How am I supposed to find time to read research?!?

Well, I mean… The Informed SLP's Monthly Reviews are helping with that in that we’re reading a huge pile of articles every month, throwing out everything that’s not immediately clinically applicable, then reviewing just the “good stuff” for you. TISLP is a massive time-saver for busy clinicians. But—nonetheless—it isn't enough. Our reviews alone don't cover EVERYTHING; particularly when you have a specific question in mind.
 
So, how on earth am I supposed to be reading these articles and staying up-to-date on the evidence?
 
Option #1: Kiss your social life, family time, and leisure time goodbye, and spend your evenings and weekends reading research articles... NO! Don’t do this. Forget that. Nobody does that. We can do better…
 
Option #2: Advocate for plan time. I know, I know... you don’t like this option either, because many of you are in situations where you feel like this is a non-option. But—here’s the thing—it IS an option. It IS an option to demand a certain amount of desk time each week, and use that time to access evidence and problem-solve for your clients. We help our clients by providing the best quality therapy we possibly can. Efficient therapy, even. The only way to make that happen is to take just a *little* time to look into the evidence-based options.
 
Option #3: Tackle it as a team. Baker & McLeod (2011) provide evidence that an EBP group can be a productive way to connect SLPs to research and increase their confidence in applying research to their caseload. As a group, the SLPs would develop a clinical question, but then have one skilled person perform the literature search, a small group critique the research, and then the whole group participate in an “EBP meeting” where they cover the evidence, then go out and individually apply it to clients. Divide and conquer can be a pretty good option, because lack of time is a legitimate barrier.

Option #4: Identify one person in your local SLP team (e.g. one person from your school district, or one person in a local group of private practitioners), and pay them (not you—your boss, obviously) to access and read research evidence for you. Or give this person a caseload release to do it. Don’t laugh. This exists, and you need to be asking for it!
Effective and efficient therapy is good for the clients/students, but also good for organizations’ bottom line, because it can lead to better treatment and kids not hanging out on school-based SLPs’ caseloads for years. So—truly—it’s not impossible to talk administrators into this. Particularly if the entire group of SLPs gets behind the idea, and sells the concept to those in charge.

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• Real-life Example A: When I was a school-based SLP, in a district with around 40 SLPs, I was paid an extra stipend by our district to research clinical topics, then report back directly to the SPED administrators and to our group of SLPs. For example, one time I gave a talk on caseload scheduling models to our SLP group during professional development time. Now (real talk) while I was in that district, I also saw some administration changes. And not all the administrators thought it was worth their money to pay me to do this.
• Real-life Example B: Another option is to have one SLP in a larger group have this role built into his/her job—so it’s not something they get a stipend to do, but something they ALWAYS do. This person would receive a partial caseload release to make it happen. Enter real-life example, Megan Staniforth. Click "Read More"...

​​Meredith Harold, PhD, CCC-SLP interviews Megan Staniforth, MS, S-LP.
3/7/17

Meredith: Megan Staniforth is a Canadian Speech­–Language Pathologist, currently working for the Queen Alexandra Centre for Children's Health, providing services to children ages birth–five. But that’s not all she does. Megan’s full-time SLP position is split between a clinical caseload and an evidence-based practice leadership role. She’s basically paid to review literature relevant to the population her site serves, and disseminate to her SLP colleagues. So—maybe you want to be Megan (I do!) or maybe you just want “a Megan” at your workplace. Let’s find out more about how this works…
So, Megan, my first question for you is how a fantastic opportunity like this has been laid out in the first place. Clearly your employer values using research to support practice. In Canada, is this position essentially funded by the healthcare system?

Megan: My position is definitely unique and has a bit of an interesting history at our worksite. In terms of funding, we are a child development centre embedded in a healthcare facility, which means our program is publicly-funded by the provincial government branches for both healthcare and children and family development.
My actual job title is the 'Resource/Evidence Based Practice SLP'. Several years ago, therapists in different disciplines were assigned 'resource therapist' duties, which meant sharing information about new assessments, training opportunities, therapeutic approaches, and equipment with their colleagues. These duties also included maintaining filing cabinets with new research articles (good old hard copies!), hence the 'resource therapist' in the job title. As the allied health fields began to recognize and focus more and more on evidence-based practice, the ‘resource’ roles started to turn into EBP-focused positions. In addition to my SLP role, the early intervention program also has EBP clinicians for occupational therapy and physiotherapy. As it stands right now, all three of the EBP therapists (SLP, OT, and PT) work on the same geographical team, which means we have several opportunities to share resources, search strategies, and collaborate on interdisciplinary projects.
I am very fortunate that the early intervention program coordinator and manager value and promote EBP in allied health and early intervention and that the position has been maintained even with increasingly tighter budgets over the years.
 
Meredith: So how did you get this position? Did you have to receive extra training, or was it on-the-job?
 
Megan: I applied for the EBP SLP position about five years ago when the EBP duties were still considered a workload assignment and were not specifically listed in my job description. After a few years of union negotiations, my EBP duties were written into the official job description. When I applied for the position, I was still a relatively new clinician fresh out of grad school, which served me well, as I had taken specific coursework in evidence-based practice. The previous SLP in this role did an excellent job of providing me with some on-the-job training in terms of where to look for articles, how to critically appraise articles, and what knowledge transfer approaches had worked for her. Other than that, I had a lot of autonomy in how I wanted to go about my role. In the beginning, I participated in frequent meetings with my clinical leader and manager to discuss current EBP questions and projects to help ease me in to the role. 
 
Meredith: Are you the only SLP who does this for the Queen Alexandra Centre? How many SLPs are you disseminating to? And how many hours per week do you do research reading and dissemination vs. clinical caseload?
 
Megan: We have about ten SLPs in the early intervention program who I support directly in my EBP role, and an additional seven SLPs who work at the Queen Alexandra Centre with a variety of populations. My full-time position is divided into 0.7 FTE for my clinical caseload and 0.3 FTE is dedicated to evidence based practice. I spend about a day and a half a week on my EBP duties, which in addition to searching for and reading research, also involves participating in meetings with management and clinical leaders focused on evidence-informed quality initiatives.
One of the aspects of my EBP role that I enjoy the most is when my colleagues send me clinical scenarios and questions. I develop a PICO question and search for the highest-level evidence available. Depending on the scope of the question, I may just forward my colleague some articles directly for their review, or (more often) I appraise and summarize the content so that it becomes more clinically useful. Other routine duties include sharing monthly updates on interesting and relevant articles and resources I come across, including links to the Informed SLP site!
 
Meredith: How do you get access to journal articles?
 
Megan: Because I work in a healthcare facility, I have access to the medical library services including a group of fantastic librarians and all the journals our healthcare facility subscribes to. Databases I use frequently are PubMed, PsycINFO, and EBSCO. I also access content from sources such as UpToDate.com*, ASHA’s practice portal, and Speech-Language and Audiology Canada (SAC). It’s also helpful to look beyond journals published just for speech-language pathology – I have come across useful content when searching in journals focusing on pediatric medicine, neurology, and occupational therapy, to name a few.
*Meredith’s note: UpToDate.com is a resource by Wolters Kluwer (journal publisher). $500/yr, so likely something you’d use only if your workplace purchased it...)
 
Meredith: What is something you’ve recently learned about, and shared with your colleagues, that they were able to immediately implement? Do your colleagues regularly give you feedback on whether or not some of the things you’ve found for them are working, clinically?
 
Megan: A large part of my role is working on longer-term EBP projects. In the past year I have completed two such projects, one on childhood apraxia of speech and the other on late language emergence. Both projects came about based on clinical questions from my colleagues, as we navigate how to best serve our clients with finite resources. The end results were ‘toolkits’ for the SLPs and summarized content from the highest levels of evidence available, as well as provided clinicians with links to resources that they could use clinically. For example, the late language emergence project includes links to the ASHA Practice Portal on this topic. It also provides clinicians with possible ‘care pathways’ for service delivery for late talkers.
I am always looking for feedback from my SLP colleague on what they have found to be the most useful clinically, and certainly knowledge transfer is one of the challenges of my role. It’s one thing for me to search for and find the evidence, and it’s another to bring about practice change in others (if that’s what the evidence points to). The feedback I get from my colleagues is that they prefer accessing evidence-informed content that is quick and easy to read and that is clinically relevant. In other words, clinicians want information that will make a clear impact in their day-to-day work.  
 
Meredith: So, other than introducing us to a model of making EBP work for busy SLPs, I also think you could probably share some tips with us! What have you figured out (over the time working in this EBP position) that has made finding, understanding, or processing the research easier? Any tips you could share with fellow SLPs to make this task just a little more surmountable?
 
Megan: Absolutely– like many SLPs, one of the biggest challenges I face in my role is managing the sheer volume of information and not getting too bogged down by it all (for example, the recent project on late talkers resulted in 966 articles to sort through). That, and not letting my clinical work creep in to my EBP time, which is all too easy to do. Some tips and strategies I have found useful include:

• Let journal searches do the work for you: I have set up monthly email alerts for specific topics, populations, and journals to be sent directly to my EBP folder in my work email. Not only do topics of interest get sent directly to me, but I can then also sort through the journal alerts when I have the time set aside to do so.
• Be specific: Spending the time to develop a specific EBP question saves more time in the long run. Use PICO questions and advanced search functions to narrow your results.
• Learn more about what EBP really is: The Handbook for Evidence-Based Practice in Communication Disorders by Chris A. Dollaghan (2007) is an excellent resource for clinicians. It was the textbook my graduate school program used for our research methods class, and it is a resource I refer to often in my EBP work. It also includes helpful templates for critical appraisals of treatment evidence.
• Brush up on your EBP skills: One of my preferred EBP training websites is the National Collaborating Centre for Methods and Tools (NCCMT). This Canadian resource has free online training opportunities for clinicians interested in learning more about evidence-informed public health (topics include how to search for evidence, how to conduct critical appraisals, and how to use knowledge transfer strategies).
• Start at the top: Rather than reviewing hundreds of articles of varying levels of evidence, learn how to identify high-quality and high-level research articles and start there. It will save you time and, more often than not, the highest-level evidence (e.g. RCTs, meta-analyses, systematic reviews) include the results from articles representing lower-levels of evidence (e.g. case studies, quasi-experimental designs, etc.).
• Be curious! Be analytical! I’ve been fortunate in my EBP role to really develop my analytical skills when it comes to evidence. I’ve been known around the office to be the first person to respond to a clinical scenario or statement with “Yes, but what’s the evidence for that?”. I think the more often clinicians take pause to ask themselves this question, the more likely we will be to engage in evidence-based practice.

​Meredith: OK, one last question. Over the course of holding this position, how has your comfort level changed with reading research articles?

Megan: I would say that, yes, the more often I read research articles and think critically about their content the easier it becomes. And so over time it has gotten easier. You also come to recognize researchers who frequently publish in a certain topic of interest, which helps with future searches as well. Sitting down and reading through a full (or several) research articles can seem really daunting to some, especially with caseload demands, but I think you can become quite efficient at reading articles, analyzing the results, and considering how it will impact your practice. I usually approach an article by reading it in this order: abstract, methods, discussion (to get the gist), results (to see the details, and also to check whether the discussion actually matches the results), conclusion and clinical implications (if it exists), and then I start at the introduction and read the article again through from beginning to end. That might be a bit much for some clinicians, but I find it meets my needs both to get the information but also to review the quality of the research presented.

Thank you Megan!