Research has been a fundamental pillar of medicine since 1747 when James Lind, a surgeon on HMS Salisbury, performed the first ‘randomised’ clinical trial on the treatment of scurvy. However, the proper conduct, interpretation and dissemination of clinical research have evolved dramatically since Lind performed this non-voluntary trial. Lind went on to prepare a treatise on venereal disease and sat the physician examinations in 1748, and was admitted to the Royal College of Physicians, Edinburgh in 1750. In 1753 he completed his treatise on scurvy, entitled “Treatise on Scurvy, Containing an Inquiry into the Nature, Causes and Cure of that Disease Together with a Critical and Chronological View on what Has been Published on the Subject”. Lind was given command of Haslar Hospital in 1753, the largest British naval hospital.
Many lessons from Lind’s work remain relevant for modern medicine; indeed clinical research was a key component to both patient management (note > 100,000 sailors died of scurvy during the Seven Year Wars) and Lind’s employment opportunities. With the volume of information now required for undergraduate medical training, formal training in the correct conduct of medical research is often left to the post-graduate years. Furthermore, the competition for advanced training posts and consultant positions continues to increase, and clinical research is one method candidates can use to differentiate themselves to assist their career advancement. While seeking a research degree should not be the primary reason for conducting clinical research, performing research in a structured environment helps to overcome many issues researchers can encounter. Of note, it was another 50 years before Lind’s treatments were applied to all sailors in the British Navy, and while while certainly not his fault, this highlights issues with maximising the benefit of clinical research.
One pathway to maximise the benefit of clinical research for both patients and doctor is to perform the research as part of a higher degree. This ensures the candidate has the training and oversight to undertake high quality research, and has the added benefit for the candidate of obtaining a higher degree in addition to publications and opportunities to present their work at research meetings. At this point, I must declare a potential conflict of interest, as the coordinator for the Master of Clinical Research (MCR) degree at the University of Western Australia. There are many higher degree options from multiple Universities, which generally have strict entry criteria. Prior research experience is usually required before a candidate can undertake a PhD. It is possible or even encouraged for PhDs to consist of multiple publications, although these are usually required to be reformulated and submitted as a cohesive thesis.
The MCR was conceptualised over a decade ago to provide clinicians with the skills and support to undertake clinical research. The degree consists of 75% research, assessed via the submission of a thesis, and 25% course work, with units in biostatistics, clinical epidemiology and the development and communication of clinical research being compulsory. The course is available for medical and non-medical candidates, and can be undertaken at any stage of a person’s medical career, with no set enrolment date. We currently have MCR candidates ranging from second year RMOs to senior consultants.
Most candidates for the MCR start with an interest in clinical research but have not had the opportunity to be involved in research in their training to date. This course is very practically orientated to provide education and resources for these people to undertake clinically relevant medical research, and achieve a degree and publication in addition to advancing medical knowledge and potentially enhancing patient care.
People interested in undertaking clinical research should also consider the option of performing a higher research degree concomitantly, as it may be advantageous to both the research project and their career. Further information is available on the university websites, and indeed some of the research supervisors may be able to provide advice and assistance.
Medical research is guided by strict ethical principles, which are designed to ensure the research is conducted in appropriate manner. One of these principles, “primum non nocere” – first do no harm, applies to research as well as the practice of medicine. Indeed it could be argued that by not conducting research that aims to enhance knowledge and ultimately patient care, this could lead to harm by not advancing care. Finally, in my opinion, an aspect of maximising the benefit of undertaking ethical clinical research involves ongoing education of clinical researchers; and if this also involves a candidate obtaining a higher degree, then the benefit to patients, the medical profession and the candidates are truly maximised.
A/Prof Damon Bell is a Chemical Pathologist and Endocrinologist with an interest in inherited lipid disorders, metabolism and secondary/resistant hypertension. He currently works in the departments of cardiology and endocrinology at Royal Perth Hospital, PathWest at Fiona Stanley Hospital, and Clinical Laboratories (previously St John of God Pathology). He is also an associate professor in the department of medicine at RPH, and the coordinator of the Master in Clinical Research at the University of Western Australia.