Meet the Team: Debs Watkins

Debs Watkins

Research Consultant, YHEC

Interested to find out more about what it's like to work at YHEC? Or maybe you have an interest in reviews and evidence synthesis and are wondering what a career in this area is like? In this blog we interview Debs Watkins, a Research Consultant at YHEC. We find out how she got into this role, what her day-to-day work looks like, and what she enjoys most about being part of YHEC.

What is your name, role and workstream?
I'm Debs, and I am a Research Consultant with expertise in reviews and evidence synthesis.

Tell us about your qualifications and career path up until this point.
I did a degree in paediatric nursing and, after I qualified, went to work at a children's hospital, where I mostly worked in paediatric cardiology, and also did some work in general, renal and outpatients. I worked in the hospital for a year: they did a one-year newly-qualified rotation, so I got to try a few different things.

My favourite modules when I was studying were research modules and, working in a hospital that was both secondary and tertiary, I would see local patients but also patients from further afield with more serious or rare conditions. It was really interesting how many factors affected patient outcomes, things that you don't necessarily think of. I wanted to look into this more, so I went back to university and did a Master's in global health and development - and this happened to be the year that Covid started, so I was still doing a bit of part-time nursing too. After that, I joined YHEC, starting as a Research Assistant and now as a Research Consultant.

Tell us more about your role and where it sits within YHEC.
A typical project in my role would be a systematic review, and I get to do lots of day-to-day work on that. I’ll be involved in the early stages, helping to draft a proposal and then a protocol that will detail exactly what we're going to do and how we're going to answer the client's research questions.

Our Information Specialist colleagues will undertake searches so that we can see all of the studies that could potentially help us answer our research questions, and we will screen those to identify the studies that meet our eligibility criteria. I complete data extraction and then we will synthesise the information that we've extracted into a report that, as far as possible, answers all the questions that we're interested in.

Depending on what the project is, we’ll work with other YHEC colleagues as well. For example, if one of the objectives of a review is to feed into an economic model, we'll work with health economics and outcomes research experts. Often, a review will include a meta-analysis or a network meta-analysis (NMA), and we’ll work with our statisticians. We've also done projects on expert opinion elicitation where we collaborate with the medical communications specialists.

Can you explain more about the methods that are used for reviews at YHEC?

We use some standard methodologies: for example, there's a lot of systematic review guidance and we follow Cochrane principles. When we’re writing up a review, we’ll use PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the University of York also has lots of guidance on systematic reviewing that’s useful. We have a lot of knowledge about conducting systematic reviews and about the guidance, so we’re easily able to adapt to an individual project's needs: the client might want a systematic review, or they might want a pragmatic or rapid review, and our experience enables us to tailor the project around the needs of the client.

Having successful projects is hugely important to us because, quite a lot of the time, reviews are used to influence decision making: they help clinicians, policymakers, patients and their families make informed choices about health care.

One of the things that contributes to the success of the projects we work on is being rigorous about writing a protocol at the beginning. It details all the steps involved in conducting the review, and we’ll follow that for the for the rest of the project: the attention to detail and the rigour of the protocol really sets us up well. Collaboration is really important too, because working closely with clients ensures that we’re all aligned on things like scope and eligibility criteria.

Tell us more about the impact of your work.
We typically work with pharmaceutical companies or medical device companies, but we often work with the NHS and other public bodies, and organisations such as charities or universities, and this gives us lots of opportunity for impact. Our clients could be based in the UK or elsewhere, or be an international company or organisation, and the scope could range from a particular country to an international perspective. Our work might inform decisions about where to go next in an area of research, perhaps in a Health Technology Assessment (HTA) or directly into actual guidelines. This means that the type of impact we have really depends on the client and the scope of the project.

It’s always helpful to have knowledge of the literature on a topic, whether that’s a systematic review, a scoping review, or a rapid review. An appraisal of the available evidence can help to focus a project and identify the gaps where future evidence may be needed. Further down the line, a review will help you to be to be more confident and make sure that you're making the best decisions for patients in the future.

What do you love most about your role?
I’m really lucky because I specialise in methods, which means the projects that I get involved with are really varied. I think it's really cool that my job is to look at a different topic every day, and to always be learning something new.

What are your favourite types of projects to work on, and why? Or perhaps you have favourite methods?
I really love a classic systematic review of effects and safety. With a new drug, I love getting to look at all of the data on how it compares to its counterparts and how that can potentially be an improvement for patients. I relish the systematic nature of it: knowing that I've looked in every nook and cranny, found all of the relevant information and put it all together is very, very satisfying. Because these are the reviews that are typically going towards guidelines, it genuinely feels like I’m making a difference.

What do you enjoy most about working at YHEC?
Well, I love the work that we do and I find it really interesting. But I especially love that all of the senior people at YHEC really like their jobs too, and they really love teaching you things: you can ask somebody a question and they'll be really excited that you're asking them about something that’s really niche but that they love.

What does a typical day look like for you?
It's nice that I get to do a variety of different tasks but screening or data extraction are the biggest tasks that I will do in a review, so a typical day will involve those. I'll look through studies to assess how they fit the eligibility criteria of our review and whether they're useful, or I'll extract the information that we need from the studies that we found. These will be the biggest task in any review but exactly how big they are can vary hugely depending on its scope.

What areas of research are most interesting to you?
The topics that I most like are the ones that overlap with my background, and I will definitely be the first to volunteer for a cardiology project or anything in paediatrics or international public health.

In terms of methods, I’ve already said that it's fun to do a full systematic review, but I also like using my creative problem-solving skills for a pragmatic or scoping review. I think it goes back to when I was studying global health: the reality is that, in almost every situation, there are limitations in what can be done. These could be practical limitations in terms of time or resources, but there can also be issues that are topic-specific, such as lack of data, or too much data or heterogeneity which may make it difficult to reach a conclusion. YHEC has been conducting reviews for 40 years and has strategies in place for getting the most value from the evidence. It sometimes feels like reviewers have a reputation for being very strict and doing exactly the same thing every time with every project, whereas actually we need creative skills as well to make sure that the client gets something that's really useful.

How do you see work in your field developing in the future?
One of the things that we’ve been involved in is testing and evaluating new AI tools – in fact, we've published work comparing different tools for screening. Our paper on machine learning for accelerating screening in evidence reviews discusses this, noting that, while they offer significant potential for reducing workload and time, there are concerns about accuracy and integration into existing workflows. There is a need for further research that assesses the overall impact.

I think that AI software will increasingly be used, but probably in a limited way, to help speed up discrete tasks. YHEC’s work will continue to be led by our experienced researchers, who will assess opportunities for using AI to improve efficiency in appropriate non-sensitive tasks.

Aside from AI, I think there's more and more need for pragmatic or rapid reviews to help with decision making at different stages. Reviews are being used at different stages of research, especially earlier on to see what is already out there and what direction the research should be going in, or whether more primary research is needed.

What’s your favourite thing to do outside of work?
Definitely baking, especially finding new recipes (I use colleagues in the office as guinea pigs) or making something really elaborate for a friend's birthday. I definitely prefer baking cakes; for some reason I cannot do cookies at all. I'm not very good at pastries either - I have my Nana's Cornish pasty recipe, but I have to buy the pastry, I can't do it!

I’ve actually been trying to learn more about the science of baking (like what reacts and how), which is giving me more confidence to experiment and be more creative. I think that there are probably parallels with my work there, in having enough experience and expertise to be able to use creative problem solving to achieve the client’s specific goals while maintaining accuracy and rigour in the methods.

Tell us a surprising or fun fact about you.
People might be surprised that, alongside my nursing training, I did a theology, philosophy, and ethics course: so, as well as my BSc I got an AKC, an Associateship of King's College. I found it so interesting to consider ethics and theology in conjunction with nursing because they are so often the things that are important to patients.

The AKC and my global health MSc are definitely helpful in thinking about how the research methods we use can deliver a project that supports ethical healthcare decision making. It means that I could consider including the patient voice in reviews, for example including quality of life and other patient-reported outcomes as eligible review outcomes, making sure we use language that patients prefer. We can also perform sub-group analyses (e.g. gender, ethnicity, co-morbidities), where data allow, which can help with health equity by checking that the intervention we’re investigating works for everyone.