Emergency care research: top tips on how to get involved. St Emlyn’s

Coauthored with Edd Carlton (@EddCarlton) and Samantha Jones

Estimated reading time: 10 minutes

The COVID-19 pandemic has largely been a difficult time for us all. However, one positive has been the speed at which research has influenced clinical practice. Emergency medicine clinicians have recruited for the RECOVERY trial, which has found treatments that work for COVID-19. Never has there been a more opportune time to develop our evidenced-based practice and contribute to cutting edge emergency care research.

Although emergency medicine is a relatively young academic specialty, it has always taken research seriously. The specialty led the way with the critical appraisal exam, which has met an unfortunate demise. Despite this there is a specialty learning outcome (SLO) in the new curriculum, which is about participating in research and managing data appropriately (https://rcemcurriculum.co.uk/participate-in-research/#1554282797005-ed406f89-f616). 

We had a discussion on Twitter, which was about how clinicians from different specialties have got involved in research. This blog summarises the main points and provide some tips for EM clinicians. Hopefully this will be helpful for medical students, trainees, nurses, allied health professionals (AHPs) and consultants. For trainees, this could help as you as you think about how you achieve SLO 10 in the new curriculum. 

Tip 1: Answer the question: Why do emergency care research?


This is the most important question you have to ask yourself before getting involved in emergency care research. This is a very personal decision. Start with the why. If you develop an interest or passion you are far more likely to put the time and effort in and persevere despite many setbacks, which are a feature of research. 

Thomas – got involved in research in his previous career, which looked at the prevalence of and factors associated with gender-based violence in post-conflict Bougainville, Papua New Guinea. During his medical career, Thomas has focused on major trauma research. Some cases did not go well, which I reflected on and thought what could be done differently. Often the starting point for research is seeing problems in clinical care or processes (i.e. major trauma triage) and then asking why it is happening and how to change it for the better.  

Edd – I fell into it and haven’t looked back! As an EM registrar I saw the need to improve efficiency and care for the huge number of patients with varying conditions we see. We can make small local changes by using Quality Improvement (and at a stretch audit), but to really improve things on a national or international level we need robust and well-done research that is applicable to the populations we treat. 

Sam – I initially became involved in research when I was working as a musculoskeletal physiotherapist with an interest in lower limb injuries. I attained a unique role as a Specialist Orthopaedic Research Physiotherapist, investigating knee injuries and pathologies. Within this role, I conducted several research projects and worked clinically in orthopaedic clinics. This role provided an excellent introduction to core research skills, by working with a research team to design a project, attain ethical approval, collect/analyse data and write up a study for publication.  

For all three a plus of research is it allows them to have a sustainable clinical career and affords them time away from the shop floor.

Tip 2: When you see a patient in the ED, consider the relevant local studies

Whether you are a medical student, trainee, nurse, AHP or consultant when you move to a new place ask what studies are being conducted in the emergency department. Then when you see patients you can be thinking about whether they are eligible for studies. 

In order to consent and recruit for studies you need to complete NIHR Good Clinical Practice (GCP) training (https://www.nihr.ac.uk/health-and-care-professionals/learning-and-support/good-clinical-practice.htm). Let the local research team know you have GCP and then ask to get involved in local studies.

Related to this you can get in touch with the research support team – locally or within the clinical research network (CRN) (https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm). They’ll be able to signpost to research training opportunities. They can help with developing research questions. They will have information on funding and can link you with other researchers.

There are lots of opportunities to be involved in COVID-19 related trials. RECOVERY trial is still recruiting. If you recruit you will be recognised as a member of the RECOVERY Collaborative Group for all publications. 

There will always be emergency care research trials. Examples include:

If you want to take your involvement a bit further you can speak with the local team for a study and see if they are eligible for the NIHR associate principal investigator scheme (https://www.nihr.ac.uk/documents/associate-principal-investigator-pi-scheme/25040). The scheme aims to develop junior doctors, nurses and AHPs to become the PIs of the future. It also provides formal recognition for engagement in NIHR portfolio research studies. 

Tip 3: Get yourself a mentor, a coach and a sponsor

Mentoring is about listening, encouraging, empowering and supporting mentees over a long-term and in a relatively informal way. The aim is to help the mentee identify issues and goals and help them find a way to resolve issues and reach goals. Mentoring can be provided by those within or outside your speciality or the NHS. 

Mentorship was mentioned by most of those on Twitter during the recent discussion. The NIHR incubator for emergency care has established a national database of research mentors (https://www.rcemlearning.co.uk/nihr-incubator-2/), which is available to all those working in emergency care. Contact the NIHR Incubator Leads (Heather Jarman and Edd Carlton) and they will put you in touch with the mentors. 

It is worth also exploring formal coaching. Coaching is usually more short term and structured in nature than mentoring. The focus is on improving performance and task oriented i.e. developing people skills, managing conflict, handling pressure, etc. The Faculty of Medical Leadership and Management have a coaching scheme for members (https://www.fmlm.ac.uk/programme-services/individual-support/coaching), and some NHS trusts support formal coaching. 

Mentoring and sponsorship can have some overlap if a more senior colleague provides advice, help and support. Sponsorship is more about using networks to aid career development and advancement. It is worth contacting local clinical academics and asking: “is there something I can help with?” Opportunities and relationship come from this approach.

Tip 4: See if collaborative emergency care research is for you

There has been an explosion of collaborative research in emergency care over the last few years. The Trainee Emergency Research Network (TERN) has already opened up new opportunities for emergency medicine trainees and specialty doctors to get involved in research (https://ternresearch.co.uk). It allows you to see if research is for you. Get involved as little or as much as you want. TERN is always looking for keen trainees to set up and lead studies locally.

TERN has conducted studies on the need for recovery (https://bmjopen.bmj.com/content/10/11/e041485) and psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic (https://emj.bmj.com/content/38/6/450). Future projects are looking into headache, acute coronary syndromes and thoracotomy in major trauma. 

If you are interested in major trauma there is NaTRIC (UK National Trauma Research and Innovation Collaborative) (https://www.c4ts.qmul.ac.uk/natric/natric). NaTRIC aims to produce high quality research to improve the care of injured patients. They have completed studies on emergency laparotomy (TELA) (https://www.journalacs.org/article/S1072-7515(21)00361-6/fulltext#secsectitle0125) and a modified Delphi to identify research priorities in major trauma (https://link.springer.com/article/10.1007/s00068-021-01722-z). Ongoing projects include: an audit on liver and pancreas trauma (LiPTA). They are planning to work with TERN on a study looking into prehospital and emergency department thoracotomy. 

If you are interested in paediatric emergency care research then there is Paediatric Emergency Medicine Research in the UK and Ireland (PERUKI) network (https://www.peruki.org/copy-of-about-us). PERUKI encourages and mentors new investigators to acquire research skills. 

Check out the TERN (If you have an idea for a trainee led study you can contact that team at: https://www.rcemlearning.co.uk/foamed/got-a-research-idea-or-proposal-for-tern) and NaTRIC websites (https://www.c4ts.qmul.ac.uk/natric/natric) and see if there are projects you are interested in. You can also contact both teams if you have ideas for trainee led research. 

Tip 5: Practice appraising evidence and writing for different audiences

The critical appraisal exam has been discontinued by RCEM, but it is still an important skill. In the 2021 curriculum emergency medicine trainees will be expected to evidence appraisal of literature and engagement with journal clubs. Knowledge of statistics and critical appraisal will also be part of examinations for membership and fellowship of RCEM. 

When you move to a new department ask if there is a journal club and if not set one up. However, if one does not exist, TERN has set up an online journal club (https://ternresearch.co.uk/tern-journal-club). This will help all clinicians develop skills at appraising the evidence.

Other ways to get experience appraising the evidence and writing reviews is to do a BestBET (https://bestbets.org/). BestBETs aim to provide rapid evidence-based answers to the clinical questions. They use a systematic approach to reviewing the literature. When you have a topic that piques your interest, search the database and see if there is any evidence on it. If there is not, write a BestBETs. It is an excellent way to build up the knowledge base for emergency care and identify where there are gaps. 

Keep an eye on what are topical issues i.e. being debated in Parliament or on the news and if you are interested consider writing a commentary piece or letter to the editor of a journal. This is one of the ways Thomas got experience writing and started to understand the requirements of journals. 

Lastly, some of you will be involved in interesting cases, quality improvement projects, service evaluations or audits, as well as research. Think about working with local clinical academics to write these up for publication or submit them to conferences. Through EMTA, RCEM Annual Scientific Conference, RCEM research engagement day or academic trainees day there are lots of opportunities to present your work and get feedback. The Emergency Medicine Journal provides a great opportunity for high quality quality improvement projects to be published (https://emj.bmj.com/pages/authors/#quality_improvement_report).

Tip 6: Develop a research profile and online presence

There are lots of websites that help to develop a emergency care research profile. One of the most important is ORCID (https://orcid.org/). When you submit a paper lots of journals will ask for your ORCID ID. It is worth taking a little time to create a profile. Others websites to have a look at are: ResearchGate, Publons, Google Scholar. For more information on developing your research profile check out Simon Carley’s blog: https://www.stemlynsblog.org/foamed-for-academics-a-primer-st-emlyns/

Twitter is an excellent forum for free open access medical education (FOAMed). It flattens hierarchy and offers an opportunity to discuss research with like-minded people and seek mentorship. Thomas – I most probably spend too much time on Twitter. But it helps with developing a network. Lots of opportunities have come from conversations started on Twitter. Try it out.

Tip 7: Check out available emergency care research resources

There are lots of emergency care research resources available. RCEM learning has a research section (https://www.rcemlearning.co.uk/research/). The website has short primers on key research concepts, as well as information on TERN. TERN has a Top Papers section which highlights the top emergency care related papers on a monthly basis (https://ternresearch.co.uk/tern-top-papers). St Emlyn’s has regular journal club blog posts critically appraising the latest research in emergency medicine. Don’t forget the bubbles (DFTB) has a wealth of resources relevant to paediatric emergency medicine (https://dontforgetthebubbles.com/the-dftb-team/). 

A subsequent blog is going to look more into how to develop a portfolio career with emergency care research as part of it.  

Thomas is the new EMTA research representative and is happy for you to contact him on Twitter @clifford0584. Edd Carlton is RCEM Associate Professor and co-chair of the NIHR incubator for emergency care, he is happy for you to get in touch with him via Twitter @EddCarlton. Samantha Jones is physiotherapist and major trauma coordinator at Royal Manchester Children’s Hospital and NIHR clinical academic fellow.

Cite this article as: Thomas Shanahan, "Emergency care research: top tips on how to get involved. St Emlyn’s," in St.Emlyn's, July 2, 2021, https://www.stemlynsblog.org/emergency-care-research-top-tips-on-how-to-get-involved/.

Thanks so much for following. Viva la #FOAMed

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