Canadian, radiation therapy, ex-University of Toronto) point of view – what struck me about this paper was that in the top 10 highest impact authors – all but two are based (and presumably teaching) at higher education institutions (HEIs). This is significant and welcomed – but publications from such authors are often an overt expectation of the role (albeit one that has to be balanced with classroom expectations etc.), and many HEI faculty members collaborate with/mentor/supervise their students which increases their output, usually without the requirement for them to actually organise and perform the research itself.  The top Canadians, however, are both clinically focused but have/had academic appointments. These appointments also come with an expectation for regular research and publication but balanced with a (usually) full time clinical role. Academic appointments for therapists in Canada are relatively new, centred mostly at the University of Toronto and based on the criteria for physician appointments. It’s fair to say that there is some tension between the traditional medically based definitions of “clinician-scientist” or “clinician-educator” (with reserved time for research, administrative support etc.) and the reality for the radiation therapist clinical researcher.  A group of us at Princess Margaret Hospital (Toronto) looked at what makes a “scholarly” therapist a few years ago. Scholarly perhaps indicates more of an academic, not practical, focus but we were trying to fit what we saw happening with the broader definitions of “scholarship” (for example, Boyer’s definition of the scholarship of integration and application). The conclusions then were that encouraging research in clinical practice is a complex mix of factors that include overt leadership support and organisational embeddedness, the development of integrated expert clinical-research roles (where possible), a link to an educational institution/university and the fostering of ongoing discussion and debate about what type of research is needed for the department and the profession. Peter’s research unit (mentioned in the blog) probably contains elements of all of these.  What we also saw more anecdotally was research success/productivity also meant working your butt off, staying late, taking grant applications home and generally putting in a lot more hours than the usual 9 to 5 clinical role.

The great doctoral debate

Peter’s blog also looks at educational preparation for research. In my experience, Masters level education is often where the lights come on for many people, the research is a little deeper, the learning a little broader and the focus of the work is usually issues with clinical practice. Doctoral level work is perhaps trickier. About 10 years ago there was a flurry of UK papers discussing the educational expectations for a consultant role concluding that they needed a doctorate. The “level playing field” argument (parity with other professions at a similar level) was used quite a bit, as well as the thought that PhD preparation would lead to research.  However – as Peter says, it doesn’t seem to be panning out this way. A doctorate can take many forms. It can be a longitudinal series of focused published papers, based on previously published academic work, entered directly from a baccalaureate level (skipping the Master’s degree) in education (EdD), a professional doctorate (DProf) and more. From my own (highly biased) perspective – a PhD is a long hard lonely slog, and the work is designed to dig deep into a tiny, really specialised, area of practice which may, or may not, lead to significant publication let alone continue after the PhD is complete. As Peter also points out “within our profession this post doc development opportunity is pretty much devoid.” For someone who isn’t based in a HEI – what use is a PhD for career development?  It’s early days yet for me but my vote is for the underdog – the professional doctorate where there is an expectation that findings must “have an impact on a professional setting as well as making a contribution to knowledge” which is what its all about in my book.


Finding a research voice


There are a few things that seem inescapable in our grad work. I have previously mentioned Foucault (or “Mikey” as one of our Profs refers to him) – that bad boy will pop up in every reference list of every paper we read. Another is the idea of the “middle ground” – aka “binaries are bad” (I may be oversimplifying this a bit). As human beings, we love binaries, good and bad, black and white, qualitative and quantitative. Sadly, life is more complex – we really know this but “tidy binaries” are just so comforting and easy to argue about. That’s why poor old bisexuals get a bad rap – come on (our imaginary exemplar yells) – pick a side already! This weekend we were all about the bricoleur, and its accompanying verb – bricolage.  This word is ubiquitous in many of the papers we are reading – it implies someone (the bricoleur) who uses a variety of methods and approaches to construct an argument, a research framework, from what already exists. It implies a pragmatic spirit, flexibility and an ability to weigh what is useful and what can be discarded.  I had seen this term before- and imagined it to be some rarified French philosophical definition, perhaps even by Foucault himself (praise be his name). Turns out it is basically French for DIY – and there are stores in France that are called “Mr. Bricolage”.  Yes, like Home Depot. Bit of a letdown.

Class this weekend was a bit of a bricolage. There was guitar playing, some Pogues, poetry writing, interviewing, free writing, a lesson in drawing owls and an attempt to discuss a paper via Twitter (#itsreallyhard).  We are trusting that this will lead us gently to the point where we can point to a research method/critical theory and say “yes, that is the one I want to take home” but in the meantime we EdD bricoleurs are like magpies – sifting through the piles of shiny, useful and not-so-useful things to construct our nests (which will really be our dissertations, in case you got lost back there.)

The free writing and the poetry writing made me consider issues of voice and style. There is a ton of advice out there about “finding your voice” as a writer, and then there’s the counter argument that voice is seriously overrated.  There is also style, the way in which something is written and why. Style depends on the purpose and the reader/audience. I realised my usual style has become (by default) the writing I do at work. The 3,500 word max, third person, hope-this-will-pass-peer-review journal article and the reports I write have become comfortable and easy for me. What I remembered (as I did the free writing) were the times in the past I wrote for fun, or felt compelled to write – when I needed just to get things out there. I wrote compulsively after my father died of lung cancer, I wrote over and over again about what it had felt like to hold his hand, to feel it go cold, My writing was full of emotion, full of my voice – I couldn’t pull apart the story and how it had made me feel.

The challenge I’m facing (and one of the reasons I started this blog) is to rediscover that voice, that passion. I want to do research – and write about research – with both my head (which I am good at) AND my heart (not my comfort zone). Unlearning the reliance on neutrality and other voices (the references, the multiple supporting quotations) is tough. However, when I remember that the reason I chose my topic (aside from “the current situation sucks”) is because the LGBTQ patients that are “unseen” in our system are also me. I am increasingly feeling that “as I write and theorize the lives of my participants, I theorize my own” (St.Pierre, 1997)- and progressively aware that it’s not only allowed, it’s mandatory.