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Research in rural hospitals: the perks and pitfalls

Professor Kausik Chatterjee, consultant geriatrician and stroke physician at the Countess of Chester Hospital, tells us about the opportunities and challenges of being research-active in a rural hospital.

How did you become involved in clinical research?

After completing my care of the elderly training programme in Manchester, I joined the Countess of Chester Hospital NHS Foundation Trust as a consultant geriatrician and stroke physician back in 2005.

Importantly, there was a strong appetite to change the stroke service through research, but funding was a big challenge. I still remember walking into the R&D committee meeting a year into the job and demanding some funding for a leg Doppler (a test to detect clots in the leg) in order to join the CLOTS trial, and noticing most of the committee members smiling at me.

After 9 months of battle, the solution came from one of my radiology colleagues. He told his managers that he would carry out those Dopplers on the ward during his lunch breaks or after 5pm – not ideal but it did the trick, and despite starting late, Chester became the third highest recruiter in a multicentric international trial.

That was just the start of a long journey. The NIHR Clinical Research Network (CRN) came along in 2009 and the research process was much more streamlined. That long 9-month waitwe had is typically less than a month now.

What are the advantages and challenges of doing research in a more rural hospital?

Most rural hospitals are still a blank canvas for research. You have the chance to shape things in a way you wouldn’t in a large urban teaching hospital. But to make it work you need to have a support group around you to make changes.

The most important ingredient of delivering any clinical research is patients.  Rural hospitals have plenty of these and they trust us fully. That is why we were able to recruit 30-40% of our stroke patients in different research studies in Chester when the national figure stands at around 5%.

Patients know that their clinical care will be better if they participate in a research project, the research-active clinician will generally provide better care, and the chance of harm is minimal in most research projects as they are well-regulated. But as a clinician you need to make sure you don’t break patients’ trust. Don’t forget also to write a synopsis for them when the result of their trial comes out – they are part of your research family.

As a consultant, you need to find something which gets you out of bed every morning. Research is one of those ‘somethings’. But if you want to build a career in research, you need a trusted partner and team locally, regionally and nationally and that will take time.

The RCP this week published the results of a membership survey showing physicians in rural hospitals, as well as women and BAME physicians, struggle to participate in clinical research. Research for all? An analysis of clinical participation in research outlines these findings and how this unequal access must be tackled.