Page 4
Unfortunately, the answer to this question might be ‘No’. Although a number of Australasian EDs have performed a range of studies, much research has tended to follow a ‘scattergun’ approach rather than a cohesive long-term plan. This is perhaps largely because of the old ACEM Regulation 4.10 that demanded every trainee do a small project, without established research networks to guide them in a strategic way. We have only a handful of College Fellows who can stand up on the international stage as respected experts in specific disease processes and/or secure large research grants. A few of our departments are actively participating in multicentre studies in a way such that the medical and nursing staff on the floor are always thinking ‘Is there a clinical study available that could help this patient or future patients with the same problem?’. We tend to adopt changes in practice based on the recommendations of various specialties that are themselves subject to commercial manipulation and conflicts of interest. There is an urgent need for trainees to be properly schooled in good research methods, critical thinking and the scientific basis of medicine. Recent changes to Regulation 4.10 allowing the study of research methodologies are a good start, but more is needed so that clinical research excellence becomes embedded within all of our major emergency medicine training networks in Australasia.
A simple plan? We propose a plan to address these problems (Table 2). Its foundations are clinical engagement, resource sharing, educational initiatives and real collaboration. Real or ‘natural’ collaboration starts from the ground up so that every participant obtains what they need, rather than dancing to the tune of others. Successful approaches might vary according to local politics and/or clinical demands. For example, some departments might decide that recruiting patients into clinical trials is an expected clinical role for all staff, whereas others might decide to separate clinical and research workloads by providing extended-hours research nurse support. Therefore, we think that the key is to pursue overall goals and principles, rather than prescribing the precise methods by which these goals are achieved. Excellent communication between all stakeholders, a free exchange of ideas and independence from commercial interests will be essential.