Monday, 29 October 2018

Reflections on my application for an NIHR fellowship

Each year the National Institute for Health Research (NIHR) in the UK award a range of fellowships to support individuals (clinicians, academics etc from a range of backgrounds) on a trajectory to becoming future leaders in NIHR research. What the fellowship offers is dependent on the person applying and the stage of their career, among other things. Full details of the NIHR fellowship programmes are available here .

In August of 2018 I was awarded an NIHR post-doctoral fellowship which, for me, means that my salary is covered for the next four years to undertake a bespoke training programme while undertaking further research and engaging with leading clinical and academic mentors to facilitate my development as a future leader in NIHR research. So, you can see already that an award of an NIHR fellowship provides major opportunities.

I often get requests for advice from people thinking about embarking on this journey so in this blog I want to reflect on my application process, hoping it will be useful for others. But, to add a caveat; this blog is my reflection on my experience and is not official advice from the NIHR. For those wanting official advice then the NIHR academy are easy to contact via their website and are always happy to advise. Also, I have now applied for three fellowships;

·       - The first one was successful but I thought my application could have been better and was disappointed with my performance at the interview.
·       - The second one was unsuccessful but I was really pleased with both my application and my interview!
·       - The third one was successful; I was really pleased with my application but genuinely gutted after the interview, I thought I could have done so much better, so much so that I was already making alternative plans before hearing that the fellowship had been awarded.

This tells me that I am no expert in the decision making process that leads to the award of a NIHR fellowship and I do not have any magic solutions to offer. Please bear this in mind if you choose to read on…

The process starts with the application form
In short, no it does not! Fellowships are personal awards to support the development of individuals capable of making an impact through NIHR research. The fellowship application is judged in relation to the person, the place(s) where the fellowship would be hosted as well as the supervisors or mentors, the training programme and the research project. Recognising all these components, if your thought process begins at the time the application is live then I suspect you might submit an application that you will later reflect could have been better, or might never actually get to the point of submitting.

Planning to submit an application begins months in advance. I first approached my manager at Keele, Professor Nadine Foster, in May 2017 prior to a December 2017 submission date. We both recognised that the six months window was tight but worth a go. I had the advantage of my previous NIHR fellowship which had given me a significant boost and also I had recently received funding from the NIHR for another study so my CV was ready in terms of publications, invited presentations, awards and research grant capture etc (all important academic metrics). These factors all contribute to the assessment of the person in this context. Most often, at the outset of this fellowship pathway, these aspects of the CV need to be developed and it is important to recognise this right from the start so that you are ready to submit the best application you can. This might mean that planning begins two to three years before your fellowship application is submitted. Thankfully now the NIHR, for example, offer pre-doctoral fellowships to support in this way (more details on the NIHR website here ).

The person
Unlike research project grants where funds are awarded to a project team, these fellowships are awarded to individuals, as described. So, success can be very sweet for that individual but the opposite is also true. When my first application for a post-doctoral fellowship was not supported in 2015 it really knocked me back and made me question my future steps. Not long after this rejection, Nadine Foster reached out to me from Keele to ask whether I would like to spend some time with her and her team to contribute to their research but also develop my own research ideas. Despite the resulting five hour commute from my home in Yorkshire to Keele in Staffordshire, I did not hesitate to accept the offer. Looking back, I’m not sure where I would have been now without Nadine’s offer of support; I guess that is one of those pivotal moments that happens to many of us in our lives. Why am I reflecting on this? Well, ask anyone who has been through the process; it is an emotional journey. Being offered the award is immense, but rejection can have a huge impact too that really tests your resilience – just something to be aware of and to recognise if you do, or have felt like this then you are not alone.

The place
Eighteen months prior to the award of my fellowship, I had successfully applied for a permanent position at Keele. This was helpful because of Keele's track-record and research focus. It was also helpful to be around others that have trod this path before me. To be at Keele I have moved my family from our original home in Yorkshire to be closer to work because the five hour commute just wasn’t sustainable. With three children of and approaching high-school age, this is not a decision taken lightly and I have often reflected that there is a selfishness to this. But, without the move, I am not confident that I would have been successful with the fellowship or even currently have an academic position. Again, why am I saying this? Well, the place is important; to develop you need to be in the best place possible so this needs careful thought and, unfortunately, might not always be the most convenient place.

The supervisors/ mentors
Who do you want to be like? Who is an expert in your chosen area? Who has experience of these NIHR fellowship programmes? These are good starting questions when thinking about the team you want around you to support you on this journey. Aim high and also think international.
I feel very fortunate to have the mentor team I do; Professors Nadine Foster, Amar Rangan, David Beard and Dr Julia Wade who have all already contributed in their own way. It is helpful to identify these people and get them involved as early as possible.

But, as well, don’t forget a very important group of supervisors/ mentors – the patients who the research will affect! Establishing a working relationship with patients and engaging with them in this process is immensely helpful, just make sure this is on your initial plan and not just an after thought!

The project
Most often I am approached by physiotherapists interested in applying for a doctoral fellowship; this is to be expected given my background and fellowship experience. These conversations often begin along the lines of; ‘I’ve got a great idea for a research project, I want to see if this muscle contraction is better than that muscle contraction for this condition that I’m really interested in.’ Of course, it is fine to start thinking in this way but you need to think strategically with reference to your project. Is this research idea just important to me, or would a national funder see this as an important research question that has a clear pathway to patient benefit. Often this means, for now at least, that you might not be able to follow your initial path; be open to this and let your idea(s) evolve as you engage with all the relevant stakeholders, e.g. priority setting groups, patients, colleagues, mentors/ supervisors and the funder.

But, of course; a fellowship is not an award to undertake a research project in isolation. So, you need to be thinking about how the project offers the opportunity to facilitate your development. The research project in my fellowship is a pilot trial exploring the feasibility of undertaking a larger randomised controlled trial that would compare surgery with a programme of physiotherapist-led exercise for traumatic tears of the rotator cuff. Some of the feedback that I received questioned how this project would facilitate my development as a future leader of NIHR research given that I had already led randomised controlled trials. My argument was that this will be a bigger, more challenging and complex study than I have led before, and will be complemented by other important investigations to determine feasibility (The Quintet Recruitment Intervention – Google it, very interesting) which I don’t have prior experience of. Also, the research aligns with my bespoke training programme that includes development as a leader, design of efficient randomised trials and the Quintet Recruitment Intervention. The research also provides a vehicle for me to engage with my expert mentor team which I see as a key component of my fellowship.

The training programme
I realise I’ve written too much already for the purpose of a blog so I’ll keep this penultimate section brief. It is somewhat ironic that the training programme is the last section because in the context of a fellowship this absolutely should not be the case. Fellowships provide significant opportunity to access training, in various forms, that you would typically not have access to outside of a fellowship. Think carefully about your development needs and how these link to your proposed research. For me, the most helpful think I did was to reach out to other fellowship holders to ask about their training plans and this really helped to begin to develop my ideas.

The process
Depending upon the fellowship scheme, you will likely submit an initial application that will then be scrutinised and, if short-listed, then be invited to submit a full application followed by an interview. The application process is detailed on the NIHR website so I just want to dedicate these last few words to the emotion of the interview. I prepared by reading and re-reading my application, discussing my application widely with clinical and academic colleagues and then having two mock interviews; one at Keele and one in Bristol. But, nothing quite prepares you for the day; facing 16 to 20 very clever people means that you will never anticipate the questions they ask. Following the expected five minute presentation, my opening question from the interview panel was, ‘so how does physiotherapy actually work?’ Wow, big question – wasn’t expecting that! After 20 to 25 minutes of questions from a range of clinicians, methodologists and patients you are excused and enter no-mans land – six weeks of waiting until you hear the outcome. This is a difficult time because the award means so much and I also felt that I could have done better, so was disappointed in myself. I had no clue how to answer one of the questions but felt I should have known; I stuttered for a little bit and then just admitted ‘I’m sorry, I don’t have a credible answer for you.’ I googled it as soon as I got out of the interview which made me feel even worse!

When the e-mail informing me of the outcome dropped in to my inbox, and I read the first line I genuinely cannot describe the feeling. I was working at home and my eldest son was kicking a ball in the back garden. I had to tell someone and he was the closest. ‘I got the fellowship’ I stuttered, he looked at me blankly ‘does that mean you’ll get more money?’ ‘No, son’, I said, ‘but I’m still very happy’ as he started kicking his ball again. Life goes on…

As is often the case, I could write much more…but I’ve got a fellowship to complete, so hope that some aspects of my ramblings were useful to those of you who made it this far.

Chris Littlewood (October 2018)

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