On every ward round I ask myself the question:
      “How can I improve the treatment of the patients in front of me?”

Some of the current therapies don’t seem to have much evidence base behind them. This may or may not be particularly evident until the literature is examined.
So how do you start with a research career or simply a research project? How do you improve the treatment of your patients?
I see two distinct pathways.

1. Ask your own question that you are really interested in
OR
2. Look to a supervisor and use his/her expertise to answer one of the questions in their quest to improve knowledge

There are pros and cons of both.

Feasibility

The Right Place?

If you have the fire in your belly to get to the answer to a question, you must be able to have the facilities at your disposal to be able to achieve the required answer. For example, it is no use wanting to do a prospective clinical trial on post cardiac surgery patients when you work in a unit that does not do cardiothoracic surgery. In other words, tackle a problem in the patient population you have access to. Alternatively, if you are keen to do a project relating to cardiothoracic intensive care, do retrospective work with colleagues at a cardiothoracic centre; or do a systematic review and meta-analysis of some cardiac surgical population via the library.

The Right Numbers?

Remember that clinically based research is dependent on patient numbers. Even at the Royal Brisbane and Women’s Hospital (RBWH), a tertiary burns centre, a research project on burns would have a small sample size. It is therefore often better to look at what is commonly in front of you when deciding to embark on clinical research. A project looking at molecule x (or outcome y) in traumatic brain injuries at the RBWH ICU will likely have more patients to enrol than looking at molecule x (outcome y) in burns patients for example.

The Right Person

Some ICUs have consultants that have pre-formed questions they want answered but haven’t the time to perform the tasks involved. This type of project often has the benefit of some previous thought process and comes hopefully with some supervision. As a junior starting out, I would suggest you do some homework on the supervisor (as he/she should do on you) and see the previous outputs from this supervisor’s team. Performing a huge amount of work on a project only to find the original task is not feasible is soul destroying. Some of the principles above of project feasibility are also applicable to supervisor’s proposed projects.

Helpful People

Most tertiary ICUs also now have Research Co-ordinators who have a vast experience in what is needed from an Ethics and Research Governance point-of-view. Get to know these people as they are a HUGE asset to have access to. The local librarian can assist with your literature search. And finally, but not least, is a friendly statistician My advice is to introduce yourself to these three parties early in a research journey.

Summary

1. Pick a question
• One of your own that you are interested in, or
• Look to a supervisor to provide/guide a question
2. Examine the current evidence base
• A librarian can help you get started on a literature review
3. Make an assessment on the feasibility of your research project
4. Seek help/resources early, including from:
• Research Co-ordinators, and
• Statisticians

References and Resources

1. From ideas to studies: how to get ideas and sharpen them into research questions – PMC (nih.gov)
2. Developing a research question (unimelb.edu.au)
3. Research questions, hypotheses and objectives - PMC (nih.gov)
4. FINER: a Research Framework | Elsevier Author Services Blog

Section Author

Emeritus Professor Lipman
Prof Lipman worked solely in Intensive Care Units (in three countries) for over 40 years and now that he has retired from clinical work (but still involved in clinical research) is becoming a beach bum in the Northern New South Wales town of Casuarina

Trainee Reviewer

Dr Jeremy Smith
Jeremy is an ICU Fellow with interest in echocardiography, ECMO and education. Outside the ICU world he enjoys time with his family including a recent addition and their Cavoodle (George), along with keeping active through running and CrossFit.