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Most patients are undifferentiated, with problems rather than diagnoses. Patients present with a broad spectrum of conditions, making it difficult to maintain study awareness and identify triggers for enrolment if the people of interest are only a small fraction of those we treat. Competing clinical pressures can be problematic and compounded by a dismissive attitude towards emergency research by hospital administrators and senior clinical staff. This attitude ‘feeds down’ to junior medical staff. There has been a call for emergency medicine as a specialty to address these unique challenges by focussing more on large multicentre trials using very simple methodology and pragmatic outcomes, requiring minimal work from enrolling clinicians.13 Although there is definitely a role for this type of research, we still need to do clinical trials that collect more comprehensive data and also basic mechanistic studies, both of which help to explain clinical outcomes and generate new hypotheses. This again requires clinician researchers who bring together science and the understanding of disease processes and treatments, with an awareness of the real-world clinical situation. A number of groups have developed approaches to ED research that overcome many of these difficulties. However, one approach does not fit all clinical conditions and environments.We believe that a common factor in all successful multicentre studies is that there has to be some sort of buy-in from the clinicians who are at the coalface, so that they see the value in balancing research with immediate clinical priorities. This is often difficult because the research might not directly affect the patient they are caring for. Examples of multicentre ED studies we have successfully completed as National Health and Medical Research Council Fellows and/or which are ongoing include the Australian Snakebite Project (ASP) including the ASP-FFP trial,14 the Emergency Department Anaphylaxis Study,15 the Redback AntiVEnom (RAVE) trials I and II,16 and the ongoing Primary Spontaneous Pneumothorax (PSP) Trial.17 The unique characteristics of these studies, practical difficulties and solutions that we engineered are summarised. Do we as a specialty (in Australasia) really ‘get it’?