The role of research in emergency medicine training

Research matters to all of us training in Emergency Medicine. It must do: otherwise, the likes of St Emlyn’s, Life in the Fast Lane and The Bottom Line would not get millions of views every year from clinicians hungry to access the critical appraisal and practical recommendations that #FOAMed has become so adept at generating. Today’s research is tomorrow’s standard of care. Look at the modified Valsalva manoeuvre in supraventricular tachycardia, for example (1, 2). Without research we simply do not know whether the care we provide to patients benefits them, and we are unable to challenge pervasive dogma—even if we suspect that it might be wrong (3).

Figure 1. Research is essential to bridge the gap between what we know and what we need to know (Creative Commons Robert Donovan)

Research drives positive change. In fact, just being more research active in general might improve patient outcomes (4). However,  very few emergency medicine trainees engage with research.  Those who do—like us—get branded  “academic” somewhere along the line. Being “academic” somehow suggests that we love statistics, like to say things like these data, and love nothing more than a good bit of critical appraisal at the weekend. Barring the odd exception however, we’re not especially different from any other trainee. We are lucky, in that we can access a research community which comprises some of the most clinically engaged, supportive, friendly and inspiring emergency physicians out there. Everyone can access this community if they choose to. Not many do.

So why is there such a barrier to general engagement with research?  Why is emergency medicine training in the UK considered so separate from “academic” training?  Why are we not like our colleagues in oncology, cardiology and surgery? In those specialties it’s seen as a bit odd if you haven’t engaged in research during your training.

“TIME!” you are shouting at the screen, “PRESSURE!” as you hang your head in despair, “I DON’T KNOW HOW” you sigh exasperated.

Or not. The truth is we don’t know why so few of us do research: we are a practical lot who thrive off evidence based practice and advocate for our patients, irrespective of tertiary advice. We’re one of the few specialties with  essential critical appraisal as part of exit exams. It is clear that we value research and it probably isn’t just time and workload that stops more of us getting involved.

Figure 2.  Note to self: Do more research (Thanks to Dave Hartin for sharing)

This is a point that desperately needs addressing. Emergency Departments should be research hotbeds. Let’s face it, we certainly have the patient  numbers, a universal front door and there are fundamental uncertainties in every corner of our practice (adrenaline for that cardiac arrest, anyone?) (5). We should be one of the highest recruiting areas of the NHS to both clinical trials and observational studies. On multiple fronts, research involvement affords us the chance to make a big difference and, currently we as a specialty are missing the boat. However, we are keen to catch it up. And we have the support of a growing and dynamic Royal College behind us to make change happen. Change that could influence our training and culture, to make research more widely accessible and engagement more interesting.

So, with this in mind, let us tell you about two things:

  1. We want to know what you think about Research engagement. PLEASE. Do the RCEM trainee research survey.

We want to understand views on research engagement from all trainees and clinical practitioners in emergency medicine. We want your opinion on research, how it does or doesn’t fit into your life and what we can do as a college to make it more appealing and get you involved.  Previous surveys have included only small groups of research-interested “academics” (there goes that word again) (6). We don’t need to patronise you about the detriment of respondent bias, so please spend five minutes filling it in so we can find out what everyone thinks, evidence what is already going on and use this information to drive the trainee research agenda of the future.

The survey can be accessed here and features heavily on our twitter feeds if that is easier.

  1. Interested but in need of support to engage? Think about joining the Trainee Emergency Research Network (TERN)

For those of you who know you’d like to be more research active but are after doing so in a supported way, meet TERN. The Trainee Emergency Research Network—approved, supported and funded by RCEM—will allow us to identify and answer clinically important questions collectively, as a trainee group. The underlying principle is that more hands makes less work, and the process is simple. Firstly, we agree on an important research question. Secondly, find a pragmatic way to answer the question and third, use lots of trainees in different localities to collect more data more quickly than anyone would manage individually.  As we all know, bigger numbers in studies equals more confidence in the answer to the question. It also means infrastructure and support, so that the paperwork and set up can be done in one place, and everyone else is left to get on with seeing patients. As TERN takes off (excuse the pun) we’ll likely have more than one study running at any one time. Specialties like anaesthetics and neurosurgery already have well established networks that have proven the concept and demonstrated the potential when it comes to recruiting large numbers of patients quickly and easily (7-10).

Network based research differs from pursuing formal academic training or an individual award like a PhD in that it is for the collective good, and not all about personal career development. That said, TERN participants could certainly expect to access some research training, develop additional skills and generate a meaningful output from the project regarding publications and presentations. Discussions have already begun around how TERN might contribute to future portfolio assessment outcomes—for example, by taking place of audit or other mandatory requirements. If successful, TERN might give powerful leverage to lobby for more protected time in training.  All of this will only happen if, once TERN gets off the ground, you can help it stay in the air (really excuse the second pun).

Interested? If you are a trainee (of any grade), an advanced practitioner or an emergency doctor working in a trust post interested in contributing to TERN either now or in the near future, please get in touch. Research experience is not required.  Our first scoping meeting is on the 4th April at the College headquarters in London. More will follow after that meeting, but until then please register your interest here so we can keep you posted about progress. With your help and enthusiasm, we can TERN around research engagement in emergency medicine (a comedy step too far? apologies…)

This is now the part where we should insert an over-the-top sign off about emergency research changing the world,  but we think you get the message.

So, let’s just get on with it, no nonsense, EM-style.

 

Thanks for reading.

Anisa Jafar @EMergeMedGlobal

ST4 Trainee and a current RCEM PhD fellow with interests in disaster and humanitarian medicine. Royal Bolton Hospital

 

Blair Graham @Timecritical

ST4 Trainee and a current RCEM PhD fellow with interests in patient outcomes and experience. Derriford Hospital, Plymouth

 

Dan Horner @RCEMProf Professor of the Royal College of Emergency Medicine. Consultant in Emergency and Intensive Care Medicine. Salford Royal NHS Foundation Trust

 

References

  1. Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015;386(10005):1747-53.
  2. R B. Board SEE, editor2015. [cited 2018]. Available from: http://stemlynsblog.org/the-revert-trial/.
  3. Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653 e9-17.
  4. Ozdemir BA, Karthikesalingam A, Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, et al. Research activity and the association with mortality. PLoS One. 2015;10(2):e0118253.
  5. Long B, Koyfman A. Emergency Medicine Myths: Epinephrine in Cardiac Arrest. J Emerg Med. 2017;52(6):809-14.
  6. Olaussen A, Jennings PA, O’Reilly G, Mitra B, Cameron PA. Barriers to conducting research: A survey of trainees in emergency medicine. Emerg Med Australas. 2017;29(2):204-9.
  7. Chari A, Jamjoom AA, Edlmann E, Ahmed AI, Coulter IC, Ma R, et al. The British Neurosurgical Trainee Research Collaborative: Five years on. Acta Neurochir (Wien). 2018;160(1):23-8.
  8. Jamjoom AA, Phan PN, Hutchinson PJ, Kolias AG. Surgical trainee research collaboratives in the UK: an observational study of research activity and publication productivity. BMJ Open. 2016;6(2):e010374.
  9. Kolias AG, Cowie CJ, Tarnaris A, Hutchinson PJ, Brennan PM, British Neurosurgical Trainee Research C. Ensuring a bright future for clinical research in surgery with trainee led research networks. BMJ. 2013;347:f5225.
  10. RAFT. 2017 [Available from: http://www.raftrainees.com.

 

(Visited 35 times, 2 visits today)