Advanced clinical practitioners (ACPs) play a vital role in modern healthcare, using their expertise to provide high-quality, evidence-based care to patients. Central to their practice is the ability to critically engage with research, ensuring that clinical decisions are informed by the latest evidence and best practices (Health Education England (HEE), 2017).
Although ACPs generally feel more confident in the other ACP pillars of clinical practice, leadership and education, the research pillar presents unique challenges (Fielding et al, 2022). Previous studies have emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a paucity of research exploring how trainee and qualified ACPs can effectively provide evidence of fulfilling the research pillar. This article examines the strategies and methodologies for both trainee and qualified ACPs to navigate and achieve excellence within the research pillar, thereby enhancing the quality and effectiveness of clinical practice. By addressing these challenges, ACPs can further solidify their position as leaders in evidence-based healthcare delivery.
Research engagement and practice enhancement
ACPs are encouraged to critically engage in research activities to elevate the quality, safety and efficiency of healthcare delivery. This theme aligns with research pillars 4.1 and 4.2, emphasising the importance of active participation in research endeavours and the evaluation of clinical practice (HEE, 2017):
‘4.1. Critically engage in research activity, adhering to good research practice guidance, so that evidence-based strategies are developed and applied to enhance quality, safety, productivity and value for money. ‘4.2. Evaluate and audit own and others’ clinical practice, selecting and applying valid, reliable methods, then acting on the findings.’
Trainee ACPs can evidence pillars 4.1 and 4.2 by undertaking research methods modules at Master's level, enriching their knowledge base and understanding of research principles. Exploring personal research philosophies fosters a deeper connection to research practices and methodologies, whether interpretivist, positivist, or post-positivist (Turyahikayo, 2021).
By engaging in primary research, such as undertaking MSc dissertations, ACPs contribute to the development and application of evidence-based strategies within their clinical settings. Furthermore, trainee and qualified ACPs can identify personal development objectives within annual appraisals, reinforcing their dedication to research engagement and continuous professional growth. Through this process, ACPs not only advance their skills and knowledge but also strengthen the overall research culture within their clinical teams and institutions.
Trainee ACPs can undertake the National Institute for Health and Care Research (NIHR) Good Clinical Practice training, establishing a robust foundation for research engagement and practice enhancement (NIHR, 2024a). Trainee ACPs can participate in the research game ‘Your Path in Research’, supported by the NIHR, to explore how performing research can help practitioners to gain new skills and qualifications. This game can help to build careers around the areas in which ACPs are passionate to make a difference to patients, service users, carers, and the public (NIHR, 2024b).
Qualified ACPs can evidence pillars 4.1 and 4.2 through roles such as the NIHR Associate Principal Investigator Scheme (NIHR, 2024c) and the NIHR Learn website (https://tinyurl.com/5ymchddp), reinforcing their dedication to evidence-based practice and ensuring valid and reliable methods inform clinical decision-making. Participation in research workshops and access to quality improvement resources further enhances ACPs’ ability to critically evaluate and act on their findings, ultimately contributing to the advancement of healthcare quality and patient outcomes. Becoming research champions within their teams and departments signifies a proactive approach to driving research initiatives forward.
Leadership development in evidence-based practice
ACPs are positioned as leaders in cultivating evidence-based decision-making and fostering a culture of research integration within clinical practice. This theme encompasses research pillars 4.3 and 4.4, which emphasise critical appraisal, synthesis of research outcomes, and identification of evidence gaps to inform practice and guide others:
‘4.3. Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin own practice and to inform that of others. ‘4.4. Take a critical approach to identify gaps in the evidence base and its application to practice, alerting appropriate individuals and organisations to these and how they might be addressed in a safe and pragmatic way.’
Trainee ACPs can evidence 4.3 and 4.4 by using relevant critical appraisal tools to critically evaluate the evidence such as the Critical Appraisal Skills Programme (CASP) tool. This can be achieved through attending the literature review workshops held by library services or through external critical appraisal programmes. Qualified ACPs can encourage colleagues to implement these tools and share the findings with the teams. By doing so, trainee and qualified ACPs can demonstrate leadership in ensuring the robustness of research findings and promoting evidence-based decision-making. Engaging actively in literature review workshops and staying updated on different typologies of literature reviews enables trainee ACPs to lead the synthesis of research outcomes and disseminate knowledge effectively. Through critical analysis of the evidence base, trainee ACPs identify gaps in research and its application to practice, thereby assuming leadership roles in addressing these gaps safely and pragmatically. Supporting colleagues in evidence-searching and fostering a culture of critical appraisal within the team further exemplifies ACPs’ leadership in evidence-based practice. Trainees and qualified ACPs can undertake the NHS Leadership Academy programmes to advance their leadership and research skills to progress to consultant levels (NHS Leadership Academy, 2024).
Qualified ACPs might write literature reviews and report evidence updates to relevant stakeholders, actively participating in research workshops to enhance the research culture. By doing so, qualified ACPs contribute to the continuous improvement of evidence-based practice and drive positive change within their clinical settings. Thus, through their leadership in critically appraising evidence, synthesising research outcomes and addressing gaps in the evidence base, ACPs play a pivotal role in advancing evidence-based practice and shaping the future of healthcare delivery.
Awareness and dissemination of research findings
ACPs play a pivotal role in actively identifying the need for further research to strengthen evidence-based practices and in disseminating research findings to relevant stakeholders. This theme encompasses research pillars 4.5 and 4.7, which emphasise the importance of acting as educators, leaders, and contributors to research activity while disseminating research findings through various channels:
‘4.5. Actively identify potential need for further research to strengthen evidence for best practice. This may involve acting as an educator, leader, innovator and contributor to research activity and/or seeking out and applying for research funding. ‘4.7. Disseminate best practice research findings and quality improvement projects through appropriate media and for a (eg presentations and peer review research publications).’
Trainees and qualified ACPs can actively engage in discussions with their teams and participate in research councils to identify areas for further research and potential funding streams. By arranging workshops and peer support sessions, qualified ACPs enhance their colleagues’ knowledge and understanding of research and evidence-based practice.
Considering leading research projects and exploring funding opportunities showcases ACPs’ leadership in driving research initiatives forward (NIHR, 2024d). Furthermore, trainee and qualified ACPs share their findings through oral and written presentations within their teams and at conferences, thereby disseminating best practice research findings to a wider audience. Considering publication in peer-reviewed journals and using social media platforms to engage stakeholders and the public further enhances the dissemination of research findings. ACPs can apply for funding to disseminate their findings to maximise the benefit of the research to the wider population of ACPs (NIHR, 2019). By attending monthly research workshops and signing up for platforms trainee and qualified ACPs establish themselves as active contributors to the research community and ensure that their findings reach and benefit a broader audience. Thus, through their active involvement in research identification, dissemination, and engagement, ACPs contribute to the advancement of evidence-based practice and the improvement of patient care outcomes (Elliott et al, 2014).
Collaborative networks for research innovation
ACPs are instrumental in fostering collaborative links between clinical practice and research, thereby driving innovation, and improving patient care outcomes. This theme encompasses research pillars 4.6 and 4.8, which highlight the importance of proactive engagement with stakeholders and the development of robust governance systems to support research endeavours:
‘4.6. Develop and implement robust governance systems and systematic documentation processes, keeping the need for modifications under critical review ‘4.8. Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers.’
Trainees and qualified ACPs facilitate collaborative links by engaging with stakeholders, patients, colleagues and academics throughout the entire research process, from design to dissemination. By collaborating with a diverse range of partners, including those from other health disciplines, ACPs use different perspectives and expertise to enrich research projects and enhance their impact. Additionally, ACPs reach out to other active researchers locally, nationally, and internationally, using platforms such as social media to expand their networks and access new insights and opportunities. Furthermore, qualified ACPs may consider applying for clinical academic fellowships such as the HEE-NIHR Integrated Clinical and Practitioner Academic Programme (NIHR, 2024d). Additionally, they can explore roles within local universities, aligning their research activities with their educational pursuits and contributing to the advancement of clinical practice and academia.
By adhering to rigorous governance systems and documentation processes, trainee and qualified ACPs ensure the integrity and ethical conduct of their research projects. ACPs can access the Medical Research Council (MRC) and Health Research Authority (HRA) decision tools to identify if their study requires ethical approval and review from an NHS Research Ethics Committee (MRC and HRA, 2024). Furthermore, they can follow university and trust approval processes, use appropriate documentation templates, and adhere to standard operating procedures and regulatory requirements.
Conclusion
Through their proactive engagement with stakeholders and the establishment of robust governance systems, ACPs foster collaborative networks for research innovation, driving the translation of research findings into impactful changes in clinical practice. By using their networks, expertise, and adherence to ethical and regulatory standards, ACPs contribute to the advancement of evidence-based practice and the improvement of patient care outcomes.