Advancing Clinical Practice Research in CSD
The need for high-quality clinical practice research in communication sciences and disorders (CSD) is far outpacing the growth of the evidence base (McCrea, 2014). Clinical practice research is a subset of the larger domain of clinical research, which comprises a wide range of research issues (ASHA, 2014). Clinical practice research, in contrast, focuses exclusively on issues related to methods and approaches used in the delivery of services and their outcomes. It seeks to answer urgent and pressing questions that directly impact practice and policy in CSD: What services work best, for whom, and under which circumstances?
The past decades have seen a growing demand for studies to support clinical decision making (ASHA, 2004a), along with broader responsibilities for speech-language pathologists and audiologists who are delivering new interventions, in new ways, to new populations (ASHA, 2004b, 2007). The scope of research has broadened with the recognition that merely identifying effective approaches is not enough to change the real-world service delivery or the outcomes of services. Emerging areas of scientific inquiry focus on research methods for integrating findings into policy and practice (e.g., health services research, implementation science, patient-centered outcomes; Weiner, 2014), as well as frameworks for collaboration with client and community partners (Senturia, 2014). In short, there are more questions, more people asking questions, and more ways of asking these questions than ever before. This situation underscores the need to increase the number of PhD faculty-researchers trained to meet the growing need for clinical practice research in the discipline (ASHA, 2013).
ASHA built the Clinical Research Education (CREd) Library to help address this widening gap between the need for research and the generation of evidence. The CREd Library supports the acceleration of high-quality clinical practice research in CSD by connecting scientists with resources on topics critical to the design, implementation, and management of a research program. In developing the CREd Library, ASHA gathered a range of perspectives, conducting interviews with more than 70 individuals who have deep experience in clinical research, including seasoned scientists, early-career investigators, clinician collaborators, and others. The CREd Library’s collections are specifically designed to address three clear trends that emerged from these conversations:
- a need for resources focused specifically on clinical practice research;
- a need for resources that acclimate emerging researchers to the network of people, activities, and methods in the research ecosystem;
- a need for resources that go “beyond the book,” sharing insights about research culture and practical considerations.
Focusing on Clinical Practice Research and Its Challenges
Clinical practice researchers in CSD face a number of unique challenges in designing experiments to investigate clinically significant questions, including “messy” real-world environments, high participant variability, and research timelines that may not neatly align with tenure cycles. The CREd Library helps researchers navigate these challenges by sharing resources that focus on the methodologies, approaches, funding mechanisms, career trajectories, research culture, and other issues relevant to conducting high-quality clinical practice research in a CSD context.
Exploring the Research Ecosystem
Though tightly focused on the clinical practice research domain, CREd Library resources explore the full context in which this research is carried out. As Leonard LaPointe noted:
If you don’t have people who are new clinical researchers, and if you don’t have research…then you don’t have the creation of new knowledge…. We happen to be in a clinical field, so the creation of knowledge can have a direct impact on the advancement of treatments and how we help people break down barriers of human communication. (LaPointe, 2014)
The CREd Library collections are structured according to about 20 categories that were identified as most important to understanding the CSD clinical practice research environment; implementing rigorous and ethical research designs; and building, sustaining, and scaling up a productive research career.
Going Beyond Book Knowledge
As ASHA developed the category structure for the CREd Library, it quickly became apparent that there was a wealth of largely untapped, yet highly valuable, informal knowledge held by experienced investigators. As Howard Goldstein said:
There are a lot of challenges in clinical practice research…not only in how to design studies, but how to pull them off. It’s often easy for people to get the book knowledge of what it is that you’re supposed to do, but not necessarily the knowledge of what kinds of decisions you have to make in light of the real-world constraints. (Goldstein, 2013)
The CREd Library gives special attention to capturing and sharing pearls of wisdom, advice, and perspectives of seasoned investigators. The collections feature a wide range of multimedia content developed to explore issues related to the culture and practical conduct of research, including:
- videos that expose scientists to emerging trends, such as adaptive designs, mixed model analysis, or crowdsourced data collection;
- “behind the science” interviews providing first-hand accounts of challenges in identifying children with specific language impairment, translating cochlear implant research findings, or“telling the story” throughout a longitudinal study;
- “lessons learned” presentations that allow scientists to benefit from the experience of others inbuilding a career from PhD to tenure track, writing grants, or scaling up the implementation of a school-wide intervention.
Paving the Way for the Future
We hope that new scientists will search the CREd Library collections for advice and answers, that faculty teaching courses in research methods will use the CREd Library to introduce students to CSD research conduct and culture, and that clinical researchers will consult the CREd Library as they design and implement their clinical experiments. Similarly, we hope that experienced investigators will continue to add their “bread crumbs” along the trail and help the CREd Library pave the way for new investigators, by suggesting resources and contributing their experiences.
The CREd Library would not have been possible without the many individuals who contributed their knowledge. Looking ahead to the coming years, Mary Pat Moeller reflected,
“I hope I have an opportunity to perhaps leave some breadcrumbs along that trail of how to conduct a complex study and how to devote yourself to discovering something new” (Moeller, 2013).
For more information about the CREd Library, please contact Suzanne Grubb, instructional designer, Clinical Research Education Library, at firstname.lastname@example.org.
Acknowledgment: Development of CREd is supported, in part, by a grant from the National Institute on Deafness and Other Communication Disorders (U24-DC012078); Principal Investigator Margaret Rogers is ASHA’s chief staff officer for science and research.
American Speech-Language-Hearing Association. (2004a). Evidence-based practice in communication disorders: An introduction [Technical report]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2004b). Scope of practice in audiology [Scope of practice]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of practice]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2013). Strategic plan to increase the student pipeline and workforce for PhD researchers and faculty researchers [Report of the Academic Affairs Board]. Available from www.asha.org/academic/reports/.
American Speech-Language-Hearing Association. (2014). Clinical practice research in communication sciences and disorders. Retrieved fromhttps://academy.pubs.asha.org/cred/about-clinical-practice-research/.
Goldstein, H. (2013). Getting Started in Clinical Practice Research [Video]. Retrieved from Clinical Research Education Library.
LaPointe, L. (2014). Why Focus on Clinical Practice Research? [Video in Production]. Retrieved from Clinical Research Education Library.
McCrea, E. (2014). What’s research got to do with it? Everything.The ASHA Leader, 19(10), 6–7.
Moeller, M. (2013). Mentoring: Following (and Leaving) Breadcrumbs on the Path to Discovery[Video in Production]. Retrieved from Clinical Research Education Library.
Senturia, K. (2014). Community based participatory research in implementation science: Is it for you? [PowerPoint slides and video]. Retrieved from http://dx.doi.org/doi:10.1044/cred-pvid-implscid1p6.
Weiner, M. (2014). Health service research: What is it? [PowerPoint slides and video]. Retrieved fromhttp://dx.doi.org/doi:10.1044/cred-pvid-implscid1p4.
Dixon, D. (2014). What “using EBP” really means.The ASHA Leader, 19(10), 28–29.
Francis, D. O. (2014). Patient-centered outcomes research in voice. Perspectives on Voice and Voice Disorders, 24(1), 21–31.
Redle, E. E. (2013). Improving practice through implementation science and knowledge translation. Access Academics & Research, ASHA, (December).