Information

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 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.

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. 

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.

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.

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.

As a growing network, it is vital we are transparent with what projects we support and we select them. We want to help our trainees by providing great research opportunities which are of benefit to them. As a result, we have to have a degree of selectivity with what we ask our membership to work on and take forward, as we get asked to help on a lot of projects. As a result, we’ve developed a hierarchy of projects and how involved TERN will get in each. In this way, we ensure our membership are involved in these decisions.