Research workshop at EMSSA

It strikes me that pre-conference workshops increasingly demonstrate the best place to learn new things. The groups are smaller, there is more discussion and it’s more personal. At the EMSSA 2017 conference we got a great faculty together with some fabulous delegates to talk research. Where to start, where to get help, how to start and how to get published.

Choosing your topic: Finding Dory with Colleen Saunders.

An introduction to the basic elements of the research design process. First up was around chosing a topic. Where to start when finding something that you want to pursue,

Starting with something that you’re interested in and something that you are intrinsically passionate about.
Read around the topic. Get familiar with what is already out there and look for the gaps.
Find issues that are relevant to your personal practice. Have a curious mind about what you do day to day. If you feel you need a solution then that might be a way forward to a research program.
Strategically you might want to work with particular people. Look at what they have done before and see where their gaps are and suggest that you might want to do that.
Similarly you could be strategic in looking at a career pathway. Look for known gaps in research e.g. JLA and ECP in SA. Take these to particular units or career pathways to get involved.

When you’ve found your area of interest then what’s the next step? In some cases it will be obvious what the next step is, like the next brick in the wall, sometimes there will be gaps that need filling (e;g epidemiological reports), and somtimes we look at old established pratice and realise that it’s weak or broken and thus needs to be redone (think steroids in spinal injury).

Once you have a topic then turn it into a PICO type question. If you can’t make a PICO – it’s not a great question! Also getting a really tight PICO leads to a clear indication of what your research design will be. In rough terms these might be.

Exploratory – Identify the boundaries and factors of the problem. This also includes qualititive as well here as that might be a separate arm of research that may be more familiar to non-physicians.
Descriptive – observe and describe factors
Experimental/Explanatory – identify casual links between factors
Evaluative – reviewing other research.

Delegates tasked to create their own PICOs based on a scenario set. Questions then developed and put on the washing line in the conference centre.

Use of the Broselow tape in malnourished children.
ED or Ortho manipulation of fractures.
What’s the neurological outcome in paedaitric drowning cases

As usual when delegates got down to writing a PICO or 3PQ or a relatively straightforward topic, it gets complex. It’s clear that developing the research question is absolutely key to a good project and also that sharing that process with colleagues through a process of challenge and reiteration is essential. We then used the PICO to help define the research design (so basically re-iterating and demonstrating why the PICO is such a key part of the research process).

Finding the perfect supervisor: Fantastic beasts and where to find them.

Simon Carley talked on what characteristics define the perfect supervisor. The format was one of co-creation with small groups tasked to define the characterics of a perfect supervisor.

The main themes were:

Research supervision is different beast to undergraduate work. The topic and the thesis is the work of the candidate and not the supervisor. This is encapsulated in a quote from Kevin Mackway-Jones (who supervised two of Simon’s postgrad degrees) ‘I have always told my doctoral students right at the beginning that a doctorate is a grown up degree and that their effort and insight is the key to success, not mine. I also make it clear early on that by the end of it (and quite often much earlier!) they will, quite rightly, know more about the subject than I do.’
Personal characteristics are important. They need to be someone you can work with, who will actually help, who is accessible and useful. Accessibility is interesting in that you might need more at the beginning and end of a research project but in the middle months and years you may well be largely self directed (see point 1 above).
Domain knowledge is important, they need to be able to understand what you are doing but realise that about 2/3 of the way into a project you will hopefully know more than they do. You need someone who can accept and hepl promote this.
A research supervisor should not be someone who tells you what to do and when, nor one that always tells you what is good or bad. Their role should be to challenge your ideas and thoughts. A great supervisor is a critical friend more than a process dicatotor.
Track record is important too. A supervisor who has good evidence of helping students through to completion – and to future careers – is probably going to be a good one. That said, a junior supervisor may be more accessible and enthusiastic about your personal project. Some would say that a more junior supervisor who is attached to a very well established research group may be a good idea (as junior supervisors may get advice and mentoring from senior supervisors in such settings).

Finding funding with Michael McCaul: The Wolf of Wall Street.

Funding can make or break a study idea. Whilst it is possible to do good research without funding, it’s likely that funding will help, and for most substantial projects you will need funding for materials, time, support and potentially publication too. There are many ways to think about it, and Michael argued that it’ a bit like fishing. As researchers we might all be fishing for funding in a sea of money, the problem is that it can be difficult to catch the fish, so let’s try and be smart about it. Here are some of his top tips.

Find out where the good places to fish are. Look for funding grants.
Collaborate. Much easier of you fish together, particularly when you need a methodological expert, Groups applications may be more successful.
Aim at an appropriate level. Don’t go for a massive grant if you have no track record. Aim for smaller grants. Consider combining smaller grants into one greater project. You can also apply for top up funding in some cases to help develop small projects.
Don’t always go for the big fish. Track record is really important. Start small and then work from there.
Be a good captain by not forgetting the importance of admin. Get advice on your plans, budgets, language and structure of the proposal. Again, don’t forget the budget issue. The budget…. get the idea…..the budget is really important.
Budgets. Salaries, travel, publication, test materials, admin support, statistical support, software, printing, computers, etc. Don’t forget indirect costs to support infrastructure. Bottom line is don’t get this wrong and makes sure that you seek expert financial help. This is one of those areas where your supervisor can help guide you through the red tape. For example if applying in a different country you might have to make sure you are protected against changes to currency exchange rates.

Revenge of the Nerds: Taking the leap into publication with Stevan Bruijns

What’s the point of doing research if you don’t get it out there? It’s important for lots of reasons of course, personally it’s a way of getting some external validation of your work, but it’s also important to share your findings with the world. If you don’t share then you really have to ask whether all that effort was worth it in the first place.

The problem is that publication is a bit of a minefield. For LMIC (low and middle income) countries it’s a real challenge as 80% of the world’s published research comes from HICs (high income countries). Is that applicable across the globe? Almost certainly not in our opinion. We need to understand, translate and embed research in the locality that it is to be used. Sadly, most impact factors are based on a global perspective that is again dominated by HICs. Quite frankly we don’t have a good measure for what the impact of research is in LMICs.

So what does define impact for EMSSA delegates? We like to think about impact differently to the simplistic methods of impact factors. Think about these factors that might influence your decision about where to publish.

Consider and compare journals that have:-

A high volume of publications (author centre)
A high volume of views (reader centred)
A high volume of citations (researcher centred)
Within the specialized area and my region of my interest.

Interestingly there is no correlation between reader numbers and citations (which kind of makes you think about what impact means). Stevan showed an interesting table that shows how journals publishing African EM work performs. There is a huge variability out there and as it stands on the African Journal of Emergency Medicine has a contintental focus.

The question left to the delegates about where they should publish is a real challenge and will of course vary between projects, but there is clearly a rationale and continental imperative to publish in journals that will actually change care where it relevant.

We also discussed the difference between citation indices and real clinical impact. Most of the metrics out there are really around the citation process. Whether that makes a difference on the ground in your department and in other departments is much more difficult to define and determine. Perhaps one day we will be able to measure true clinical impact, but until that happens we are probably stuck with the score such as impact factor and h-index (other score are available).

For Africa there is a real challenge in getting a balance between journals with high impact, with relevance to the continent and and with a high impact factor. Whatever you decide it’s important to read the aims of the journal and to write your paper with the journal’s editorial and readership preferences.

What did we get from the day?

A theme throughout the morning was the necessity to motivate and support research here in Africa. The needs of the population and the knowledge translation processes are subtly different here and so we can’t just impose or adopt an HIC model of research. Having said that, the fundamentals of research topic selection, research design and supervision transcend any geographical boundaries.

Our final thoughts are with everyone out there who is interested in research. Please feel motivated and inspired to take those thoughts forward. Get in touch with us, with your local research teams and with your clinical colleagues. It’s really hard work, but it’s really worth it, for you, for your patients and for the world.

@EMManchester

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