Research Without Test Tubes

When I first mention I’m trying to do a PhD to people, they assume that I mean something with labs and coats and magic liquids. I have no idea why they would get that idea from media portrayals of people who do research.

All science liquids are also brightly coloured.

All science liquids are also brightly coloured.

What they don’t appreciate is not only do I not get the PhD showbag with the white coat, protective eyewear and cocktail set is that a lot of my PhD is not (so far) about “researchy” stuff like that. In the 2 years of study set-up a lot of it has been about a bunch of skills I didn’t expect to pick up (as mentioned here and here). I’m not developing pipetting skills for stock photo shoots, I’m doing other bits to make the project work.

The Messy World of Prehospital Research

For so many projects, data is king. Without data, there’s no real stuff to measure. And without real stuff to measure I might as well work on writing homeopathy manuals and horoscopes. Collecting clinical data in an environment where cars might be driving by and medical teams might be sweating into small puddles in the summer sun has the potential to be a little challenging.

To add to the disastrous set-up for sober clinical research, I can’t collect all the data myself. If you were going to choose to conduct research, would you do it where you can’t control when you can do it and you can’t control the data capture? If so, we can do a joint run on T-shirts saying “I’m not with stupid, I am stupid”.

Mind Control

The only thing I can do is make things as uniform as possible. Which brings me to the latest chapter of my PhD – the education bit. What I’m aiming for is some type of control by getting everyone on the same page.

The set-up of this project involves other people collecting data (our trial observers). Thanks to turnover, we won’t necessarily have the same trial observers the whole way through. Add in the fact that we’re trying to get overseas recruiting sites involved, and there’s a bit more complexity. A conservative estimate over about 3 years of total study time is that we might have 20 or so trial observers and I need to aim for them to capture consistent data every time (as I can’t control how often we see patients, I have to make sure we’re not losing data through sloppiness).

So we’ve set out to produce a trial education system, that can be replicated and that we can demonstrate ensures consistency. Here’s our version of how, ready for robust criticism or enthusiastic blowing of annoying plastic trumpets (figuratively only – no one should blow those things).

1. Break it Down

The first thing we did was break down every component of the trial observer’s job. We started at the moment they turned up in the morning to set-up, through every bit of the job and then up until the point they had to leave the hangar at night. Each bit of the day has a learning package, which also means each package is pretty small.

2. Build on Prior Knowledge

We have the advantage of having engaged people who know a bit already. We’re not trying to sell skis in Kiribati. Assume people are completely unaware, and we figured they’d switch off in the bits that felt patronising.

3. Don’t Assume They Know What You Think They Know

The catch was to recognise the bits they actually wouldn’t know. Once you’ve lived inside the project for a bit it can be easy to forget that other people don’t know the details of what you’re up to like you do (like this inventor). So everything gets run past someone who should have no idea what I’m talking about, to see if it kind of makes sense.

4. Multiple Media

There’s no telling what will work for people when you’re trying to get stuff through. Some people at the base don’t even like coffee, so allowances are necessary. So each bit that we’ve developed learning material for has a written bit, a video bit and a walk through with someone who knows the system.

The biggest challenge of this was probably learning how to make a video. It didn’t take that long to use the really simple software (I’ve used iMovie, and it has a few flaws, but it got stuff done). It’s a quick skill to get better at too, particularly if you start planning in advance what you want to put in and how you’ll tell the story while keeping people engaged.

5. Standards and Documentation

The last bit (which we’re just getting to) is the roll out. So each person doing the trial observer job will go to a site (we’re using Moodle because the organisation had that already) where the written packages can be found. We’ll be able to tell when they’ve read the material. They’ll also be able to see the videos that go with different sections so they can check out how things work wherever they are.

We’ll then put them through face-to-face chats going over everything and get them to demonstrate they know how it goes. This whole process will have something for the trainer to document they’ve demonstrated how awesome they are before we finish by putting them through a simulated job where they collect the data and bring it back. Easy, right?

A Sample

Here’s a sample of one of the videos where we’ve simulated a job to demonstrate how things might go when working with the crew of doctor (in red here), paramedic, pilot and aircrew. Keep in mind that some of the stuff leading up (like preparing the monitor in the morning, how to make the trial monitor link to a stand alone iPad and why we mark certain things that happen like patient movement) is covered in other videos. There’s also a couple of internal gags there and a bit of jargon (“packaging” for example is shorthand for wrapping everything up with a neat little bow for patient transport).

The aim though was to give our potential observers an idea of how things will run, while stopping them from getting so bored they pulled out their eyelashes.

I’ll leave it to the chorus to tell me if we’re close or not – here’s the computer version and the mobile version (this is a quirk of iMovie that I might have to address).

So I started a PhD. Then I ended up making videos. And now I do education packages. I’ll get the shock of my life when I actually have some data as part of this “research”.

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7 thoughts on “Research Without Test Tubes

  1. Yeah, pretty good! Nice choice of music, too.
    Questions:
    1) What are you measuring?
    2) You were looking for a modem in your bag??
    3) Can you fit all the required apps on the one page so you don’t have to flick between screens to find the ones you need?
    4) Is that a first generation iPad?

    So, when did you say we get to the test tubes with bubbling coloured liquid and stuff?
    ; )

    • Hi and sorry for the slow response (deep in grant writing haze). And yes, James Brown.

      1. The monitor measures something to reflect local amount of oxygen in a tissue (regional oxygen saturation), and the amount of oxygenated and deoxygenated haemoglobin (the stuff carrying the oxygen – sorry if I’m over labouring) to produce an index measure called total haemoglobin index – this one corresponds with blood volume in that little wedge of tissue.
      2. We have a research monitor version which plugs the cables back into a tablet computer tough enough to cope with our working environment. We didn’t want the trial observer to have to stand right next to the patient and in the way. So we’re using an app to mirror the tablet display on our usual iPad. This way the observer can step away from the patient and still watch the monitor or mark activity. To make sure the wireless link between the iPad and the computer is reliable, we’re using a 4G modem as a local network.
      3) Most of those other apps are ones the aviators like having on there for potential use in the outward leg etc. At the moment we’re deliberately keeping the research app on page 2 (but under discussion).
      4) Second I think …

      And still trying to figure out how to incorporate bubbling coloured liquid …

      • Hi Andrew,
        Still on no 1, if the patient has a broken ankle, why put the receptors on her wrist and forehead to measure regional oxygen saturation?
        Or is this just for the purposes of the demo and you’re usually going to be doing this for people suffering head trauma? (I may have missed some earlier posts.)
        : )

      • Hi,
        Don’t know that I’ve covered that point in earlier posts. For the demo, we did choose something relatively simple because it was more about reminding our team about the steps in getting the monitoring on (and there’s only so far you can push your research nurse to commit to fidelity).
        The location of the probes is standardised for all patients, regardless of injuries. The two for the brain are a compromise to best monitoring of the brain without shaving patients (can’t put them over hair). The brain is of interest in all because it’s a critical organ obviously. The one on the forearm is placed to give some sense (hopefully) of the general delivery of oxygen and blood to other tissues.
        Our biggest interest is in patients with traumatic brain injury. However, we haven’t found any work previously done indicating what the patterns of monitoring would look like in the general trauma patient with other injuries. So we didn’t want to try and pre-select only patients with TBI and subsequently examine monitoring patterns and assume they were only confined to TBI patients, when we might just be observing patterns you’d see in all trauma patients.
        In effect, the general trauma patients we will include form a control group, so that if we see recurring patterns or changes in TBI patients we can be sure they are confined to the TBI group.

      • I see. You need control group data, too.

        Last question, and just out of interest – what if the person, very unfortunately, had an injury to their face and you can’t place the receptors there? What are your second preference head spots?

      • (Again, sorry for the delay) Yep, no one else seems to have control data we can refer to so we’re it.

        And a very reasonable follow-up question. One of our exclusion criteria is cuts or bruises on the forehead. This is partly to be appropriately kind but also a practical one.

        Imagine the light as coming out one side of the monitor probe and travelling in a nice arc down into the tissues then curving back to reach the probe on the other side. The distance the average bit of light physically travels to reach that detector matters. The system assumes that distance the light travels is a standard distance.

        So if you lay a big layer of bruise or swelling under the probe, not only might it change how that light is absorbed, it might also just increase the length the bit of light travels to reach the detector, and the assumptions that spit out the magic number don’t really hold.

      • Thanks for all the replies Andrew.

        Definitely keep us posted when you’ve got the colourful potions distilling, condensing and flowing through tubes all down pat. You’ll know you’ve really earned your white coat then!

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