Author: Laura Cottey, Tom Roberts / Editors: Rob Hirst, Govind Oliver / Codes: CC20, HAP29, SLO10 / Published: 05/11/2020
The core TIRED team: (From left to right) Tom Roberts, Blair Graham, Laura Cottey, Dan Horner
We write this as the TERN TIRED study has had its first accepted paper: ‘Need for recovery amongst Emergency Physicians in the United Kingdom and Ireland: a cross-sectional survey’ published in BMJ Open, check it out here[PO1] . This feels like an important milestone for TERN and almost a final milestone in what has been an incredible two-year process for the TIRED project. As our first inaugural project, in addition to achieving the aims of our study, along the way we have gained invaluable learning about the process of setting up a successful large multi-centre study. Hopefully TIRED is the first of many TERN studies. We wanted to share our reflections to help future trainees thinking about embarking on the process and to help smooth their path. To read the inaugural TERN manuscript, click here.
Develop an idea:
The process for any research study is a long one (although TERN is blazing a trail here as well with the CERA study). You need to be passionate about your research idea to be able to see it through. More than that though, you need to ignite others with passion for the topic to generate support, particularly when progressing to a multi-centre study. Identifying a clear clinical question, which is relevant to others is a good first step. The next step is to ensure you provide the support and evidence for why your research question needs answering; literature reviews, the James Lind Alliance Emergency Medicine Priority Setting Partnership research priorities[i] and peer focus groups can all be invaluable.
We were fortunate that for the case of TIRED, the initial research idea developed into a medical student single centre study[(LC2] and then evolved to the inaugural TERN study. Whilst not essential for all projects it might pay to invest time trialling your project on a small scale in your department to make sure a research project could be feasible and of interest to others.
Build the team:
Lots of people will help you along the way; from ad hoc conversations sharing information to people you need to work with every day to make research happen. TIRED was built on these impromptu conversations from identifying the ‘need for recovery’ concept with a human factors expert to a medical student undertaking the initial work. Attending events such as the RCEM Trainee Research Engagement Day can be helpful to build up your informal support networks.
A range of people will help you along this path, often at different times points of the project and with different skill sets. Seek expertise from those that have experience but peers can also provide that important voice of practicality. Varying personalities on this journey can be really helpful, identify your personal weaknesses and find someone who can complement them whilst appreciating you also need to be able to work effectively together over a long time period. A research project of this scale will allow you to learn a lot about yourself and your role as a leader and a team player. Leadership and teamwork are key to building a collaborative project and the time and effort that goes into this aspect of research should never be under estimated.
Dealing with knock-backs:
The process can be frustrating but remember to maintain positive and respectful relationships with all the different organisations and people you have to work with. You are doing research and by definition you are creating new knowledge, therefore no one has ever done the specific thing you are trying to do. Don’t be surprised if people say ‘no’. Take a breath. Pick up the phone and start understanding the rationale for the decision and you’ll work through it – it will likely result in a better research study!
TOP TIP = When you get a setback, identify the key decision makers and discuss with them directly.
The success of the TIRED study was due to the huge numbers of sites, principal investigators and data collectors that signed up to help. Key to mobilisation of this group was communication. This was conducted by emails via the TERN and PERUKI network but also by going out there and talking about it (over and over again!). Most people are probably fed up of us talking about ‘need for recovery’ now but our team presented wherever and, now with COVID, however we could to make sure Emergency Departments (EDs) heard about the project. This also included blog posts, twitter and emails. We also had a long lag time for planning and communications, this is really important to ensure that collaborators had enough time to get study leave, arrange local approval and advertise within their EDs.
Think about this at the start, not just once you’ve got data. This is certainly one of the areas we were most worried about. It is really important to engage with a statistician at the start of the process so they can input and help guide how to answer the research question. Don’t under estimate the cost (both in terms of money and time) of this valuable input and have realistic conversations about that at the beginning. If there is one thing to take away from this blog, it is apply for funding for statistical support.
TOP TIP = Apply for funding for a Statistician
There are a lot of ways to access funding. Local hospital charities, deanery support but we are lucky in Emergency Medicine with RCEM holding annual funding rounds for small projects. These are great for your first ever entry into funding. The process forces you to prospectively define and design your study. By doing this, you are more likely to engage local experts in the funding application and even if you aren’t successful by going through the application you already have buy-in from some local experts who will be keen to continue their support (and sometimes have secret money pots they haven’t yet told you about!)
TOP TIP = Engage local expertise
Planning the write up:
This takes a lot of time. By the time your project has finished data collection, you can guarantee everyone will have inevitably moved on in every aspect of life! We thought we had done the right thing and had a writing retreat but it still took over a year post that (we did also both welcome to the world a newborn each during that time!!). The writing retreat worked well at synthesising the results and we could have benefited from at least 2 further groups sessions to really drive forward progress.
TOP TIP – Book in at least 3 days, separated over 3-6 months to get together to write the paper. The first for results synthesis, the second for review of the draft manuscript, the final day for manuscript sign off.
From the start we were clear about the fact we wanted this piece of work to make a difference and with so many people giving up their time to either complete the survey or be a PI or data collector we needed to make sure that effort was valued. We spent a considerable time planning how we could get the message out there. Providing the study sites with a presentation, a thank you poster and coordinating social media we hope we have managed to reach as many people as possible with our results.
It is important to thank everyone who helped make a research project a success, this included everyone from our Sponsor to data collectors and we have continued to communicate with them post the study and let them know how their work and data has been disseminated.
 Smith J, Keating L, Flowerdew L, O’Brien R, McIntyre S, Morley R, Carley S; JLA EM PSP Steering Group. An Emergency Medicine Research Priority Setting Partnership to establish the top 10 research priorities in emergency medicine. Emerg Med J. 2017 Jul;34(7):454-456. doi: 10.1136/emermed-2017-206702. Epub 2017 May 4. PMID: 28473529; PMCID: PMC5502232.