Research, trainees and prioritisation in UK emergency medicine.

The UK Trainee Emergency Research Network (TERN) was created (officially) in 2018 and mentioned previously by Simon & Dan in this early digital outing. The initial mission was to demystify clinical research, improve access to research opportunities, and produce practice-changing evidence. We want to make research a part of your everyday practice. 

The first two years of TERN have seen the network develop from an adhoc meeting of interested trainees and academics into a wide national network with representatives all across the UK and Ireland. We have recruited over 10,000 patients to NIHR Trauma and Emergency Care portfolio studies, secured national competitive funding for three projects and published protocols / completed projects with news interest from high impact journals. More are in peer-review. This has all been due to the efforts & support of our trainees, the research staff and academics helping them – and of course a lot of good-will.

Most of our first projects were selected by the trainee membership at early steering committee meetings, where everything from future projects through to the angle of the bird’s wings on our logo was discussed. This is to reflect the fact that TERN is a research network that seeks to serve the needs of our members. We are interested in the perspectives of our trainees on the research questions they think clinically matter. We want to answer the questions they encounter in their everyday practice. 

Research Priorities – but for who?

In 2017, the James Lind Alliance and the Royal College of Emergency Medicine formed a Priority Setting Partnership (discussed on St. Emlyn’s here) to determine research priorities for emergency medicine. These research priorities [1] helped drive the research agenda and ultimately helped leverage the current NIHR themed funding call for the injuries, accidents and urgent and emergency care domain. We will likely see many of these priorities addressed in work to come.

The questions that people want answers for are driven by their everyday working practice. The Intensive Care Society undertook a similar James Lind Alliance Priority Setting Partnership in 2014 involving patients, doctors (consultants and trainees), nurses, and other allied health professionals. The authors of this report subsequently analysed their priorities by professional background. The table below shows the top five research themes identified by trainees & consultants [2]. 

Whilst there are many commonalities, the priorities likely reflect questions related to different working practices. Intensive care registrars wish to predict which patients may deteriorate quickly and so might require earlier admission to the unit; intensive care consultants want to know which patients will take longer to recover and how best they should organise their department. Of the top ten EM research priorities chosen by the Priority Setting Partnership, six concern systems-orientated research questions. This is not to say that they are not important – they represent some of the greatest challenges we face as a speciality. 

However, as a trainee-orientated research network, we’re interested in helping our trainees answer more immediate questions – which patients with a thunderclap headache can be discharged with a normal CT head? When should you think about starting peripheral vasopressors in a patient with sepsis? What pathways for exclusion of ACS are in use within the UK and how safe are they? This is where you come in….

The Delphi Process & determining research priorities

TERN are planning a Delphi process to determine the research priorities that are most important to trainees. A Delphi process is a structured group facilitation technique that explores a problem or topic through an iterative process of determining consensus amongst invited panellists. 

The initial questionnaire is usually designed to identify a range of issues pertinent to the topic at hand, and may involve a literature review or a process of information gathering from a wide group. A questionnaire is then presented to the Delphi panel, who comment on the topic and provide their thoughts. These comments are returned to the steering panel. Comments are aggregated, analysed and descriptive statistics are used to quantify central tendency (consensus) and spread (disagreement). The results of the first round and an amended questionnaire is returned to the panellists, and the process continues until consensus is broadly reached. The definitions for consensus are pre-determined during the study design. The whole process, broadly, looks like this [3]:

This process seeks to find consensus and is typically used to explore assumptions, seek expert opinion where none exists, or collect informed judgements on a topic that spans multiple disciplines. The process is anonymised and seeks to reduce some of the confounding interpersonal processes that can occur in face to face large group discussions. It can involve a geographically distributed group of people and can be done entirely remotely, which makes it well-suited for the new normal of coronavirus 2.0. 

The use of this process to determine research priorities is well recognised in the literature. TERN are currently in the process of gathering information for the initial questionnaire.  We are looking for your input. We want to know and understand what key questions you encounter in your everyday practice. We want you to think about what you perceive to be the most important research question for emergency medicine right now (and up to five other research questions). This initial questionnaire generates ideas that will be formalised, aggregated and presented to the Delphi participants to be ranked & rated. We will generate a final list of research priorities that will then influence the projects TERN works on and the research opportunities we seek to engage you all in.

How can I get involved?

By getting involved. Go to https://tinyurl.com/TERNDelphi and have your say. The survey is open until the 8th December. There will also be further discussion at the upcoming EMTA 2020 conference. We’re looking forward to hearing from you. And we are excited to hear what you have to say.

Cheers,

Rob Hirst

TERN Fellow

@ternfellow / [email protected]

References 

[1]. Smith J., Keating, L., Flowerdew, L., on behalf of the JLA EM PSP Steering Group, et al. An Emergency Medicine Research Priority Setting Partnership to establish the top 10 research priorities in emergency medicine. Emergency Medicine Journal 2017; 34(7):454-6.

[2]. Arulkumaran, N., Reay, H., Brett, S. JLA Intensive Care Research Priority Setting Partnership. Research priorities by professional background – A detailed analysis of the James Lind Alliance Priority Setting Partnership. J Intensive Care Soc 2016; 17(2):111-6. 

[3]. Hirst, R. (Delphi) Method Man. https://www.rcemlearning.co.uk/foamed/delphi-method-man/. Published 2020. Accessed November 13, 2020. 



Cite this article as: Dan Horner, "Research, trainees and prioritisation in UK emergency medicine.," in St.Emlyn's, November 18, 2020, https://www.stemlynsblog.org/research-trainees-and-prioritisation-in-uk-emergency-medicine/.

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Posted by Dan Horner

Dr Daniel Horner BA MBBS MD PgCert MRCP (UK) FRCEM FFICM is an editorial board member on the St Emlyn’s blog and podcast. He is Professor of Emergency Medicine of the Royal College of Emergency Medicine. He is a consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust. He is chair of the national exemplar centre Thrombosis Committee and Regional lead for Injuries and Emergencies on the NIHR Clinical Research Network. He is a Senior clinical lecturer at the University of Manchester and collaborator with the University of Sheffield. You can find him on twitter as @RCEMProf

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