How I see it … Evidence versus Protocol

Two things are on my mind today, the first relates to immersion in my PhD topic and the second relates to getting around in the dark.

I have been so focused recently on completing my PhD that I hadn’t stopped to think about the broader context. When I first started my PhD journey in 2016 I believed that my ideas and research would change the world – well resuscitation practices in New Zealand to be more precise.

The expectation of changing practice has motivated me to continue working on my research over the last four years. What I mean is I felt that this was the end goal and was achievable.

With around 2000 words left to write (one more topic in the discussion, the limitations, future research and conclusion) my motivation has begun to wane and to change the world doesn’t seem as realistic as it did previously. I am left wondering how to translate the results of my PhD into action when publication alone is not enough.

In 2015 I published work that proved that current practice was not accurate and in 2016 provided a solution. Despite being published in a Journal that reaches the specific population of clinicians required the previous research and proposed changes have not been further validated or found their way into practice. While testing and statistics show that my PhD work improves accuracy and reliability is society ready for change?

I now doubt whether my PhD research is worthy of continuation because my previous research does not seem to have made a difference other than to inform and provide a starting point for my PhD.

On reflection, this makes me question the power of published evidence to instigate change in practice. The previous change in method that I suggested was motivated by statistics, which showed a 35% increase in accuracy with a small change in the process. Surely this is evidence?

As a clinician, I am conditioned to use evidence-based practice, and my registering body calls for us to utilise research to inform practice. In this case, even though the evidence is out there the uptake is poor and change is slow. This causes a dilemma in such a protocol based profession, follow the rules or follow the evidence. I do not believe either of these should be mutually exclusive yet this is what I see in practice and is evident in the user testing portion in my PhD.

When I tried to discuss this with one colleague, they suggested that I am on this journey to gain a PhD and don’t need to change practice. However, I feel that without changing practice what is the point of doing a PhD?

Another wise colleague suggested that all students come to a point in their PhD journey where they doubt the work they have done as they only see the limitations and not the positive outcome. This is a good point, but, as a researcher, I am feeling a little demoralised with the inability of my prior research to change clinical practice it seems logical that the research extending in my PhD will also not instigate a change.

I will save the post about getting around in the dark for my next blog entry as this one has become rather long.

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