Research methodology workshop of a different kind

Research methodology workshop of a different kind

Vijay Gopichandran

I was 10 years old and was told by the school health nurse that I needed to check my eyesight for possible distance vision problems. I remember going to the friendly optometrist near our house, having my eye checked and prescribed spectacles to wear with a spherical lens of -1.5 and cylindrical lens of -1.5 in both the eyes. I was told I had ‘power’ in my eyes. I asked my mom, “If I had power in my eyes, why is it that I cannot see the aliens on the moon and all those tiny germs that contaminate my hands when I play in the sand.” I don’t remember what answer she gave, but I vividly remember being shocked when I later understood that ‘power in the eyes’ in the optometry lingo, actually meant ‘powerless eyes’. Those days it took anywhere between 3 days to a week for the spectacles to be ready, especially the complex ones with both spherical and cylindrical power. I remember eagerly waiting for the spectacles. Dad brought them home on his way from the office in the evening one day. As is customary in our home, anything bought new is kept in the ‘Swami Room’ (a separate room where the portraits of Gods are arranged, and worship is performed) and released only after prayer and offering to God. Since it was late in the evening when the specs arrived, my mom kept it in the Swami Room. She performed her prayers the next day morning and handed the specs over to me to wear. I was excited. The heavy brown coloured plastic shell frame with glass lens that were large enough to cover almost 1/3 of my entire face, were quite uncomfortable to wear. I wore it and stepped out to the bus stand to take my bus to school. I can never forget the first moments in the world with the new spectacles. Everything was so bright, beautiful, colourful and appeared full. It was like I was in a different world. I saw things that I had never seen before, some beautiful colours, the contrasts of the pink and dark red on the oleander flowers on the tree next door contrasting with the dark green leaves, some expressions on people’s faces that I had never seen before, smiles, frowns. I was able to see differently. It made things so beautiful. And when 17D, the bus I routinely took to school came and stood in the bus stand, it looked like the number plate had been repainted fresh in 3D and it popped out clearly to me. I will always remember that day and those experiences.

Yesterday, I was part of a research methodology pre-conference workshop in Vizag, as part of a South Zone Critical Care Conference 2019 that will be held between 15 to 18 August 2019. The workshop was directed by a colleague and friend of mine and he had invited me to co-facilitate some of the sessions. This workshop was one such paradigm-shifting, transformative moments for me. It gave me a new pair of spectacles through which to see medical research. In the past, I have been part of several research methodology workshops where I have facilitated sessions on research methods to a varied audience including public health students, undergraduate medical students, community medicine postgraduates, orthopaedic surgeons, obstetricians and gynaecologists, general medicine specialists, general surgeons, ophthalmologists, ENT surgeons and so on. In all these workshops I would be a co-facilitator along with people from my own discipline – epidemiology and we would teach research methods and evidence interpretation the way we were taught and the way we practice it. This workshop was unique as among my co-facilitators three were from the speciality of critical care medicine and one was from emergency medicine. They gave me a perspective that was so different that I re-lived my ‘new pair of spectacles’ moment during the workshop.

The most humbling lesson for me was that these colleagues who co-facilitated the workshop with me are all extremely busy critical care and emergency medicine experts handling high-stress jobs, making high impact life-death decisions on a daily basis, running round the clock on-call and in-person duties in their under-staffed, over-filled units and in the middle of all this were passionate about medical research. This passion was evident in the grasp they had on the various nuances of evidence-based medicine. During the various mealtime and travel time conversations with these colleagues, I learned that it is often the busiest of people who get the time to do most things. One of these colleagues was balancing his tight schedule of critical care medicine with playing the flute, listening to music, reading non-medical, non-fiction books, regular gym sessions, a masters course in clinical research, over and above his passion for teaching research methodology.

I realized the beauty of teaching along with experts who come from a different world-view. During one of the small group facilitation sessions, I was working along with a critical care colleague to explain to the participants about effect sizes. My colleague was mentioning that in critical care medicine if a study reported a reduction in deaths between two treatment groups to be anything more than 10%, he would be circumspect about it. His words were, “there are no magic bullets in critical care”. This was logical, as we all understand that the mortality rates in critical care are so high and there are probably very few interventions which make a very high impact. However, coming from an epidemiology and community health perspective, I was always trained to dismiss small effect sizes. We used to learn that any difference of less than 30% between the two groups is not meaningful enough to warrant a public health intervention. This is because when interventions are planned to be implemented at a population level on a large number of people, they need to produce a substantial impact for us to be justified in investing a scarce amount of budget money on the intervention.

On another occasion my colleague was describing a specific study design called the “non inferiority randomized controlled trial”. In this design, the main aim is to show that one treatment is not inferior to another, and therefore can be used instead of it. It may not be superior or even equivalent, but it is not inferior to a pre-defined margin of difference, therefore we are willing to tolerate it. He explained this with treatment and its impact on death of ICU patients. He said treatment A kills X number of people. If treatment B does not kill more than (X+delta) number of people, then it is not inferior to treatment A, where delta is the non-inferiority margin. As a person from epidemiology and public health, I have always understood non-inferiority in terms of mortality prevented and cure. I would have typically described it as “if treatment B cured not less than (X-delta) number of people, then it is not inferior to treatment A”. So, when he was making the presentation, I was trying hard to wrap my head around what he was saying. But finally, when it became clear, it was once again the ‘boy with the new pair of glasses’ phenomenon!

These are just two small examples of how transformative it was to co-facilitate the workshop on research method with colleagues from a different speciality but with similar interest and passion in the subject. This makes me realize that there is a need for truly multi-disciplinary partnerships in training medical researchers. I now have a new pair of glasses with which I can look at research and evidence. I am enjoying the novelty, and I know I will incorporate these lessons in all my future research methodology workshops. My new spectacles are helping me see the world differently now. When some clinicians interpret the same research differently, I will now try and understand it from their perspective. I have a new paradigm to consider, a new path to travel. This is fascinating!