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SLIDE 1: Hello and welcome to the editorial podcast
series from the Asian Students’ Medical Journal. Today, I will attempt to elucidate
the thinking process which should be followed to develop a research question effectively.
Now, the primary objective is NOT to make your thinking process a regimented and rule-bound
activity, but just to titillate your research-inquisitive neurons and present an unembellished version
of practicable research rather than theoretically pristine but unattainable counsel of perfection.
SLIDE 2: As a young researcher myself, I have been
faced with the eternal dilemma of trying to narrow down and hit on a single research question
to deal with. Later on in this podcast, I will try to build an example using the general
principles I talk of. This could be used as an example exercise in zeroing in on a research
question after starting off from a broader area of interest.
SLIDE 3: Before we start building the research question,
it is essential to understand what the research question happens to be.
The research question deals with the uncertainty about something in the population that the
investigator wants to resolve by making observations or measurements or by implementing some interventions
and then analyzing the effects thereof.
SLIDE 4: So, in essence, the research question forms
the crux of the case. And even as we produce perfectly viable answers aplenty today, more
and more questions open up. Unlike the financial world, there seems to be no signs of a recession
in the production of good research question!
There is no denying the fact that the research question plays a key role in the whole business
of conducting a research project. From the writing of the proposal, to the determination
of methodology to adopt and statistical tools to use, the research question impacts egverything.In
fact, one may argue that for young researchers, the most important exercise may be perfecting
the art and science of developing a good research question than excavating the answers to the
same.
SLIDE 5: Which brings us back to the same question.
Most of us are aware which general area piques our interest, but find it difficult to zoom
in on something more specific. And this very dilemma brings us to the very important question:
where do research questions come from?
SLIDE 6: And, in what appears apparently counter intuitive,
the best answer to the question is that research questions come from pre-existing knowledge.
The cutting edge of knowledge for a particular problem is where one should start looking
for the research questions, as these answers are the key to generating newer questions!
However, this requires an in depth knowledge of the area concerned so that the student
interested in the topic can assess which direction to move in with his research question.
In case of medical students, this is the area where the role of a mentor becomes very important.
Whilst some argue that not all institutions have the infrastructure and academic diversity
to support an ambitious research question, it becomes the responsibility of the medical
student concerned to devise a strategy which fits the bill the best. I will talk more of
this when I discuss the fesibility of a research question.
Another interesting way out of this quandary may be to challenge conventional wisdom which
may not always be based on hard evidence. This may lead to some bruised egos and negative
results eventually, but it does not undermine the quality of the research question. Research
shows that very few negative results get published, but the fun, as they say, is in the journey,
and not just in the destination and conducting this kind of a research may be an equally
enthralling experience.
SLIDE 7: Rarely is a research question a stand alone
entity which comes off like a light bulb phenomenon. Of course, the light bulb must eventually
come on, but more often than not, it happens as a result of concerted effort over a period
of time rather than a one-off event.
Revisiting the research question after reviewing the available literature and thus building
up on the knowledge base around the question is a very good way to modify, enhance, or
in some unfortunate cases, even *** it.
Since the research question also determines, in part, the methodology to be adopted, it
becomes imperative to keep the question malleable until the whole project has been streamlined
at a primary level.
SLIDE 8: So, to summarize, the main challenge is to
find an important topic and then transform that into a feasible and valid research question.
SLIDE 9: Once the skeleton of the research question
has been assembled, the investigator needs to stand back and take the third person’s
viewpoint and ask themselves if the research question is worth asking. This is also the
phase where one can interact with people whose research encompass the field of interest of
the question to judge the suitability of the question. And one needs to be brutally honest
with oneself at this stage because if the question is not worth asking, the effort put
in working out the answer is a waste of time, money and energy!
SLIDE 10: Thankfully, as always, conventional medical
wisdom comes to out rescue with an aptly named acronym to assess the worthiness of the research
question!
SLIDE 11: To assess the feasibility of a research question,
certain materialistic questions need to be asked. Often, the medical student starts with
a great deal of enthusiasm to work on a research topic to find out that the plan is unfeasible
and has to drop out midway. This is nothing short of a heartbreak.
So, the prudent thing to do is to assess if the question can be worked on in the environment
you have to deal with. From my personal experience, I have seen that most o the medical schools
do not have the infrastructure to support very ambitious and expensive questions. One
of the ways to deal with it is to modify the question to suit the setting. Another slightly
unorthodox method is to approach institutes which are primarily involved in basic research
in your area of interest for laboratory and infrastructural support. Although this seems
to be like a daunting proposition at first, I have found out that most institutions are
glad to have medical students over for short periods working in line with their research
topics of interest.
However, one has to keep in mind, no matter how elegantly the question is framed, if it
is not feasible, there is no point in asking it!
SLIDE 12: The question has to pique the interest of
the investigator. Medical research comes with more than its fair share of red tapism, bureaucracy,
failured, lab disasters and unmet expectations. And unless the investigator himself or herself
is interested in the question, the project may be abandoned midway.
However you define your interest: whether as a method to get out of the rigors of medical
school and indulge in expansive analytical thinking, or padding your CV with certain
exams in mind, one must conscientiously answer the question if he or she is genuinely interested
in completing the work!
If the question is abandoned midway, there seems little reason in having asked it in
the first place.
SLIDE 13: Good research contributes new knowledge. A
study simply repeating what has been previously confirmed time and again is not asking a good
question. However, a question may not always be original. It may adopt a methodological
or analytical modification to find the applicability of the previously elicited results. It may
try to address specifically the weaknesses of a previous study and therefore keep extending
the horizons of existing knowledge.
However, when it comes it medical student research, not always is it an absolute requirement
to ask an obviously novel question. Since the purpose is to incite the interest and
introduce the student to research tools, an interesting question may get precedence over
a novel one.
SLIDE 14: Since the days of Auschwitz and Tuskegee are
behind us, ethical research is very important. Clearance from an Institutional Review Board
or Institutional Ethical Committee is an absolutely essential criteria to apply for research funding.
Special care must be taken when involving human subjects in the experiment. Additional
measures to secure informed consent must be in place.
One has to remember that asking an unethical question may lead to more harm being done
in the process of revealing an answer which may, in essence, be greatly beneficial. In
this case, the end does not justify the means. And we, as human beings, and doctors-to-be,
must follow the very first and foremost principle of doing no harm.
SLIDE 15: Although it is difficult to gauge the relevance
of the study from the question itself, without having started the inquiry, a good way to
have an idea of the relevance is to outline all the possible answers that the question
can yield, and then outline how it may impact the present body of knowledge in that field
or change policies in place or even open up new gateways for future researchers to follow.
SLIDE 16: Now that we know ho to judge whether a question
is worth all the trouble it is time to assess if the question is framed well enough to be
complete in all aspects so that it can guide the research methodology and arrive at a conclusive
answer.
SLIDE 17: And once again, a fancy acronym comes to our
rescue.
Patients imply the study group who are the main interest of the research question. In
case of interventional or experimental studies, the research question must clearly expound
the same. The best questions compare the changes in the study group vis-à-vis those in the
control or comparison groups to rule out any confounding factors that may play havoc with
the results. Sometimes, it is helpful to specify a time frame as well in order to control the
use of resources. This reminds me of an anecdote that a senior researcher once told me. This
last parameter is especially important if one is talking of this in Chile and some other
countries speaking a similar tongue, since in those countries PICO is a slang for an
expansile part of the human anatomy!
SLIDE 18: As it is evident by now, a good research question
has to undergo several stages of metamorphosis before it can evolve and manifest itself in
all its glorious splendor.
SLIDE 19: Now that we have gone through the motions
of learning how to set up a research question, it istime to applythis approach to zero in
on a research question starting from a broad field, like endocrinology, which happens to
be one of my areas of interest!
SLIDE 20: Digging around the literature in recent advances
in endocrinology reveals a lot happening on this front. From understanding receptors and
ligands in a new light to elucidating the role of hormones in carcinogenesis, from drug
designing to unmasking environmental contributions to the genetic manipulators of endocrine disorders,
the field is expanding at the rate of knots.
However, one thing which caught my attention was that very few studies have tried to look
back at the traditionally accepted drug regimes that are in place as a part of standard therapy.
So, we might choose to go rebellious and decide to challenge conventional wisdom in this area.
SLIDE 21: One of the drug regimens which comes to mind
almost immediately is the morning, empty stomach administration of levothyroxine for treatment
of hypothyroidism. Naturally, the question is why not at bedtime? What does the evidence
base have to say about that?
SLIDE 22: Quite surprisingly, for such a universal regimen,
there seem to be relatively few studies which look at the results of morning administration
of the drug. None of them are large and comprehensive and randomized controlled trials are hard
to come by. So, we end up devising the research question: why not administer levothyroxine
at bedtime instead of in the morning?
SLIDE 23: Now that the skeleton of the question is ready,
it is time to assess if it is indeed worth asking!
Since it requires the simple monitoring of serum T3/T4/TSH, which hypothyroid patients
on hormone replacement anyways need to do on a routine basis, it is feasible.
Since it falls *** in the middle of endocrinology, it caters to my interests, so I am more likely
to stick out with it! The relative paucity of evidence shows that
while it is not a newfangled notion, it is indeed a novel idea.
Since there will be no withholding of treatment and the patients will be informed, and monitored
from time to time to prevent iatrogenic hypothyroidism or hyperthyroidism in course of the experiment,
it is an ethical study.
And the relevance is obvious because even if it managed to refute the bedtime administration
of drug and prove it to be inferior, then there would be good, solid evidence in favor
of the conventional wisdom. SLIDE 24:
Now it is time to assess the PICO criteria fulfillment and since it only outlines the
intervention and none of the other parameters, it fails to qualify this hurdle. Time to evolve,
then!
SLIDE 25: Once the details are sorted out, relevant
literature, physiology and epidemiology studied up, it is a simple matter of filling in the
blanks to conform to the PICO parameters and hence make the research question not only
structurally complete, but also methodologically sound as well.
Clearly, the best method to answer this question is by conducting a rather simple randomized
controlled trial where patients would be segregated randomly in the control group of morning drug
takers and study group of evening drug takers.
SLIDE 26: And that brings out the research question
in all its opulent splendor! Now, if you are thinking of ripping off this topic for your
next ICMR STS proposal, then think twice, because some people in the Netherlands have
not only thought of it,
SLIDE 27: …but also published it! And quite surprisingly,
they have found that bedtime administration may actually be better than morning administration.
Now that was a study with only 105 participants in a population ethnically and genetically
very diverse from ours. Why not conduct one in our settings to see if the results tally?
Why not see how bedtime administration affects compliance? Are there an quality of life issues
with different times of administration? Just let the other, better, half of your cerebrum
go crazy!
SLIDE 28: That brings me to the end of this EdCast and
I hope now the puzzle of developing the research question is a little easier to unravel! For
more resources on medical student resources, go to the website of the Asian Students’
Medical Journal at www.ASMJ.info. More EdCasts, research tips, original articles, viewpoints
are there. Feel free to wade into the wonderfully intoxicating world of medical student research
with ASMJ!
Thanks.