Research

Mentorship | Ethical Approval | Funding |

The mission of the Pathological Society is to promote the understanding of disease. Thus, in addiction to facilitating the training and education of pathologists, the society provides individual support for those wishing to undertake research. This might take the form of studies of direct relevance to the practice of diagnostic pathology, or more basic research that aims to further our understanding of disease processes. The Pathological Society provides a variety of research support, all of which is available to trainees. One member of the Research subcommittee is co-opted from the Trainee sub-committee, ensuring that the Society provides relevant and accessible support for all trainees. We aim to be responsive to member needs, so if there is something you would like to see the Society offer, please email This email address is being protected from spambots. You need JavaScript enabled to view it..

 

For trainees interested in combining clinical training with a substantial element of research experience there are dedicated academic training posts; Academic Clinical Fellowships (ACFs) or Academic Clinical Lectureships (ACLs). For an overview of these posts please see the Health Careers website[clickable text, hyperlinked to https://www.healthcareers.nhs.uk/i-am/working-health/clinical-academic-careers/clinical-academic-medicine. These posts are predominantly funded by the National Institute for Health Research (NIHR) and are advertised on their website[clickable text with hyperlink to http://www.nihr.ac.uk/funding/academic-clinical-fellowships.htm. However, a number of posts are also locally funded by universities, other medical research bodies and charities - for more information on these speak to your Training Programme Director or local medical education centre team.

Although desirable (and hence competitive), these schemes won’t be attractive to everyone and it is essential that the wider pathological community continues to participate in the kind of “grass roots” research activity which has made significant contributions to practice in the past. Pathologists’ involvement in research can take a variety of forms, for example:

Providing histopathological interpretative skills, facilitating access to tissue or support other researchers.

Leading or contributing to studies aimed at furthering the practice of diagnostic pathology, from case reports to major studies linking histopathological findings to patient outcomes.

Leading laboratory studies which aim to advance our understanding of the disease processes encountered in diagnostic practice.

Whatever the nature of the project, three practical elements will probably need to be in place before you can proceed – mentorship, ethics, funding.

 

Mentorship

In order to generate high quality research, it is essential that potential new researches work in partnership with a more experienced colleague or group of colleagues. If you are going to join an established research group - perhaps to help with interpretation of histology or to provide access to tissue - then the group leader will be managing the project as a whole, organising ethics, identifying and acquiring funding, developing and refining the hypotheses and devising the technical approach. They may have a clear idea of how they want the histology element to be performed, but it still helps to have a histopathology colleague to whom you can turn for advice. If there is someone suitable in your department who is familiar with the tissue or technique to be used then that may be ideal, but you may also want to look further afield.  If you are looking for advice try contacting the Trainee Subcommittee[clickable text linked to trainee subcommittee page] members, who have a research network they can put you in touch with.

If you are undertaking a project in which you are going to play a more central role, then good mentorship becomes even more vital. If you are carrying out research as part of an Academic Clinical Fellowship or other structured programme then appropriate support should be in place. For other projects there may be someone in your department. You’ll be looking for someone who can help in the following areas, amongst others:

Identifying and refining the research question. You need to work with a really good overview of the relevant literature to ensure that your proposed work will make a genuine contribution to the field.

Guiding you through your application to the relevant Research Ethics Committee and in obtaining any other necessary approvals.

Identifying suitable funding opportunities, if needed, and helping develop the funding application.

Helping maintain the momentum and seeing the course to successful completion of a project, particularly when clinical commitments compete for your time.

Dealing with the inevitable unforeseen technical challenges. A good project leader and mentor will know what technical problems can be anticipated, how to address them, and thus should be able to devise an alternative technical strategy should they prove insurmountable.

Helping you decide where to submit your work for publication and helping you assemble the manuscript. And, of course, knowing how to revise your manuscript when it gets rejected – most manuscripts go through several incarnations before finally being accepted for publication, so it helps to work with someone who has experience of this demoralising experience.

 

Ethical approval

The Human Tissue Act requires research carried out using human tissue to have the approval of a Research Ethics Committee (REC). If you are slotting into an existing project devised by a senior colleague then one would hope that he or she will either have organised this aspect, or at least understands the process and can guide you through it. Alarm bells should ring if whoever is leading the project expects you to sort this paperwork out yourself and doesn’t appear to have any existing applications you can look at. If you are using human tissue held in an NHS Pathology Department then you’ll also need the approval of the relevant Trust.

The forms required for ethical approval and Trust approval look daunting. In fact, many of the fields disappear when you click “No” to questions such as “Will you be using radiation? Experimenting on prisoners? Using a new and untested medical procedure? Etc. For the kind of projects most Pathogists are likely to undertake, the typical concerns of RECs are:

Is the scientific design of the study sufficiently robust to deliver a clear result? If not, it is unethical to spend time and resources on carrying out the work.

If human tissue is to be used, will the researchers have the consent of the patients from whom the tissue was obtained?

If the researcher is to have access to patient data (e.g. survival data), how is that data to be safeguarded?

You’ll need to provide a lay summary of the research plan and technical details of the project including evidence that the statistical design of the project is robust. Some of the key points are:

If you are going to use archival tissue that does not have specific consent for use in research, this can usually be justified by explaining that (1) The tissue is surplus to diagnostic requirements, (2) There is evidence that most patients are happy for their tissue to be used in this way (3) Contacting patients some years after the operation at which the tissue was removed is impractical, potentially distressing, and violates their privacy.

If you are going to use freshly acquired surgical tissue, you’ll probably need the explicit consent of the patient, because item (3) above doesn’t really apply. You’ll need a patient information leaflet and a consent form, and the patient should be given at least 24 hours to make up their mind whether or not they wish to participate. You’ll also need a clinical collaborator, because the ‘initial approach’ should be from a clinician with whom the patient is familiar.

Tissue samples should be anonymised (no ID on the samples), or pseudo-anonymised (samples bear coded ID which links them to relevant data such as tumour stage, but samples cannot be linked to patient names or addresses, etc; the lab number is usually sufficient).

You’ll also need to provide details of the project title, its duration, the researchers involved and the institutions involved. You’ll be invited to attend the meeting at which your application is considered to answer questions from the Ethics committee.

Funding

It is possible to undertake research of genuine significance without the need for any funds. Correlating a histopathological feature with patient survival, for example, requires no more than commitment, a microscope, and a suitably sized patient cohort with appropriately stained slides and patient follow-up. But many projects will need some degree of funding. This might be anything from a few hundred pounds to pay for immunohistochemical reagents, to tens of thousands of pounds to pay the salary of a technician – or indeed your own salary if you are taking time out of your training programme. There may be some allowance within your departmental budget for small projects, but many projects will require external funding. Many hospitals have a charitable fund which can provide small to medium sized grants amounting to several thousand pounds or more. Competition for funds is usually very strong, and so it helps to have some preliminary data to demonstrate your proposal is at least technically viable. Reviewers usually want to see evidence that the applicant has the experience to see the project through, so teaming up with more experienced colleagues is pretty much essential – see “mentorship”.

Your hospital’s research department should be able to help you identify funding opportunities, and don’t be shy about asking colleagues if they know of any good local sources. The Pathological Society also provides a number of funding schemes that are advertised on the Research Section of the Society website.

 
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