Incomplete Idiots Guide to Research

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Here's the Incomplete Idiot Guide to Research....

How does one start on research? What is required initially is a research question—and obviously this should be a question that has not already been answered. A search through the published literature in the medical and scientific databases will give an early indication of whether there are already many research papers dealing with that issue. Discussion with colleagues in the field will also help determine if the specific research question is worth pursuing. javascript:emoticonp('')

Conducting a sufficient literature review can be a substantial task. But even after a vigorous and thorough literature review that does not reveal information about the proposed study, other reasons may exist that indicate a proposed question or hypothesis is not appropriate for clinical research. The study may simply not be important enough. Central to the ethical conduct of clinical research is the requirement that unless important information can be reasonably expected from the completion of the study, it is unethical to subject anyone to even a mere inconvenience. Importance is used in its broadest sense. Adding to the world's knowledge about human health, welfare, disease, or suffering and learning more about how humans function in their environment may well advance medical progress. The breadth of important knowledge to be obtained is wide. Nonetheless, justification for the study and the knowledge to be accrued as a result of the investigation is an important part of the process of shaping a clinical research question or hypothesis appropriate for involvement of human research participants.

Avenues for research ideas
What is the source of a research question for a new researcher? There are several possible avenues. javascript:emoticonp('')

1. Clinical observation and practice. In the course of clinical practice, a health care provider may make an observation about a clinical sign, technique or procedure or method of treatment, and this may lead to a question that can be answered by a research project. For example, if it is observed that a proportion of patients with alcoholic liver cirrhosis seem to present with Dupuytren’s contracture, then one could well ask whether this is just a chance finding, or whether there is a definite link between the two conditions. If the association between the underlying medical condition and the clinical sign is confirmed, it could be a valuable sign in the diagnosis of alcoholic liver cirrhosis. This could form the basis of the research question.

2. Trawling the literature. javascript:emoticonp('')When reading journal papers or articles in the medical literature, the author(s) may pose a research question. The reader can adopt or modify that to formulate his/her own research question. It would be a useful part of the research process if the reader also has some ideas on the possible methods that can be used to answer the research question. At times, several articles on the same topic in the medical literature may all point to the same unanswered research questions. There may also be occasions when there appears to be conflicting information in the literature. A research study may come to a different conclusion from another study, and an individual starting out in research may wonder why this is so. The details of the study design or methodology used or interpretation may explain some of the contradictory findings. And it may even lead to a proposal for a better or different study to resolve some of the apparently conflicting information.

3. Continuing professional development (CPD) activities. Research ideas may emerge in the course of or following CPD or continuing medical education (CME) activities. This includes attending presentations at scientific meetings or conferences, and discussions at seminars and workshops.

4. Media attention. Programs on television and items in newspapers on health issues may form the basis of a research question. Media attention can reflect public interest in an issue. An example is the controversy over use of mobile phones and brain tumours. It is uncertain whether the alleged links between exposure and health effects are real, and research into the area may provide a clearer view. javascript:emoticonp('')

5. Audit findings. Many organizations, including the Toronto East General Hospital, have regular audits of their activities. Audit enables the assessment of progress in service delivery, facilitates implementation of remedial action and improvement of service provisions. Discussions at audit meetings and findings from audit processes may lead to the formulation of research questions. For example, auditing a Hepatitis B immunization program can result in the question ‘Should determination of antibody status be done before and after immunization, or is it sufficient just to check antibody levels after vaccination?’ This question can form the basis of a research project.

6. Funding agencies. Organizations and agencies that fund research, e.g. the Canadian Institutes for Health Research (CIHR), Natural Sciences and Engineering Research Council of Canada (NSERC), and Social Sciences and Humanities Research Council of Canada (SSHRC), may publish a list of research topics for which funding is available. The topics indicate gaps in current knowledge and point to possibilities for research. A new researcher can use such lists to formulate research questions, prepare a research protocol and submit this for research funding. Such lists may also emerge following invitations from funding agencies for submission of research ideas for consideration. Publications and information from these agencies can be a ready source for research ideas.

7. Self-generated research questions. javascript:emoticonp('')Occasionally, someone interested in research may initiate a research question just through thinking about a particular medical or scientific topic. This may result because the individual has a specific interest in that topic. Or perhaps it is part of the inquisitive nature of successful researchers.

Formulating the research question

To craft an appropriate study question, the following questions can be used to guide the process:
1. What is it that I want to study? What am I most interested in learning?
2. What does the literature say about this topic? How widely has this topic been studied in the past?
3. What was the scientific path leading to the current results?
4. Logically, what is the next question to be answered or hypothesis to be tested to advance the knowledge and understanding of this phenomenon?

By asking these questions, and discussing answers with colleagues, the clinical researcher will be on his or her way to shaping a scientifically and ethically sound question for clinical research.
Some of the characteristics of a good question are:
(a) It should be a real question, answerable in some form (as opposed to pure description). Projects that seek to "describe the role of..." tend not to be immediately useful.
(b) Better still, it should be susceptible to a simple answer (yes or no; how much; which option should be selected). This also helps the researcher know when the project is finished; open-ended questions lead to open-ended projects.
(c) An answer should be feasible with the resources available. It may be necessary to "cut the coat to fit the cloth", narrowing down the question to what the time and budget will allow.

Formulating a hypothesis

A hypothesis results when the questions are transformed into statements that express the relationships between variables as an “if/then” statement. For example, if the question is “What effects does viewing violence on television have on boys?” then the hypothesis could be: Boys who view aggressive acts during prime-time cartoon shows are more likely to exhibit aggressive behaviours right after the television viewing session than are boys who watch nonaggressive acts during prime-time shows. A good hypothesis poses a question in a testable form. Good questions lead to good hypotheses, which in turn lead to good studies.
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Conclusion
There are many possibilities for posing research questions and finding research ideas. It is helpful for a new researcher not to be overwhelmed by a multitude of research questions. This tends to confuse and may make research appear to be an unmanageable activity. It is often best to limit the research questions to a few important issues. And each research question should be clear, concise and answerable.
Please note that answering an important question, or testing an important untested or inadequately tested hypothesis, does not ensure the appropriate design of a study question or hypothesis.
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