DIVIDED WE STAND

Here at the BCP, we try our best to find the delicate balance between the clinical and academical worlds. But it's tough, really tough trying to find the best evidence-based solutions for our patients whilst dealing with the day to day clinical realities and challenges.

Find out how the BCP is closing the gap between the academical and clinical worlds here

Despite some initiatives to bring the clinical and academical worlds closer together, it does still feel like there is a huge metaphorical divide between them.

Often clinicians feel like academics and researchers don't appreciate or understand the time and resource restrictions they face, and academics feel like clinicians are ignorant and lethargic in understanding basic scientific principles and following research-informed suggestions.

And so it appears that many clinicians and academics are 'standing divided' in their attempts to help patients and unless this divide is reduced then both are going to be united in failing patients.

Divisions

Despite significant advances in modern healthcare, there exists an ever-present threat to further progress that desperately needs to be acknowledged and addressed. This is the persistent divisions between healthcare academics and clinicians to fully understand and appreciate each other.

This ongoing divide is arguably one of the biggest factors that impedes the progression and translation of new advances in healthcare, with delays of up to 17 years being reported before evidence-based recommendations are routinely used in clinical practice¹.

Objective v Subjective

The academic/clinical divide can be attributed to a number of factors; the first is that individuals working in these two groups tend to have very different personalities, ambitions and goals, both personally and professionally.

The academic often tends to be more objective, analytical, and calculated, motivated and focused on statistics and publications. The clinician, however, tends to be more subjective, empathetic and caring, driven and focused on people and their problems. The academic tends to work with large populations and diverse pathology, whereas the clinician tends to work with individuals and select disabilities.

These different personality types, goals and motivators – although not mutually exclusive – do make finding common ground, collaboration, and agreement between clinicians and academics difficult.

Hierarchy

Another barrier that contributes to the academic/clinician divide is often an archaic, dogmatic, hierarchical system that traditionally places academics at the top and clinicians as subordinates. This can, at times, make it daunting for clinicians to question, discuss, and debate anything with academics openly and freely. This academic snobbery can also be attributed to some individuals over-inflated perceptions of their standing and position within the profession due to the amount of work and effort they have undergone to achieve their qualifications and positions².

This can make some academics susceptible to eminence-based thinking – quick to rebuke, rebuff and reject potential new ideas and thoughts from others without fair consideration. These factors can lead to clinician lethargy and apathy, with them too fearful or demoralised to discuss, question or challenge academics’ work. This situation is then worsened by academics viewing clinicians as lazy or lacking interest in research due to their lack of questioning.

Different Language

Another factor contributing to the academic/clinician divide is that they often don’t speak the same language. Differences in terminology, acronyms and jargon exist on both sides making it hard at times for one to understand the other.

For example, academics tend to discuss pathology and treatments in terms of statistical prevalence, incidence and treatments and assessments in terms of probability and reliability. Unfortunately, many clinicians do not get taught or just don't understand these terms well, which can make it frustrating and exasperating for academics to get their message across ³.

Adding to this communication barrier is the disparity in understanding of the basic scientific principles that academics and clinicians have. Unfortunately, many clinicians have poor understanding of the fundamentals of scientific investigation and processes and tend to be unaware that their day-to-day observations and clinical expertise are prone to many biases and errors.

No Control Group

Often many clinicians convince themselves that a treatment is effective when academics prove otherwise simply because they see it working clinically and not compared to a control, sham, placebo or other treatment. This causes a lot of cognitive dissonance and resentment between the groups and leads to further divisions.

All these barriers in the hierarchy, language, terminology, communication and basic scientific knowledge mean communication and collaboration between academics and clinicians will always be challenging. But they are not insurmountable.

Solutions

First, clinicians must simply be better at understanding the basic scientific principles and have a better grasp of statistics and be aware of their cognitive biases. This means spending some time learning and even unlearning what you may have been taught previously and investing some time and energy in something you may find mundane and boring but will ultimately make you a better clinician.

And academics need to work harder in reducing the long-established hierarchical barriers and make themselves more approachable and willing to accept constructive criticism and challenges of their work by clinicians. This means getting down off their high horses and out of their ivory towers and recognising that most clinicians are hard-working dedicated people with little time and energy to spend on other things.

Academics and researchers also need to consider making their research findings far more accessible and far, far easier to understand and digest. Most research is written in an archaic format and hidden behind paywalls, making it difficult for clinicians to find it and understand it.

Currently, most research is written for other researchers and NOT the average jobbing clinician. If researchers want clinicians to practice what they suggest then they need to be better at disseminating and sharing it.

Finally, both academics and clinicians need to recognise and embrace the many different ways of knowledge translation and acquisition that are now freely available. Gone are the days of only being able to learn in a lecture hall or classroom when new research could only be read once a month via a printed journal. In today’s world information is only a click away.

 With the expansion of digital resources such as the internet, social media, hyperlinks, downloads, RSS subscriptions, keyword searches, blogs, vlogs, infographics, webinars etc, there are almost an unlimited number of possibilities to share, promote and disseminate information and just as many ways to connect, collaborate and work to close the divide that separates academics and clinicians.

Summary

The phrase ‘united we stand, divided we fall’ has long been used to inspire unity and collaboration. It is based on the belief that if individuals with similar goals work on their own instead of as a team they are doomed to fail. Unfortunately, this prediction could become a reality in healthcare if we don’t work harder to acknowledge and address the divisions in our profession.

It is without a doubt that academics and clinicians have the same goal – to help patients. But to do this we need to better understand and respect each other’s strengths and weaknesses, we need to work harder to overcome the barriers and prejudices that stand in our way and ultimately, we need to stand united.

Find out how the BCP is closing the gap between the academical and clinical worlds here

Further reading

1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med; 104:510-520.
2. Aronson E, Mills J. The effect of severity of initiation on liking for a group. The Journal of Abnormal and Social Psychology 1959; 59:177-181.
3. Fernandez-Moure JS. Lost in translation: the gap in scientific advancements and clinical application. Front Bioeng Biotechnol 2016; 4:43.