Asking the research question: How to develop an original hypothesis
Asking an original research question comes more naturally than you may think. In fact, if you are a resident or medical student in emergency medicine, you do it every day. Every time you ask yourself or a colleague “why do we do this?,” “why don’t we do that?,” or “upon what evidence are we basing our approach?,” you have created a research question.
The first step in developing your idea is to comprehensively review the literature available on the topic. If there is “too much to read,” then your question may be too broad. The next step is to develop a testable hypothesis. Make sure your question is narrow enough to yield meaningful results. Understand (and be prepared to explain) exactly how answering your question would change or reaffirm your clinical practice.
The next step is to select a study design suited to your question. Selecting the correct design can make executing your project much easier, while selecting the incorrect design can result in a fatally flawed approach. The type of study design will depend primarily on the question you ask and the resources you have available. A good resource is: Rennie D, Guyatt G, eds. Users' Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice.
One relatively painless way to start is with a retrospective chart review. Institutional Review Board (IRB) approval is usually relatively easy to obtain for chart reviews, as there is no direct contact with patients, and data collection is much easier since you are analyzing existing data. What would such a project look like? How about reviewing all of the patients admitted through your emergency department with sepsis to see if an association exists between time to first antibiotic and survival to discharge?
Your initial conclusions from a retrospective study can build the hypotheses for future advanced projects directed at building your area of expertise. Simply put, doing a well-defined project on 3rd metatarsal fractures could make YOU the department expert!
It is important to realistically assess the time and resources required to answer your question from start to finish. Part two of the EMRA Research Committee series highlighted the importance of building a student-mentor relationship to help define a realistic timeline for each project step from IRB approval to publication. Team building is an integral part of emergency medicine, and emergency medicine research is no exception. You should not hesitate to bring others into your project if they complement your skills and contribute to the overall outcome of the project.
Emergency medicine is the most diverse specialty in the house of medicine--it touches every other specialty from infectious disease to gynecology to sports medicine. The specialty is still in its infancy, however, and that means the sky is the limit for emergency medicine research. As you develop your clinical skills, you will be exposed to numerous original ideas and have the opportunity to select from a vast array of research questions.
You may find it more rewarding to study a topic in which your program has readily available expertise. Identify the content area experts in your department and seek them out. Of course, if your interests take you in a novel direction, it is perfectly acceptable to seek appropriate support and carve out your own niche.
The most important thing to remember is this: only study a topic about which you are passionate. Following this advice will make the process easier, enhance the quality of your results and keep you fulfilled. Now get to work!
Jesse A. Borke, MD
NY Presbyterian Hospital
New York, NY
Brian C. Geyer, PhD, MSIII
University of Arizona
Phoenix, AZ
