Getting Started in Research: The Role of Mentorship, Forming the Team, and Developing a Process

Mentorship

Mentorship is critical to success in research. Physicians who have received mentorship have higher career satisfaction, are more productive, and have higher self-efficacy.¹¹ Physician-scientists have well-developed career pathways for those interested in research. They receive specific research training during fellowship or as junior faculty and are often paired with mentors within their institution. Unfortunately, RTs often do not have any specific mentorship when learning to do research. Generally, RTs learn through an apprentice type model where early-career projects are developed from attempts to solve existing clinical or administrative challenges.² Mentorship exists at the department level. Research training is not part of standard education for RTs, although it is included in graduate degree programs.

A particular challenge for early-career researchers is finding a formal mentor. Usually, RTs are mentored by an experienced and skilled researcher within their institution, although the mentor can be from another center. Most commonly, these relationships are informal but are likely more effective when formalized. The mentor can be an RT or a physician, depending on the mentee’s needs. If an early-career researcher is having difficulty finding a mentor, some professional societies have formal mentorship programs. Other avenues to consider are to contact the editorial staff of Respiratory Care or other journals, who may be able to connect those looking for mentorship. A mentee may have to reach out to several people before finding a suitable mentor.

When embarking upon a mentor-mentee relationship, finding a good fit is critical to a fruitful relationship. Both the mentor and mentee should have clear expectations from the start, including regular meetings. These meetings should occur at least monthly and discuss the goals of the mentee and progress or lack of progress being made and specific feedback to improve the mentee’s skill development. Early in the relationship, conflicts may occur due to personality clashes, differing goals, or lack of time to devote from both parties. Often, the mentor has limited time, and it can be challenging to schedule uninterrupted time. Some RTs who are interested in research may be unwilling to make the commitment and effort required to be successful, especially early-career RTs without protected time for research who are volunteering to help.

Despite both parties being well-meaning, some relationships will not be fruitful, especially if there is a personality conflict or differing goals. Knowing when to terminate the relationship can be a challenge. Mentees may feel compelled to stay with their mentor, especially if there is a power imbalance or the mentor has control over future research or professional opportunities. Some mentors may take advantage of the mentee’s enthusiasm and skills to further their own career at the expense of the mentee’s professional growth. Changes in the mentee’s needs is another reason to find a new mentor. For example, early-career researchers often grow beyond their mentor’s ability to help them be successful and will need to seek out a new mentor. RTs often start out doing bench studies or quality assurance–related work and desire to perform more complex studies, which may necessitate a new mentor. The request to switch to a new mentor may result in an emotional response. However, in most cases, the mentor wants their mentee to be successful and will help to find a new mentor. Often, the prior mentor can continue to serve as an informal sounding board for ideas or become a collaborator on future projects.

Experienced researchers may not require formal mentorship but rather need sponsorship to further their careers. While there is some overlap between mentorship and sponsorship, sponsorship generally refers to a person in a position of power who actively works to support the career aspirations of a protégé or less experienced person.¹² Sponsorship is more periodic, specific, and transactional than formal mentorship.¹² This often involves the sponsor putting forward the protégé for opportunities to be part of groups developing guidelines, serving as site investigator for multi-center studies, writing editorials, and giving lectures at national or international meetings. Long-term success in research is often dependent not only on mentorship early in one’s career but also continued sponsorship by those in positions of power and influence. Like mentors, finding a sponsor may be difficult and often presents a challenge for mid-career researchers looking to work on multi-center studies or clinical trials. RT researchers may benefit from sponsorship but also face barriers to functioning as a site investigator for multi-center trials as many centers only allow physicians to serve as principal investigator (PI) ( Table 1).

Forming the Research Team

Research is a team activity that requires a significant amount of cooperation and collaboration to be successful. There are numerous roles on the team that require specialized knowledge and skills. These include the PI, project leader, clinical research coordinator (CRC), institutional review board (IRB) specialist, statistician, data management, and team members who collect the data. RTs can function in any of these roles; however, some require specialized training or extensive on-the-job training. Generally, RTs start by helping to collect data for a study led by another researcher or lead their own project with close oversight from a mentor. Characteristics of the best team members to recruit are those who are enthusiastic, willing to volunteer, have time to devote to the project, and are willing to learn. Ideally, team members working on their first project will be passionate about the topic as this will help overcome any difficulties encountered during the study. Most research skills can be learned; however, it takes effort, time, and mentorship to develop them.

The PI oversees all activities of a research project and is ultimately responsible for any adverse events related to the study, regardless of whether they were the result of the study. RTs may or may not be allowed to serve as the PI for research studies, depending on the institution and nature of the study. For academic centers, the PI usually needs to have an academic appointment at the affiliated university, or in some cases only physicians may serve as the PI. Community hospitals may have different standards; however, it’s important that the PI be able to treat any adverse events related to the study protocol (pneumothorax, anaphylaxis, hemodynamic instability, etc), which may be outside the scope of practice for RTs. This does not preclude RTs from being investigators, only that they will serve as project leaders, Co-PI, or co-investigators instead of as PI.

The project leader is responsible for performing the literature review, designing the study, recruiting team members, assigning team member roles, and writing or delegating the writing of the project proposal and first draft of the manuscript. Being the project leader requires not only research skills but also leadership skills to direct the team, lead meetings, oversee team members, provide education, and ensure the study is completed correctly.² Generally, the order of authors is determined at the beginning of the study to avoid any confusion or hurt feelings. Any disagreements can be resolved by the project leader or PI. All studies should have a formal proposal written before starting and discussed by the team or a research committee, including a statistician or other team member with expertise in statistics. This strategy has been shown to increase the quality of research published by RTs,¹³ illustrating the importance of having a good process for research.¹⁴

Additional roles RTs commonly fill include clinical expert, CRC, or data collector. As a clinical expert, RTs may not have significant knowledge of research study design or methodology but rather are experts in what is being studied. RTs have valuable insights into patient care but are often underrepresented in guidelines and studies where expert consensus is used to make recommendations.^15,-,17 CRC is a full- or part-time position that obtains consent, collects data, takes care of IRB documents, and ensures compliance with rules and regulations. Individual respiratory care departments may have a CRC; however, most often their work falls under funded research as most RT departments do not have the resources to have their own CRC. Generally, the CRC is not involved in the design of individual studies, the analysis of data, or writing of manuscripts; but their role is to carry out the study as designed, although this varies from institution to institution. RT CRCs often serve as the clinical expert for respiratory care–related projects.

Many RTs first become involved in research by collecting data for a study or by doing a simple project with oversight from a mentor.² Most often this is done on a volunteer basis, but some departments may allow for dedicated time or for staff to be paid for research work. This is an important role as data collection is usually the most time-consuming part of clinical studies. Most active research teams are limited in the number of projects they can pursue due to a bottleneck around data collection, especially for complicated studies using electronic medical records that require extensive manual data collection. RTs collecting data need to have completed all the required local ethics and ethics requirements and receive training on the software used for the study. Specific training related to each project must also be completed to ensure data are collected consistently and entered correctly into the case report form.

Additional roles that can be filled by RTs include IRB specialists, database managers, and statistical analysis. IRB specialists are often CRCs who have developed expertise in communicating with the IRB and are very valuable to the study team because they understand how to word different sections of the IRB application to maximize chances of approval. They can also provide insight into whether a project could qualify as a quality improvement project, have a waiver of written consent, or strategies to ensure subject safety. In some centers, RT will also serve as a member of the IRB. In most respiratory care departments, RTs are in charge of data management. Data management is critical to a successful project, and the person in charge of data management should be an expert on the software being used and the requirements for data security ( Table 2).

Developing a Process for Research

Having a consistent process in place for conducting research is critical to developing projects with a sound scientific rationale.^13,14 A successful process involves regular meetings, written plans or proposals, buy-in from department leadership, and clear goals for each project. Meetings should occur at least monthly and include discussions of each formal proposal, updates on individual projects, and any potential projects. The formation of a formal research committee has been associated with an increase in the quality of RT research.¹³ Forming a committee is an opportunity for staff to participate in research in an open and constructive format while keeping department leadership apprised of what projects are ongoing. Interested staff can also learn about the process of research and how projects get started.

A formal proposal should be written for each project. This should include the personnel, background section summarizing what is known, research question, hypothesis, and methods. The personnel section will include the project leader, PI, and the role of each team member. The background section is critical to a successful project as it will summarize what is already known while clearly stating how the current project will contribute to the scientific literature. This process allows novice researchers the opportunity to write in a low-pressure environment while allowing mentors or project leaders to evaluate their ability to summarize the literature. The background section also provides a strong foundation for the paper. Even if the decision is made to not move forward with a project, the information learned during the literature review will strengthen the team’s knowledge of the subject. When well executed, the project proposal can be used for IRB documents and the study protocol.

The research question and hypothesis should be clearly stated in the research proposal. There may not be a specific hypothesis to test in certain types of descriptive studies such as surveys or small case series of limited sample size. The methodology describes how the study will be executed. This should include the type of study, inclusion/exclusion criteria, variables to collect, and statistical analysis. This should also include any preplanned subgroup analysis. The details of different study designs and statistics are beyond the scope of this paper ( Table 3).

While RT research can be done without buy-in from departmental leadership, it is significantly easier when leadership is supportive as projects often require resources and equipment. Leadership support is essential if projects will require extra work from bedside RT staff recording data or if protected time is needed. Presentation at conferences also requires monetary support, and leadership may be reticent to provide funding if they are unaware of the project. Staff presenting at conferences will also need time off or adjustments to their schedule.

Summary

Getting started in research usually requires mentorship and sponsorship over the course of a career. There are many roles where individuals can contribute as part of a strong research team. A formal process for research is important to a successful research program. RTs can fulfill many different roles on the research team from PI to data collection.