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Paul McCallion is a physiotherapist at Newcastle’s Freeman Hospital where he specialises in respiratory conditions and in particular bronchiectasis – a long term condition that affects the airways in the lungs.

Affecting over 300,000 people in the UK alone, bronchiectasis causes widening of the airways which can become inflamed with thick mucus. This is often difficult to clear leading to problems such as chest infections, breathlessness, fatigue, anxiety and even depression.

Paul has recently been awarded a NIHR Doctoral Clinical Academic Fellowship which will provide the support he needs to conduct research into bronchiectasis with a focus on shared decision making, working collaboratively with patients to develop non-invasive techniques to clear the airways.

Increasing research impact whilst strengthening academic links

The highly competitive and prestigious fellowship was awarded by the National Institute of Health and Care Excellence (NIHR) and is funded by Health Education England (HEE) through the Integrated Clinical Academic (ICA) Training Scheme.

The fellowship is being hosted by the Newcastle upon Tyne Hospitals NHS Foundation Trust working in close partnership with Newcastle University, as part of the Newcastle Health Innovation Partners (NHIP).

This is a partnership bringing together Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW), Newcastle City Council, and the Academic Health Science Network for the North East and North Cumbria.

Paul explains what he hopes to achieve through his Fellowship. “Airway clearance techniques are ways to aid coughing to clear mucus from the lungs. Research shows patients with bronchiectasis who do not perform any airway clearance techniques have worse health outcomes including more chest infections, than those who do perform one.

“However, there are many techniques with little evidence to say which one is best for patients. The best may be the one that the patient commits to and uses most regularly.”

Supporting patients to self manage their condition

“Many voiced the unmet need for research in the non-pharmacological management of bronchiectasis, specifically around airway clearance.

A passionate advocate for his patients, Paul adds: “I’ve listened to my patients and other people living with bronchiectasis in the UK.

“I want to improve patients experience and outcomes in bronchiectasis, to optimise their self-management strategies for airway clearance techniques – the cornerstone treatment for bronchiectasis.

“This Fellowship will allow me to research all aspects of bronchiectasis that are important to our patients.” – Physiotherapist Paul McCallion

This research project will be the first co-produced (with patients, physiotherapists and national charity leads) shared decision-making intervention for patients with bronchiectasis.

The findings from this research will be essential in ensuring patients are actively involved in deciding their physiotherapy treatment for bronchiectasis.

Paul adds “This research has the potential to improve adherence to airway clearance techniques, quality of life and long-term health for patients with bronchiectasis.”

A research journey full of mentorship and collaborative support

Paul says that there are a number of people and networks who have supported him so far in obtaining this fellowship, including his supervisors: Professor Anthony De Soyza, Professor Judy Bradley, Dr Joanne Lally and Dr Lisa Robinson, as well as the Trust’s lead for NMAHP research Dr Linda Tinkler and the wider team and line manager Jennifer Glennie.

He also cites support from charities pertaining to his specialist field such as Asthma and Lung UK and Primary Cilia Dyskinesia UK alongside local networks; the Research Design Service North East & North Cumbria (RDS NENC) and the Newcastle Health Innovation Partners (NHIP).

“This group of individuals and charities will play an essential role in the development of my research, academic and leadership skills,” explains Paul.

“They will support me on rationale and theoretical stance for the proposed methodology and will promote critical and analytical thinking to explore the underpinning theory. They will also develop my skills in co-production as well as a wide range of trial designs (RCT, observational).”

He adds: “Importantly, my supervisors and NHIP team understand the operational oversight of the evolving landscape in relation to AHP clinical-academic careers, and they will support me with competencies and challenges associated with navigating and developing this role during my fellowship.

“Finally – my first research “taster” session was led by Dr Niina Kolehmainen in 2017. Niina was an inspirational speaker and facilitator and her email to me after that session ignited my research spark and opened the door to other mentors and research leads in my field.

“I want to thank her for that.”

Healthcare at its best with people at our heart

Associate director for therapy services Ewan Dick is delighted to see Paul win this award.

He says “Shared decision making and self-management are at the heart of patient-centred and person

alised care and these are important themes that we want to develop further across Therapy Services.

“It will be fascinating to see Paul continue to develop this important area of research, which already is recognised internationally and how it can contribute to improving clinical care and self-management for patients with bronchiectasis.”

Fostering innovative clinical academic careers

A key priority for our NMAHPs Strategy is to increase research opportunities and impact whilst strengthening our academic links.

We do this in Newcastle by fostering innovative clinical academic careers and attracting external funding and national fellowships through our unique mentorship approach and collaborative working.

Professor Dave Jones, Director of NHIP Academy, said: “Paul is part of the next generation of clinicians developing careers that integrate research and practice to improve patient care. As a physiotherapist, his success speaks well of the past decade of investment by organisations in Newcastle, to widen research opportunities across all professions.

“Developing and retaining talented people like Paul is important for the health of the people in the North East and we are delighted for his success.”- Professor Dave Jones, Director of Newcastle Health Innovation Partners (NHIP) Academy

Paul explains more about his Fellowship

Hello. My name is Paul and I have been a physiotherapist specialising in respiratory medicine for over 9 years. I am particularly passionate about working with patients with bronchiectasis.

I’ve listened to my patients and other people living with bronchiectasis in the UK. Many voiced the unmet need for research in the non-pharmacological management of bronchiectasis, specifically around airway clearance techniques.

I want to improve patients experience and outcomes in bronchiectasis, to optimise their self-management strategies for airway clearance techniques – the cornerstone treatment for bronchiectasis.

This Fellowship is really all about researching aspects of care for bronchiectasis that are important to our patients.

Bronchiectasis

Bronchiectasis is a long-term lung condition with permanent widening of the airways leading to persistent cough and mucus retention which then leads to chest infections. Bronchiectasis affects over 300,000 people in the UK.

Airway clearance techniques are ways to aid coughing to clear mucus from the lungs. Research shows patients with bronchiectasis who do not perform any airway clearance techniques have worse health outcomes including more chest infections, than those who do perform one.

However, there are many types of airway clearance techniques with little evidence to say which one is best for patients. The best technique may be the one that the patient commits to and uses most regularly.

Why shared decision making is key

National bronchiectasis guidelines state patient preference should be considered when choosing airway clearance techniques but provide no indication how this should be performed. My hypothesis is that shared decision making will play a key role.

This project will be the first co-produced (with patients, physiotherapists and national charity leads) shared decision-making intervention for patients with bronchiectasis. The findings from this research will be essential in ensuring patients are actively involved in deciding their physiotherapy treatment for bronchiectasis.

This has the potential to improve adherence to airway clearance techniques, quality of life and long-term health for patients with bronchiectasis.

Why this research is important

There are three key elements to why this research is so important:

Listening to Patient Voices

A survey by the Asthma and Lung UK (the lead UK Respiratory Charity) patient and public involvement team, showed 100% of patients with bronchiectasis (n=100) felt it was “extremely important” or “very important” to be involved in making decisions about their care.

They also found that 92% of patients with bronchiectasis “strongly agreed” or “agreed” they had the skills and knowledge to be involved in making decisions about their care.

“We should be given the range of techniques [airway clearance techniques] and then how to figure out which one is the best one for us. We would stick to it more often” – Patient A

“We do really need to be more involved…it [choice of airway clearance techniques] shouldn’t be a paternalistic approach” – Patient B

Improving adherence to treatment

Consensus bronchiectasis guidelines state patient preference should be considered when choosing airway clearance techniques but provide no indication how this should be performed.

Significant external prioritisation

My fellowship project aligns with the Chartered Society of Physiotherapy (CSP) and James Lind Alliance’s published “Top 10 Priorities” for research in physiotherapy.

Additionally, this project aligns with the National Institute of Health and Care Excellence (NICE) published guidance on Shared Decision Making and NHS Long-Term Plan priority theme – to have personalised care as “business as usual”.

Shared Decision Making is highlighted as a method to facilitate this.

National and international recognition

Over the past 5 years, I have shown consistent research commitment obtaining two national awards on the (NIHR) clinical academic pathway.

These include the HEE/NIHR Internship and the HEE/NIHR Pre-Doctoral Clinical Academic Fellowship (PCAF) where I completed an MSc in Public Health and Health Services Research.

My passion in this field has been recognised at an international level as evidenced by my invitation as speaker and faculty at the World Bronchiectasis Conference in Prague in June 2022 – a Global webinar on Airway Clearance Techniques in Bronchiectasis hosted by Trudell Medical International – and again as a speaker at the British Thoracic Society in May 2022.

I have developed a range of clinical and academic networks and am the long-term conditions champion for the Association for Chartered Physiotherapists in Respiratory Care (ACPRC) for the UK.

This role will support recruitment and engagement with key stakeholder during my fellowship as well as communication and dissemination of outputs.

I have an established publication record for my current level of academic training including high-impact journals such at the European Respiratory Journal.

This doctoral clinical-academic fellowship will be funded by HEE through the NIHR Integrated Clinical Academic (ICA) Training Scheme

I successfully obtained funding for Patient and Public Involvement in preparation for this fellowship through the NIHR Research Design Service North East & North Cumbria (RDS NENC). This network was one of many who supported me in applying for this award.

My research and expertise in airway clearance has been presented to patients, clinicians and the academic community at the World Bronchiectasis Conference in Prague June 2022. This trip was supported by the Newcastle Hospital Charity, for which I am very grateful.

Doctoral Clinical and Practitioner Academic Fellowship (DCAF), Formerly the Clinical Doctoral Research Fellowship (CDRF)

The DCAF scheme funds registered healthcare professionals to undertake a PhD by research and, concurrently, to undertake further professional development and practice.

The funding covers salary costs, PhD tuition fees, the costs of an appropriate research project, and the costs of tailored clinical and academic training programmes.

The Fellowship is a three year award (up to six years part time) with approximately 80% spent working academically and the remaining 20% of fellowship hours devoted to practice and professional development.

You can find out more about DCAF and other HEE-NIHR Integrated Clinical and Practitioner Academic Programmes on the NIHR website