Key findings

This exploratory Delphi study incorporated views from 26 eating disorder ECRs to highlight common concerns and opportunities for ECR support in the eating disorder field. Consensus was reached on seven out of 18 career concerns and eight out of nine desirable career opportunities. Full consensus (100%) was reached on career concerns over timelines and funding, and on the importance of career opportunities for networking, mentoring and interdisciplinary approaches, as well as the importance of working closely with policy makers, clinicians and those with lived or living experience. Lowest agreement across ECRs was reported for concerns of overspecialisation or feeling a lack of association with a specific discipline, as well as on the need for eating disorder training opportunities. Findings are discussed in light of previous research and ECR initiatives, and the implications for supporting eating disorder ECRs are discussed.

Eating disorder ECR concerns

Common concerns across participants comprised of a lack of clear career progression, job insecurity, a lack of funding, personal sacrifice to remain in the role and a pressure to publish research, reflective of concerns held by the general ECR environment. ^{Reference Christian, Johnstone, Larkins, Wright and Doran34,Reference Herman, Nicholas, Watkinson, Rodríguez-Bravo, Abrizah and Boukacem-Zeghmouri35} Eating disorder ECRs in this study also highlighted a pressure to publish manuscripts to retain their role, which serves an additional major concern held by ECRs across research disciplines. ^{Reference Christian, Johnstone, Larkins, Wright and Doran34} Importantly, eating disorder ECRs’ concerns reflected generalised concerns in regard to the personal toll of maintaining their role, such as relocating to remain in the field, sacrificing long-term planning or family building, and overlooking mental and emotional well-being for the sake of career progression. ^{Reference Christian, Johnstone, Larkins, Wright and Doran34} Such findings are therefore in line with ECR experiences in other research disciplines and extend these to eating disorder cohorts, calling for increased clarity around career trajectories and improved financial and well-being support. Additionally, although funding concerns are unfortunately common for many ECRs, there may be a unique pressure in the eating disorder field because of the historical underfunding of the eating disorder research field as a whole. ⁸ As participants in the current study indicated, the lack of funding in the eating disorder field appears to have a spill-over effect on to other concerns, and could therefore be seen as one of the most central concerns for ECRs and eating disorder professionals beyond the early career stage. Future research needs to further explore the causal role of funding insecurity on researchers’ careers and well-being.

There were differing opinions on isolation across participants, with some feeling notably isolated from their peers and agreeing that this was a leading concern, whereas others did not experience this to be so. Concerns surrounding professional isolation have been on the rise since the COVID-19 pandemic; ^{Reference Jackman, Sanderson, Haughey, Brett, White and Zile36} however, several benefits, such as improved work-life balance and flexibility, have been reported. ^{Reference Williams and Shaw37} The impact of hybrid or remote working is likely to be very individualised, based on a range of factors and circumstances, and it could be that this is reflected in the differing opinions of the current sample. An important consideration that was felt to be more relevant to the eating disorder discipline in the current study was a lack of individuals working in the eating disorder field and limited support from institutions or departments where eating disorder research may not be a focus. If an institution does not have academic staff working on eating disorder research or is not affiliated with an eating disorder research group, it is likely to contribute to difficulties with feelings of isolation, lack of support and difficulty progressing.

Interestingly, consensus was not reached regarding work/life balance concerns, unlike those reported in previous studies reporting ECR perspectives. ^{Reference Christian, Johnstone, Larkins, Wright and Doran34} ECRs in this study generally agreed that work/life balance was a concern in their role, but the level of consensus was lower than for other areas such as funding, job insecurity and pressures to publish. This would suggest that concerns surrounding work/life balance, as well as concerns around other factors that did not reach consensus, such as power imbalances or mental health and well-being concerns, are likely to be context-dependent and influenced by a range of factors specific to the individual. For example, this could be influenced by factors at an individual level, such as stage of career or role (e.g. postdoctoral researchers or research assistants), the presence or absence of lived experiences of eating disorders and by research focus (e.g. genetic or biological methods, qualitative approaches). Differences in individual experiences could also be influenced by intersectional factors such as gender, ethnicity or cultural background. ^{Reference Torbor, Sarpong, Maclean and Fletcher38,Reference Bourabain39} Finally, a lack of consensus could be linked to differences at an institutional or organisation level, influenced by cultures and support offered across different organisations. Future work capturing and accounting for these nuances will advance our understanding and allow for more targeted strategies to support ECRs.

Eating disorder ECR opportunities

Career opportunities for eating disorder ECRs that were unanimously considered important were networking, receiving mentoring from more senior academics and incorporating members of the lived experience community, clinicians, policy makers and third-sector organisations into their research.

Incorporating lived experience perspectives in research was considered the most important opportunity for eating disorder ECRs. Although inclusion of patient and public involvement (PPI) across research disciplines is becoming increasingly important to receive funding and conduct impactful research, ^40,41 participants in this study reported that lived experience research is particularly important for the field, to ensure that future research and interventions meet the needs of those struggling with an eating disorder across diagnoses. These sentiments reflect existing eating disorder research, in which incorporation of lived experience has improved rates of self-advocacy ^{Reference Musić, Elwyn, Fountas, Gnatt, Jenkins and Malcolm42} and patient treatment outcomes. ^{Reference Pellizzer and Wade43} However, existing literature notes that the continued stigma associated with eating disorders may discourage lived experience community members to engage with research, and that effective PPI in eating disorder research is rare. ^{Reference Musić, Elwyn, Fountas, Gnatt, Jenkins and Malcolm42} It is positive to see that ECRs strongly advocate for the inclusion of lived experience perspectives, and that encouraging and growing relationships with lived experience researchers is a priority at this early stage in their career. The importance of collaboration with other stakeholders was also encouragingly advocated, with ECRs agreeing on the importance of working with policy makers and clinicians, which is reflective of a field-wide push to support stakeholder engagement in eating disorder research. ^{Reference Verma, Salom, Miskovic-Wheatley, Aouad, Sidari and Caldwell44,Reference Hart and Wade45}

Eating disorder ECRs across the UK also agreed that networking is a significant career opportunity. Perspectives shared by participants suggest that taking advantage of networking opportunities pave the way for interdisciplinary collaboration, raise awareness of the political or research culture environment within the eating disorder field, or allow ECRs to learn skills not available within their respective department. Additionally, networking has potential to stave off existing concerns associated with job instability by facilitating links for future collaborations and projects. For example, lead authors (E. Nimbley, M.-C.O., M.S.) run an eating disorder ECR network in the UK, seeking to address these concerns and build a sense of community and peer support among ECRs. Mentoring was also considered an important career opportunity by eating disorder ECRs, as a way to learn new research skills and assist with the postdoctoral to ECR transition, but shared perspectives suggest it is important to account for additional workloads of senior academics to adequately provide this guidance.

Limitations

There are several limitations to consider for this study. Low sample sizes and attrition across rounds limit generalisability. Furthermore, across all three survey waves, participants were predominantly White women within the field of psychology. In addition, we did not inquire about previous research experiences, whether participants worked exclusively within research or had other assignments outside research (e.g. clinical work, teaching). This extends to enquiring about individuals’ history of personal experience with an eating disorder, which may introduce additional nuance to respondents’ shared perspectives. Considering the open-text comments of some of our participants, future research could look into specific subcategories of eating disorder ECRs (e.g. those with and without other research/work experiences) to explore differences in experiences more explicitly. Because of the anonymisation of survey responses, some of the participants of the Delphi study might have also attended our networking event in September 2023, where attendee discussions contributed to the generation of our initial list of challenges and opportunities included in our study. This event was attended by 22 individuals who were predominantly from the field of psychology, as well as psychiatry, public health, medicine, nursing and English literature. Thus, some voices might have contributed to the presented findings more than others, and consensus calculations might have been affected by the inclusion of the same participants in the consultation and Delphi study. Future research with larger sample sizes should prioritise those with intersecting roles, underrepresented ethnic groups and career fields, as ECR concerns and opportunities are likely to differ as a result of existing barriers posed by sexism and racism in academia. ^{Reference Bourabain39} This includes implementing more diverse recruitment strategies to reach diverse demographics (e.g. collaborations with professional associations that focus on underrepresented groups). Future research would benefit from examining the role of intersectionality in eating disorder ECRs, as well as examining the psychological impact associated with career concerns that affect ECRs, such as isolation, job instability and lack of funding. There was a notably lower percentage of participants who reported they were in their last year of their postdoctorate, compared with those who had been in postdoctorate positions within a span of 8 years. Although this definition is in line with UKRI definitions, there may be subtle nuances in perspectives on career concerns between those in the last year of their doctorate when compared with those who have been working in academia for 5 or 6 years. Future research could seek to explore these nuances, extending our understanding of ECR experiences and perhaps informing a more scaffolded approach to strategies supporting emerging researchers. Finally, future research could explore eating disorder ECR experiences across different countries, to explore similarities and differences, and to learn from what factors or strategies may be working elsewhere.

Implications

This study highlighted a range of career concerns, such as the need for personal sacrifices to continue research and persisting job insecurity, that are likely to have a significant impact on the ECR working in the field of eating disorders. Strategies to mitigate this can be implemented at an individual, institutional and systems level, in line with previous recommendations that suggest the importance of involving multiple interest holders in efforts to empower and support ECRs. ^{Reference Kent, Holman, Amoako, Antonietti, Azam and Ballhausen14} For example, the individual may consider engaging with existing or creating new peer support systems with other eating disorder ECRs or take advantage of workshops on professional development, which may address concerns surrounding isolation and unclear career development and trajectories. ^{Reference Khodabakhsh, Hoffmann, Sauchelli, Shi and Mitchell46} At an institutional level, universities or research departments should consider creating mentorship schemes or allocating more funding for eating disorder ECRs to attend conferences or other networking events. Equally, to expand opportunities for the distribution of high-quality research and to satisfy previously identified readership interests in eating disorders, editorial boards of (high impact) journals could provide more opportunities for research dissemination and citation through eating disorder-focused special editions or explicitly welcoming papers in this field. ^{Reference Marzola, Panero, Longo, Martini, Fernandez-Aranda and Kaye47}

Finally, at a broader systems level, considering the high prevalence and considerable impact of eating disorders on the individual and society, governing bodies should invest more into eating disorder research, particularly interdisciplinary research and research that includes working with lived experience, policy and clinical practice, as well as across different stages to ensure a clear trajectory of support along the career path. Encouragingly, the UK Government and leading funding bodies, such as UKRI and the Medical Research Foundation, have heeded calls for urgent research funding, the latter of which has recently funded a range of ECRs specifically in the field of eating disorders. ¹⁰ Such funding calls should also seek to diversify eating disorder research across the UK, moving away from the current high concentration of funding allocated to London universities toward a wider geographical representation. This would also serve to ameliorate concerns articulated in the current study around relocating to remain in the field and broader funding concerns. Highlighting the importance of ECR support in funding applications would further provide incentives to create a supportive and sustainable environment for (eating disorder) research.

Retrospective reflection on this collaborative study

Both ECRs and established academics worked together to conceptualise this study, and ECRs led on data collection, analysis and write-up. As co-founders of an eating disorder ECR network, E. Nimbley, M.-C.O. and M.S. felt very passionate about gaining more structured insights into the concerns of ECRs in the field of eating disorders, as well as more insights into the opportunities that could facilitate the development of ECRs in such a growing field of research. Being on fixed-term contracts themselves, eating disorder ECRs on the study team particularly resonated with respondents reporting challenges securing funding and job security. In fact, during the completion of this study, E. Nimbley and M.-C.O. both transitioned into new positions and had to balance study tasks with the demands of new roles and responsibilities. M.S. is affiliated with an institution showcasing a history of world-class nutrition-based research; however, this field does not extend to eating disorder-based research. M.S. reflects that there is a scarcity of local research peers in the field of eating disorders, and particularly resonates with other ECRs’ concerns regarding geographical disparity.

As one of the senior academics involved in this study, F.D. was particularly struck by how little has changed over the past 20 years, with many ECR concerns resonating with her own historical experiences where, as a clinical academic external to the major UK-based eating disorder research centres, she remembers being overwhelmed with what felt like a lack transparency in academic career trajectories. It was a matter of chance that she found herself in a department where she was supported and grew alongside other eating disorder academics in a similar position, reinforcing the need for supportive peer structures and mentoring. H.S. had a different experience, having conducted her postdoctorate within one of the large, established eating disorder research centres in the UK, and only after leaving for other posts did she recognise the level of geographical disparity in resource and expertise in this field. E. Newman perceived that pressure to publish and obtain funding has increased since being an ECR herself, but agreed that networking and forming collaborative teams is a key area for training, especially in a field where there are fewer individuals across a wider geographical area. However, she also reflected that greater opportunities for online meeting is potentially a positive development. K.G.-S. was particularly moved by ECRs who mentioned the need to connect with groups that include senior academics, so that mentorship opportunities can be provided to all eating disorder ECRs regardless of location (i.e. not only for those based in the universities with eating disorder research groups). This indicates a need for more senior academics to offer mentorship to eating disorder ECRs outside of their own institutions to enable widespread connections and facilitate growth in this research field. Both H.S. and F.D. highlighted that as senior academics, the findings of the study reflect the ongoing pressure they feel to make successful funding applications to nurture and provide career stability to eating disorder ECRs, but also reinforce their passion to be an advocate for supporting sustainable research infrastructure in the field. In contrast, one area that all of the senior academic team found incredibly heartening were key differences in this new generation of ECRs in the eating disorder field who are far more aware of the necessity of individuals with lived experience co-producing research and consideration of cultural inequalities within the field.

In conclusion, this Delphi study aimed to explore consensus on career concerns and opportunities for ECRs working in the field of eating disorders. Consensus was reached on a number of career concerns, including timeline pressures, increased personal sacrifices, unclear career trajectories, funding concerns and job insecurity. ECRs also agreed on the importance of engaging with lived experience, policy makers and clinical practice in their research. Other concerns (e.g. isolation, difficulties juggling multiple roles) and opportunities (e.g. eating disorder-specific training) did not reach consensus, perhaps reflective of variations in settings and circumstances. Thus, eating disorder ECRs share several common concerns and opportunities, whereas others are likely to be context-dependent. Study findings suggest eating disorder ECRs face significant barriers to remaining and progressing in the eating disorder field, alongside highlighting several important directions for strategies to retain and support eating disorder ECRs, including increased ECR peer support systems, mentorship schemes within institutions and increased funding from governing bodies.