Abi

Age at interview: 37

Brief Outline:

Abi is a speech and language therapy researcher. She likes being able “to actually utilise some of the clinical skills […] that I wasn’t always able to exercise in a real world clinical setting” and that she is adding to her discipline’s research culture.

Background:

Abi is a speech and language therapy researcher. Her ethnic background is White English.

More about me...

Abi is a speech and language therapy/therapist (SLT) researcher. She has been working in research for 10 years, during which time she has completed her PhD. Abi is currently employed by a university on three separate research projects which will span the next two years. She is also a co-chair of the Computers in Therapy Clinical Excellence Network. After qualifying as a speech and language therapist, Abi combined bank work with part-time research contracts. She had enjoyed her dissertation and felt research offered something that was otherwise missing; “kind of ironically”, the research activity allowed her “to actually utilise some of the clinical skills that I gained when I was training that I felt that I wasn’t always able to exercise in a real world clinical setting”. However, “it was difficult juggling the demands” of both clinical and research jobs, in part because “they’re slightly different mindsets” and the two types of workplaces have “their own set of rules and policies […] and systems that you need to be familiar with”. After about two years in both roles, Abi moved into research full-time.

Abi’s first research role was as a research assistant on a study which involved introducing participants to a computer-delivered therapy and assessing any changes. She shadowed an experienced colleague who “gave me a lot of time to learn the protocols and then withdrew support so that I was doing them more independently”. Building on an interest in using computers in speech and language therapy, Abi completed her PhD which involved delivering an intervention to adults with aphasia following stroke. It was “daunting going from being part of a team to carrying the overall responsibility” during her PhD, but it developed her skills and gave her experience with analysis and dissemination. 

Abi describes the research culture in speech and language therapy as “an emerging thing”. She thinks it was fortunate that there was a cohort of SLTs undertaking their PhDs at the same time as her, providing mutual opportunities for support and learning. Many were working on studies about other aspects of aphasia and so they developed a “collaborative co-operative” arrangement to visit various support groups to highlight their studies: “that was a really lovely way to work actually because it meant that we could share the load of going out and speaking to people about the research”. Since then, she’s connected with more SLT researchers online and has been involved in developing a Twitter account (@CLINACSLT) to share news about SLT research. The online community and activity has also led to plans to set up a Clinical Excellence Network with the Royal College of Speech Therapy.

For Abi, there are many aspects in research which draw on her clinical experiences and skills. This includes “adjust[ing] and modify[ing] my communication to make it appropriate for a listener with aphasia”. For example, when approaching potential participants about a study, Abi tends to use customised information sheets, gesticulation, and plain language. Many of the studies Abi has worked on have involved seeing study participants in their own homes, meaning that “you can very easily become a part of their world and learn things about their world”. This experience has challenged some of the power dynamic arrangements Abi had assumed when she first trained as a SLT. Compared to a top-down approach whereby the SLT is in charge, she thinks researcher-participant relationships are “much more of a collaboration”.

At first, Abi struggled with feeling she was a “traitor for not using my clinical skills […] on the coal face in the NHS” but she has since come to see research as a way she can contribute significantly to the SLT profession. She also faced challenges in bringing together different disciplines and fields together in her work. However, her current arrangement of working in two departments seems to be going well at bridging interests: “I’m there as a sort of speech therapy ambassador in the computer science department, and then I go back to the speech therapy department and I’m sort of the computer science ambassador”.

Most of Abi’s research posts have been fixed term. She doesn’t recall ever feeling this was a concern but thinks short-term contracts would be an issue if she had a mortgage. Abi is unsure what is next for her when her current contracts end in two years’ time. She feels there is “no clear cut path” which integrates clinical and research work for SLTs, and it remains “a challenge to identify how you fit in”. There are a few options Abi doesn’t want to pursue, such as becoming a lecturer or returning to clinical work full-time, but “I don’t know where that leaves me […] I’m quite open to the next interesting thing”.

Abi’s key message to other SLTs thinking about research careers is to “find something you’re interested in and pursue it, don’t be scared of it”. She hopes that there will be more scope in the future to have protected time in both clinical positions (for research activity) and research positions (for clinical activity) so that, rather than seeing these components as “an added extra” or “luxury”, “the two worlds can intersect really effectively”.

Abi found that following a protocol left less scope to use her “clinical judgement” and make alterations. This experience led her to challenge some previous assumptions.

And then in the, so the sort of challenges that come up in a research role are you, you need to often when you’re doing clinical research you need to adhere very strictly to a research protocol and that sometimes means you can’t use your clinical judgement to say, “Oh I think that I might prefer to do things this way for this scenario.” So you need to carry out x, y, z assessment, you need to carry out therapy according to this set of you know predefined things, so that it can then be testable and you can make clear assertions about how it works across a group of people if it’s applied consistently.
 
So that can sometimes feel, there’s, there’s an element of sort of sitting on your hands when you’re doing clinical research that you don’t have when you’re doing clinical practice in the same way. But that can also be, that can also be quite liberating because it, it frees you of the, the clinical judgement, the sort of clinical decision making where you might get it wrong or right, you can sort of relinquish that and say, “Okay I’m following the protocol, and this is how it has to be, and I’m just going to see how it happens.” And it means you don’t need to necessarily make any pre- you don’t need to necessarily have any preconceptions about how it’s gonna go, or who it’s going to be best for. Or if you do then you might be proven wrong and you can be proven wrong for instance about things.
 
So an example might be that my research is largely with older adults who’ve had a stroke. Which obviously contrasts to paediatric clinical work, but in my research I work with older adults who’ve had a stroke and I work on the effectiveness of computer based therapies, and they’re, certainly for me coming into it and a lot of people who I’ve explained my role to, they have preconceptions that older people won’t get on with computers, or wouldn’t be able to use or it wouldn’t be a suitable treatment to offer to somebody who’s older and maybe hasn’t been used to using a computer throughout their life in the way that some younger people might have. But actually when we have to meet everybody who takes part in the research and present them with the same opportunities and then do the therapy with them, it challenges that and has shown me that it isn’t the case, that actually lots of people can get on with computers if the if the scenario, if the intervention is appropriate for them and if it offers them something that they that they can benefit from.

Abi sometimes struggled with her professional identity as a speech and language therapy researcher.

I remember very early on when I was just about to go and qualify as a, when I was going to go and train as a speech therapist, I was working in a, I was working in a speech therapy setting as an administrator before I trained and one of the managers there said to me, “Oh so somebody who had come and done their placement with us, was training to be a speech therapist, then went on and did research, and I thought ‘oh what’s the point, we’ve completely, we’ve completely wasted all of our efforts doing clinical training with this person, ‘cos she’s not going to be a clinician’. And that really stuck with me. So ever since sort of I graduated and I’ve been doing research I’ve been thinking, you know, does everybody who works clinically think I’m a traitor for not using my clinical skills in research, in, in clinic, you know should I, should I be on the coal face in the NHS you know doing clinical work?
 
And I guess over time my feeling is that I feel that I can be more effective, that I can contribute more, I personally can contribute more to the profession by feeding into the research side than I might be able to were I entirely in the clinical setting. So Yeah, I think that’s evolved, but I, I do, I do have a, a big sort of what’s the word? A big sort of imposter syndrome sort of fear that I’m not a real speech therapist, at the bottom of it, even though I have my clinical competencies, even though I’m registered with the allied health professionals, even though, you know, I, every year when I sign the thing off that says you know I pay money to the HCPC, Health Care Professions Councils to say  that I do use the skills that I trained clinically with, within my role. I still have that bit of me going, “Yeah but I’m not doing it in the hospital ward, so maybe it’s not real, maybe it’s not genuine,” That’s a bit weird, isn’t it?

If she was audited by the Health and Care Professions Council for re-registering, Abi was unsure whether the documentation would be suited to her role as a speech and language therapy researcher.

But it would be interesting, so I haven’t see the exact sort of criteria against which you have to provide evidence. But when you do your newly qualified practitioner competencies, so like when you’re a teacher and you spend your first year doing your newly qualified year, similarly when you’re a speech therapist you go from being a newly qualified practitioner and you sign off your competencies amongst a certain set of criteria, and then you’re able to, you know you’re a fully-fledged independent therapist, right? Certainly being able to fill those in for me in my research role, there are gaps that I couldn’t fill in, I’d had certainly loads of extra stuff to put in the blank space at the end that said, “You might have additional things that you can add,” but there were certain things about like maybe writing case reports, or different things, working in a multi-disciplinary team with different healthcare professionals, that I couldn’t fulfil with my research role. And I ended up filling those in when I was working clinically as a speech therapist, and in my other part-time role.
So this goes back I think to what I was saying about having that pathway set up, there isn’t necessarily a clear pathway set up for you to integrate clinical work and research work. So, it’s interesting to think about why, you know how, everybody who I know is a researcher and a clinician has sort of cobbled together something and found their way and uses their skills and enjoys using their clinical skills, whether it be within delivering a clinical intervention, whether it be in supporting students to train, or informing research methods so that they’re appropriate for people with communication needs. Yeah, it’s, there’s no clear cut path and it, it can be a bit of a challenge to identify how you fit in it I suppose.

Abi recruited participants from a stroke club for her PhD on aphasia. In this, and when she was previously employed in a research delivery role, she drew on her communication skills as a speech and language therapist.

So meeting face-to-face is, is a really useful way of, of getting that process started.
 
Then when somebody has shown that they might be interested in hearing more I would go to visit them at home, and talk them, talk to them individually, away from the bustle and noise of the group, and talk to them individually about the specifics of the project. Exactly what it would entail, and I’d do that accompanying the consent form, so that they can read the consent form at the time, or they could follow it, but I’d read it aloud word for word so that they were getting the same written information as they were getting auditory information. And then I would pause and emphasise different bits as they go along. I would check and ask for questions. So, I’d use my kind of I’d monitor somebody’s facial expression or whatever, if they went, or you know where I’d check to say, “You know, have you understood what that is? Do you, do you get that?” And we’d talk about somebody’s specific situation.
 
And at that point I would say, “Okay, so that’s the information,” I’ve given them the opportunity to ask any questions, and so as I say I’d support any questions with a writing or reading or you know you can see I use gesticulation a lot, tone of voice changing re-wording things if they’re too complicated, using plain language, and then give them the time to think about it, and say when I’ll come back. If you’re happy for me to come back, so I would never do consent straightaway. There’s the time to think about it and you know be with others and if, if the person wants somebody else to be with them for that and to support them in that exercise then that’s great, we’re very happy for them to do that. But equally I feel very strongly that it’s important that it’s the person who’s taking part in the research, and critically it is the case that people with aphasia have capacity, to make these decisions but that the information needs to be delivered and presented to them in an accessible way.
 
Yeah.
 
So I think historically there might have been, it might have been easier to you know defer to a carer or a significant other, to explain things and to you know check that they’re alright with it, but my preference very much is to have the conversation directly with the person who’s got aphasia, and check that they understand it and then and then similarly with the consent form, I would, I wouldn’t just give it to them and let them read it, I’d say, “Okay so what you’re agreeing to here, this says, are you happy with that?” and then they can give a tick or whatever. And then even things like writing down their name at the end, on the bottom of the, on the consent form I would, if they’re not able to do it by themself I would write it down for them so that they could copy it, so there’s layers of different little support things. But that’s very much drawing on my clinical experience to do that.

Abi met other speech and language therapists who were undertaking PhDs at the same time. They had shared interests and teamed together to visit stroke clubs where they could discuss their research.

And so, in terms of recruitment we I mentioned previously that there was a big cohort of people doing their PhD around the same time as me, all this actually sort of benefited us ‘cos there were a number of aphasia projects going on and what happened was that we each project was looking for a slightly different profile of people with aphasia. So, for example my research was about people with very severe aphasia, so people almost unable to express themselves verbally, whereas other people were doing research for people who might have better spoken abilities but had difficulties with reading for example. And a number of others in between, a number of other kind of studies around aphasia in between.
 
So, at the time of recruitment we, we did a little roadshow, going out around visiting the different community stroke groups and we had like a little booklet, a little menu of different projects offering a variety of different research, and that might be suitable for different people. And that was a really lovely way to work actually because it meant that we could share the load of going out and speaking to people about the, the research, but also that we could present research that wouldn’t necessarily exclude people from the group when we approached them. So yeah, so we ended up with a big sort of collaborative co-operative research drive, and that’s that investment at that time I think has led to us having a very a very good community of research participants that are now connected to us at the university here, so the investment at that time and, and the subsequent involvement in research. And anybody who was happy to stay connected with us at the end of that research project, or who was interested in doing more could, would agree for us to contact them if future relevant research came up.

Abi had often taken on part-time clinical jobs to make up full-time employment. It was a challenge to juggle and adjust between them.

So oftentimes, the thing about research roles, which I’ve done for the most part is that they’re on fixed term contracts, so a certain amount of money comes out and you’re employed either part-time or full-time for X amount of months. And so there have been times when I’ve worked on a speech therapy bank and a speech therapy service as well, and so I’d be doing two or three days a week in clinical practice with children with speech and language therapy needs, and then two days a week on a research on a research role.
 
And it’s, yeah it was very hard, it was, it was difficult juggling the demands of that I think they’re slightly different mind sets, and I think regardless of whether it was two different roles I think having two different work places to, to juggle can, well it is, it’s a challenging thing ‘cause everyone has their own set of rules and policies and familiarity and dynamic and systems that you need to be familiar with to just do the day-to-day things. And in the role, in the clinical role that I was doing I was a speech therapist visiting a number of schools, and so I, then within that role further I would need to develop relationships with each individual school and things. So, there was, there was quite a lot of settings and situations to get comfortable with and understand.

Abi had two more years of a contract left, but wasn’t sure what would be next.

So now I’m on a sort of a three-year trajectory I suppose on, on three different research projects, one of which I’m a co- investigator on, so I was on the application for the funding, and we got the funding, so I’m a researcher and a co-investigator on it, which is really good. Obviously that’s a fixed term affair, so I’m going to be a researcher, a post-doc researcher, for well I’m a year in, so the next two years. And beyond that I don’t know. I don’t feel particularly inclined to be a lecturer, that might change, so, but that’s, that sort of the long term employed permanent position way to go, within academia. I don’t feel particularly inclined to be a permanent position, clinical speech therapist in a, an NHS setting for instance. But I don’t know where that leaves me, so I guess I’ve just been enthusiastic about everything I do up until now, and opportunities have presented themselves, and I’ve seized them. And I don’t necessarily always know quite what it’s going to be, but I’m quite open to the next interesting thing, so, watch this space, I suppose.

Abi felt there was no clear clinical-academic pathway for speech and language therapists, and that often the roles had been “cobbled” together.

So this goes back I think to what I was saying about having that pathway set up, there isn’t necessarily a clear pathway set up for you to integrate clinical work and research work. So, it’s interesting to think about why, you know how, everybody who I know is a researcher and a clinician has sort of cobbled together something and found their way and uses their skills and enjoys using their clinical skills, whether it be within delivering a clinical intervention, whether it be in supporting students to train, or informing research methods so that they’re appropriate for people with communication needs. Yeah, it’s, there’s no clear cut path and it, it can be a bit of a, a challenge to identify how you fit in it I suppose.