TERN Updates and Posts

TERN Updates and Posts

TERN Updates and Posts have historically been hosted on RCEMLearning. As part of TERN’s educational remit, we aim to talk about our trials and ensure people know about them. We like people to be engaged with the network and feel some ownership over it. As a result, we like to talk about the studies, what we’re up to and how people can get involved. Before this website existed this was done on RCEMLearning. We foresee this continuing alongside this website as well. For now, you can read TERN updates and posts about our studies, and about the network here.

TERN Studies

Que CERA, CERA

TIRED: My Slice of the PI

TERN’s first migration is complete

Current Projects – Tired

Current Projects – AHEAD2

Current Projects – HED

TERN Updates

Ternty twenty one

Join the TERN committee!

A New TERN

TERN around bright eyes

TERN February 2019 – Chickens and Eggs

TERN January 2019

TERN September 2018

Research in Emergency Medicine training: one straw too many?


Research Methodology

Research Methodology

As part of TERN’s educational remit, one of the strands of our posts on RCEMLearning is Research Methodology. These are designed to discuss different types of studies and help improve the knowledge-base of our trainees. We hope you find these useful! A lot of these are hosted on RCEMLearning, but we wanted to ensure these were easy to find in one place.

If you’d like to contribute a Research Methodology post, feel free to get in touch with us!

(Delphi) Method Man

The cost of a Starbucks Latte – a publication cost analogy

Explaining Research Methods in Emergency Medicine (ERM-EM): Introduction

PPI in research: Nothing to do with proton pump inhibitors or payment protection insurance


TERN Breaking Evidence

TERN Breaking Evidence

The TERN Breaking Evidence series forms one part of TERN’s educational remit, and is one of the strands of our posts on RCEMLearning. This is designed to discuss contemporary breaking evidence, recent papers, the latest news, or read our selection of COVID updates.

 

RCEM COVID-19 CPD Top 5 papers: Week 9

RCEM COVID-19 CPD Top 5 papers: Week 8

RCEM COVID-19 CPD Top 5 papers: Week 7

RCEM COVID-19 CPD Top 5 papers: Week 6

RCEM COVID-19 CPD Top 5 papers: Week 5

RCEM COVID-19 CPD Top 5 papers: Week 4

RCEM COVID-19 CPD Top 5 papers: Week 3: The Director’s Cut

RCEM COVID-19 CPD Top 5 papers: Week 3

RCEM COVID-19 CPD Top 5 papers: Week 2: The Director’s Cut

RCEM COVID-19 CPD Top 5 papers: Week 2

RCEM COVID-19 CPD Top 5 papers: Week 1: The Director’s Cut

RCEM COVID-19 CPD Top 5 papers: Week 1

Loop recorders and the 24-hour tape: there has to be a better way! The IPED study

Breaking Evidence: The Rod Little prize 2019

Breaking Evidence: The Elizabeth Molyneux prize 2019

Silencing the seizure: Phenytoin vs. Levetiracetam in paediatric status epilepticus

EMTA 2018 prize winners

To tube or not to tube? That is the question. The AIRWAYS-2 TRIAL

My patient has a pulmonary embolism (PE) – can I still send them home?

Breaking Evidence: EuSEM top scoring PEM abstracts 4-6

Breaking Evidence: EuSEM top scoring PEM abstracts 1-3

Breaking Evidence: the Rod Little Prize shortlisted abstracts 4-7

Breaking Evidence: the Rod Little Prize shortlisted abstracts 1-3

Breaking evidence: Non-Trainee Abstracts blog 4-6

Breaking evidence: Non-Trainee Abstracts blog 1-3


TERN Top Papers

TERN Top Papers

TERN Top Papers

Trainees do not always have time to read the most recent papers. We want to help trainees stay abreast of the evidence base. We have started by producing a monthly summary of important articles. Indeed, improving engagement with research is one of TERN’s core aims. Teams of trainees from each region (with the assistance of the TERN Education Leads) will produce a summary each month. These will be comprised of a selection of the most important articles to trainees based around that month’s theme published from the past year.

TERN Top Papers will presented a curated and summarised selection of papers on a theme chosen by a regional panel. Themes are predetermined for the first few, but there is scope to bring your own research interests to the panel. By going region by region, we hope to develop different regional leads, encourage closer-working and build a wider network of research-minded individuals.

This summary will be written by trainees for trainees. Participation will help EM trainees evidence the research specialty learning outcome (SLO10) and will help aspiring EM trainees demonstrate commitment to specialty. If you are interested in getting involved email us at tern.education@rcem.ac.uk with your name, grade, and deanery.

Our links will be updated each month, or they can be found on RCEMLearning.

TERN’s Top Papers: March 2021 – top papers

TERN’s Top Papers: April 2021 – trauma & orthopaedics

TERN’s Top Papers: May 2021 – critical care

TERN’s Top Papers: June 2021 – toxicology and psychiatry 

TERN’s Top Papers: July 2021 – analgesia and sedation

TERN’s Top Papers: August 2021 – diagnostic imaging

TERN’s Top Papers: September 2021 – cardiac arrest

TERN’s Top Papers: November 2021 – wellbeing and training


TERN Journal Club

TERN Journal Club

What is the TERN Journal Club? As you may know, the new RCEM Curriculum has removed the critical appraisal exam, moving towards a portfolio-assessed process.

The aims of TERN are to improve research literacy and confidence. At TERN are keen to introduce evidence-based practice into our everyday working practice. The previous college focus on critical appraisal (by way of making it an exit examination) has meant that this has become the step of evidence-based practice we focus on. The most crucial of the five steps of evidence-based practice, and the one the literature suggests is the most neglected, is the actual application of the evidence to the patient in front of us.

We are planning to meet a number of needs through creating the Virtual Journal Club. Practically, trainees can demonstrate engagement with the new curriculum (and the SLO10 research outcome) and develop skills at appraising the evidence. We want to centre the application of evidence to clinical practice to the forefront of everyone’s mind. Too long we look at a guideline and follow it blindly – we want to go behind the evidence, behind the guidelines, and really get to know the evidence-base behind our practice.

Find our articles on RCEMLearning – they can be found below:

March’s TERN Virtual Journal Club – MAGraine: Magnesium compared to conventional therapy for treatment of migraines

April’s TERN Virtual Journal Club – Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT)

May’s TERN Virtual Journal Club – Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack

June’s TERN Virtual Journal Club – High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

July’s TERN Virtual Journal Club – A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

August’s TERN Virtual Journal Club – Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients with Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Department

October’s TERN Virtual Journal Club – Diagnosis of Traumatic Pneumothorax: A Comparison between Lung Ultrasound and Supine Chest Radiographs

November’s TERN Virtual Journal Club – Identification of very low-risk acute chest pain patients without troponin testing


Research Priorities

Research Priorities

Most of our first projects were selected by the trainee membership at early steering committee meetings, where everything from future projects to the angle of the bird’s wings on our logo was discussed. This reflects the fact that TERN is a research network that aims 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.

We know that the questions people want answered are influenced by their working practices. An analysis of the Intensive Care Society’s research prioritisation exercise with the James Lind Alliance showed a few difference between the priorities that consultants & trainees thought were most pressing.

Table contrasting the research priorities of ICU consultants vs ICU trainees.

Table from [1]

Whilst there are many common themes, the priorities demonstrate a different focus in their everyday working lives, and the priorities of consultants vary from those of their trainees. If we look at the top ten EM research priorities chosen by the Priority Setting Partnership in a similar exercise [2], we see that six of the top ten concern systems-orientated research.

This is not to say they are not important; indeed they represent some of the greatest challenges our specialty faces. 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? What pathways for exclusion of ACS are in use within the UK and how safe are they? These are the questions our trainees need answers to on an every-day basis. The TERN Research Priorities must reflect the working practices of our trainees.

Determining priorities

Now, how do we select these priorities?

We are running a Delphi process to determine the TERN research priorities that are most important to trainees. A Delphi process is a structured group-facilitation technique exploring a problem or topic through an iterative process to determine consensus amongst invited panellists. The use of a Delphi process to determine research priorities is well described in the literature [3-5].

Delphi process

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. We distributed a questionnaire asking for people’s research priorities, and encouraged them to put it into the part of a three-part question or PICO format. The submission period was for a month, and we spammed it across our email, Twitter, at the EMTA2020 conference, and made a post publicising it on St. Emlyn’s. My enthusiasm remained high throughout the process but I’m sure others’ waned…

We’re now in the process of refining these responses. This cleaned up initial questionnaire will be presented to the Delphi panel, who will 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 [6]:

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.

We’ll keep you updated with how this process is going, and update this page accordingly!

 

References

  1. 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 17(2): 111-6 (2016).
  2. 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 34(7): 454-6. (2017)
  3. Hartshorn, S., et al. Establishing the research priorities of paediatric emergency medicine clinicians in the UK and Ireland. Emergency Medicine Journal 32(11): 864-8 (2015).
  4. Alshibani, A, et al. A consensus building exercise to determine research priorities for silver trauma. BMC Emergency Medicine 20(1): 63 (2020).
  5. Dewa, L. et al. Identifying research priorities for patient safety in mental health: an international expert Delphi study. BMJ Open 8(3): e021361 (2018).
  6. Hirst, R. (Delphi) Method Man. https://www.rcemlearning.co.uk/foamed/delphi-method-man/. Published 2020. Accessed December 18, 2020.
  7. Hirst, R. “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/. Accessed December 18 2020. 


Student TERN / STERN

STERN

Student TERN (STERN) was developed to bring TERN’s aims of improving access to research opportunities, demystifying clinical research and developing our trainees to EM-interested students.

We want to get students engaged in research early, as we know it can be hard to get research opportunities as a medical student [1]. We want to get students engaged in Emergency Medicine research early, so that when they do become doctors they have some research experience and skills, particularly at a time when they are also getting used to working as a doctor.

Exposing students to research opportunities stimulates research interest & skills [2], and encourages students to undertake research-roles. Students who undertake early academic training programmes such as the academic foundation training programme or academic clinical fellowships find the experiences helpful for preparing for a career in academia [3, 4].

We feel that encouraging early research activity is just another way in which we can reverse the decline in emergency medicine academic output over the past twenty years. This is why we are working to develop a Student TERN – STERN.

Implementation

How this works is still an evolving process – currently we are working with universities offering undergraduate degrees in the urgent & emergency care sphere. How TERN works with your course will differ according to your course circumstances, as these are heterogenous and have different structures, syllabuses, and student cohorts. We are happy to work alongside your academic year, existing research infrastructure, and student population.

We are currently working with the University of Plymouth and have started working with the University of Cardiff, and are taking different strategies to each approach. If you’re interested in getting involved, please feel free to email us or get in touch with us on our Contact Us page. We’re always happy to have a chat about how we can work collaboratively to make student TERN (STERN) more than a slightly-amusing acronym.

 

 

References

  1. Funston, G., et al. Medical student perceptions of research and research-orientated careers: An international questionnaire study. Medical Teacher 38(10): 1041-8 (2016).
  2. Chang, Y., Ramnanan, C. A review of literature on medical students and scholarly research: experiences, attitudes, and outcomes. Academic Medicine 90(8): 1162-73 (2015). 
  3. Darbyshire, D., Baker, P., Agius, S., McAleer, S. Trainee and supervisor experience of the Academic Foundation Programme. J R Coll Physicians Edinb 49(1): 43-51. (2019).
  4. Clough, S., et al. What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study. BMJ Open 7(6): e015722 (2017).
  5. Smith, J., et al. Evolution of methodology and reporting of emergency medicine quantitative research over a 20-year period. EMJ 37(6): 324-9. (2020). 


Benefits

Benefits

We want TERN to provide benefits for our trainees. We value the time and energy that our trainees give to us, and we want to ensure that we make their lives better.

Greater research opportunities

No longer does a trainee need an ACF or a badged research role in order to eke out time to get involved in research. We provide the opportunity to get involved in research without having to start a new project from scratch. We give trainees the opportunity to develop skills as Principal Investigators (PIs) so they can develop their own projects armed with this knowledge.

Reduced time burden

Through taking care of some of the set-up centrally and running these network studies, we reduce the time-burden placed upon busy doctors, and make research a more sustainable professional activity.

Research training

Our training & education comes in several forms. Through acting as a PI trainees learn through doing, turning the abstract process into a familiar practical skill. We also provide education through our RCEMLearning platform, through training days and presentations. We are planning to expand and start putting on webinars for our trainees on a number of topics.

Supporting study leave

TERN supports the use of study leave (image), so trainees can undertake research activity supported by their deanery and don’t have to spend their Sundays recruiting patients or staying late after a shift. We believe research is an integral part of trainee development and training, and think it should be recognised as a supported professional activity with time set aside for it.

Concrete outputs

The size of the TERN projects and the work that goes into them results in high quality studies that result in presentations and publications. This results in concrete outputs for trainees, who are named & listed on all presentations and publications – just see the contributor list for TIRED. We want everyone to see how TERN benefits trainees.


Aims of TERN

Origins

TERN is the Trainee Emergency Research Network. TERN was started and funded in 2018 by the Royal College of Emergency Medicine. The TERN network was created to fulfil a number of different aims.

TERN was inspired by the successful research networks of anaesthetics, surgeons, and paediatric emergency physicians. It was formed to improve access to research opportunities & demystify clinical research in Emergency Medicine.

It is a collaborative research network that seeks to produce pragmatic research projects which can rapidly influence practice.  

This approach aims to provide research opportunities for all trainees in EM. Through collaborative project design, provision of support & training, and research infrastructure, we hope to make research more accessible.

Aims

Improve access to research opportunities

TERN was designed to improve access to research opportunities for trainees and allow them the chance to participate meaningfully in research activity, even if they’re not doing an ‘academic’ badged post. The model of network research results in more sites engaging in research and so provides more opportunities for trainees to get involved in research. This is one of the primary aims of TERN.

Demystify clinical research

By improving exposure to research and making it a part of our everyday practice, we want to quash the notion that research is purely for tertiary centres and professors. We want to centre it in our departments.

Generating pragmatic, clinically-driven research projects 

We want our studies to be pragmatic, applicable to many different sites. By using network research and large numbers of sites we can produce studies that recruit the right numbers of patients in a way that is compatible with working in a busy ED.

Developing our trainees

We want to develop the research skills & provide training for our clinicians. Through practical experience, training, and providing educational material, we want to make the world of research more accessible.