Pioneering a bold new clinical academic frontier

The availability of career paths that include clinical and research work is something the CSP believes is crucial to delivering best physiotherapy care and an important part of our ongoing development as an evidence informed profession.  

Professor Caroline Alexander is a champion of such careers. She is lead clinical academic for allied health professions at Imperial College Healthcare NHS Trust and professor of practice (musculoskeletal physiotherapy). 

She forged her own career marrying her clinical practice with research (including the creation of a motor control laboratory in her physiotherapy department).  She has also been instrumental in supporting the next generation by building capability and capacity within her local trust and championing the National Institute of Health and Care Research (NIHR), Health Education England, Integrated Clinical Academic pathway.

Career path

When asked about who and what inspired her to pursue research alongside clinical work, Caroline shares that many people and learning experiences have supported her career journey – though she has created her own path. Completing the first MSc course in musculoskeletal physiotherapy in the 90s and then being unofficially mentored by Ann Thomson, the course leader, provided her with opportunities to teach and thrive in an inquisitive learning environment. It also exposed her to other professionals – including Dr Phil Harrison, a neuroscientist at University College London who later supervised her PhD. On completing her thesis, she recalls not knowing exactly ‘who’ she was. The only paths available at the time were to continue to do research in a university or be a clinician...until she convinced her local trust to employ her to do both spending her time split 50:50. Throughout our conversation it is clear Caroline has repeatedly broken new career ground, often strategising her next role and working with manager and colleagues to create new clinical academic job descriptions – before subsequently successfully applying for them!

Driven by clinical questions, Caroline has a special interest in investigating the mechanisms behind why some people with hypermobility develop symptoms and others are symptom free. Such insight can, in turn, help physiotherapists tailor their treatments accordingly.  A valued spin off of this work has been the chance to work alongside different professionals, including bioengineers and neuroscientists, who all bring fresh perspectives and expertise.

Her current role involves a combination of MSK outpatient work, hypermobility research and AHP research supervision. However, her largest responsibility is the strategic development of AHPs to be more research aware, prepared and active through clinical academic training and opportunities. She says ‘I couldn’t have done this without a team approach’. She works closely with clinical academic training office colleagues, the trust leadership and their therapies leadership team. When asked what she enjoys most about her role she responds ‘seeing clinicians use research to impact their clinical practice’. 

How clinical academics make a rippling impact

Caroline believes that measuring and showcasing the impacts of clinical academics in clinical services is important to justify their place.

We know that in research active trusts, outcomes are better, mortality is lower and patient satisfaction is higher.

She brings ‘all of herself’ to her research and to her clinical practice. She also believes that recruitment and retention in her local NHS services have improved through them being research active. Research active clinicians have an important role in the implementation of evidence-based practice and can speed up implementation of research. They also tend to bring national and international expert networks and external grant funding which, taken altogether, can lead to improved care. 

So how can we grow more clinical academic physiotherapists?

The AHP Research and Innovation Strategy highlights the importance of building research culture, capability and capacity, so I asked what practical steps Caroline has taken to help build these in her local trust. 

Her first response is that this is a great ongoing challenge involving multiple stakeholders and requiring time to change culture. To increase research knowledge and capability, physiotherapists can access mentorship and conduct clinical academic training alongside other professions. In her local trust they use their Imperial College Academic Health Science Centre’s research training framework and offer a suite of linked opportunities including a yearly research symposium, learning events, library support and monthly workshops such as ‘How to write a fellowship application’ and ‘Resilience in research’.

One of her first steps to build capacity was to create a strategic research plan for the trust with the deputy director of nursing for research, then work with the trust leaders such as the chief AHP and chief nurse along with the trust research and innovation lead. She has also worked in partnership with her therapy managers and funders to create therapy clinical academic posts at multiple career stages. The trust funds three senior AHP profession specific clinical academic research leads to help embed the culture and within therapies they now offer: two band 5 rotations which includes one day of research time supporting existing research projects; a band 5-6 rotational research opportunity sitting within Imperial College London’s Care Research & Technology Centre and a one day a week research opportunity for their post-doctoral clinical academic. Caroline is also pragmatic in partnering with, and targeting, a suite of stakeholders to support research funding including the NIHR Imperial Biomedical Research Centre, the Imperial Health Charity and other National Research Fellowship funders.  

Caroline was also involved in penning a standard operating procedure for service managers to help them with moving clinicians between their substantive clinical posts and research fellowships. Though there is still much to do, she believes such opportunities and a visible supported career path are paramount to nurturing more physiotherapist clinical academics. 

Equity, diversity and belonging in research

Caroline welcomes the recent focus on equity diversity and belonging in research and believes this to be ‘vital’ and ‘a long time coming’. Locally, she works in partnership with EDB ambassadors to ensure that there is equity in education and career progression – for example, by ensuring some research education bursaries are for clinicians with protected characteristics. She also highlights that having inclusive patient involvement in research is key in representing the diverse populations we serve, from the creation of relevant research questions right through the research process and to the sharing of findings.

What makes Caroline Alexander tick?

I ask Caroline to share a couple of projects that she is currently involved with that excite her. Her eyes glow when she talks about her new physiotherapy PhD student exploring why some people with hypermobility feel more clumsy and fall more and she is looking forward to being part of a mixed-profession supervisory team supporting a speech and language therapist who is interested in improving therapy after laryngectomy. Time moves on and I ask about the achievements that have made her most proud in her unique career. For her, it is the progress that she has made in forming the local clinical academic career structure, which complements the existing fellowship structure from the NIHR HEE. She is at her most satisfied when she sees the growth and development in others through their clinical academic journey and when she sees others achieve their research awards and PhDs. It is clear that Caroline is a perpetual innovator and her research is rooted in a desire to answer clinical questions, improve care and support the next generation.