Bridging the gulf between academia and practice
There is an ever-increasing awareness within the profession of the requirement to establish, develop, support and maintain an evidence-based approach to veterinary medicine; that is, an approach that focuses on the optimisation of patient care. The RCVS has highlighted this need and RCVS Knowledge (previously the RCVS Charitable Trust) has recently refocused its efforts to become a global intermediary for evidence-based veterinary medicine (EBVM), committed to assisting practitioners to make well-informed treatment decisions and encouraging the development of partnerships and collaboration between practices and academic organisations in an effort to help achieve this aim.
Practice and Academia-Linked Study (PALS) network
In recognition of this requirement, the University of Edinburgh's Royal (Dick) School of Veterinary Studies (R[D]SVS) recently launched the Practice and Academia-Linked Study (PALS) network, a resource designed to facilitate stronger links between its academic and practitioner members for the completion of high-quality clinical research with direct relevance to clinical practice.
The structure of the PALS network is largely modelled on the highly successful practice-based research network (PRN) template that is now widely established within the medical profession. PRNs represent a group of primary care medical practices and/or practitioners affiliated with each other and with an academic organisation, with appropriate channels of communication between network members. They were originally established to investigate questions relating to community-based practice, following the recognition and demonstration by a group of dedicated pioneers that important new knowledge could be discovered by the practising family doctor, even within an era of commitment to clinical specialisation and the linking of research to specialists. The establishment of PRNs has firmly demonstrated that primary care facilities not only represent important routes of application of the fruits of research conducted elsewhere, but are also invaluable sources of relevant clinical questions and vital clinical data resources.
Setting up the network
Currently, the R(D)SVS has established formal links with a group of veterinary practices in Scotland and the north of England, which are committed to the PALS network's mission statement: ‘To draw on the relative clinical and academic strengths of primary care practice and the R(D)SVS to develop a synergistic approach to the promotion, support and dissemination of the results of high- quality research within the practice setting, with a view to improving the evidence base for clinical veterinary practice.’
"PALS is designed to facilitate stronger links between its academic and practitioner members for the completion of high-quality clinical research with direct relevance to clinical practice"
First and foremost, the PALS network represents the ‘laboratory’ where important clinical questions can be addressed with appropriate scientific rigour; questions which, in keeping with the original ethos of the PRNs, have direct relevance to the practitioner members and their patients. Through two-way communication between members, the PALS network aims to encourage an evidence-based practice philosophy, developed and nourished from the continual analysis of practice-based evidence. These aims, as with sole reliance on much of the current veterinary scientific literature, inevitably fall short of fulfilling the true definition of ‘evidence-based medicine (EBM)’, ie, that derived from conscientious, explicit and judicious use of current best evidence, primarily from clinical trials, in making decisions about the care of individual patients. However, the PALS network initiative shares the EBM ethos to standardise not individualise treatment, although within the network and based on data obtained from network members (assuming no conflicting evidence base exists within the scientific literature).
The PALS network has an organisational structure that transcends a single research project. Due to the extensiveness of data available from first-opinion practice and the pooling of research skills across the network, a wide variety of study types are possible, including case studies, qualitative inquiry and longitudinal outcome studies. Appropriate expertise in the design and execution of such analytical approaches will be made readily available from within the R(D)SVS and the Roslin Institute. Furthermore, the academic section of the PALS network has membership representation from a wide variety of veterinary disciplines and species specialties.
Inevitably, the validity of any research output is largely dependent on the size of the study and the quality of the inputted data. Therefore, immediate prioritised areas of focus include recruitment of new PALS members (practitioners and practices) and the development of the research capability and capacity of network members, particularly in relation to the standardisation of recorded data. Consequently, the academic division is committed to the provision of appropriate training in study design and data acquisition and recording.
With such a collaborative venture, the success of the initiative is wholly dependent on the commitment of all members and such commitment is highly dependent not only on the relative interest of each party, but also on the direct or indirect benefits to themselves or their clients. The benefits to the academic members include an improved awareness of the needs of the profession and access to a significantly larger and less biased dataset, thus optimising the clinical relevance and the robustness of the research output. The benefits to the practice-based members include the opportunity to direct high-quality research towards the requirements of their clients/patients, the receipt of formal training in research techniques and inclusion in a large-scale practice-based clinical governance and clinical effectiveness programme.
"Through two-way communication between members, the PALS network aims to encourage an evidence-based practice philosophy, developed and nourished from the continual analysis of practice-based evidence"
Additionally, mutual benefits can be achieved, both by bridging the real and perceived gulfs between academia and practice and through the establishment of professional relationships with a common goal. Finally, the sharing of information among members is essential to the success of the initiative. This applies not only to the rapid conveyance of study outcomes to all participants, thus permitting immediate translation of results to everyday practice, but also to more general issues affecting the practitioner that may benefit from input from other network members.
The need for such an initiative is well recognised, the framework is applicable, the skill base appropriate, the aims achievable and the outcomes relevant. However, the success of the venture is dependent on the commitment, cooperation and honesty of the members. Over time, it is hoped that the PALS network will become an integral part of the professional life of its members, constituting a valuable research tool for addressing important clinical questions, a useful surveillance tool for monitoring the prevalence of specific diseases and a safe forum for the discussion of topical clinical issues.