Research, ICU Training, and the Formal Project – by Ed Litton
HomeResearch, ICU Training, and the Formal Project – by Ed Litton
The ICU community in Australia and New Zealand continues to produce some of the most important clinical research into critical illness. For a couple of relatively small countries clinging to the bottom of a big globe we punch well above our weight. This is at least in part due to the high quality of our intensive care training, the culture of collaboration and cohesion within the specialty and the efforts of many exceptionally talented researchers.
For those currently training in intensive care this is an exciting time to be starting out in this young and growing specialty. Improvements in the economic and health conditions of major sections of the world population increases the interest and ability to treat critical illness. Pragmatic and relevant research questions continue to be designed and answered locally in our ICUs and inform the management of those caring for an ever increasing number of critically ill patients.
The fundamentals of research are also the fundamentals of good clinical practice. Irrespective of whether we go on to publish multicenter trials in the New England Journal of Medicine, the patients we look after are best served when we understand the evidence on which their treatment is based. Additionally and perhaps more importantly we must be able to recognize dogma and uncertainty in our management strategies and be able to formulate this as a question. To put it another way as the famous American cowboy Will Rogers once said:’ It ain’t so much what we don’t know that gets us into trouble, as what we do know that ain’t so.’
So, after such a lofty opening salvo, why is the formal project often near the bottom of a long to do list for the trainee? Competing priorities and the need to attain a high level of core clinical knowledge and competence play a part. Perhaps also it is the inadequacy of our formal training as medical students and junior doctors to properly equip us with the skills necessary to undertake research, perhaps this can be part of a future discussion on this site.
With the ghostly specter of the fellowship exam haunting every waking and sleeping hour, too often the formal project is brushed aside as an inconvenience or yet another hurdle to clamber. Dipping your toes into research is seen as an important part of specialty training and is mandated in some form or another by most of the postgraduate medical colleges. The specific requirements however differ. An emphasis more on understanding the implications of how research is conducted and its critical appraisal is a welcome recent development in some colleges, noteably ACEM, that now accepts specific postgraduate research and critical appraisal modules from accredited universities in lieu of a research project. To my mind this is something worthy of consideration within our own college.
For CICM trainees, sound advice on the formal project can be found at on the college website www.cicm.org.au/formalprojects.php. Much useful information is also provided on this website and in particular the article on research in paediatrics by Jan. My personal opinion is that the formal project is necessary but not sufficient to equip a trainee for post-fellowship life. In order to maximize the enjoyment and benefit of both the project and clinical work in general, it is first vital to have an understanding evidence based medicine. EBM is an often maligned term drawing sniggers and mutterings of placebo controlled trials of parachutes, it is nonetheless fundamental to how modern medicine should be practiced.
On last look, www.amazon.com had 8 used copies of the invaluable Users’ Guide to the Medical Literature priced at $0.01USD. I havn’t conducted a cost-effective analysis but for 1 cent there are probably more QUALYs to be gained in reading this essential book than a lifetime of discussions on activated protein C in sepsis.
Building and maintaining a research interest post fellowship starts with first understanding what is involved. Collaboration in larger groups, questioning and advancing science and the potential to impact more than the single patient at the end of your central line or endotracheal tube can be enormous draw cards, but fundamentally you just need to work out whether you like research or not.
This question doesn’t need to be answered definitively during the training period but a lot can be done to test the waters and get some guidance. The ANZICS Clinical Trials Group (www.anzics.com.au/ctg/ctg-scientific-meetings) runs three research meetings a year where current projects and the results of studies undertaken by established and early stage ICU researchers are discussed. The flagship ‘Noosa Meeting’ held in March every year is an excellent place to start to get a feel for the enthusiasm, breadth and quality of research currently being conducted as well as gain some ideas for formal projects.
For those with an interest in research there are a large number of short courses, diplomas and full Masters programs available to develop a solid base in research skills. The modular components may allow the flexibility to start a course while still in training.
For those simply wanting to navigate the formal project it is a good idea to start thinking of a topic early in the training period. Enlist the help of your SOT and those in your unit with an interest in research, find a project that interests you and if this is your first attempt at research don’t be too ambitious. I’m not sure if the CICM keeps a list of all the projects successfully completed by trainees, I think this could be a valuable resource. An alternative is looking through the abstract of all the presentations for the Felicity Hawker Medal at the yearly ASM to get an idea of what sorts of projects have been conducted.
This website presents a fantastic opportunity for trainees to discuss research issues, share ideas and potentially develop collaborative projects.