Jonathan Shepherd
Professor of oral and maxillofacial surgery at University Hospital of Wales and director of the Violence Research Group at the University of Wales College of Medicine
Public services depend, above all, on public-service practitioners - police officers, teachers, lawyers, social workers, doctors and dentists - doing "what works". Since what is known to work and not work is subject to change as evidence becomes available, the delivery of public services must be responsive to research. This research must of course be relevant to practice. Unfortunately, though, there is not only little integration between academic research and public service practice - they often have no crossover at all. Indeed, some groups of practitioners have even come to see academics as almost irrelevant to their practice.
The obvious dangers are polarisation of theory and practice, alienation between evaluators and practitioners, neglect of practice-oriented research, uncritical practitioners and splits between academic and practically- oriented research. For example, in relation to crime the Economic and Social Research Council mostly funds research that will provide new theoretical knowledge, which has come to be seen by social scientists as having higher status in academic terms, whereas the Home Office funds evaluations of practice in the crime-prevention field.
Furthermore, few criminologists are also crime-reduction practitioners and few crime-reduction practitioners are trained in the evaluation of crime-reduction practice. Astonishingly, there are no university police schools in the UK.
On the other hand, it is not possible in this country to train as a doctor or a dentist outside a university medical or dental school. University-based practitioner-academics are a foundation of health services since they generate, transmit and implement knowledge. The management of research relevant to practice is also more integrated. For example, the Medical Research Council has a clinical trials unit dedicated to rigorous evaluation of clinical interventions.
There are five reasons why the practitioner-academic should be a cornerstone not only of the health service but of all public services. First, as a teacher, the practitioner-academic promotes effective practice and helps turn out evidence-oriented practitioners and the practitioner-academics of the next generation.
Second, as research supervisors, practitioner-academics teach a range of research methods, with the randomised field trial as the gold standard. He or she will be able to ensure the relevance of research to practice.
Third, practitioner-academics carry out research, mount randomised trials and lead systematic reviews of practice-oriented evidence. The result to date in the Cochrane Library of healthcare evaluations alone, is more than 300,000 references to randomised trials and more than 4,800 published reviews.
Fourth, as an advocate of high-quality research and from the position of independence that a substantive university appointment bestows, the practitioner-academic can challenge the dogma of the day and pioneer changes in practice as new evidence dictates.
Fifth, this twin academic and practice perspective is also important in a public-policy context. As an authoritative practitioner, the practitioner-academic can influence decisions about investment in research. For example, in the National Health Service a substantial research and development budget supports practice research and also funds the Cochrane Library. Few or no parallel funding arrangements exist in other public services, for example, there is no similar arrangement as regards the Campbell Collaboration in the social sciences.
The history of medicine and dentistry demonstrates how barriers to recruiting and maintaining a sufficient cadre of practitioner-academics can be overcome. It is a challenging but hugely important role in healthcare that other public services, particularly the police and education, would do ell to adopt.