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SECTION 5:
EXTENDING THE MODEL TOWARDS CLINICAL AND BASIC BIOMEDICAL RESEARCH
None of these streams of research had in any sense been commissioned: there were no formal prior processes of needs assessment by the AHFMR or other independent parties. It was, therefore, interesting to see how the researchers had identified the original topics and how they continued to identify key research sub-topics and objectives at each stage of their work. What emerged was that, typically, the original interest in the body of research, the broad topic or theme, arose through happenstance. For example, one of the clinical researchers whole interest had been triggered by a personal medical problem: one of the scientists had been stimulated by one particular lecture attended as a student. Subsequently, their interests and focus may have moved to being more or less curiosity-driven or problem-led. It appeared that Dr. A had been initially, and remained, essentially problem-led. His aim was to apply intellectual rigour to finding a better clinical therapy for diabetic patients. Dr. D had been and remained curiosity driven: his intellectual challenge was to achieve a better understanding of lipid metabolism at the molecular level. Dr. C had initially been entirely curiosity driven, but increasingly recognized or accepted the importance of ensuring the clinical relevance of his work. Dr. B's interest had been initiated from an applied concern to improve on available therapy but increasingly he saw the need to go back to very basic science to begin to provide a scientific underpinning, and was increasingly fascinated by that basic science. While this no doubt represents both an oversimplification and perhaps an over-reading of brief informal interviews, it raises some interesting questions. Why have some of these researchers moved their original curiosity-driven, or health needs-led positions? For the clinicians, moving towards basic science, it may on the one hand be recognition of the need to understand mechanisms by trying to determine the molecular basis of a disease state before you can properly treat it. It may also be the result of experience that has found bench science easier to deal with than persuading subjects and clinical colleagues to participate in clinical trials. For some basic scientists the need to focus on clinical application may reflect not only a real interest in improving health, but also a recognition of the access it provides to alternative sources of funding. Overall it suggests that the differences between basic scientists and clinical investigators may not be as stark as might be expected, and that as careers develop the balance of motivation may change. The subsequent process of defining and refining research strategy and specific research objectives also differed. The relative importance of personal views on direction, of the ideas of an immediate group of colleagues within the university and of influences from a wider international research community varied. In some cases, the strategy was a personal one, devised in the context of what was seen as an essentially competitive international research community. In other cases what emerged were quite significant attempts to define an agenda with, and to some extent to agree to a division of the research amongst, groups of researchers working internationally on a basis of friendly cooperative rivalry. In none of the cases studied did there seem to have been a significant interaction between the researcher and the AHFMR (in terms of its staff or its scientific advisers and reviewers) in refining or focusing a research program or research strategy. The researchers welcomed this lack of interference, but it may represent a lost opportunity to get the greatest benefit from the AHFMR's international scientific review process. In considering inputs, what emerged unprompted was recognition of the very privileged circumstances they have enjoyed through the long-term support of the AHFMR. All noted that this was a major advantage to working in Alberta, and one that gave them a competitive advantage over colleagues elsewhere. The second interface in the model relates to the way in which results are disseminated, or fed into the international reservoir of knowledge ready to be picked up and used by others. One point of important difference that showed itself in the interviews was the weight different individuals placed on publications as a measure of research output and as the main means of communicating or disseminating results. For some, publications were the key measure of success and the key means of communication. For others, other indicators of success were as important, for example influencing colleagues clinical behaviour and a key means of dissemination was through more informal communications within research 'networks' that brought together the key research players working on a particular topic. Tentatively, it seems to be the case that there is a relationship between degree of concern about the extent to which research results influence others, particularly in terms of the downstream application of research results, and the perceived importance of outputs other than publications. This, in turn, suggests that the value and relevance of bibliometric measures may vary between areas. Certainly the differences in opinion expressed in this study suggest that such measures cannot be ignored but should not be used alone, incautiously or crudely. Further evidence is needed on the correlation between bibliometric measures and other more subjective measures of research 'value' and impact (40). Until now, accounts of the Buxton/Hanney model have stressed that research, even at the applied end of the spectrum, feeds back into future research. Research paybacks are the second main Buxton/Hanney category of payback. From the earliest account of the linear model, it was recognized that feedback loops existed from the primary output of research back to further research. Subsequent iterations of the model have emphasized the complexity and importance of such feedback loops, but have never attempted to analyze them specifically. If the model is to be used for basic research then it would seem important to begin to conceptualize how these feedback loops operate, and to categorize what is being fed back. This is a step that needs more analysis but at first sight the following categories emerge:
Alternatively, it might be conceptualized in terms of two types of influence that research might have on subsequent research. It may produce incremental knowledge: bit by bit filling knowledge gaps or providing building blocks for subsequent research, or identifying dead ends. Alternatively, it may produce a dramatic conceptual change: a breakthrough in how a problematic issue is perceived, refuting or challenging previous research or current perceptions and requiring a major readjustment of how to proceed. It has been argued more generally that the "impact of research information depends upon its ability to change beliefs or assumptions within the relevant policy audience" (28). Additionally, the research process itself, rather than its specific outcomes, may feed into future research through the development of trained personnel or tools and techniques that can be used by others that were not the formal research objective. It would appear that this aspect of the model - research feedbacks - could beneficially be developed, focusing logically on the 'dissemination' interface through which these feedbacks occur, particularly when the feedback is to research being undertaken by quite separate groups. For example, in analyzing publications and dissemination via conferences etc, it may be useful to try to distinguish the types of audience to which they are directed. The type of journal may be a proxy indicator for the type of audience: generalist, specialist or sub-specialist. In order for research ideas to migrate from the basic science bench to application in the clinic, it may need to be disseminated out of the narrow specialty into the thinking of a wider scientific audience.
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