Relationship Between Research Culture and Research Activity of Medical Doctors: A Survey and Audit

Figures & data

Table 1 Demographic Information and Professional Qualifications

Gender	n (%)
Female	57 (46.0)
Male	61 (49.2)
Other/prefer not to disclose	6 (4.8)
Current employment status	n (%)
Full-time permanent	61 (49.2)
Full-time temporary	23 (18.5)
Part-time permanent	28 (22.6)
Part-time temporary	9 (7.3)
Casual	3 (2.4)
No. of years employed as a Doctor	n (%)
Less than 2 years	11 (8.9)
2–5 years	9 (7.3)
6–10 years	13 (10.5)
11–15 years	28 (22.6)
16–20 years	24 (19.4)
20+ years	39 (31.5)
No. of years employed in this health service	n (%)
Less than 2 years	33 (26.6)
2–5 years	29 (23.4)
6–10 years	29 (23.4)
11–15 years	13 (10.5)
16–20 years	15 (12.1)
20+ years	5 (4.0)
Current career stage	n (%)
Consultant	90 (72.5)
Registrar	15 (12.1)
Junior doctor	16 (12.9)
Not specified	3 (2.4)
Master’s or PhD by research	n (%)
None	104 (83.9)
Completed PhD	9 (7.3)
Enrolled in PhD	2 (1.6)
Completed research Master’s degree	7 (5.6)
Enrolled in research Master’s degree	2 (1.6)
Research-related activities are part of role description	n (%)
Yes	43 (34.7)
No	53 (42.7)
Unsure	28 (22.6)

Note: n= number of respondents.

Table 2 Median Score for Organisation Level RCC Items, Arranged in Descending Order

Item	Median Score	IQR	% Unsure Responses
Promotes clinical practice based on evidence	7	5–8	3.2
Engages external partners (eg universities) in research	6	4–8	12.1
Supports the peer-reviewed publication of research	6	3–8	16.1
Has regular forums to present research findings	6	3–7	10.5
Supports a multidisciplinary approach to research	5	4–7	18.5
Encourages research activities which are relevant to practice	5	4–7	6.5
Accesses external funding for research	5	3–7	25.8
Has resources to support staff research training	5	3–7	11.3
Has identified experts accessible for research advice	5	3–7	16.9
Has a plan or policy for research development	5	3–6	20.2
Has software programs for analysing research data	5	3–7	36.3
Has mechanisms to monitor research quality	5	3–6	32.3
Supports applications for research scholarships or degrees	5	3–6	27.4
Ensures that organisational planning is guided by evidence	5	3–6	16.9
Has executive managers that support research	5	3–7	16.1
Has consumers involved in research	5	2.5–6.5	29.8
Has funds, equipment or admin to support research	4	2–6	13.7
Ensures staff career pathways are available in research	3	2–5	21.8

Abbreviation: IQR, Interquartile range.

Table 3 Median Scores for Team Level RCC Items, Arranged in Descending Order

Item	Median Score	IQR	% Unsure Responses
Conducts research activities which are relevant to practice	7	5–9	6.5%
Supports peer reviewed publication of research	7	4–9	10.5%
Supports a multidisciplinary approach to research	7	3.5–9	10.5%
Has team leaders that support research	7	3–8	5.6%
Does planning that is guided by evidence	7	4–8	10.5%
Disseminates research results at forums/seminars	6	4–8	9.7%
Has applied for external funding for research	6	3–9	25.8%
Has external partners (eg universities) engaged in research	6	3–8	18.5%
Has identified experts accessible for research advice	6	3–8	14.5%
Provides opportunities to get involved in research	6	3–8	2.4%
Supports applications for research scholarships/degrees	5	2.25–8	21.0%
Has mechanisms to monitor research quality	5	2–7	27.4%
Ensures staff involvement in developing the plan for research development	5	2–7	11.3%
Has resources to support staff research training	5	2–7	9.7%
Has consumer involvement in research activities/planning	4	2–7	25.0%
Does team level planning for research development	4	2–7	12.1%
Has software available to support research activities	4	2–6	28.2%
Has incentives and support for research mentoring activities	3	2–6.5	16.9%
Has funds, equipment or admin to support research	3	2–6	12.9%

Abbreviation: IQR, Interquartile range.

Table 4 Median Scores for Individual Level RCC Items, Arranged in Descending Order

Item	Median Score	IQR	% Unsure Responses
Finding relevant literature	7	7–8	0.8
Integrating research findings into practice	7	6–8	2.4
Critically reviewing the literature	7	6–8	1.6
Collecting data (eg surveys, interviews)	6	5–8	1.6
Writing for publication in peer-reviewed journals	6	4–8	4.8
Writing a research report	6	4–7.25	3.2
Using a computer referencing system (eg Endnote)	6	4–7.25	0.8
Analysing quantitative research data	6	3–7	1.6
Using computer data management systems	6	3–7	2.4
Writing a research protocol	5	4–7	1.6
Writing an ethics application	5	3–7	3.2
Providing advice to less experienced researchers	5	2.5–7	4.0
Designing questionnaires	5	3–7	4.0
Analysing qualitative research data	5	2–7	3.2
Securing research funding	3.5	2–5	6.5

Abbreviation: IQR, Interquartile range.

Table 5 Reported Frequency of Personal Barriers and Motivators to Conducting Research, Arranged in Descending Order

Item – Barrier	% of Response Across n=124	Item – Motivator	% of Response Across n=124
Lack of time for doing research	83.9	To develop skills	70.2
Other work roles take priority	82.3	Increased job satisfaction	66.9
Lack of funds for research	57.3	Problem identified that needs changing	58.9
Desire for work/life balance	45.2	Career advancement	58.1
Lack of a co-ordinated approach to research	45.2	To keep the brain stimulated	57.3
Lack of skills for research	45.2	Desire to explore a theory/hunch	53.2
Lack of support from management	39.5	Dedicated time for research	52.4
Lack of software for research	39.5	Links to universities	50.8
Isolation	36.3	Increased credibility	50.0
Lack of access to equipment for research	34.7	Mentors available to supervise	45.2
Other personal commitments	34.7	Opportunities to participate at own level	45.2
Intimidated by research language	21.0	Colleagues doing research	42.7
Different experience levels of team members (applies to team only)	17.7	Research encouraged by managers	37.9
Staff shortages (applies to team only)	16.9	Grant funds	37.1
Intimidated by fear of getting it wrong	14.5	Research written into role description	36.3
Not interested in research	4.0	Forms part of post-graduate study	25.0
Lack of library/internet access	2.4	Team building (applies to specialty group only)	25.0
Other barrier/s (please specify) – lack of dedicated research support roles	4.8	Study or research scholarships available	21.0
Other barrier/s (please specify) – lack of pathways to engage in research	3.2	Required as part of Specialty College Training	20.2
Other barrier/s (please specify)- difficulty with research ethics and governance processes	1.6	Other motivator/s (please specify)	0.0
Other barrier/s (please specify) – lack of value placed on research in organisational culture	1.6
Other barrier/s (please specify) – contract role does not allow research	0.8

Table 6 Codes from Qualitative Analysis of Final Free Text Question

Expanding on barriers (n= 21) Example quote: “It is so very difficult to balance doing the clinical job with finding time to do, or supervise, research, especially when most of the time is spent just getting the project running!”	• Difficulty finding out about research projects
	• Research is not valued by leadership
	• Lack of research/nonclinical time and overloaded clinical rosters
	• Lack of skills and knowledge, including HDR experience
	• Lack of interest in department
	• Lack of general support and infrastructure
	• Ethics and governance process and long start up process for projects
	• Lack of support staff
	• Lack of awareness about what support is available
	• Casual contracts
Potential strategies (n= 11) Example quote: “Please make available projects easier to find. Consider an online noticeboard where all research groups post available roles and projects.”	• Involvement with statewide clinical trials networks
	• More professorial appointments
	• Pathways to make available projects easier to find, including online listing
	• More long-term planning
	• Appoint more research support staff
	• Increase awareness of the benefits of research at an executive level
	• Substantial investment in changing research culture
	• Dedicated time for research, including rostering more clinicians
	• More funding and access to HDRs
	• Research criteria should be included in performance reviews
Benefits of a research culture (n= 4) Example quote: “At exec level there needs to be awareness this investment will be paid back in spades in 1) economic return; 2) job satisfaction; 3) career progression; 4) staff retention.”	• Attraction and retention of high quality trainees
	• Retention of quality staff
	• Economic return
	• Job satisfaction
	• Career progression for staff
	• Generally a good thing for the health service
Tension for change (n= 16) Example quote: “Urgent need for institutional support for formal research ….training among clinical staff in all disciplines”	• General statements that there is a need for change
	• Our health service is not as research active as others in the region
	• Increased research engagement is needed to strengthen our identity as a tertiary institution
	• Despite being part of clinical role descriptions, research is mostly completed in personal time
	• The health service is focused on short-term operational concerns at the expense of research

Table 7 Characteristics of Publications and Projects from Medical Doctors in 2018 and 2019

		n (%)
Projects (n= 197)	2018	92
	2019	105
Site information	Health service as only site	100 (50.8%)
	Health service as lead site of a multisite study	13 (6.6%)
	Health service as nonlead site on a multisite study	84 (42.6%)
Inter-specialty collaboration^a	Investigators from only one specialty	158 (80.2%)
	Investigators from more than one specialty (eg cardiology and rheumatology)	39 (19.8%)
Inter-professional collaboration^a	Investigators only from the medical stream	132 (67%)
	Investigators from nursing and medical streams	28 (14.2%)
	Investigators from Allied Health and medical streams	16 (8.1%)
	Investigators from other^b and medical streams	6 (3%)
	Investigators from more than two streams (eg nursing, Allied Health and medical)	15 (7.6%)
Publications (n= 327)	2018	175
	2019	152
Number of unique medical doctor authors and their number of publications in 2018	2018	161
	1 publication	117 (72.6%)
	2 publications	22 (13.7%)
	3–5 publications	19 (11.8%)
	6–9 publications	1 (0.6%)
	10+ publications	2 (1.2%)
Number of unique medical doctor authors and their number of publications in 2019	2019	162
	1 publication	122 (75.3%)
	2 publications	31 (19.1%)
	3–5 publications	5 (3.1%)
	6–9 publications	2 (1.2%)
	10+ publications	2 (1.2%)
Authorship order	Medical doctor as first or last author	174 (53.2%)
	Medical doctor as middle author	153 (46.8%)
Inter-profession collaboration^a	Authors only from the medical stream	282 (86.2%)
	Authors from nursing and medical streams	26 (8.0%)
	Authors from Allied Health and medical streams	14 (4.3%)
	Authors from other^b and medical streams	3 (0.9%)
	Authors from more than two streams (eg nursing, Allied Health and medical)	2 (0.6%)
Publication type	Primary research	196 (59.9%)
	Case reports	42 (12.8%)
	Systematic reviews, scoping reviews and meta-analyses	19 (5.8%)
	Protocols	4 (1.2%)
	Other article types (eg correspondence, topic summaries, opinions, etc)	66 (20.2%)

Notes: ^aOnly represents collaborations within the health service, specialty/profession data was not collected for other institutions; ^bOther refers to staff outside of medical, nursing or Allied Health streams (eg statisticians, human resources professionals).

Table 8 Mean Scores for Team Level RCC Items and Publication and Projects per FTE, Separated by Broad Specialty Group, Arranged in Descending Order

Median Scores	Group 1 (n=16)	Group 2 (n=14)	Group 3 (n=12)	Group 4 (n=17)	Group 5 (n=18)	Group 6 (n=20)	Group 7 (n=26)
Survey results
Overall mean for team-level items	6.4	4.0	4.6	5.2	7.8	3.1	6.0
Overall SD for team-level items	2.1	2.8	2.3	2.1	1.1	2.4	1.7
Audit results
Number of publications per FTE	0.50	0.01	0.15	0.33	0.67	0.18	0.44
Number of new projects per FTE	0.26	0.08	0.09	0.31	0.21	0.13	0.45

Figure 1 Relationship between Projects per FTE of teams and the teams’ mean RCC scores.

Figure 2 Relationship between Publications per FTE of teams and teams’ mean RCC scores.