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TERN January 2019

Author: Tom Roberts / Codes: CC18 & CC2O / Published: 31/01/2019

Producing practice-changing research via a network that doesn’t exist, using trainees without any research experience, in a time when Emergency Medicine is under significant clinical strain is always going to present challenges. But within 6 months we’ve done it!

What! How’d that happen? I keep having to remind myself of the remarkable progress that TERN has made in 6 months. Our ambitions are so grand – a 10,000 patient observational cohort study (SHED) and a nationwide Need for Recovery validation study (TIRED) – that the fact we just completed a 22-site service evaluation study, using 37 trainees and involving over 400 patients, seems to disappear under the mountain of work we are about to do.

This shouldn’t be the case. Completing HED:1 (Headache in Emergency Department) is a gargantuan achievement in the timescale. And the main reason behind the success is you. There is so much enthusiasm from everyone I have had the pleasure of talking to. Doors are being opened for TERN, money is becoming available and opportunities are being given. But the most important factor is trainees want to do the work. TERN has tapped into a simmering pot of passion and energy that is inspiring to work with. We have regional representation from every part of the UK and Ireland, a space on RCEMLearning that already has over 12,000 views and two massive projects that are going to challenge the way that research is done.

However, the network isn’t perfect; we are still learning the skills to facilitate multicentred research and working out how to unravel the bureaucracy of research approvals. We do though have very sage guidance. Our energy and passion are not being frittered away by doing senseless projects. With the support of Prof Dan Horner and all of the academic faculty at the RCEM, we are being given the freedom to be brave, bold and ambitious but the support to make these ambitions a success.

All TERNs are working hard

TERN is starting to venture into unchartered territory. Trainees as principal investigators of studies has been done before but rarely. Stripping back data collection to the bare minimum is going to be a new trend that TERN hope to lead on. We are trainees and we understand the constraints we are under, so we have challenged ourselves to be ruthless with data collection. Every single data point is being scrutinised to assess its importance. Every second we can save a trainee during data collection will make them more likely to contribute in the future. Gender. Do we need to know? Blood pressure. Why? Mode of arrival. Not anymore.

So, we are stripping collection to its minimum and, also, to increase efficiency we are being innovative in how data collection is constructed. Vital pieces of data need to be collected prospectively, whilst speaking to the patient to ensure accuracy, but others can be left for later. By front-loading crucial bedside questions and leaving everything else to be filled out off the shop floor, it allows us to be precise but also maximise recruitment 24/7.

What next? The fact that you are reading this shows we have come far, but you are still probably in the minority of trainees. TERN needs to continue to work on its self-promotion but also its relevance. By answering questions that matter to trainees, in a way that develops them as individuals and helps their careers, we will be able to grow the size and scope of the network and, in turn, our studies.

Feeling inspired to raise the profile of this research in your department, but too busy? Don’t worry, TERN won’t dominate your time. We want to harness people’s enthusiasm but not exhaust it. So how do you prepare to join in? Start building a team of trainees together, email me, ask me for coffee money. Once there are a couple of you involved in your department, you will be ready for TIRED in April – our first attempt at flash mob research where we aim to collect all the data in one week. Then, come the summer, we will attempt to validate Perry’s 6 hour CT head rule in Subarachnoid haemorrhage. For this, you and I, will need a fair bit more coffee money – It’s a bigee!

TERN@rcem.ac.uk

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