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so quick work from our sponsors. So it's a humid. It unfortunately joined this because they've got clinical case. Eso They've asked if we can download the app on Apple Store and it will tell you all the products you need, um, to run a very successful career. Yeah, acumen. We'll do pull everywhere it later on about questions. There's a few fun facts like, When was this first randomized clinical trial run? And that's James Lynn first speaker off the out program Speed dating is Ms Mira was a dear friend on. She is currently doing her or p r with the British Society for Surgery of the Hand and she's come back especially from London from I fished to be with us. So welcome here. Uh huh. It's some good advice. Hopefully thanks everyone for having me today. Hopefully this will be very useful. I'm in orthopedic registrar of Just started ST eight and my out of program for research. I think the main aim is to hopefully give everyone some useful advice. I think lots of people will try to give you advice even when something you don't ask for it. So this will hopefully help you in navigating threw out program for research. So I think the title for the session was formulating clinical question into research. But I think there's some important questions that we have to first of all, answer for ourselves before we actually do that. So these are some important questions for out program for research. Why would you do this? So we have to do some research element throughout our training to complete our C C C T. So whether that's writing papers, recruiting patients into trial or attending the Research Research day for your Diener E, you have to do some element to it. But no, everyone needs to do enough program for research. So it's an awful lot of work to do for a line on your CD. So I think the main conclusion I drew for myself is that you really have to want to do this, and you have to really enjoy doing research and want to be part of this because it's a long period of time on depending on what you decide to do, it can be even longer period of time if if you have not got the right support. So I think answering why you want to do this is a really, really important question. The next question is what? So formulating that research question might be quite easy for people. Some people take a long time to decide on what their subspecialty areas. Some people know exactly what they would be doing at at the start of ST three, and then even within that, you might decide. Actually, I want to do something which is much more basic science related, too much more broad rather than a more clinical based questions. So exactly what your creed research question is may not come about very easily, but you will get there as you continue reading. And that research question may also evolve as you learn more about your subspecialty on subjects. So my advice is continue talking to your potential supervisors. It might be that you want to investigate something which your lab doesn't hasn't done before, so therefore, you might need to bring in some other supervisors from another area in order to help you with that. And actually that may be a real strength to your project. So think about what it is that you need and think about how you can achieve that. The next question is where? So I've touched on this little bit. There's we're very lucky in the east of England. Diener e. We have three University of East Anglia and we also have Cambridge University, and I think that's really great. You may also need to go further a field, depending on what your research topic is on. But I think you have to really consider the links for your institutions on D how they can support your project if there is a precedent. So, for example, you may need ethics consideration. You might need some other approvals. You may be collecting sample, so there's a precedent within your institution that can also really help you. Alternatively, if there isn't the president, you might have to think about how to set that up. And that may involves another layer of complexity to your project. But it doesn't mean that you can't. You just have to think about how to get around that. So where is a very crucial thing? The knowledge by repository is right next to the north. A conduction velocity hospital on that really helps with sample collection on. There is also President so I'm very lucky in that respect. But again, it just requires thinking ahead. When is an interesting question. So I think this is quite personal. So everyone has their own career path throughout their training. Know everyone's training is the same. And sometimes the actual timing of when you start your out program for research isn't necessarily even up to you, depending on how you get your funding. So sometimes you do have to be flexible in how you arrived. They're on. But if you have got a set path in your mind, then just keep working towards that. But all I wanted to say is that this is a very individual thing. So not everyone needs to go along the same past. And you just need to find out what's right for you and my personal timeline. So at ST three, obviously just really wanting to operate on everything on that was a really that was really important to me. I wasn't really considering exactly what my research question would be. I was talking to people a lot of advice throughout ST three, s t four, and I think the real realization that you please will need to take some time out of your program to do this really started hitting home because it's very difficult to do it as a part time, especially in surgery where you need to be involved in operating. So I think that was the main thing that came out of that. And then, unfortunately, before you know it, you have to start revising for the exam. And sometimes you feel like you're really on a roll at ST three and four and you just want to keep going. So, actually, heading to ST six and then thinking I really probably can't take any time out of the moment can happen. The other thing is covered makes things a bit more interesting. So of course, funding organizations didn't really have any funding rounds. At that point, everything was closed. So I had a spreadsheet full of different potential funding bodies that I could approach and Alli got from asking was I'm sorry we're not finding any projects at the moment. Please let us know. Please have a later on. So this took actually quite a long time. I'm Eventually they did open some funding round. So my my time was spent revising for the FSGs looking at funding bodies, writing funding proposals. And then unfortunately, this takes a long period of time. So you have to be just really organized about how you split your time on the B s S H funded the first year of my projects. So I think that really helped to secure funding for the other two years. It's a PhD projects at the three year project. So, um, action Arthritis in the fish fund provided some other funding. But I actually started my out program for research before secured my final bit of research funding from the Orthopedic Research UK Fund. So it is possible to do that caveat with having multiple funding bodies is that you have lots of funding reports to right, so you have quite a lot of work. But again, it's just is just how things are sometimes come come to be. And the main thing, the main message that I wanted to send everyone is that through whatever you're doing with your after program for research, think it's really important to yeah, your hand in clinically because ultimately this is a really, really important skill on. It's better not to lose it and have to regain it, but it's just to keep it up. So that's my advice. Thank you. Now, just before I take any questions, I just wanted to highlight one thing that we're doing at the's thinking Diener E. So Baby Lifeline is a charity on. They specialize in maternity equipment, urinates and mother's. They've also been very good at adapting and have started providing surgical and medical equipment to Ukraine. So if everyone can just take a photo of this and please think about whether you can donate 5 lbs, it's really worthy cause it's really important because we're actually in direct contact with the hospitals in Ukraine. So some funding some charity organizations can give lots of equipment, and then they're distributed. But we have direct contact with the hospitals, and we can respond to specific medical request. So we've provided thumb kit with see our surgical equipment. These are the specialists community made with three bags and these other teams that work really hard, and I think they still need our help. So please think about this, Uh, and thank you very much. So we'll take questions towards the end with all the four panels. That's okay. so next will be Alex, unfortunately, Can't join us. Do is having some personal medical issues she's currently on any, uh, a CF and one of our east of even register office. Um, and she's going to tell us about her journey in research through the night, or and she's recorded kindly recorded session for I'm Alexandra Like melon. I'm in ST full registrar Intraluminal pedic on the East of in the rotation on an academic beautiful fellow. I'm right at the beginning of my research journey, in contrast to the other speakers on this panel who are further on doing that. PhD. So therefore, I'm going to tell you my outlook from this early perspective on particularly what I know about which is the application system and structure off the academic clinical fellow program as one route and formal research. So this slide shows my career timeline with the vertical timeline representing the current time and sections, therefore to the rights representing possible options moving forward. So to begin with, I did my foundation training in the Oxford Diener E. On after this and f y three years on. This was a research fellowship in a plastic surgery in John's, Hopkins and Baltimore. They're I focused on technical research projects, developing a team of medical students and doctors on lead, numerous clinical retrospective review studies. Following this, I went to Sonny Devon to complete my core training and Exeter and Limit on. After a short stint to the other end of the country, working the same city of Aberdeen gained an academic training number in the east of vitamin D. Naree. But I elected on my first few years. So my ST three and four year four ones on developing my old building up my number three in October. Therefore, I will move on to complete nine months full time academic research, which also represents nine months of my ST five year. And you're in this. I'll aim to develop a research question on protocol on gather enough results to apply for further funding for a high research degree. Following this, the options could be that I'm successful. Continue one toe I'd degree weather will be a masters, so probably about one year of additional funding and MG 2 to 3 years or PhD 3 to 4 years. Most of my predecessors in the east of England on have been successful and gaining funding for fulltime. Fully funded PhD following the a CF time. Most of also continued in a part time fashion on the on the road, and addenbrooke's keeping their hand in on be keeping up their experience clinically. Following this, the usual path Should I wish to continue in for market mean you would be to apply for a clinical lectureship, which is a post doctoral route to continue 50% research. I'm 50% clinical training. The other option is after this nine months. Should formal funding not be gained would be to join back into the clinical program, completing my final three months of 55 then moving into ST six and beyond. So now what is an academic clinical fellowship? And how does the application system work? So it's a three year program combining research time a clinical time of 25 75% respectively. Entry is usually at either ST one ST three level, but once you have your number, believe you could still apply to this program. So if you're a nasty three level, you can still apply advertisements. Applications are vial oriole on down. I apply the white space questions covering that the general areas ordered teaching management presentations Publications on overall academic career plan applications as opposed to the clinical national applications. Art A particular region and center, such as not to Go or Cambridge specifically on their handful of applicants are shortlisted. One interview Based on these applications currently on the this current year, the activations air. The interviews will help digitally, but prior to Kobe, there be a panel interview at center, too, which you apply it on to. The other part of the lackadaisical program is that the jobs can be applied to from different specialties. You could have, for example, a GP training and an orthopedic trainee interest. Applying for one particular activity number on the purpose is to allow for this allocated research time with the support and resources to develop this research question on apply for a higher degree whilst continuing to develop a clinical skills at the same time. Clinical lectureship, in contrast, is the senior trainee specifically so not the junior trainees on this is post doctoral on. As I said, a 50 50 Actonel split on this is four years or until CCT is reached on part time options are available for both of these, um, they're in mind that in terms of the application system, clinical benchmarking is still necessary. So once you've gone through the interview process, I'm accepted in academic number. You still need to go through the national clinical Application System and be deemed be deemed appointed Ultram your specialty. The price for on In terms of the interview, it is obviously more academically orientated and ask you more about the research you've done before you eat. Research aims compared to the clinical interviews, but it's still a standardized process that covers the applications on In summary eso the A CF. It's just one of many fruits into formal research. It offers this specific flexible time. So the other thing to bear in mind is you don't have to take it all in one block so you could do your research time as one or two days a week with your clinical time as three or four days a week just depends how you want to organize it with your supervisors. Um, uh, yeah, it does mean that you are taking time out of your training program and so you, but that same time is part of the training program. So it's actually counting for me as my ST five year, much off. So you need to be either a head or ready to catch up on your rating skills. If you're considering applying, just go for it on If anybody's got any questions, feel free to get in touch with me. Many things cool. Great. So we have Mr Hassan Folly. Who's appears She Canada currently know an imperial uh, he are also on East of England training and P I for the season study with Public Health England. So let Hassan take the floor was good afternoon. Everyone, um, hasn't far. We have an orthopedic, restarted the PSA finger, and Dina, perhaps the reason why I'm standing in front of you here is because also a PhD student and Pedia University, thank you very much for organizing committee and my colleague eager for the kind invitation to give me the chance to speak to you today. So if I can give you a quick journey Still, my research background on if I can summarize in one line, is that taken a clinical interest question from the hospital and I'm taking it to the lab or the computer in my case and trying to find an answer for it. This is where it all started. 4.5 1000 miles away from here from University of Cartoon Faculty of Medicine on where I cut my teeth first time doing a case controlled study and podiatrist community medicine. And it actually was a clinical order it as a court trainees. I got me interested in the prevention of surgical site infection on first exposure off the CDC guidelines and how to classify it. Meanwhile, I tried to stay curious, getting engaged in different research. Um uh, projects and trying to learn skills. I found academia interesting. Look for me. And then I decided to take a little bit more serious on land essential basics on over two years. Part time was are dedicating a specific time on taking any out of program on The two great mentors have done an M. C H orthopedics. That actually cemented my interest and experience in had doing fair is a research generally speaking to do PhD. My understanding off it so far is that you've got two options. You are the joint an established study and the major problems is is that you potentially have secured funding and this is a major benefit. Oh, do, uh, like, why did I picture on idea disclaimer here? Be aware of the broken heart syndrome because potentially you can get some rejection. It doesn't mean that it's you personally, but it may be that groups that you going to might not have interest in your question. Most importantly, either route is perfectly fine, because essentially a PhD is a training opportunity. So it again transferrable skills. Most important is to find the question that you can actually look at that will make you awake up at night at four o'clock in the morning. To look into that will make you come to work very early. So finding your passion, whatever you take it is answer for giving us a few er for that journey. Furthermore, from that point, then you have to develop your question on for me. It was that bedside clinical question development, so I'll give you a quick background off for doing now on. Basically, my work is on surgical site infection in hip and knee replacements. These are operations are done about two million times a year globally. Unfortunately, they get infected. And that's really bad. No, only for patients by cost, hospitals and healthcare system a lot that is emerging evidence from the states. Australia, Japan actually operating on different patients, not specifically hips. Any replacement in summer can have double the risk of developing surgical site infections. Double the risk of having diabetes, A very well known high risk factor on every 2.8 degrees. Increasing temperature has been associated with 2.1% increase in the incidence of surgical site infection on a group from Australia from America. Have done a very nice house economic modeling, and they actually found for patients that risk if you develop. If you did use 25% off the surgical cases during the high risk seasons, you can actually save the whole healthcare system more than 20% reduction and SSI and the associate it cost. Preventing surgical site infection is a global surgical on public health challenges there for because we know from graft into southern and 15 that an effect the joint replacement can actually cost 100,000 lbs to the NHS was the initial operation because just about 6.5 1000. No, only that, to treat the surgical site infection case, you have to give them sometimes prolonged antibiotics. There's only adds to the potential of developing risk of antimicrobial resistance, which is unfortunate and expand. Emmick convicted wh show as sophistication, say correlation is not a course for causation sometimes. So it is actually be off meat behind this, rather than just finding that somebody is correlated with that. A group from Australia found that actually, the warmer parts of Australia have got a different bacteria profile to the core the parts of Australia, and they actually bit more multi drug resistant and actually grew from England back into Southern and 15 reported that they actually perplexed, as in, why the northern part of England. I've got lower pseudomonas count in comparison to the season part on England on London, inferring from what we know so far, if we extrapolate from this, if we look at the graph on the uh right side here, the temperature difference between the nose and part of England on the southern part is consistently different throughout the year, even in the cold weather off inland. So there is a potential pattern here to recognize. And that's where the season study came from, which stands for the seasonality of surgical site infection in hip and knee replacements seasons. So my aim is to investigate this association in about half a million joint replacements and try and find if there's any different bacteria profile that we can actually look into. I'm very grateful for the supervisors and mentis on the collaborators from UK. Have Security Agency Imperia College, London Business School on the Generous Fund. I've got the pump primed grant from Secret. This is a study that we're running in coordination with Cambridge University Hospital. So my finding so far if I take you quickly so we've done a systematic review looked at over 4000 religion cases. Paper Sorry on Throughout the world, the data's it's available comes from four continents and six countries. The majority come from the States, Canada, Australia, Pakistan, Japan. On Australian, we find three million eligible joint replacements to include more striking. Think the names is a point here, but that's right. Having an operation in summer is associated with increased risk of infection off 11%. That's across three million joint replacements this gets worse if it's a knee replacement, that's 33% more risk of developing infection in summer. Good news for hip surgeons. Electively. It's only 7% but if you're doing an operation for hip replacement for tumor, it's still high. It's still 11%. So the potential finding here is that we can inform even at this level what we know so far we can inform the potential high risk patients as a consent. Timing, if you have in your operation, is somewhat we might need to improve our pre operative management and try to optimize your further on for me and for other future colleagues. Looking into this is to guide our future research on find a little bit more, finally going to this. So in somebody, I hope I managed to take you through my slightly atypical way off getting into a PhD. Okay on. I hope I got your interest into this because I research is actually interesting. Why? Because it helps all patients and to start somewhere, I strongly advise you find good mentors on it can be really tough, but such his life. But enjoy it. If you find that's your call. Thank you very much. It's okay. Next we have again of your friend A swells. Both academic rep. His PhD is currently with Oxford. Without further ado, he will tell you his experience would take questions towards the end. Okay. Sorry I'll. Then I'll be quick. Um, concise. A lot of my colleagues have already covered quite a lot of the important things on. Do you get sick and tired of hearing me talk today? So we're just going to talk for next 10 minutes a little bit about my research journey Coming up with the questions, talking a little about funding on where you could go potentially if you're interested in doing higher degrees and further work. So thanks again for having me. And I'm joined. Funded by the NIH armor doctor, Research fellow Finished ST four at Imperial College on the Northwest Times trainee on, then came out to do full time research at the university Oxford under supervision of Mr Down Perry on who is a pediatric orthopod on. I also look after the academic side of both, so you can ask me questions about that as well, if you'd like so just a little bit about my career so far, the research question that I've went about getting two and then, you know, taking that further a little bit about funding because it can be quite painful. It's better to go into that process with your eyes open to find out what's out there on, then finally, where to start? So let's jump in. Um, that's in Queens town and during elective, which feels such a long time, just the basic idea of the career. So far, so under graduate training was on that extra plummet in which I got introduced. Orthopedics, like all of us do through potential special study units. You know, I did that indicated BSD in parasitology on because I wanted to gain an extra know because I want to take cricket. And I got some experience in doing lab work, though, which was super important because it showed me that I couldn't be a lab scientist because almost very good at it. And but I think everyone just talks about the positive parts of research. But I think it's okay to have experiences and learn that you might not be suited for some parts of research because I think that leads you to a better path. So did my B. A. C didn't enjoy lab work very much after that. I didn't go down the academic route, so I was full time F one F two North Central Thames work that role free on West Middlesex. During that time, I wanted to do research, but I wasn't convinced that I would do the academic route into it. So fast. Forward to my core Training years again didn't do the A CF process, but did a master's during that time at Oxford looking to learn the ropes off, conducting good research that hasn't spoke about learning some techniques and epidemiology, trying to learn some stuff, trying to stand a jargon. What? What do people mean by interventional versus observation or research? You know, basic statistics around analysis of papers. So that's sort of really started to show me that Yeah, research was what I was going to get involved in. So after that, the process was off doing it. A CF versus clinical number, so went through the process but got clinical number in Northwest Temps. So decided to take that number over my A CF appointments because I again was convinced I want to do be a best condition first and then, you know, be taken to be taken seriously as a research. I felt that it was really important to have clinical credibility so focused on that high of it. After doing the Masters, it was very obvious that I was destined to do some more research. So at this point will come back for that later. But this point, I'll talk to you a little bit about how the question came about. That's me trying to trying to figure out if that if the baby has hip to space, your not on. I remember trying to do the order on the bottom, a new version on turning, rented a consultant and saying, I don't I have no idea if that is dislocated or dislocate a ball on. That's where the question came about, that actually, the screening system. A lot of people don't know if they can. If the hip is dysplastic on in the UK, we don't do ultrasound screening on every newborn. We only do understand screening on patients who are born feet first or have a family positive family history. So this will surprise you that late diagnosis rate in the UK for hip dysplasia, which is diagnosed after and three months, uh, hasn't changed since 1986. So that's where it led me to my clinical question. So it started in the clinical practice saying, I don't know if this is if this works, being told it doesn't work and then doing some digging and finding out that, actually, it hasn't worked since 1986. So what that leads to is lots of patients progressing onto having major surgeries when if they have been picked up earlier, they could have been put in a harness at which is, which works about 90 92 to 97% of the time. So that was how the clinical question came about. After that, I got interested. I've always been interested in artificial intelligence, so my project now looks at artificial intelligence diagnostics within hip dysplasia. So one of the problems that people talk about not being able to do a universal screening program for hip dysplasia is cost because it costs money to, you know, employer radiologists on senior conditions to look at the scans. So would it be better would be great if we had an A i system, which was able to do the process of screening on, in fact, go one step further. Everyone seen a bladder ultrasound machine. You know, it says, Go left, go right up or down To find where the bladder is on the ward would be great if there was something similar for DD age. Because of the moment the screening tests are done by anyone from an F two to a consultant orthopedic surgeon. So it's It's very varied. So this is just some idea of what the Ph. D is looking at. So we're trying to find ways of identifying critical structures automatically on on, you know, segmenting them out to look like this. Or the computer understands what it's looking at. And then also coming up with ways of the dots are called landmarks, the colored dots coming up with ways of identifying it, automatically calculating things like graph angles. So just to just to make that process much more accessible in clinical practice, because it will have huge ability to help, not just our practice in the UK, but other also lower middle income countries where, if you could have this process, would be fantastic outcomes. So that's where the research came about in terms of So then I applied for an eye chart Doctor Research Fellowship, which I I read the grant application whilst doing S t three and t four, which I wouldn't advise because it takes a long time to ride to grant applications. The first thing is, fine a mental and find a unit that's going to support you. Okay, it is completely doable. But the application, the grant applications can be about 50 pages long. So you need to have that support. So And you need to know off the time lines off when you're gonna apply for things. Because if you just think, oh, I'm going to start my PhD sometime after ST five. You need to start thinking about it when you come into program. Seem to tell you have a chat with your TPD to find out. You know how long before you can actually come out of program to do these things And funding is a super important aspect off it, okay. And especially if you're going to not be doing a project which is already automatically funded, which is rare because funding cycles take about 7 to 8 months. So the NIH R D R F, which is a doctor research fellowship slightly different to what Alex was talking about in terms of the integrated academic training part, the Doctor Research Fellowship is open toe or conditions on on. It basically pays your salary on a low research costs. So the grant is about 400,000 lbs, which doesn't mean that I am 400,000 lbs richer. It's just the money goes to University of Oxford, and they get pain in my salary and other costs. But there are lots of other avenues, and this is the process that I wish somebody had told me about when I was coming into the process so you can go buy a charity funding. So Dunhill Trust, for example, look at lots of frailty related projects. Okay, and you've got the partnerships between B o h o r u k N J R, which are all sort of highlighted on the boat, a website, shameless plug. And but these are also present that you can get an idea of what's what's out there. Be aware that there are, um, welcome trust on MRC doctoral training programs. We've talked about the National Joint Registry already so And finally there's pump pie pump prime in grants, which are offered by a lot of stuff specialties. So I wasn't aware of this because these are not always massive the advertised. So hopefully now that you've seen this slide, you might know where to start if you want to go down that route. But em lot of specials organizations will give you up to 10,000 lbs to get your project off the ground. It might be enough to start your red cap registration. It might be able to, you know, support you through your grant writing. For example, do some PPI work. Perhaps so these are the avenues if you're interested in for the research that you could also explore, and that's it, really, that's That's what I have to say about it. If you have any questions. Okay, you guys, the best session. You've seem to very conventional roots to research, and you've seen to sort of unconventional roots to research. So if you're thinking of doing reaches and if you have a passion and if you are at ST seven s t eight, don't give up because you can start there. And if you're completely mad like me than he can predict, you start your PhD once you get your consultant job. So that's possible, Uh, or if you want to go down a very guided part, then what is done and what Alex have done have up pretty much the straight forward fruits to research. But one thing is very important. You you need to decide are selling out with this in the morning, whether you want to be and academic, or you want to be an orthopedic surgeon who wants to do research, because whatever route you take, that's very important on on Meter showed that beautifully in her slide that the surgical training bit has to go right through out. So if you want to be a surgeon, you want to make sure that you're good with your hands and that has to continue. So even if you're doing research, please ensure that you are doing some beacon operating. Are you coming in and doing at least one or two days of operating because they can't like on that on this? If you want to be an academic and just stare academic them. That's fine. But if you want to be a surgeon who's an academic, then you need to be good with your hands on. Get clinical problems from the clinic. That's important. Yeah, I think planning is really important for this, that aspect itself, because you need to have open conversations from the moment you join the rotation on about what your plans are going to be. So currently, I assist once a week. I'm in theater once a week on a Tuesday with my boss at and, um, period, because these are conversations that I had prior to starting this process on on these conversations I've had about two years before I started because it's not easy to just sort of say, you know, can I just can't I just walked into do this Hemi. That's it's not fair on the person who's list. It is, for example, so you have to think about it. And you do realize that clinician add your You know, consultants are very open toe having these conversations, so if you start it early, it'll definitely help. And the last thing to say about the grant application itself is that the research design service which I needed to earlier in the talk. They're really helpful. Okay, You're not in it alone. We're currently creating a list of supervisors on the boat, a website that you can approach if you're interested in your region to take things forward, which will include the list of the current I 80. You know, a CFTR EFS on the website. So if you have a question, you want to approach one of us and ask throughout, You know how our grant application process, what's We're more than happy to talk about it. Um, most people are I set me up on, so you know, that can also be help. I think on we've got the research design service talk coming up in in the next 30 minutes or so. So you'll hear from them as well. Great. Thank you. Any other questions? I would like to thank you with this thing. Thanks for coming all the way here. Thank you. Uh, Mr as far away as well. Thanks. It's just okay. Can I invite Mr Sit back up? It's well just to give his talking appreciation. He's come all the way from Hamburg, so thank you very much. Thank you. Yeah, thanks. So for the online audience, there are a lot of terminologies that arts quite specific for the UK program. But the principles are essentially the same where you have to plan and plantarly and then executed and have a clinical question that it's centered around patients if it's all summarize into one. Okay, we were supposed to have a coffee break, but I think we're going to go straight. We're gonna change the program sightly so that we have. We do old everything that we have a lunch break. So we allow for the online delegates to finish the day. Is that all right? So I would like to invite with some Muneer Hussein who off chance was my consultant back in our park when I was a court rainy. And he's done a fantastic chapter in Been ask of it. So all all the UK trainees who has the finasteride book for the F. R. C s exam will go to the last chapter and read all about areas under the curve. He's done a fantastic book by Cambridge Press making sense of medical statistics. I would like to invite him to enlighten you on statistics applicable to the f R C s and daily living everything Transit. So it's the left, right, Left, right, great, good for this one. And yeah, I mean, okay, thank you very much. Thank you again Issues and thank you. Because for inviting me to this talk really place to be here amongst all of you. So you know how things are. I remember the last time I was here was many, many years back Game to recur. Skandia's the basic science course when I was preparing for my exam on. But I don't know if you remember, I found it so useful. I felt compelled to right back to me after the exam to say, Oh, it's a great course on I thought I was the best basic science because I don't know if it's still doing it. We're still doing it annually, but you just make me feel so same goes for me as many very moved back. So it's great to be back on the other side. Eso It's so nice to hear all this talk about stats on day just shows how much orthopedic research has evolved over the yes s. So I remember when I started my training. Our orthopedic research used to be writing up if you had one patient, he wrote a book, A support. If you have three or four, I'm sure you would agree with me. You wrote a book, a series, and that so there's no need for style. But obviously things have changed a lot. So when ignitions asked me to give a talk, so I thought What you talk. So rather than giving something for the exam like you say, you find it in the books, All the things I said I would talk about just go in a bit more detail about some of the statistical terms because from my experience, I find that when I asked candidates in the example sex, they know the definition, but they don't quite understand it. So I thought, We'll talk about this thing. The basic terms may not be. I don't know, the PTSD guys, maybe two simple for you guys were hopefully for the rest. It would help you not only, for example, where you carry a so this light all off you would be familiar with this town that they say the status sticks is like one light so the three types of life one is status sticks on, and you can see there was actually a book that professors to take you how to live with stats Onda your may or may not be aware of this paper from profit on it is with a stimulus from Stanford on This is a highly cited paper in Period the General on, he claims, as you can see that he claimed that most of the published research findings on untrue. Now the question is, Do you think we are professional liars? We go to all these trading just so that we can live with impunity. Obviously not. So the point is, this happens because we sometimes fail to appreciate the new insists on the cab. It's related to statistician. So I'm I thought I would give this example off our trusted orthopedic implement. We love this implement, so it's like any other tool, so if you know how to use, it is great. But the problem happens when you don't know how to use it, or worse, if you use the wrong implement. So apologies to the ladies I got nothing else high heels, but it's just so I get the message. I don't use the wrong too. So the first thing I want to say is try and understand the tool that you have. The Communist misconception about medical status takes is that it's a match, and I material here to tell you No, it's no. So obviously it is. You know, that equation we're all familiar with. So a plus behold, square or reminders beholds quite gives the same results in whatever. Whether you write it, whatever kind of writing, implementing views where they use it in paper or something give same result every single time. But that's not the case with medical statistics. And the reason is when you limit yourself to talking about the numbers in itself, you know, smallest, biggest, mean median, everything is fine. You're okay the moment you start making inference that that's when you go into this, risk it a tree. And the reason for that is, remember when you were doing a research automatic research. You have a research question, which involves a population. Now you cannot actually do your research involving everyone involving the whole population. What you have is a small convenience population in front of you that you use, which is a sample. So when you do your research, what you're doing is you are trying to make an inference from this march smaller sample for the whole population that deals with this is where you run into trouble on. This is where this agreement start. The best example of this we lived through these areas is doing the Kobe period. Many if you, you may have followed it in the especially, you know, the tablets had the filled today a lot of these agreements about the interpretation off Kobe data on there were people you know, with big names off academics and reach researchers standing on both sides off the academic divide and are going at each other. You know, people between Oxford and Cambridge, even without without Oxford and even within the same building, the question some off it may be, you know, personal. But the bottom line is, the reason this disagreement happened is because people were looking at the data and they're making their own interpretation. They were applying some inferences on some caveats into it. We did not always agree. So this is what important to understand. So the first message I wanted to give you is to remember that medical status sticks is an estimate. It's not an absolute perfect number. The second thing to remember is that obviously you are all familiar with the term dies. So from the medical statistics, point of view dices. Got it. It's an acronym, which stands for Do Not Ignore Chance Effects. This term was going by my clock with the professor in Belfast on he's a Cochran methodology ist in about 20 years. Back during the millennium, he did quite a lot of research, essentially using actual patient data but on putting it against playing it again different colored isis and showed how he orally from chance. You can get a result at the conclusion from all of his research findings. Well, that even if we first of all, obviously, if you have a flow in your childhood, then you can make mistakes. But even if you have a well designed trial, you can still be affected by chance. It's very important to understand that the chance is always there, so always look for it in your research findings, so do not ignore it. Remember, there's a natural variability off events so that is the second. Listen, I want to emphasize So the next what I wanted to do is I wanted to quickly go through the different stages off a study starting from how we conceived the trial study on a look at some of the commonly use statistical terms on just go beyond the the definition just to explain on a lof us understand what it actually made. So obviously, when you have a study, you have a research had poultices? Yeah, so But when you come to doing your actual study, then you have a non hepatic cysts, which is different from your research hypothesis. So, for example, let's consider house and for the study. So things from his initial finding that there is increased risk of a society, the this is no variation. So that is your research purposes. But when it comes to your study, you know, hypothesis is is going to be that there is no difference in the incidents basis. Yeah, what whatever season you use it. So the question is, why do we have an allergy? Both cases, which shows there's no difference. The reason is, is akin to quiet the concert off natural justice which is basically it's a status school until proven otherwise on. The reason is this is a bit philosophical. If you think about it, it's actually very difficult to prove that someone is innocent beyond any doubt or anything, because you can always find approve that showed this person, you know, somebody don't know the next movement Next moment on evidence might creep up that showed this person is guilty. So the way it works is that we assume this person is innocent until you can come up with an evidence that shows otherwise, which means the, you know, so you're starting school remains. Until so that's what he said, that you cannot actually prove that somebody is no scent beyond any doubt. You can only prove that this person is not guilty off the off the particular crime that you are accusing off. So exactly the same thing happens with the enalapril senses. So we started this at steady school is that there is no difference until you can bring a cumulative evidence to suggest the otherwise. Now is everything else I remember. It starts. It's not straight forward and they're a cabinet. So here we come up with our first cabinet, which is a non infinity trial, is You know, automatic researchers, you know, improved so much nowadays that not only are we progress beyond case reports to our cities, we're looking at complex accident in a B J J regularly would come up with known in for to trial. So what kind of non happens is, is, should we have in a non in for the trial? I'll be so yeah, not not on. The reason is if you go back to our thing, you know, remember when we do a normal trial, we were trying to prove that something is better. That's whole point. Our new intervention makes a difference, So if you cannot prove it, that means there is no difference. But if you have the same now hypothesis in a non Infinity trial, which shows there is no difference, there's no on us on you to actually to prove your side, isn't it? So it doesn't make any sense. So, in simple terms, to make things easy from what we say is in a non Infinity trial, the non hypothesis is that the new intervention is actually inferior to the existing intervention. Until you can prove otherwise. Okay, so we've done so. You you've thought about your study. You conceived it. So you've got your knowledge Oppose. This is right. So then they move forward. So the next thing you want to do is he wanted a poor calculation. So you have all heard about it. But what does it actually mean? In simple terms, I tell people it's actually the ability to reject your knowledge about this is correctly that mean? So if you if if you are right in rejecting the now hypothesis is which means that there is a difference between the two things. Yeah, so your alternative happens, is is is correct. So when you were doing the power, her positive is what are you actually trying to prove? So let's have unexamined. For example, let's think that ignitions here has come up with a new drug or researcher new drug that will reduce the incidents off blood loss with the new You know, if you do have any replacement with the tuning K compared to trying to make us see, this magic drug will reduce your risk off. Bloody. So remember when you give this drug to the patient not everyone is going to have a set. Average amount of this 150 minutes is your MCV I d it. Not everybody is going to have lunch. Bled reduction, blood loss by 150 million. So you're going to have a natural variation. Three middle six more 50 bills or even 200 mils is going to be a different range, isn't it? So when you were doing the power calculation, what you're doing is you're asking the statistical software. How many events do I need to observe in my trial so that I'm going to see enough off this trend of blood loss so I can pick up Even all happened. This is incorrect, or my alternative I put it, is right. I'm going to pick it up. And obviously you don't actually ask for the event. So what? Essentially, when you do a power and vices or it's sample size calculation, what you were asking the software is that how many patients do I need to recruit in my trial so that I'm going to see enough number off events in my trial so that I can pick up if the alternative diagnosis is correct, so that's your no sample size calculation. And parentless is now The question is, if we do this powerless is for this ignition study. We we consider the study in your absence. So So let's see the power power cognition says, you know, for, you know, 80% power You need to recruit 500 patients for this trial. So how many patients do we need to recruit for this trial you want? Is it enough? So the question is, is it okay to recruit 500 patients for the trial? Because that is what the you know, this software told us to do this is our, you know, adequate sample size. Sorry. Yes, exactly. So remember, even if you do it and you're 500 you were starting off with just about right as soon Inglewood, your 0% dropout, which is impractical. So you have to take that into account. Okay, fine. So we've done our sample size calculation. Now we want to start our trial to design the trial. That's when you can start having problem with bias is you know, people have a bit of a misconception of bias. It is not always intentional. So if you intentionally want to make a problem with your trial. That's fraud. We're not talking about it, but this is unintentional on essentially, what bias is that? It is the way you design your trial. And if they're inherent, falls which are going to so remember, bias is a system. Medicare. Uh, it's not random. It will be. Systematically, I were either over or under analyzed your your trial. So that is bias. And we won't go through all the different stages of bias to just to give you example. These people get a bit confused about this. Just keep it less. Keep it simple. So remember the random era. If you have lots of random era, what's happening? Suppose this is what you were aiming aiming to measure in your trial. So if you are making random mistakes in measurement, then you're going to be all over the place is but if your random mystic so let's take random mystic out of the way. But if you are highly biased, that is, you can see what's happening is you have a definite trend. You are on one side off your list. This is you know you're overestimating you're overestimating your results. Similar time. If your bias is low, then you could be depending or error. It could be around all over the place is. Or if you're making you know, random error as well as buyers, then it would be more widely spread. So that's what is bias. So, you know, you have designed to your trial and you finished your trial. Then you come to analysis. How do you allies? Especially when you try to be good. We're all interested in our city. So the thing is, we have got all these options. So I'm not going to discuss about our city because all if you understand the rational for randomizing a trial because you want to avoid confounding factors. Yeah, so Well, so we were randomized their sample to call the trouble. So we've got to control our versus an intervention up. So which is absolutely fired. Then the moment your trial starts, what happened is everything falls apart. So you have patients with change their mind, so they cross over to the other side. Is it green? So we got a few green on this side. Something the intervention side the good. Then you have a loss to follow up. Some people did. So you have a, you know, mishmash off people on both sides. So the option you have is what you could do. You could leave out all the people who did not follow your intentions. So you have a pure samples. So this is called parp critical analyzes. You could have pure red versus pure green, where the people who actually stuck to the, you know, pretty goal. So that's your part critical, Unless is, or you could be fragmented. And he said, Okay, I'll do whatever I got to. You got the mishmash of people that are straight ID or you could be really, really obstinate, as you know. Now, I'm going to ignore everything. I am going to treat people as leave whatever. They were my intention at the very beginning. So it doesn't really matter whether ended up there going to be exactly the same. So then this is known as intention to treat analysis. So remember, intention to treat ITTF know the patients in intention is your intention as found through their location. Okay, so the question is intention to treat or I t is a bit, you know, It's not quite natural thinking. You're not really sure why it happens. For example, if we go back to that our initial trial ignitions trial. So we had this people who had this magic drug versus trying some, I guess it. So then you have some people who actually had the magic. You know, they were ordinary, allocated to crank stomach acid, but had magic drug, and you notice that they had excellent reduction of blood, you know, blood loss very little. So you're great. So this is going to help with my crowd. But actually, because these patients, your original allocation were for chronic stomach acid. When you start your eye T t e, they go back to the track stomach acid as you get. It doesn't really make sense because this patient actually had the magic drug. But you can put them in that group. You consider them as if they're trying to make us it. But how does that make sense? The reason for doing that is to go back to this. Remember, you are randomizing people in groups because he wanted a board confounding factors on your sorry happened. Now the skin Did I touch anything Yeah. Which one letter? No. Sorry. You know, So coming. Well, yeah. Yeah, that's a very good point. Anybody else that hasn't told on that? Okay, Yeah. Yeah. Okay. Yeah, yeah. Do you want to be a bit loud? So, everybody here? Yeah. Yeah. Okay. Yeah. So we really got that. It's complete, you know, extreme scenario. What do you do in that scenario? That's a good question. So remember, stars, there are always options is nothing is fixed in it, so you've got to be pragmatic. So what do you do? So I mean, obviously that's an extreme case, and that won't happen to realize. But what could happen in real life is that you have a lot of cross over, you know, loss of follow up to the point that you were worried that you do intention to treat. It's not going to be, you know, representative of the real life. So what do you do in that scenario is that there is a thing called and said, if it you know it, Has anybody heard of that? So, essentially you want so your scope, you want to see what the result is. So what do you do In that case, you go back, you do your intention to treat because that's your That's where you have people who are free of confounding buyers. But then you want to see that all this problem this happened to what extent it has affected the results. So at the same time, you do a particle analysis. Okay, so then you do both. And so you say that because off this problem, we did both the analysis so that well, so are you said that we did a sensitivity. Allies is by also doing a proper tickle an issue at the same time to see what extent all this study violation affected our results on. Then what happens is if you find that there's not a huge difference between the two, then you say Okay, we had this violation, but actually, fortunately, as you can see with after particle, they did not significantly affect your results. Okay, so remember you always. The option is always to remain pragmatic. Okay, So Okay, so we've gone off. We have to go back to this line. So Okay, so remember, So that was the reason. So, going back, the reason we have to do intention to treat that you just answered it because you've got This is where you're confirming factors avoided. So the other advantage is off. Intention to treat is that remember, with far protocol, other things. You have a smaller sample. Your power in a license on allocation is based on your intention to treat orginal sample. So if you do the other sample where your sample sizes smaller, you probably do it. You know, you're highly likely to do it type two era. So that's the other thing I would finally and most important thing, which is what people say nowadays. Remember, intention to treat is a pragmatic callouses on it Tells you what happens on a community level if we choose a particular treatment options. So you remember going back to this. You know, many off you'd have heard of the draft travel, you know, comparing K where versus you know, already for this radial fractures. So what's the saying is the people you think you could benefit from either on a community level? If this is the treatment, you recommend that Oh, never is. This is what's going to happen. Okay, So again, remember, as they say this is my favorite time and starts the You always have cabinets. So caveats going back to the intention to treat dollars is for our favorite study design. Non Infinity trial. When it comes to known in 30 trial, I t. Is not recommended. The reason is, remember with the idea that just say, even if you have the intervention of people who cross over the other side, you treat them. I think they had the control. Yeah, So what happens? The other advantage of doing I t t. It's a concentrated estimate off your intervention. So it's always favors, you know, unless it's a big difference. No difference with the two groups. So remember when you do a non infected trial, your Amy's to show there's no difference. So if you do an intention to treat dollars, it is actually going to go that way. So it's not the right, you know. It's not the ideal analysis if you're doing and on in for to trial. Okay, so you've done your allies is now you need to know. Are you right or not? Your results. This is where people who come. So the question is, what do you actually mean by the evil. So when we're looking at the people what we're actually asking ourselves the result that we have is it's so unusual that it could not have happened by chance. Or it could have only happened by chance, not more than one in 20 times. That's all we're asking. Okay, so remember when you when you conduct a trial and you make your measurement measurement is based on your sample on, then you want to make inference from your sample for the larger population. So the moment you're doing it, you're doing some estimate because you don't actually what they did. So when you do your status tickle test and you're looking for the P value, what you were asking is that you are asking the statistical software that a guy's Why don't you compare my estimate with the natural variation or natural distribution off this particular estimate on, See whether it falls within the expected you know, distribution? Or is it so far out off it that you said that this is very unlikely to happen by chance? That's what you want to ask. So that is all it is people. The problem people. It is widely misunderstood. Just remember this thing. Sometimes, even if you find there's no significant difference between the two arms, it does not mean there's no difference. There is a difference. It did not read the 60 artistic ultrasound of Significant. The second thing to remember is that even if this statistically significant difference, it does not actually mean this is going to be useful Going back to that, you know, the blood loss, our magic drug. We might find that actually, there is the difference in blood loss between the two. Arms is only about 15 mills, and it is highly started, sickly significant difference. That means that you didn't find it as a fluke. It's a really difference if you give this magic drug compared to trying to make us, it will reduce blood loss by 15 milk. But hey, 15 with what difference does it make is not going to make is different, so don't think you're just because something is statistically significant. There's actually important things. The other thing is that when you have a cut off of people, significant or not, it gives you no idea what the effect size or you don't actually know. You know whether the trial was adequately powered. So going back So the issue of the P value people, when you're looking for the people what it is you are looking for strength of evidence against your multiple. This is the smaller the P value, the stronger the evidence against your multiple cysts is. As you know, the pressure we use is not 05, but some some of the studies when the important things they would even is not 01 So but as they say, people who gives you no idea what the strength of the treatment. Okay, so again to emphasize, remember, even if he was very small people not punching real one that does not have a stronger effect company, not points or what it just showed that here is even more unlikely to have happened by chance. But we have no idea about the strength effect on going back Just because it's tight a signal is significant, does not mean actually is really, you know, clinically useful. The final thing to remind you again is that when we're looking at the P value is looking at the range of probabilities. But it's the ordinary difficult cut of value. So, you know, I'm sure none off here. If you buy in a national lottery ticket, would you stop buying your ticket if your chance of winning goes down from 5.1% to 4.9? No, but this is what we were asking a new doing in your You know, when you choose the people whose remember that it's actually just a cut a bell, which is artificial. So the thing is, they say, because we don't actually have any idea about this effect size with P value to find out, what you have to do is we have to find a confidence interval, the confidence interval. What is it Is that remember going back to our actual population because, if not measured, the whole population? We do not. Actually, no the truth, population parameters, which we're making estimates. So when you're looking at the confidence interval, we are trying to find out or make a guess about the actual population parameter, which we have no idea about, okay? And generally is, you know, it's a 95% confidence interval is what we use on is working definition to understand that it's 95 times out of 100. You're two population value will be within this range from a pure, pure statistical point of it is an incorrect definition, but for a working, understanding is fine. So confidence in trouble. The way I told people is, it's actually all it is. It's an educated guess. The reason is, is educated. Guess because you've done a measurement on your sample, but still, it's a guess, because you've not measured the whole population and you're trying to make some inferences for the whole population from your sample. Okay, so let's given example, for example, we wanted to know, Let's say, for example, we wanted to know the mean height off. Everyone who was registered for this course to come here to do this, you know, research today. Now, obviously, you know, there's lots of people online we don't have. We only have people around here, so we do the measurement in this room on, we find that our men hide with 160 centimeters, 95% confidence in the 55 to 75. So when we do this, what we're saying is that we don't actually know what is the main height off the participants off this course. But we had a sample. We did some measurement. We think it could be around 160 centimeters. But we're 95% sure it's going to be any of it in this range. Yeah. And remember, the important thing is it could be anywhere. So you have no idea whether it's any 455 175 just because you have that mean value, it doesn't mean it's more likely to be wrong there. Okay, So okay, so coming towards the end. So now you've done your analyzed the plan, you pee value. You had the effect measures and you've done your confidence interval. You could still be mistaken. So, um are now hypothesis is the two scenarios it could be are the true or false. If it's true, you ecliptic, you're fine, is false. You rejected your finds the rest of the time you could have mistakes. So type one error is that when did now happens, this is is true. You reject it, so you make it false. Positive era type to error. It was in his false. But you accept it by mistake. So that's your type two era. You know, type one error is because we already deciding on the people who have not 25. So you have. That's a 5% chance of making your type. One era type to error is generally accepted. It's got to be maximum around 80% so you know, 20%. So you're 80% power and the rest is your type two. So easy way to remember is that your type one is false positive, and his type two is false. Negative on the weight I remember. I tell the my candidates to the courses Go, go, go back. Remember a shelf stable? You know the boy who's to cry Wolf. So the question is, what's going to be the non hypothesis? Yeah, so the night. But it's very easy. That means there is no wolf. Yeah, on your type one era. So remember, type one area is false. Positive, isn't it? So which means you think there are wolf when there is not on your type two era is they put it off that you said there are no bullets when there is one. Okay, so that's just a very quick, brief overview of some common statistical use terms. I hope you found it useful. So in summary, to remind you. Just remember, status sticks is just a tool. It's 12, so learn to use it properly. And also remember, that is easy to make mistakes. Check and recheck your data. Remember that chance happens very easily. So if you find a result which looks too good to be true, probably is so always look for alternative. All explanation. And finally I want to remind these statistics is about average is whenever you dealing with your patient. Remember, every patient is unique, so average and may not be applicable to the patient. Even if all your results are fine, you're absolutely okay. Okay, That's it. Thank you very much. You know, that was brilliant. Thank you very much. I wouldn't be able to explain it to six. Better than saying Oh, you have the pleasure of it this afternoon. Thank you very much for coming in a school. Small talk. Any questions so far about statistics? I think there's one about TT and versus pee pee on the online chat. But I think you've answered that beautifully. Any questions from the floor? Okay, great. Thank you. So we like to invite John Scales. So last on our program will be John. Who's part of NIH are his own zoom call. Now, at the moment. Hello, John. I can see you. Yes. So he's a research advisor for the R. D s at night are low acronyms. Uh, and he's been to the course before, representing east of England. And he's an eye doctor research advice. Or since 2008, it was messing around with both And he lives in East Anglia, and I'll let him introduce himself. And what his splendid work for the eastern and I start networkers. Okay, canisters. So I should have my screen and go ahead. Yes, thank you. Just for the delegates on site the NIH, our research network is actually here, so if you wouldn't mind just engaging with them, and they will be. And there's a lot of leaflets about how to go about your research questions. That's a fantastic title, don't you think? Jones Not here. Yeah, so just a Yeah. Here we get from the treatment. Uh huh. Um, sir, uh, I'm drawn Scales are research advisor with the NIH, our research design service. They strictly Addenbrooke's Hospital on Essex University. My role for the past decade has been to provide guidance and advice to NHS clinicians applying for research funding from the anorexia. Today, I'm talking specifically about achieving funding success with the HR. But these insights could be applied to any other health related funding opportunities, so applying for research funding on top of the demanding clinical work load could be a a very challenging task. I know from working without lines just how much of their own time is put into developing their funding applications. Onda Just how much effort this contagious funding awards? Ah, highly competitive on designing research in the really world of the NHS adds to that challenge. In this presentation, I'm going to do three things. I'm going to talk about what we do as Thean Research design service and how we can help you develop your funding application to the child. I'm going to give a short overview of NIH are funding looking both at the funding programs on the fellowships on offer on. Then I'm going to finish by looking at what I think are the foundations of a strong NIH. Our application on looking at some of the key questions, which you need to compellingly answer to convince the funders to fund you so the audio were regionally. Based on this, we're a free service for clinicians, academics and small or medium sized companies. Developing applications to the NIH are we're spread across. Five teams were in the universities off Bedford here, Hartford here. SX you a, um you also have a team Addenbrooke's Hospital on D. The key thing to know is that we're here to support the development of funding. Applications to the energy are. But we consequence ought, um, people who are doing research where there is no intention to submit a funding application. I will put a caveat in. We can support applications to other peer reviewed national research funding programs, for example, like the well contrast. So we do have the discretion to do that. But unfortunately, we can't help you with designing your research protocol for a piece of, you know, for a degree, or for Messi whether it's no intention to apply for research funding, the sort of expertise we offer Well, first and foremost will help you understand. The NIH are funding programs and we'll help you understand what the remit of those is on with. Your idea will fit. Excuse the spelling mistake. There we weigh have experts in quantitative and qualitative methods. Research, design statistics. Health economics is a strong is a is a large part Now of any energy HR funding application, we have a team of dedicated health economists of it. You're a but specialists in public patient in public involvement again, any, uh, NIH funding funded research has to show meaningful engagement with patients. We can help you with systematic reviews, and we can help you build that narrative. What we call groundsman ship making a compelling story. Very little little research is now done in isolation. The days of the loan clinician working on their own. Long gone. Any funding now is probably going to require a lion's on across other organizations. So we're tapped into things like the Academic Science Network, Health Enterprise East, who are experts in commercialization and the intellectual property clinical trials units who would manage large trials and ensure quality assurance. The Cold Brands of Research Network, which again is another part of the NIH, are and is yet another acronym and last but by no means least trust. Oh, no. R and D in finance office is so we can help you navigate all of these different organizations. We try to be as, um, being a criticas possible. We're aware you're busy people on So, Teo, get in touch with their simply register on L A client inquiry form on our website, and within a day or two, a key research of Bizer will be appointed and we'll contact you. What we will then do is set up the first meeting where we will interrogate your idea and we'll interrogate it from the perspective of funders. And we'll we'll try and help you identify the most appropriate funding scheme for it. It's not. A one off meeting over over the period of months is you develop your application will give you ongoing advice and feet back and, when necessary, bringing colleagues with specialist expertise. Some of the funding programs require you to give a presentation and to attend for an interview, and we'll help you with that will help you prepare your presentation on. We'll give these and look into the sessions to really get you up to speed with giving you a page and then finally will be brief You on your application outcome. If you get funded, that's great. That's where our involvement stops. But if you don't get funded and we never use the word fail or rejection, But if you don't get funded on that attempt, we'll have a look at it with you on will help you decide whether it's worth reworking it, resubmitting it or whether to call it a day and move on to something else on. We will help you through that process again and help you to put in another application on, but something that I would like to say Here is a lot of people when they first applied, don't get funded on the first time around up with further work and development with successful subsequently. So so what I'd like to do now is just have a bit of a look. Aunt, uh, enrich our funding generally and what's over arching a miss. And also look at some of the specific funding programs, which may be of interest to this audience and also talk a little bit about fellowships. So you know, HR mission statement. Our mission is to improve the health well of the nation through research. No, just health, but also well, it's applied from do it's translational funding. Yeah, it's so it's no funding for basic science. In the next slide, I'll show you where this funding sets on the translation pathway. So across the top, the banner across the top goes from invention, evaluation, adoption, diffusion and NIH funding really fits between the translation off scientific knowledge into something. Whether that's an intervention or the way of using an intervention through to the evaluation on adoption off it. Basic science is more to the left off this schematic. And really, that's more the work of the Medical Research Council. So the NIH are is funding research, which is likely to lead to impact or changes in practice or improvements in care in the short term. Medium term, that's sort of three years, five years, perhaps seven years, son. Just a bit of an overview and further information. There's a link at the top of the page, which will take you through to the different funding programs and give you some more detail on that of the funding. It shouldn't focus on a current or emergent helps or social care need in the UK. That's not to say that they may not be a global need. Yeah, if you're going to get funded by the NIH, I think you need to be addressing a current or emerging health care need in the UK projects that typically up to three years in duration. Although there are some funding programs, which do you go beyond that? It's a two. Most of the funding programs or a two stage funding process. They must demonstrate, uh, meaningful PPI on DTaP. Be realistic. Starting from now to getting funded is a minimum of 12 months. That's what a month period, usually a little bit longer than that. Just looking at some of these cool funding programs running down the left of this slide of the names of the program and across the top on the grid, the ream it on. I'm just going to pick out a few of these just to give you some sort of sense of the scale of funding on the type of ream it. If we look at the third funding program down on the left, that's health technology assessment. HTA. That is a big funder off clinical evaluation. So really, that would be funding things like big multi center, randomized controlled trials. And that would be trials of interventions, which are already in use in the NHS, where there is already efficacy shown, but where the level of effectiveness compared to other interventions isn't necessarily know or the cost effectiveness. So these would be a big, big trials to actually show whether Intervention A is more cost effective than intervention be on Does it gives better outcomes. These could be funded up to sort of 2 million lbs. So these are big awards. I know that in the audience I think you're off a pedic. Surgeons on one of the really fun parts of the interesting part of my job is when we get a call from a surgeon on Dave invented something that invented a a gadget, forgetting to a part of the body to do an operation. We've had some success with Adam Brooke surgeons. Do you have wanted to take their prototype device and turn it into a marketable, say level medical device on? That's where the invention for innovation funding comes in. This is a whole umbrella of innovation. Funding to support the development of med tech could be a diagnostic device. It could be a surgical device. It supports it from proof of concept through to market. And again, these warts can be well in excess of a billion pounds. Although there are small awards, which gives sort of seed funding Fridays, the final, uh, a program that I will just draw your attention to is at the bottom research for patient benefit. This is a much smaller trump for funding up to $350,000 for a full CT, which is very modest for a randomized controlled trial. There are two other tiers of funding. One is 250,000, and that is for feasibility trials. And in the United chart, feasibility trials are either to look at the feasibility of delivering an intervention or the feasibility of doing a large scale, multi site trial on but just how well that trial would work. So this quarter of a million pounds on offer for anyone who wants to develop a fever bility trial, and then there's also a lower tier of funding of 150,000, which really is quite a modest amount of funding for what the funders call more exploratory work, and that again, could be if something been trusted, this Ilyin one meal to move on to fellowship. It's so as well as funding actual research, the interaction will fund a range of fellowships from pre doctor research training in terms of master's degrees, treated, doctoral research and advanced post doctoral programs of resection development. What I really want to draw your attention to here is that the fellowships are not on alternative to research funding, so it's a mistake to think, Oh, they're a shortcut to getting a piece of research funded. The release of the fellowships is very, very different to the funding programs, more details of the fellowships or at the link below on. But I just want to explore them in a little bit more detail here. So I'd like you to think fellowships has not put Escalator a series of escalators where you can go up on escalator step off, climb onto another one on. The idea of the fellowships fundamentally is to help support the development off the research leaders of the future in the NHS, and the reason that's important is because it's the people on the front line of delivering care in the NHS who understand the research needs of the NHS and the idea of the fellowships is to help develop people who are working at the front line of clinical delivery also develop their own research pathways. Applications to the fellowships need to reflect this in the narrative of the applicants research journey before curing on after the fellowship. They are very, very generous packages. I think someone has already alluded to 400,000 lbs. What a fellowship will typically cover is the candidate salary costs, um, for a part time, so that's 60 to 100% ft over 3 to 5 years. And that obviously could be quite considerable. The costs of the research, you know, So the full costs of doing a properly funded piece of research, which can go into some hundreds of thousands of pounds if, for example, if I I'll unit is also involved the costs of registration for Post Grad study, intuition, specialist research, training costs on things like a tendency conferences for the all up value of a doctoral fellowship can easily exceed half million. We've had some which have been approaching a million pounds when everything is included, so these are very, very competitive. Awards want a very prestigious Onda, I think very worth considering applying for the fellowship assessment criteria are different to the research funding criteria. Yes, the very first thing that they're assessed Oh, is the strength of the research protocol that you put in on that has to fulfill all the requirements of any NIH I'll piece of research. It's got to be translational, and it's got to be moving towards creating some kind of improvement in healthcare. So that's a given. It's gotta be feasible. It's gonna be scientifically robust. But the funders air also looking at you as an applicant, are you at in appropriate place in your career? And, um, appropriate place and commute demonstrate a commitment to research up to date. So, for example, they don't expect you to have dozens and dozens of first or third examples, but they would be expecting you to be able to demonstrate that over the over your trajectory today you've been involved in research. Maybe you've got your name on some papers, Onda, that this research has had some sort of impact. Evening had a local level. The funders also want applicants to be able to look at their research proposal and look at themselves on identify their research. Trading needs not just research training needs, but maybe leadership training needs. Maybe communication training needs on. They want applicants to develop themselves that they spoke. Training package on the funding, Remember, is there to pay for this? And this could be a considerable, um, additional some of money. Your application for a fellowship will also be looked at in terms of the strength of the supervision and mentorship that you have. So the funders don't want you to be seen advised boy. Just anyone. They want someone who's a leader in their field nationally, plus possibly internationally, and they want you to register to do that At and Institution, which is a leader in its field in a department perhaps, which has got a track record off influential publications in the field that you want to do your finish it then, and finally, the applicants are interested in what your future career trajectory is. They want you to be able to describe a realistic and but I am vicious vision of where you're going subsequently, how are you going to use this opportunity to become a research leader, you know, how is that going to prepare you on what's in upwards alongside your clinical work? So it's not just project. It's also people in place. The application process. It's a two stage application process, and it always includes an interview. A realistic timeframe to put together a fellowship application is a year. Don't if you're somewhere in your training pathway at the moment, you might think, Well, it's something for a few years time, and that's great. Start thinking about it now and be strategic. Stopped positioning yourself for that fellowship application now, perhaps by getting involved in surgery. Yeah, keeping a poor failure, keeping a record of what research is being involved in what your role in it. Waas What probably cations came out of it. And importantly, what the impact was, what the impact on care was, what the impact on outcomes waas or patient experience? Take it back to remit of the energy. I want to finish by being a bit more general on a bit broader now, So we're going straight how the obvious can help you on how to look at the overview of funding and fellowship. I want to drill down now a bit into what makes a strong anti action NIH other application. Look at some of the key questions. I'm not going to be going into the finer points of methodology. Your statistics. I'm looking at it from or from a broader a broader perspective. Are you familiar with televisions Dragons? Then competitors picture group of business dragons for funding of the business idea in exchange for a steak in it. Applying for NIH funding is a similar process. I would add that without the piles of cash on display when did siding you to back, the dragons are seeking a meaningful, untimely return on their investment, a proportionate level of rest. And they won't. This presented with in a well within a well fault out business plan in the NIH All dragons. Then you can substitute the word impact for profit or return on investment. Impact is the return of it on investment. On that impact is improvements. In help comes improvements in patient experience or better cost effective Nestle Better use of resources. The funders are looking for high impact no or proportionate risk investments to improve the health wealth of the UK applicants weather for a fellowship or for research funding are in competition with other research ideas. There is only so much money to invest and you are pitching in your application for that investment. So this slide demonstrates what I would call the flow of a strong and I jump it, you know, And it runs from What is the clinical problem on what is the evidence of that clinical problem through how you did how you turn that into a research questions? Yeah, and how those research questions and then packaged into a set of clear on consistent aims and objectives on how those aims and objectives are delivered through an appropriate research plan that give answers that will feed into a solution not in 30 years time, not in 20 years time, but maybe in five years time. Yeah, in the short, medium term on how that solution, how that is going to be rolled out to implementation in the NHS in the real world of the NHS as we know it. And crucially, what is the potential for impact? What is the return on investment going today? So I want to look at some of these in a little bit more detail, starting off with what's the problem? Foundation off any night or application is a description off the clinical problem. Ah, lot of applications fail, either because the problem is not considered important enough by the funders, or it hasn't been explained to them enough to them in enough detail that the application hasn't made explicit what the problem is. How you position and describe the clinical problem is your opportunity to get the attention off the funders. So what's the problem in the photo? Your immediate response? My immediate response will be with the truck stuck. Yeah, that's a fact. The truck is stuck, but it's not really getting to what the problem is. We don't know if it's one truck or whether there's hundreds of truck 30 stop. We don't know if it's stuck just simply because there's been a bad downpour of rain today. Whether it's always like that, we don't know if it's just because the driver made a foolish decision to destroy it, to drive down a dirt road when there's a perfectly decent highway going to the same destination, we don't know if it's because there's too much weight in the trunk. Or maybe the trucks got the wrong sort of tires on. So these are the sorts of questions. When you translate there, since your clinical question, you know, how do you describe the clinical problem? What is this scale? How many people does it effect? What are the consequences? What is the evidence that that problem exists? Yeah. So time and thought put into defining and explaining the problem is the first thing in making that pitch to the actual get a hold of programs. You know this, but you you you're working with it all the time. The funders want to invest in solutions. Yeah, they're unlikely to fund research that is not heading towards a solution you need within an application. It within that narrative flow, you need to give an explanation of what that solution might look like. How will it fit into the NHS patient pathway? How much will it cost? How what extent will it improve patient outcomes, the patient experience or reduce costs? Is it really viable within the really world? Constraints of the NHS will be easy or hard to deliver it. These are all the things to consider within the picture your maker for funding in your research funding application age. Did you research plan? So within your application, you need to create those clear research questions, which are logical. Extension off the clinical problem and to translate that is into focused and consistent rains and objectives. So one way to lose a funders confidence is tow, have a mess and objectives which are too complex. We can not following a logical flow on which are inconsistent, and it's very easy with these funding. Applications are very complex pieces of work, and it's very easy for a month and objectives to start to drift across the course of the application. They need to be consistent on something else that needs to be considered. Very little. Research now is done by the individual is a team effort and their needs at an early stage to be a consensus achieved across that research team as to what those aims, objectives and questions are, And then those aims and objectives need to be translated into your research plan, and that has to be feasible. And it has to be scientifically robust. Yeah, so, by feasible, are you really going to read. Recruit all of the target, your order, the patients who are in the inclusion criteria. No funding committee will believe you'll be able to do that. So you need a have realistic recruitment targets. You got to show that it's gonna be operationally deliver a bill as a piece of research within the real world. Maybe an acute hospital trust gonna be scientifically robust. And that's obviously wearing a statistical input. He's going to come in on the the careful way off designing the research, and I'm going to have one more thing here. It needs to be parsimonious. You need to deliver on the aims. No more. Certainly no less, but no more. The funders want to fund the research to deliver the answers that will get to the solution that would improve outcomes. They don't necessarily want her fund your whole rate of spirits research papers which aren't really going anywhere. So that's really gonna be focused. My final thing that I want to discuss is the pathway to implementation of impact. Funders want to see a clear pathway impact too many junctions and roundabouts. After the conclusion of your research will make them nervous, it increases risk that a return on the investment will never happen. And remember that return on investment is improved. Patient outcomes improve patient experience or better cost efficiency is, yeah, so the straighter, simpler, shorter and more direct that pathway to implementation and that pathway to potentially impact the better. A straight line is ideal, but it's seldom achievable in the real world. No, but a meandering seen it route will not get funded. Of course, how applicants present their research proposition to the NIH are is also important. A poorly, poorly presented application with a decent review of the evidence base or little with typos and spelling mistakes will undermine confidence. It will increase the perception of risk. Yeah, no about a how strong the rational for the research idea won't everything could be fixed other than a week. I did a strong underlying research idea that flows from important clinical problem and is able to demonstrate a timely, low risk path to meaningful impact can always be turned into a fund, a ball proposition, even if it's not successful on the first attempt a week idea. By contrast with that return on investment is too small to be worth pursuing or the path to implementation off a solution is to call. Complex is unlikely ever to get funded, no matter how well written the proposal or how technically accomplished the research methodology. Remember the NIH are dragon seek a timely and meaningful return on investment balanced by a proportional risk all set within a sound business plan in terms of a business plan. Think of it as a piece of joinery, perhaps Yeah, well designed to fill it e simple. When I say simple know, overly simple, you need to answer the questions but elegant in its construction. Strong functional research funding proposal should be balanced, Well crafted precision all the parts off the flow from clinical problem through to what is the question? What are the names you know? What is that potential solution on pathway to implementation? Need to look together with a structural integrity, the logic and incoherence that will inspire confidence in the funders. So I'm going to finish how to get started would suggest if you think you might want to apply for research funding from the child, right? A short working document, a couple of a four signs setting out What is that political problems. What might that solution? Replying? Yeah, what the aims might be maybe sketch out just a rough architecture of maybe how you consider going about doing it. And crucially, what would the pathway to future implementation of solution replied and then interrogate your idea from the perspective of the funders and laughed. But means least register with the audio? Yes. Then come talk to us. Onda, uh will help you to tell that hopefully into a fund. A ball proposition. So I'm aware that I'm out of time. I'm ready for questions. I'll forget. Great. Thanks, John. Any questions on online or from the floor? Let me just really just for the benefit of the trainees from our point of view, your services being excellent both and getting to off our projects. Funded. It's taken time, but it's been a great service, so thank you. Very kind. Great. Thank you. So we don't have any questions from the chat box. Great. Thank you very much. 11 thing I would like to say yes. Yes is I believe my colleague Jerry is with you with some literature on. If anyone is thinking of research a research idea, they can always just passed her there. Details on to her. Great. Yes. She's out at lunch, and I encourage all of you to speak to outside. Okay, Great. Thank you dot They were quite lucky to have our DS in our region. So it's fortunate. So better plug in before we end. Cambridge Orthopedic Club If they helped a little bit of funding on this program, so thank you very much. Please do. Come First of July, Jason will be very happy. Um, another plug in for one of our ST ones run through trainee. Who's doing a surgical part or is a Shin Project? Some of you have known this is a orchestra ported regional port check. So do support. And anyone who's a co author. Um uh, anyone who supported this part, it will be a cool off the on this paper. Um, so thank you all if you could do the feet, but it will all be automated, including the online and the face to face delegates. Please do stay for the face to face that obsession later on. And lunch will be served soon. Thank you, everyone for joining and thank you all to our partners. and invite the faculty on. Don't like to invite Mr Because Candies you up for any closing remarks and a small token of appreciation for me. What? Thanks it up. So no, no major closing remarks from from me. I think it's as I said in the morning. It's is essentially being biggies effort and the teams that, too get this going. It's a lovely music videos. Well, but become we can't get the music on for some reason that possible, and we'll play it again for you. So up up to fantastic days, the second day on the Thursday is going to be virtual. So do joining for that. And then, uh, the first, which is the Friday would be the Setauket face to face meeting on, then dinner What kings call it. So do please do sign. And if you haven't signed in for that a big thank you to all the people who have been attending internationally virtually thank you all for attending. Uh, if you being on the platform, then you'll get your certificates in in time on. But for all of you who are returning face to face, we've got some libelous for you. The soft noon. Enough lunch. We'll start that. So thanks a lot. Thank you again. Once again. Thank you. And least I like to thank Mr Come for helping me. My good deal of volume or not really? So let's try that.