• Episode Two – The Basic Questions

    by Trystan Donnelly. Last modified: 15/03/14

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    This week we’re going to look at some of the very basic questions surrounding research. I’m trying to ask questions on every paramedic’s behalf that are intended to be general enough to be applied to anyone’s journey in research and that assume that we’re all starting from “scratch”. Moreover, they’re not intended to be “stand-alone” statements, they’re intended to precipitate discussion.

    So, if you have something to add to the discussion, just comment on the article. It’s that easy! If there’s another question that fits in with the theme of the week, feel free to throw it into the mix. Just keep in mind that there is an outline for subsequent posts and we’re trying to “stay on topic” with a group of similar, related subjects in each post.

    On to this week’s discussion…

    questionsWho can do research?

    So, who can do research, or who should do research? Is a bachelors degree or any other qualification necessary? Is a solid education and genuine interest in the subject sufficient? Maybe the question should be turned around – why aren’t more of us doing research with the qualifications we have? I’m sure every one of us can see where there is room for improvement.

    Who do I need to bring “on board” to do a research project?

    If I decide to do research, who else do I need to “bring on board”? Whose support do I need? If I’m planning a randomized control trial, I’ll probably need the support of the agencies that will be involved but what if I’m just going to do a retrospective meta analysis, do I need backing from an educational institution? What is a thesis advisor? Do I need to be involved with a university and get support from their faculty?

    Who can sanction my research and/or lend legitimacy to the work I do?

    What gives my research credibility over say, a newspaper doing an unscientific or quasi-scientific survey or poll? Again, is this association with a recognized institution or are there organizations that generally oversee research for various disciplines? I imagine that when I want to get my research published in an academic journal, the journal is going to be looking for some assurances that rigorous standards were met along the way.

    Academic Journals?

    Why do I even want to publish in a journal? What academic (refereed) journals do we have in paramedicine? Are there any or are paramedics still just submitting our work to journals that are more closely tied to the other medical professions? For the neophytes among us: what is a refereed academic journal and how do I even recognize one in the crowd?

    Who is responsible for ethical approval?

    Some of our research might require ethical approval. For example, if I want to know whether epinephrine is really effective in resuscitation, I might want to withhold it in half of the resuscitations I do. Obviously, there are some ethical ramifications! However, what if I just want to know whether “customer satisfaction” is affected by early disclosure of the costs associated with service? Someone is going to have to have a good long think about the ethics of that. Who does this and how do I get these ethical experts to look at my project?

    If there are costs involved, where can I look to find financial support?

    In many cases, especially with modern technology, the costs can appear to be negligible for the actual research. This is probably a two-part question though: What are the hidden costs? Where does the financial support come from? I know its “the million-dollar question” but really, people get research done all the time, who’s paying for it? I realize that there is an ethical aspect to this question in terms of biasing the outcome if, for example, “big pharma” is paying for drug research but let’s not let that overwhelm the actual intent of this question. The intent is just to find out where beginning researchers can find support for our projects.

    In our next post:

    We’ll talk about how this all ties into educational credentials. How does research tie in to earning advanced degrees?

    Thanks in advance for your comments,

    Respectfully

    Trystan

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    Trystan Donnelly

    Trystan Donnelly

    Trystan is a Canadian Advanced Care Paramedic. After completing a degree in biology at the University of Victoria and the University of Alberta, Trystan returned to the UofA and studied paramedicine. After more than a decade of practice, Trystan's energies have returned to academia where he is an active educator and a nascent researcher.

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    10 thoughts on “Episode Two – The Basic Questions

    • David Menzies says:

      Again, congratulations on the website – it is rapidly becoming a superb resource!

      There is one other important question with respect to research: WHY?

      To my mind, there are several reasons people undertake research:

      1. To create new knowledge
      2. To attain a higher qualification
      3. For career advancement
      4. Out of genuine interest

      These are not mutually exclusive, but perhaps don’t expect your first foray into the world of research to be all 4 things!

      If your research is leading to a higher degree or promotion, it is probably easier to tolerate subject matter that is less than fascinating. However, as a rule something that genuinely interests you is much easier to reaearch!

      • Alan Batt Alan Batt says:

        Thanks very much David, baby steps, but it’s getting there! Definitely a very good point – we shouldn’t be doing research for the sake of doing research, a common pitfall I think! And +1 on the finding a topic that’s interesting to you!

    • Don Sharpe says:

      I love this question!
      None of my research has ever been approved in advance, in fact much of it has been very unpopular.
      In the ’90’s I did a retrospective case study on EMS Vehicle accidents for the year 1988 in Alberta. Statistics were horrifying, the pictures even worse. The conclusion that we were doing more harm than good by crashing Ambulances in people and killing them was pretty unpopular, to say the least. But it led to good things eventually, both in our industry and the legislation.
      Implementation of EMD pre-1990 was also unpopular at the time, with lots of Dispatch Center staff refusing to even attempt pre-arrival instructions until it was proven they wouldn’t be sued if the patient didn’t survive.
      My latest project on the Design & Function of Hospital Ambulance Bays has landed me in hot water a couple of times. I don’t mind, I LIKE IT HOT!
      So my advice is to pick a topic that looks interesting and investigate it.
      If you have think you have an idea that will advance pre-hospital care, or improve safety and increase efficiency, then begin a Quest!
      Research can be an exciting adventure, and can provide your career with that extra boost that keeps you excited & interested over the long term.

    • Trystan Donnelly Trystan Donnelly says:

      Hi Don, thanks for your comments! Its great to have researchers with an interest in advancing pre-hospital care. I have a couple of follow-up questions:

      What was your experience with publication? Did the fact that you didn’t have operational or ethical approval hold you back in terms of publication later?

      How did you deal with costs? Were you able to acquire financial support? Did the projects incur significant costs?

      How did your projects relate to the outcomes set forth by Dr. Menzies above?
      1. To create new knowledge
      2. To attain a higher qualification
      3. For career advancement
      4. Out of genuine interest

      Thanks for your contribution Don, I look forward to hearing more from you!
      -Trystan

    • Niels Tangherlini says:

      This is an excellent way to excite our profession about the why and how of research. So lets look at all the questions in turn:

      1. Yes our profession needs to embrace research. For us to truly own our aspect of medical science, we need to be become scientists. This does not all paramedics and EMTs need to conduct and publish research, but we all must become good consumers of what other professions are concluding about us and how we practice. However, paramedics and EMTs who are truly interested and have the willingness (and talent) to conduct primary clinical research must do so. The future of our profession is riding on our ability to step up and both formulate and answer questions about how we operate.
      2. If we assume that only MDs RNs and people with advanced degrees can conduct research ,we are doing a great disservice to our profession and science as a field. Who better than to ask and answer questions about EMS than the people engaged in the profession. In fact I have noticed that much of the “EMS Research” that is conducted by professionals who are not true field EMS providers is always lacking and frequently draws its conclusions on erroneous assumptions. Research is a science and I would strongly recommend taking at least a college level statistics class as a primer to conducting clinical research, but it is definitely possible to formulate research without any such training.
      3. The first step is to have an intense curiosity about why things are the way they are and always look at things in terms of is there a way to prove this could be done differently/better.
      4. Developing your inner scientist will allow you to decide what it is you want to research. Once you know what it is you want to research you will want to develop a hypothesis (the question you are going to test).
      5. Now you will want to build your team. Residents, particularly ER residents, are great to team up with as they are often required to conduct research as part of their education and it is a great way to foster the connection between field EMS providers and the physician community. Universities are great places to find graduate students and professors who may be completely interested and excited to work with EMS providers. If you can find an epidemiologist who wants to work with you that can be excellent as many are willing to share their incredible knowledge about conducting research as they work with you on a project.
      6. You are going to need the buy-in and consent of the provider where you work or whatever provider is going to be the source of data. Additionally you must go through a committee on human research if you expect to be printed in a peer reviewed journal (the gold standard of scientific research). Morally and ethically you want to go through a committee on human research, which will require you to assure that you obtain informed consent from any person that could be affected by your research (the standard of consent is considerably lower if you are conducting retrospective research). This is important, however, because we want to be sure that we protect the dignity and rights of our patients who become subjects of our research.
      7. Research can be expensive if you want to train everyone in a system to do different things on different days for example or if you want to have half the units in a system use one type of equipment and the other half use something else. Money also helps in hiring research assistants to collect data or biostatisticians to help with the pesky analysis. Money for prehospital research conducted by EMS providers, however, is virtually non-existent.
      8. Good luck and keep up the good work!!!

    • Trystan Donnelly Trystan Donnelly says:

      Hi Niels, just a quick note because I wanted to thank you for your great comments! Its been many,many years since I did statistics in university. So, on your good advice, I’m doing a refresher. I did a quick search on the internet and found several stats courses online, self-paced and free. I will work through a few of them and update the readers on my progress shortly. Thanks again,
      Trystan

    • Alan Batt Alan Batt says:

      My quick thoughts on your questions Trystan.

      1. The research projects I’m currently involved with are based on a personal curiosity in the subjects, and are not part of any academic pursuit or qualification. At first I thought that research was only for those undertaking higher degrees, but that is certainly not the case!

      2. I’ve been fortunate enough to receive fantastic support and avice from Dr. Niamh Cummins of the Centre for Prehospital Research in the University of Limerick, Ireland (http://www.ul.ie/cpr) on my projects so far. She has helped me with navigating the proposal, instruments, ethical approvcal etc. and I’d strongly recommend finding someone similar in your jurisdiction to help guide you along those first few steps.

      3. My ultimate aim is to publish the findings of these projects in peer-reviewed journals, and the main ones I’ve found relevant to paramedicine specifically are
      a. Journal of Paramedic Practice
      b. Journal of International Paramedic Practice
      c. Prehospital Emergency Care
      From what I’ve seen of my wife’s attempts to publish research, the journal submission and acceptance process can be lengthy, frustrating and disappointing, so I’m prepared for that when it happens.

      4. I’ve been lucky enough not to incur any major financial burden as a result of these research projects, in that they are generally questionnaire based, researching educational methods. I have no experience running clinical trials or similar, but hope to get involved in some in the near future.

      With regards to the statistics courses, the upcoming events section of the site has some great info on upcoming courses on research methods, statistics etc.

      Again, great post, and look forward to reading your next musing!

    • Paul Carroll says:

      I wish someone would initiate a study on the development of medical professionals with multiple sclerosis. Purely subjective on my part, but a sizable percentage of my MS friends have a medical background. I joke about exposure to fluorescent light as a factor; maybe so.

      Kind of off your topic, Mr. Donnelly; my apologies.

    • Mike Kennedy says:

      Trystan,
      I conducted research for the Army for 16 years and always kept “The 21 Threats to a Good Experiment” in mind as we developed methodologies, data collection plans, conducted trials, investigated anomalies, analyzed data, and drew our conclusions. While some of them may be specific to the kinds of research we did, military experimentation, but I am sure many of them apply to your work, which I applaud by the way. Here are the threats and a brief word or two about each.
      1. Capability not workable.
      2. Player (soldier in my case) non-use. Do users have the training and tactics, techniques, and procedures to use the capability?
      3. No potential effect in output. For us, there are many, many variables to be considered. We always had to make sure the capability, if it worked effectively, effected overall mission success.
      4. Capability not exercised: about once a year we did really big experiments with 50-75 new technologies, ideas, or concepts. In some of the missions, the capability did not fit or did not make sense to use. This does not reflect badly on the technology. Make sure that the capability fits the scenario and can be used in it.
      5. Capability variability: depending on the echelon of employment we had from just a few to 20-30 pieces of the same technology used by different people during the experiment. The challenge was to make sure that if one of them wasn’t working very well we knew it so that it did not skew the data collected. We strived to make sure all of them were working to the same level so that our data would be clean.
      6. Player variability: lets face it, some people are better than others at doing certain things or using certain technologies. We had to make sure that the players were all very similar, trained to the same level, and all passed a proficiency test. A great piece of equipment used by someone who did not really know how to use it ends up not being used very well by that person.
      7. Data collection variability: Is there a large error variability in the data collection process? Remember, analytical rigor, always. All data collection methods should be the same, when making comparisons. Always make sure your data is correct.
      8. Trial conditions variability: Are there uncontrolled or unmonitored variables in trial conditions for like trials? Look for intervening variables not recorded. In essence, analyze everything in its proper context.
      9. Low statistical power: Is the analysis efficient and the sample sufficient? One trial with one user (sample size of 1) is sufficient.
      10. Violation of statistical assumptions: Are the correct analysis techniques used and error rate reduced?
      11. Capability changes over time: Are there system or process changes during the research? Make sure you track these so that you are comparing apples to apples and not apples to the great white shark.
      12. Player changes over time: We always insisted that units provided the same people every day throughout the experiment. In other words, don’t let different or untrained personnel skew your data.
      13. Data collection changes over time: Are there changes in instrumentation or manual data collection during the research. Strive to avoid this at all costs. Exercise your data collection methodologies extensively before you research for record to avoid this
      14. Trial conditions change over time: Are there changes in the conditions (weather, light, start conditions, and threat) during the experiment? Track these carefully. Analyze everything in its proper context.
      15. Player differences: Are there differences between groups unrelated to the treatment (technology being used). Don’t compare the golden boys to the duds. Their personal abilities may have done more to contribute to their success than the technology did.
      16. Data collection differences: Are there potential data collection differences between treatment groups?
      17. Trial conditions differences: Are trial conditions similar for each treatment group. If not, it may have been the difference in trial condition that attributed to the performance of the technology.
      18. Nonrepresentative capability: this applied with advanced prototypical equipment. The prototype had to accurately represent the actual technology.
      19. Nonrepresentative players: Is the player unit similar to the intended operational unit. For us this meant that we could not use engineers to experiment with a capability that was intended for the Infantry. Keep this in mind at all times.
      20. Nonrepresentative measures: Do the performance measures reflect the desired operational outcome. For us this meant that If using the technology or product should increase lethality, we had to collect data to answer that measure.
      21. Nonrepresentative scenario: for us it meant make sure we don’t evaluate a surveillance technology in a scenario where no surveillance was required, or users had to force a surveillance task into the scenario. Bad juju! You control it, not the technology, not the player, not the scenario.

      We always remembered this to: The purpose of an experiment is to verify that A causes B.
      A valid experiment allows for the conclusion, A causes B, to be based on evidence and sound reasoning by reducing or eliminating the 21 threats to validity.

      I hope you find this helpful.

    • Trystan Donnelly Trystan Donnelly says:

      Wow Mike, thanks! I think that this on its own is worth the price of admission! I think a lot of years of experience and learning went into the “21 Threats”. I expect I’ll be referring back to this list for many years. Thanks again,
      Trystan

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