in the UK, called the MIMIC study, run by the BURST collaborative. The study was looking at patients presenting to the emergency department with renal colic (pain secondary to a kidney stone). I emailed the study lead to register my interest in collecting data on 50 patients at my local hospital. I also found one of the urology consultants at my hospital to ask if he would be interested in being the supervisor for this project. I then applied for ethical approval in my hospital, using the ethical application letter provided for me by the lead author.
Once this was approved by the ethics department, I was given an Excel file by the lead authors, with a number of pieces of information to collect on each of the 50 patients. Doing this took some time, including figuring out which IT systems to use. The MIMIC study involved 71 hospitals worldwide. The study was a great success, led to a number of presentations at national and international conferences, and received a number of prizes as well. The presentations were shared among the collaborators so that a number of people had the opportunity to present. I presented the findings of the study to my local hospital's urology department. The findings were also published in the British Journal of Urology, with all of the collaborators named. Although I took a peripheral role, the study was a worthwhile endeavour and a good chance to gain experience in research without having to do it all alone!
One alternative to becoming involved in a collaborative research project is to lead your own collaborative study. It is without doubt more work to do so, so I would recommend becoming involved as a collaborator first. However, the rewards can be immense, and if you have the time and the motivation, leading a collaborative is a great experience.
Case Study 1.3 Prostate cancer research collaborative
During some dedicated research time, I had the opportunity to lead a nationwide study throughout Ireland that sought to collect information on men undergoing prostate biopsy and to create an Irish prostate cancer risk assessment tool. Under the guidance of my MSc supervisor, I met with each of the department leads in urology at all eight tertiary urology centres operating under the National Cancer Control Programme in Ireland. I presented a research proposal to the heads of department, seeking to recruit patients for the study from each centre. I then completed the ethical review board applications for each hospital and recruited members to assist with the data collection. The number of patients recruited to this study was more than 4000. My role also included working on the statistical analysis of the data and enlisting the help of the biostatistics department at my university. The next step was the dissemination of the research findings and presentations at local, national, and international meetings. The project has led to a number of publications, and the research project has continued with patient recruitment and the development of more refined risk models, an ongoing interest in my research team.
As you can see, the creation of a collaborative project gives the opportunity to engage in a multi‐institutional project with a large number of clinical and research teams, to prepare and present research proposals, to complete ethical review board applications, to collect large numbers of data, to analyse and interpret the results with the appropriate statistical methodology, and to disseminate the findings. Although it may seem like a daunting task, it is incredibly rewarding, and throughout the sections in this text, we will discuss each of these stages and how to do it for yourself.
Collaboratives don't need to be big, formal organisations with national or international interests, as previously described. And, while large collaboratives are a great way to get started in research, or indeed, get your name on a publication, the topic of research chosen by collaborative leads may not be of particular interest to you, and being listed along with a very long list of co‐authors may not appeal to you.
Therefore, it may be best to form what we term a ‘pseudo‐collaborative’. This is a small group of individuals who may share the same interest in a topic as you but are at other geographical locales and have different key skills and knowledge to bring to a research project.
Case Study 1.4 Learning outcomes in surgery collaborative [4]
I decided to pursue my interest in the teaching of surgical skills to Foundation Year 1 (FY1) doctors. This was important to me because this was the level at which I was working, and I was keen to find the best and easiest way to acquire surgical skills to help me on the way to becoming an ENT surgeon. I discussed this with my mentor, a foundation training programme director who was also a surgical consultant, and we came up with a curriculum of work‐based assessments that, we felt, would prepare FY1 doctors for surgical training as well as allow them to enjoy their surgical FY rotations.
With the idea formed, it was important to recruit team members with expertise and reach that I lacked. I created a PowerPoint presentation with the idea and pitched it to colleagues at my level with greater statistics and recruitment expertise than I, as well as my former professor of surgery, all of whom I found to be receptive. The paper was later published, with data from across the UK and Ireland, which would not have been possible if working without collaboration.
1.3.7 Case–control study and cohort study
Original research is arguably the most important type of research to perform and should be the goal. The first step in original research will be to identify an interesting clinical question and then design a study to attempt to answer the question. For example, if we consider migraine‐type headache, we could ask: what is the relationship between patients' migraine headache and patient clinical features? Are there any risk factors that predispose patients to migraine headache, such as age or weight? We can then look at a group of patients with migraine and a group of patients without migraine and compare the findings in both groups. This would be termed a ‘case–control study’. These sorts of studies are retrospective in design and look back at risk factors in patients with a defined outcome (i.e. a diagnosis of migraine headache or not). Case–control studies can be an excellent starting point for original research because they are cheap and easy to perform.
In contrast to this, cohort studies look at a population of patients and compare those who were exposed to something and those that were not and then see what the outcomes are in each group. A classic example of this type of research is the Framingham Heart Study [5], which began in the 1940s. This study followed large numbers of patients from the beginning of the study and waited to see which patients developed heart disease. The researchers then looked back at the clinical features that differed between those patients who developed heart disease and those patients who did not. This study found correlations between heart disease and risk factors such as smoking, high cholesterol, and high blood pressure. The disadvantage of this type of study is that it requires large amounts of funding and takes a long time to conduct. Therefore, although this type of research can be very valuable, it is not the ideal place to start.
1.3.8 Randomised controlled trial
A randomised controlled trial (or RCT) is a very important study design utilised in medical research. It involves recruiting a cohort and randomly assigning the patients in the study to receive one treatment or another. In a double‐blind trial design, the patients and the researchers also don't know which treatment the patient has been assigned. These trials are the best method of determining the optimal treatment strategy for patients in medicine. This method is commonly used in oncology for comparing new cancer treatments to the current gold standard treatment.
1.3.9 Systematic review and meta‐analysis
This type of research involves summarising all of the research that has already taken place on a particular topic. There is a very detailed methodology to follow in conducting this sort of research, and the meta‐analysis is also carried out in a particular fashion. This type of research can be very time‐consuming when performed for the first time, but it can be an excellent way to gain an in‐depth understanding of a topic and can also be very useful if you cannot identify a research question for a piece of original research.