Sir,

High-quality research forms the basis of evidence-based medicine. A strong grasp of the fundamental principles of research is essential for all doctors of all grades. Studies have shown that research training embedded within clinical training programmes helps to promote trainees’ critical thinking and analysis, improve quality of patient care and facilitate post-training academic output.1

Unlike other surgical trainees, participation in research activities is not mandated—albeit highly recommended—within the ophthalmology training programmes in the UK. However research participation is often deterred by the lack of time and inadequate research skills.2, 3 In 2017 we sent out a 26-item questionnaire-based survey to all the ophthalmology trainees in the North East of England to examine their research attitudes and perceived barriers to conducting research. Trainees were asked to rank the utility of RSTA—a dedicated session allocated for Research, Study, Teaching, and Audit (or Administrative)—against 6 activities (1 (least common activity) to 6 (most common activity)) and the barriers to conducting research against 10 barriers (1 (least common barrier) to 10 (most common barrier)).

A high response rate of 90% (26/29) was received. RSTAs (mean 1.6 (SD 0.5)) were most commonly utilised for administration (4.3 (SD 2.0)) followed by study (4.0 (SD 1.6)), clinical work (3.6 (SD 1.8)), audit (3.4 (SD 1.4), research (2.6 (SD 1.8)) and teaching (2.4 (SD 1.2)). Positive research attitudes were observed amongst the trainees (Figure 1); the majority of the trainees strongly agreed/agreed (SA/A) that they are interested in research (81%) and that research training is important (88%). Lack of time (8.4), clinical training being too intensive (8.0) and lack of mentorship (6.4) were reported to be the three most common barriers to conducting research (Figure 2). Other reported barriers included the lack of funding and the 6-monthly migratory nature between hospitals during training.

Figure 1
figure 1

The summary of research attitudes of 26 ophthalmology trainees in the North East of England. SA—Strongly agree; A—Agree; N—Neutral; D—Disagree; SD—Strongly disagree; MCS—Multicentre study. Q1: I am interested in research. Q2: Research training is important for the trainees. Q3: Research should be mandated as part of the clinical training. Q4: I am confident in conducting research. Q5: I have been given enough opportunity to participate in research. Q6: I feel that I have enough time to participate in research. Q7: I know whom to speak to if I want to participate in research. Q8: I feel that participation in multicentre studies is of low importance because I am not included as a named co-author. Q9: I am interested in participating in multicentre studies but the research subject is not within my interest. Q10: I am only interested in non-pharmaceutical led research.

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Figure 2
figure 2

The summary of perceived barriers to conducting research amongst the ophthalmology trainees in the North East of England. The results are presented in mean (SD).

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Comments

We believe this represents the first study exploring the research attitudes and perceived barriers to research amongst the ophthalmology trainees in the UK. We observed a positive attitude towards research participation amongst the trainees. Our survey findings are consistent with several other studies where lack of time and lack of mentoring were reported as the common barriers to conducting research.2, 3, 4 We observed a low utility of RSTA for research; this might be attributed to the lack of confidence and opportunity in conducting/participating in research (Figure 1), and the non-mandatory nature of research within the ophthalmology training programmes.

With the vast expansion of ophthalmic literature, having the competency to critically appraise the literature and practice robust evidence-based medicine are particularly important in the field of ophthalmology. In addition, there is a rising expectation for senior trainees and consultants in the UK to participate in NIHR portfolio adopted studies within the National Health Service (NHS) setting (https://www.nihr.ac.uk/research-and-impact/nihr-clinical-research-network-portfolio/). Recently we have reported the positive attitude towards the establishment of NETRiON (accepted for publication in Eye—Ting et al).5 We hope that this network could serve as an effective framework to address the research barriers described in this survey.