A few years ago, whilst out of clinical medicine, I applied to join one of the London Research Ethics Committees. I did a BSc in Medical Ethics many years before and had been a lecturer and tutor in Ethics and Law in Paediatrics for the Imperial Undergraduate program but was very new to the world of Research Ethics, and indeed very new to the world of research. I wasn’t convinced they would want me on their committee. As someone with a fairly severe form of ‘Impostor Syndrome’, I was especially pleased to be offered a place, as an Expert Member, on the Camden and King’s Cross Research Ethics Committee. 4 years later and I’ve recently been appointed as the Vice Chair of the Committee. I have been looking back at everything I have learnt while on the Committee and thought I’d share some of my learning with you, and how this role has allowed me, as a senior trainee, to develop some additional professional skills.
So, firstly what is a research ethics committee?
There are approximately 80 research ethics committees (RECs) in the UK and collectively they review over 40000 research proposals a year. They are part of the Research Ethics Service, a division of the Health Research Authority (HRA) which is part of the NHS. All research involving NHS patients, staff and services has to be approved by a REC before research can start. RECS are made up of approx. 10-18 people from a diverse background. There is a mix of “Expert” members (medical and allied health care professionals) and “Lay” members. Lay members come with a wide range of experience; patients, carers, parents, lawyers, bankers, research scientists, academics… the list goes on. Do not be fooled by the title “lay”; my old Professor of Medical Ethics is a Lay Member of his REC and the idea of me being more “Expert” than him is laughable.
The purpose of the REC is to “enabl(e) and support ethical research in the NHS…maximise UK competitiveness for health research and maximise the return from investment in the UK while protecting participants and
researchers” (hra.nhs.uk). By having a mix of experience and background on the Committee we can provide both scientific/medical expertise to analyse proposals thoroughly for scientific value and rigour while also seeing the patient’s viewpoint and ensuring that any risks to participants are minimised and adequately explained.
Many of the Committee have extensive experience in research and will make suggestions to improve the proposal, increase the likelihood of recruitment and increase the likelihood of generating quality, publishable results. So please do not despair if a Committee ever send you a long list of additions or changes; bear in mind that they are fulfilling their brief to “support… ethical research… maximis(ing) the return from investment…while protecting participants and researchers” (hra.nhs.uk)
Each REC is compelled to work to time standards (much like any ED!) and must give a decision within 60 days of the proposal being submitted. However, it is usually quicker than that; on average decisions are given in under 40 days.
What I have learnt and gained from working on the REC
In addition to the factual things I have learnt (such as an understanding of the Human Tissue Act, appointing Mental Health Act consultees and the wider structure of the NHS) I have gained invaluable experience and “soft skills” as a senior trainee. It has reminded me that as clinicians, particularly Paediatricians, we have a lot of knowledge and communication skills that we can bring to a variety of roles and give to a wide range of people, not just our patients and their families. I often have to summarise 50 pages of research proposal to the committee, explaining complex concepts and issues. This has built on, and developed, my skills in my clinical “day job”. There is also something very attractive about using a different bit of your brain, bleep free, red phone free, for a few hours a month!
The organisational skills, communication skills, and diplomacy required to work on a committee, alongside a clinical job, have taught me management and leadership skills that have been invaluable in my clinical role. Analysing hundreds of research proposals has given me the confidence and drive to be more involved in clinical research in my ED, including recruiting patients to FiSH, CAPIT and FORCE, as well as being the Associate PI for FORCE. It has made it easier to explain trials, risks and benefits and consent parents for these trials.
It is a privilege to work with some very senior, experienced people, whose names I would otherwise only see at the top of papers in “Archives” or on the spines of text books on my shelves. As a trainee, rotating through departments every year, it is a pleasure to develop some longer standing professional relationships and informal mentors. For example, when I first started chairing the M+M meeting at work and realised I had NO idea how to chair a meeting, the Chair of my REC shared her tips and experience of Chairing with me. It is fair to say, that the ED M+M meetings ran much smoother after that! Which in turn, led to my REC Chair encouraging me to apply to be the Vice Chair. The HRA have sent me on a (free! no Study Leave form needed, simple pleasures!) course on how to Chair a meeting, which I know will be incredibly useful (indeed, already has been) in my clinical work, especially as I approach Consultant applications, interviews and jobs.
Every so often the HRA will thank me for the time and commitment I give to the REC; but when I reflect on the transferable skills I have learnt from the REC, I suspect I should actually be thanking them. If any of you are even contemplating sitting on a REC I would really encourage you to do so.
Do contact your local REC and ask if you can attend a meeting as an observer to find out more. RECs are also very happy to have researchers attend a meeting as an observer to have a better understanding of the approvals process, before submitting a proposal. So do get in touch!
Emily Cadman, Paediatric Emergency Medicine registrar