A guide for those of you with little research experience to help get your thoughts together and point out some common pitfalls for you to avoid. Click below to expand the content and read our useful guidance on getting started with a research project.+ Why do research?
There are a large number of reasons why you want to do a research project. A good research project is always much more work and much harder than you initially think, it is therefore worth looking at your motives right at the beginning.
If you have been told that you have to do research or feel that you have to get some research published to pad out your CV you are unlikely to successfully complete a project (and it would be worth discussing with your trainers whether learning about critical appraisal and audit would be a better use of your time).
Remember that starting but failing to complete a project may look worse than not doing any research at all (especially as there are alternative academic areas in which you could show excellence, such as audit or BETS). However, if you motivation is a desire to know the answer to a burning question, a desire to take on the intellectual challenge of academic methods or a fascination with a particular part of Emergency Medicine – read on!
What do you want to achieve?
Be realistic about what you might achieve. For trainees the goal of your first research project (and probably the next few as well!) will be to learn about academic methods, rather than to produce information that will change the future of Emergency Medicine. At this early stage your research may be a success (in terms of your academic development), even if it does not get accepted for publication. You should bear in mind that the primary endpoint should be your personal development, however there is a satisfaction at also becoming expert in a particular field, producing original information and learning self-motivated work.
As you develop your skills in academic methods your objectives will change, and as the quality of your research improves you will start to answer larger and probably more important questions. Like anything else in medicine acquiring these skills takes time and practice.
Research and Academic Careers
Very few Emergency Medicine trainees will be intending to follow a academic career, most will become full-time NHS Consultants.
However it is not only academics that produce excellent research! A career is an awfully long time, and we all need stimulation to maintain our interest in our work. For some, research provides this additional interest. However, fitting good research into a busy NHS Career can be difficult. If you are planning to do this learning about research methodology is a good idea. Those in an academic career may have more time for research, but have additional pressure from teaching, university administration and their honorary NHS commitments.
If you are contemplating a career in academic emergency medicine talk to those who are already embarked on this pathway at an early stage (and make sure that you know a good psychiatrist!).
This section is intended for those of you who have not had much experience at running a research project. It is very, very , very (is this enough ‘very’?) important to adopt a structured approach from the beginning and get expert advice early on. This sounds simple and obvious – but you would be amazed at how many people ignore this advice in their enthusiasm to rush to designing a data collection sheet!
If you ignore this advice your project will fail – it is as simple as that.
A successful research project requires a structured and disciplined approach. There are a series of stages to go through. These have to be done in the right order – it may not be immediately obvious to you why this has to be done, and it may seem like a waste of time to give so much attention to the details of working out the question, the exact methods and the way that the data will be analysed before actually collecting data. However, if you follow this advice you are much more likely to actually complete a successful project.
This advice comes from people who have made the mistakes (see) so it is well worth following. You should have planned all stages of your project, including the analysis and presentation of results before starting data collection (as data collection comes fairly late on in the Structured Approach to research). Planning may include the collection of some pilot data. It is often a good idea to write up the project before you start data collection! This may sound odd – but it is the best way of making sure that you have undertaken a structured approach (writing a research grant application has the same effect).
First write the Introduction (for which you will need to do a literature search and formulate the research question), then write the Methods (being specific about all aspects of the research), then write the Results, leaving gaps to be filled in when you have collected the data (this will make you think about data analysis and presentation). All of this needs to be done before any data is collected!
If you have an idea for a trainee led research project, provide us with a summary here and it will be discussed at the relevant TERN meeting. If the wider group like the idea, then we can provide academic support from the RCEM professors, research committee and a research design service.
There are a number of recurrent themes that come up when we look at why Emergency Medicine research projects fail. Projects rarely fail due to the underlying idea being bad – most failures are due to not having a structured approach, poor supervision or poor motivation.
A successful research project requires a structured and disciplined approach. There are a series of stages to go through. These have to be done in the right order – it may not be immediately obvious to you why this has to be done, and it may seem like a waste of time to give so much attention to the details of working out the question, the exact methods and the way that the data will be analysed before actually collecting data.
However, if you follow this advice you are much more likely to actually complete a successful project. This advice comes from people who have made the mistakes so it is well worth following. You should have planned all stages of your project, including the analysis and presentation of results before starting data collection (as data collection comes fairly late on in the structured approach to research).
Planning may include the collection of some pilot data. It is often a good idea to write up the project before you start data collection! This may sound odd – but it is the best way of making sure that you have undertaken a structured approach (writing a research grant application has the same effect). First write the Introduction (for which you will need to do a literature search and formulate the research question), then write the Methods (being specific about all aspects of the research), then write the Results, leaving gaps to be filled in when you have collected the data (this will make you think about data analysis and presentation). All of this needs to be done before any data is collected!
When starting to think about your project there are 10 things that you should consider from the beginning:
1. Define your research question
Research should be driven by the need to answer a question. The question should be well-defined, important and relevant. Having a well-defined question will help guide you through the many methodological problems that lie ahead. Issues such as who to study, what intervention to study, and what outcomes to measure should be determined by the research question. See our document – Defining and refining your research question.
2. Make sure your idea is original
If your idea is a good one someone else may already have thought of it. Do a reasonably thorough literature review using Medline and the Cochrane database. Also, check the National Research Register for work in progress. If someone has already investigated your idea, don’t necessarily give up. A lot of research is flawed or irrelevant to local or emergency practice. Maybe you can do it better or in a more relevant setting?
3. Draw up a research proposal
Use your well-defined research question to guide you and our document Writing a research proposal to help you. Writing a proposal is a good way of working out what difficulties you will face before they arrive.
4. Decide what methodology you should use
Your choice of method should be determined by your research question, not vice-versa. A basic introduction to the various types of research methods is available on this website. Work out what type of question you are asking and then look at the relevant document.
5. Find out what skills you will need
Research is a professional business, you need to know what you are doing if you hope to be successful. Skills can be acquired from many sources, but there is no substitute for talking to someone who has been there before. This website has some basic resources aimed at helping you to communicate effectively with experienced researchers. Use them to develop your idea and write your proposal.
6. Work out what resources you will need
All research consumes resources. Mostly it consumes your time and energy. Do not assume that either are boundless and use them wisely. Plan your project carefully then double all your estimates of the time each stage will take. Estimate your sample size and plan recruitment. Acquiring major research funding is a difficult business, but many smaller grants go unused. Ask your research office or look at our sources for funding.
7. Work out what help you will need
Doing research on your own is hard work. You can easily make mistakes without realising. Formal research supervision is the best option but very difficult to come by. Hospital and health authority research offices will be able to point you towards taught courses and the resources to fund them. University departments of epidemiology, statistics and health economics can often give up to an hour of advice without charge. Contact experienced researchers in emergency medicine or related specialities. Whatever you do, make sure you have a well-defined idea, have searched the literature and have at least attempted to write a protocol before you seek help.
8. Get ethics committee approval
Always consider the need for ethics committee approval. Even retrospective case note review carries issues of consent and confidentiality. Projects that do not directly involve patient contact (e.g. case note review) will usually be approved by Chairman’s action, without full committee review. Any project involving patient contact, even to simply complete a questionnaire, will require ethics committee approval. See our document on How to get ethics committee approval.
9. Establish proper research governance
Things can go wrong in research- adverse events can occur, data may be lost, patients or staff may complain or results may be flawed. Just as with clinical practice, make sure you have the skills to manage your project, the supervision you require and everyone understands who will carry the can if it all goes pear-shaped. Ensure that you know what you are responsible for and who you are accountable to. See the Department of Health guidance on research governance.
10. Pilot or die
No matter how carefully you have planned your research you will almost certainly have overlooked something. The only way to find out is to get out there and start doing your research – and then stop before you waste too much time. Analyse the data you have collected so far. You will almost certainly find out something very important that you wish to change in your protocol. Nobody ever regrets pilot work.
There are a number of websites that give information about research methodology. These pages aim to point out specific aspects that are particular relevant to emergency medicine research and to give you links to articles that we think are worth reading. However, although reading about specific methodologies is important, it is also vital for you to get advice from someone who is experienced in research using that particular methodology.
Read here the BMJ’s curriculum guide for experienced researchers.
Surveys are an important means of collecting healthcare and health related information from a sample of people in a standardised way, to better understand a larger population. There are a range of methods used to conduct surveys, including questionnaires and in-depth interviews which can take place via phone, mail, email, and in-person. The benefits of survey research are that it allows researchers to collect empirical data in a relatively short period of time. Depending on the design and scope, surveys can collect data on a representative sample of people, particularly when samples are randomised, or purposive nonprobability sampling is used. Information on a survey designed to collect health data might focus on patients, providers, or hospitals and doctor’s offices.
Like all research approaches, survey methods have disadvantages, and are therefore not always suitable for the type of research being conducted. It can be hard to get detailed information using survey methods, and sometimes people choose not to answer more difficult questions. Another weakness of surveys is that it relies on the participants memory as the source of information, meaning sometimes participants will not remember important details correctly or at all, this is known as recall bias. Surveys can have low response rates, and those who do not have access to the medium through which the surveys are distributed are excluded. For example, homeless people may be excluded from a survey conducted via mail, and those without health insurance who cannot afford to see a doctor may be excluded from surveys conducted by health care providers.
When designing surveys, it is important to design questions carefully so that they are clear and understandable to the respondent, produce results relevant to the purpose of the survey. It is vital to avoid using ‘leading’ questions, or questions that prompt a specific desired answer, as they often draw from assumptions and biases, and tend to lead to unreliable results.
The BMJ have a guide on how to plan and conduct a survey.
The National Institute for Health Research have also produced a surveys and questionnaires guide.
These pages list a variety of web-based resources that may be helpful in developing your research project. Many are cited in the supporting documents to this site. Web based resources are constantly changing and many new resources appear. Please let us know of any useful resources that you find. Please let us know if the links no longer work.+ General
Good Clinical Practice
Writing and submitting a paper
RCEM Research Funding Opportunities.
Taught courses in research methods vary from one day courses providing an introduction to statistics or qualitative methods, to Masters degree courses in Health Services Research. These courses usually cover quantitative and qualitative design and analysis, health economics, epidemiology and statistics, systematic reviews and critical appraisal. They provide a good general grounding in research methods for anyone interested in pursuing an academic career.
London School of Hygiene and Tropical Medicine
Masters courses in Epidemiology or Health Services/Systems Research. The Masters in Epidemiology is available by distance learning.
Bristol University Department of Social Medicine
Short courses (2 to 5 days) in research methods, statistics, health economics and qualitative research.
University College London Research Methods for Health Professional
One year course in quantitative and qualitative research methods aimed at junior doctors.
The Masters in Health Services Research– takes one year full-time or two years part-time.
University of Leeds – the MA in Health Service Studies (Research) is a one year full-time, or two years part-time, Masters course in health services research methods.
Research in Health Care. Crombie I K & Davies H T O. John Wiley and sons.
An excellent introduction to research methodology. Well worth reading before you commence any research project.
Clinical Epidemiology: A Basic Science for Clinical Medicine. Sackett D L, Haynes R B, Guyatt, G H & Tugwell P. Little, Brown and Company.
The ‘bible’ of evidence based medicine. A good way to ensure your research is favourably appraised is to understand critical appraisal before you start.
Epidemiology in Medicine. Hennekens CH, Buring JE. Little, Brown and Co.
Basic epidemiological principals lie behind a proper understanding of research methods. This is a good, readable book to remind/familiarize you with the key issues.
Methods for the Economic Evaluation of Health Care Programmes. Drummond M F, O’Brien B, Stoddart G L & Torrance G W. Oxford Medical Publications.
Essential reading for anyone contemplating an economic evaluation. Also useful if you want to understand what health economists are talking about.
Randomised controlled trials. Jadad A. BMJ Books.
A very readable book covering the key issues that need to be considered by anyone undertaking, or wishing to understand, a randomised controlled trial.
Medical statistics: A Commonsense Approach. Campbell M J & Machin D. John Wiley and sons.
Statistics are sometimes seen as just a p value and a funny sounding test that gives credibility to your study. This book explains the many valuable ways that an understanding of statistics can improve the validity of your research.
Practical Statistics for Medical Research. Altman D G. Chapman & Hall.
A more detailed statistical text yet starting from an assumption of little statistical knowledge.
Statistics with Confidence. Altman D G, Machin D, Bryant T N & Gardner M J. BMJ Books.
Medical journals are encouraging researchers to move away from hypothesis testing, with p values, and towards estimation, with confidence intervals. This book provides the explanations and simplifies the process by including some simple to use computer software.
Health Services Research Methods: A Guide to Best Practice. Black N, Brazier J, Fitzpatrick R & Reeves B (Eds.) BMJ Books.
An advanced text relating to recent advances in research methodology.
How to Write a Paper. Hall G M (Ed.). BMJ Books.
Written by a variety of authors who have published research or been involved in the editorial process. Even if you don’t agree with what they say, you would be wise to take note if you want your research to be published.
Qualitative Research in Health Care. Mays N & Pope C. BMJ Books.
A concise introduction to qualitative research containing papers originally published in the BMJ.
Information on Good Clinical Practice training for Emergency Physicians and key documents from the Research and Publications Committee.+ Good Clinical Practice for Medicine Research
Training in Good Clinical Practice for medical research (GCP) is required for everyone who is taking any part in medical research.
The 2021 RCEM Curriculum requires evidence of active participation in research, including recruitment to clinical trials, throughout training. EM trainees are therefore encouraged to complete GCP training as early as possible on their training schemes and maintain certification until completion of training.
The previous RCEM GCP training package is now no longer recognised or accepted by many sponsors, and we are now suggesting that RCEM members complete the NIHR GCP training available here. This is the same certification required to continue involvement in research as a consultant.
You then have a choice of completing either the ‘Introduction To Good Clinical Practice (GCP) ELearning’ (if you haven’t previously completed the course) or the ‘Good Clinical Practice (GCP) Refresher ELearning’. Your NIHR GCP certificate is valid for 2 years (as opposed to a year with the previous RCEM GCP training package) and in future you can recertify through the Refresher module.
Note that for some research studies it may be possible to complete a study-specific GCP (e.g. the Recovery trial) rather than the full NIHR GCP training package. However, if you have a valid NIHR GCP certificate, it will cover you for all research studies. For those of you with existing RCEM GCP training certificates, these will remain valid until 1 August 2022, although sponsors may require additional NIHR GCP certification.