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Two. Um Good afternoon, everyone can everybody hear and see me clearly. I don't know if there's a chat function. Um Can everyone hear me clearly? Yeah, so microphone is working. So I, I'm assuming everybody's able to hear my voice. Um Welcome to the second session of the um teaching series in the research in the NHS. Um I'm Rizwana, I'm a research fellow based in Birmingham. For those of you who don't know about me and um today's session, we will basically have a quick chat about the research, study design, what that means and um what are the different types of study designs. So for those of you who don't know about uh about me or who basically missed the previous session, I'm an international medical graduate. Um um And then I have also done masters in clinical and research psychology. Then I went on to get a couple of diplomas and then I landed myself uh as a research fellow in the NHS not so long ago. So um a quick um housekeeping rules that we're all aware of. Um And one other thing that I wanted to put out in today's session would be a small disclaimer. Um, which basically states that although I, um, you know, we, uh, we completely understand that, um, this teaching series is basically based on how research in the NHS can be done. Um, but the advices and the opinions that we put forth does not follow any guidelines that are set out there for junior doctors because research is, to be honest, for a junior level, it's a very intentional process is how you pursue it. GMC does not have any particular guidelines for junior doctors to follow in order to get research work done. So anything that we express here does not entitle to any NHS guidelines. It's just our journey, uh you know, giving you some free advice and uh based on my experience as a research fellow and also experiences with my other colleagues as well, just a disclaimer for you out there, we're not following any strict guidelines by any NHS or any of our employing trust. So that being said, um I think today's session, what we'll based on is we'll, I'll divide the, today's talk on two things. First is we'll talk about um the different terminologies used in research. We'll basically try to learn the research language and the different uh vocabularies that are used. And the second half we'll discuss about the different types of study design. So again, um at a junior level, I think if we just get a basic idea of what each type means, I think that's more than enough because we are not expected to know everything about research, um, at a junior doctor level. So let's start off with the important question. Why is research so important? I mean, why are we making a teaching series about it? Why is it as a junior doctor you should be doing or taking part in research studies? Well, you all, you all probably have heard of the good medical practice which is uh you know, exercised by the GMC. So GMC has set out the good medical practice and we as doctors are, are, you know, sort of um have to strictly adhere to the good medical practice and in the good medical practice in their book, it clearly says that every doctor who's working in the NHS should follow evidence based medicine. Well, what is evidence based medicine is, is basically what we find out from research. So all the results and everything that we find from research is evidence based medicine. What we do in research is what ends up on the protocols and all the guidelines that we follow in the NHS. And in providing clinical care, you must provide efficient treatments based on the best available evidence. So again, it focuses on that particular part of evidence. So most of the times we follow what's there and research and we put that in the guidelines and we deliver that in form of treatment to patients. But there are some situations where we don't have enough research on that. So what we do in that is we try to make, you know, clinical judgment, um ask our seniors help and then follow it. But generally, um overall, we should be following. Um If there's one treatment that's better than the other, then we are obviously expected to deliver that as doctors to the patients. Now, this is uh something that I touched upon in the previous sessions. Again, if you have missed the first session, um the recorded version of it is put up in our community. So if you follow our community, you will have access to our recorded sessions, which you can go and view and catch up on it as well. So this, this is uh the, so I would say the textbook definition of research, it's quite fat. We don't need to know that, but basically, we need to get an idea of what research is, which is finding answers to questions. It's basically how you find out the answer to the question. And I'm gonna put this quote out there. I think in every session, the earlier you start the better because research is a very timely process. It's a very intentional process. And the more time you have in hand, the better chances of you doing much better in your research and chances of you ending up on the paper as well as a no thumb. So again, what makes your research a bit more interesting is how you do the research, so how you find out the answers to those questions? There are so many different types of studies and, um, you know, I can sit there, talk about each one of the study and that will be, I think, quite boring, but rather I'm gonna try and make sure, um, I try and make it as interactive as possible and I think every study designed that is out there, it's got its own advantages and disadvantages. But overall, they all add to our um evidence based medicine that we have out there in the form of research. Now, when you start working or when you start uh taking part in a research project with your consultant or with your academic professor, the first thing that the professor will tell you is or your consultant will tell you this. OK, if you want to take part in this particular research, how about you go and do some reading? So when you start reviewing, going online and you're googling your topic and you're trying to read all the different papers, you will come across so many different um terms related to research. It will uh you know, some will say case series, one, someone will, some, some and we'll say a trial uh what's an audit. So when it sometimes it's quite easy when you know what those terminologies are because it's easier for you to quickly go through each of the paper and understand what exactly they're talking about. So the first half of the session, we will uh focus on just understanding or just learning the research language. Now, the research language, I think if you uh just learned maybe the first six terminologies that are commonly used in research, um you will be able to get a better idea when you're going through or, or when you're sort of whizzing through each paper when you're researching. So the first terminology is longitudinal. So when you come across a study that's longitudinal, it basically means they're dealing with patient more than one point in time. So if I've got a group of patients, I'm gonna, I've got a group of uh study patients here and I'm gonna watch them over time and I'm gonna see how they're progressing. I'm gonna collect data from them at particular points. I'm watching them develop something that is known as longitudinal. For example, if you're working in the surgery department, uh and you look at all the patients who've had an appendicectomy and you're watching them over the next seven days if they develop any complications or maybe the next month or two or even years, that is known as longitudinal. Now, the next terminology which is right across, I'm not going down, I'm going across, which is cross sectional. Now, cross sectional is sort of the opposite to longitudinal here. You're just taking a quick snapshot of that particular population. For example, if I decided to um you know, gather all the junior doctors working in the surgery department and I asked them how many toilet breaks they've had that day. And then I take the urea and electrolyte levels. That is me just trying to see if there's any link between the number of toilet breaks they've had and the level of urea and creatinine. So that's just uh me not taking time in, uh into consideration just looking at them like a snapshot of that part of their behavior of their pattern in that particular time. Now, n below that you can see perspective. Now, perspective and retrospective, very commonly used terminologies are very commonly used research language perspective is very similar to longitudinal as well is basically when you've got a group of patients, they've already have the disease. Um I mean, they've already got some symptoms and you basically watch them develop the disease. So if I've got a group of patients who've got uh knee pain, I'm going to basically collect all the data I can about them and then watch them maybe over months or years and see if they develop osteoarthritis. So it's looking into patients from the present and into the future. And prospective studies are to be honest, very much um famous or popular in cardiology studies. When you're looking at cardiovascular system, when you're trying to find out the risk factors of someone developing um myocardial infarction. So they will collect data of all those patients and see if they develop heart diseases in the future. Now, the retrospective is again the opposite of perspective where here, what I've got is I'm looking at all the patients who already have the disease and I'm going back in time and I'm trying to see if there's any risk factors that they might have, that have actually caused them to have the disease in the present right now. So it's more like from the present, going back is known as retrospective. And here I'm gonna be using or the um existing data that's already been collected, maybe the patient's past medical records. And I will be assessing that to see if I can get any kind of uh correlation with between any of the factors. Now, the next one is explanatory, explanatory and pragmatic are very commonly again used. An explanatory is nothing but basically me taking a couple of participants, putting them into a research center and watching them um giving them maybe a medication, giving them a tablet and just watching them see how they get on with it. So it's a very much of like AAA strict environmental control where I control everything. You know, it's not like they take the tablet and they go home and then they come back for a blood test tomorrow. Now, they will probably be staying in a uh maybe like in a dormitory in a research center. So in the research center is usually converted into some kind of a set up and they basically, they stay there. And this is really good because um as a researcher or as a, a head of researcher, you can control everything else that might be altering your results. And um and because of that, the data that is usually collected from a research that's explanatory is quite efficient. Um because it's exactly measuring what you want to measure without any disturbance of anything else. Whereas pragmatic is sort of the opposite. So here, what happens is here, the study takes place in an ordinary setting, like for example, in a hospital where you're often trying to put an intervention compared to a standard care that's already been given. So for example, if I've got uh patients, uh if I work in cardiology and I've got patients with complete heart blocks who need pacemakers, and I've got a new pacemaker and I think this is much better compared to the ones that's already been used. What I'm gonna do is I'm gonna probably go to the cardiology ward of people. If they want to try out this new research, new um pacemaker, it's much more faster, it's effective, it's really good. And I basically install this or I basically operate these pacemakers into the patient and compare it with patients who maybe have had the standard ones. Now here, I'm not really controlling anyone because this is their disease. They obviously get to take the pacemaker. I mean, after having the pacemaker they go home, they lead on their normal routine. So there are a lot of things that can affect them, but because this is very much closer to what actually happens in real life as well. So here, um this basically reflects the everyday practice that can happen. So I hope you are all able to get an idea of all the different um uh I would say uh terminologies or words that we use in research any questions so far? OK. So just so um I can tell if we are all able to understand what's going on. I've got a little um phrase that's been cut out from a paper. And I want you to tell me whether if you think if it's a pragmatic or an explanatory uh research. So I'm gonna quickly put out a poll, read the uh please read that and tell me what you think, whether it's pragmatic or you think, whether it's explanatory, any idea? So sorry. So when I say here it's, I know it's quite hard to understand what it says is basically we restrictively restricted dietary carbohydrate versus fat for six days following a five day baseline diet. In 19 adults with obesity confined um to a metab ward where they exercised regularly subjects received both iso um you know, caloric diet in random order during each of two patient stays. So here, what they basically did is they grabbed 19 obese adults and they put them in a Metab ward. And what they did is they made them all exercise every day and then they gave half the patients or half the, half the adults, they gave them diet that had no carbs and the other half diet that had no fat. And they basically tried to see if that made any difference and they did that for five days. Now, any idea what you do, you think if this is something that might have been done in a hospital setting or in a research setting, if you think it's hospital and it would be pragmatic. If you think it is explanatory, it would, I mean, if you think if it's done in a research, then that would be explanatory. So we've got a uh two responses which says is explanatory. Yes, you are right. So this is basically an explanatory, although it says Metab Ward, um you don't expect people in hospital ward to exercise every day. So this is again a like a research center that's been converted into a Metab Ward and they're trying to make sure everybody exercises, they're trying to control everything and they're strictly watching these people giving them exact diet with the exact calories and everything. So this is an example of an explanatory type of research good. So the second half is the types of study design. Now, this triangle is actually uh the bread and butter of research in the NHS. This is known as the triangle of evidence and what this basically is is this triangle is um a representation of all the different types of study designs that are out there. For example, if you look at the bottom to the top, the ones that at the, at the bottom, they are the types of studies that have very less value. They're not so valued example, case series, case reports. Whereas as you go up to the top systematic reviews and meta analysis, they have the highest value in clinical medicine and the ones at the top like the trials and the systematic um reviews and the analysis, they basically make it to the research. Uh they make it onto papers, they make it on to journals. They, they are the ones who actually end up making differences in our, in our treatment protocols and our guidelines. So this is sort of like a hierarchy that they explain. And on the left side, I've just put the different types of study designs and we'll go through each one of them very quickly with a bit of an example as well. Any questions you have in between um feel free to pop them down in the chat box. So the first type is what is known as a case report. Now, case report is nothing. But basically, if I'm a doctor in the ward and I find, and I come across this very interesting patient who's come with a very atypical presentation of a particular disease and you think that's quite rare. What I'll do is I'll, I'll write up about that patient. I'll write up the symptoms and the signs and how they're presented, um, what medications they were given, how they responded to the medications and what you think you basically worked out for this particular patient. So, anything that you think is quite interesting and you write up about it and you create a report is basically known as a case report. Now, case reports do get published there, although they don't create a big difference in the way we practice or the way we deliver medications or treatment to the patients. Um, you know, they form the building block of bigger studies. So over time, lots of case reports added together will be studied for bigger studies like a cohort. Um, they're very easy to write up. You will find a lot of reg, um, a lot of junior doctors who are working in the wards who need publications with their names. As first daughter, they usually go for case reports because it's easier to write up about it. But the only disadvantage is there are high chances of, uh, bias because you're the only person who's, who has, who's writing up about it. And you don't have anything to compare. Nobody's really there to tell you this might be right, this might be wrong. It's just in your observation about that patient. So there are high chances of bias that would be the biggest disadvantage of it. And an example of P is basically a man who is presented with shock and then he developed multiorgan failure and then rash. So a very unique case that could be presented, maybe it's a rare disease. That's an example of a case report. Now, if I've got a case report, if I've got a group of patients who have the same disease, and I thought, OK, they all presented very similarly, but they all responded slightly differently, then I can make a case series. A case series is basically a collection of case reports. And this is also quite useful for studying rare diseases as well. An example of this is like um when I uh when you make a case, uh you know, osteo osteomalacia, a case use of patient with atypical presentation. So all these patients who've had osteomalacia, I'm just writing about them and how they present and how they responded and how, what the outcome was that would be considered as a case series as well. Now, compared to a case report, case series slightly has a high a value, not so much but slightly to an extent. And this is also um regs favorite thing to do in the ward. If they want to get something published quite quickly, they quickly do a case series and write up about it. But again, the only disadvantage is you have to come, you have to have come across a rare disease or an interesting case um in order for you to write a case series about it. Now, the next type, very common something you will come across uh when you do research or, or when you read about research is what is known as cohort study. Cohort basically means a group. So in a cohort study, what happens is you've got patients who are either re uh you know, exposed to a risk and you've got a group of patients who, who don't have or who are not exposed to the risk. And you basically watch them over time and see if they've developed the disease. Like, for example, um if you've looked at groups of smokers and groups of non smoker, you match them together and you watch them over time, maybe months, years, decade and see and see if they've actually developed the lung cancer. And this is very nice because um it's a long research, you get loads of data because you're collecting data at every point and seeing if they've got any changes in their lungs or if they're developing lung diseases or anything like that. But the only thing is it's very long, uh it requires a lot of patience, um quite expensive as well because you have to maintain the quality of research over time. And the biggest disadvantage is known, uh what is called attrition, which means there are high chances of your participants dropping out because it's going on for years after years. Um and this is a basically a type of prospective study because it's looking into the future. So if any of you here are applying for jobs in the NHS uh and um are interested in research fellow jobs. A lot of the questions that are coming up in the interviews are no longer related to uh clinical cases or how you do. If a patient comes with this, this, this, they're asking questions related to research because um the the ultimate truth is when you start working as an essential, you will definitely pick up on the ward duties. But when you're working, when you're getting hired as a research flow, they want to know if you've had some, if you know something about research. So recently, um my partner who gave a uh uh an interview for it, he was asked, can do you, what do you mean, what do you know about a cohort study? And um and just the fact that mentioning some words that are um highlighted and read here like attrition, it's a prospective study. It, it looks at a group so these things can really help you remember it and hopefully you'll be able to um explain it well in an interview as well. So as I'm going along the slide, um try to at least remember whatever has been highlighted in red so that you can get an idea. Uh you can remember that study a bit better. Now, next is case control. This is the opposite of a cohort. So here, what happens is here, I already have patients with lung cancer. I have patients with lung cancer and I'm gonna go back in time and I'm going to see if they actually smoked. So I have patients with and without lung cancers. And then I'm going to go and ask them history and see if they've smoked young, um, when they were quite young. And again, this is really good because you can find out if, um, you know what the risk factors are for a particular disease. But the thing is, um, you're very much basing your entire research on how much the patient can recall and remember. So you have to understand, you know, if you ask me what I had for breakfast last Sunday, II wouldn't be able to tell. So if you ask someone who's in their fifties and sixties, uh, you know, whether they've smoked in their twenties or thirties, they may or may not be able to remember exactly. So that's the main drawback of a case control. It's, you're completely, you're basing your study or basing your findings and your data on patients memory, which may may not be true at times. But apart from that, it's actually a very quick study, it's very cheap to do. But despite of this, it is a study that's been commonly been done. So another example of this is an example of put up here, which is a risk factor of knee osteoarthritis. So, here, what they did is they gathered the groups of patients who, who have knee oa osteoarthritis and they went back in time and, uh, and they looked at the history and, and saw whether they were at risk of, or maybe they were obese or maybe they smoked. So, again, it helps you to identify particular risk factors within that disease. And it's a very nice, um, study designed to do as well. Now, cross sectional. So I've already touched upon this. It's basically, excuse me, it's basically taking a snapshot of a particular population. An example of this would be cross sectional study of undergrad, teaching of trauma and orthopedics in the UK. And the relationship between, um, medical schools and interest in trauma and orthopedics is a career. So, what this, they did basically here is, um, they reached out to all the medical students in the UK and they gave them all surveys to fill and they asked them, what is it that they liked about orthopedics? Um, do they understand the, uh, the topic? Well, uh, what they institute, how did they institute, teach it? And whether they would consider becoming an orthopedician in the future, would they consider taking up orthopedics as a career? And this is just trying to see whether, you know, if there's any difference in the location or in the way that the institute taught the subject that helped them or that um that sort of inspired them to take up that particular specialty in the future. So I'm not trying to dwell into so much into their uh time or whether they've had interest as a childhood. No, I'm just trying to find out what they know right now and I'm just trying to find out if there's any sign of kind of a correlation. So that's basically what a cross section is studying the population at that particular time. Now the next question, next one, very, very common. This is the bread and butter of research in terms of clinical medicine. So RCT S now RCT S are the the gold standard for studying treatment effects. So if I've got treatment A and treatment B for a particular disease, if I want to find out which one's better, I will go for a RCT randomized controlled trial. So here what basically happens is I give half the people, half the participants, the tablet or the medication I'm studying and the other half I'll give them placebo and I'm basically trying to see if it makes any difference. Now, here you need to understand two terminologies which is patients have to be randomized. Two treatment arms arms is again a research way or a language of saying group of patients. So I will have a treatment arm means patients receiving the treatment, I will also have a placebo arm which is patients not receiving the treatment. But this is it can get quite difficult because you have to control so many things and it's very time consuming and very expensive to do as well. And there's loads and loads of ethical issues behind it because you're dealing with patients, you're giving them medications, which you don't have enough experience or enough, enough, um, information about that medication. So, um, you have to take the ethical consideration behind this, uh, when it comes to dealing with RCT S randomized Control trial. And when you and in the NHS, if you start working at a junior doctor level or when you work as a junior research fellow, uh a lot of the um fellows are now directed to re trials that are happening around the UK and they're, they're employed to take part in these trials as well. It's a very popular um uh things that go on in the NHS at the moment. An example of this again, this is a very uh huge uh title for a research paper. But this paper basically is trying to see if we can fix um a distal radius fla fracture with AK yr or maybe we can put a, a plate fixation. So they're trying to see which is much better, which has better outcomes for distal radius fractures. This is a trial that's been, that's actually was going on is about to come to an end in the UK and it's known as the UK draft trial. Now, the next couple of ones I'm going to tell are atypical type of trials or like quite rogue. Um Something that you won't come across everywhere, but these are being practiced here and there but not so much. So, a crossover trial. Very interesting here. Basically what happens is patient receives one treatment and then they switch over to the other treatment. An example here, I think I've got a very bad image. Next time I'll try to work on the images a bit. So here you've got group A and group B, group A receive the medication, group B, also receive uh another type of uh group two, receive group B medications and then you cross them over. And now here, the one thing you need to remember is you need to give them some period called the washout period. Now the washout period is basically it's to get rid of all the medications so that the medication effect isn't carried over. Now, this is again, very useful when you're trying to study rare diseases. Like if I've got phenylketonuria disease, I want to find out if there are two medications, if I want to know which one is better. But I don't have a lot of patients with that particular with, with the phenylketonuria. So I'm going to use what I have and I'm just going to switch over and see if it makes any difference. So another example of a crossover trial is this study which basically looked at um, patients with high cholesterol level. Um They, they divided them, they gave the first half butter in their diet and the second half they gave them margarine. Margarine is basically the vegetable form of butter. And then they checked their lipid profile levels and then they gave them a bit of a washout period and then they switched it over. So the people who are get, who are eating butter had to have margarine and the ones that had margarines had to have butter and then they checked their lipid profile again. So this is an example of a crossover trial. Now, n of one trial again, a very rare uh trial that happens. But um this is basically when you make a study on one patient and you repeatedly give them different courses of intervention and controls, maybe in random order or in alternate order, like for example, a patient might get a medication, then you switch them to B, then you go to A and B and this is actually very common in um pain studies. And it's just trying to find out what's best for that particular patient. Very interesting in terms of uh the, the studies that come out like for example, um when you're trying to find out uh uh uh the treatment between statins and muscle symptoms, so we all know um one of the common side effects of uh statins is that patient de uh developed muscle cramps and aches over time. So here what they did is basically they got a group of patients, they gave some of them statins and they, so they watched if they developed any muscle symptoms, then they made, then they had a period of no statins and they saw if they developed any symptoms. So like that they sort of altered, alternated it to see if that intervention made any difference. Now, audit, I think we, I'm not gonna dwell so much on audit because we all know what audit is. And it's part of our gmt criteria as junior doctors to know what audit or at least take part in one or two. But a common question that does get asked in interviews for Jr F is what's the difference between an audit and um research? So the main difference is research is when we're trying to find something new, whereas audit is when we try to find out something and we compare it with whatever the current standard is and we're trying to see whether we're able, we're able to follow the current standard that's going on. Whereas research is completely different where we're trying to find new protocols and we're trying to see if we can come up with different, different protocols by finding out new things or answering questions. So this is an example of an audit. Again, if you are uh you know, if you're in need of research or um as part of your portfolio and you want to get research done. You can always uh you know, tag along with one of the, one of your um in the ward. And if they've got any ongoing audits and it's quite a big audit, you can always try and get that published as well. A lot of audits in the UK do get published. An example of this here is they try to look at um a multi open limb fracture or lower limb fractures in the UK trauma system. So basically, they, they um this is a multicentre audit. That means they didn't only gather information in one particular hospital. Rather they gathered all the information from different, different hospitals and they tried to create an audit. So they basically saw how open fractures in the lower limbs were being dealt or how they were being managed, whether they had was it AK wire or was it any locking plates like that? And they try to create an audit out of that. Now, the last part, these are basically the dawns of that pyramid that I was talking about. They are right at the top. There are, these are the highest quality of research, something that journals and papers they love having. If you are someone who likes to, who wants to get your paper, p your research paper get published in a very well known journal, then you might want to start doing meta analysis and systematic review. So what is that? So as here, what you basically do is you gather all the research that is out there related to your topic and just sort of synthesize it and make your own paper. It is uh quite long but it, it, it gives you loads and loads of information. And there's two types of this, uh you know, um taking up all the research out there and synthesizing your own one is called a systematic review. Another one is the meta analysis. What's the difference between the two? Well, the systematic review, this is basically you going through paper after paper uh that's related to your topic and just trying to find, you know, systematically reviewing it and just writing up your own paper. Whereas metanalysis is picking out all the statistics from the papers that are already out there and then creating your own statistics and coming up with your own uh statistical results and then trying to interpret from there. So metasis is more to do with statistics where a systematic review is just I'm just trying to find out what each paper said about that particular disease. For example, POSTOP complications in appendicectomy, I want to know all the different um complications patient develop. So that again, I can do a systematic review where I can gather all the papers related to appendicectomy and make my own paper out of it. So this is an example of a meta analysis and you can see this little diagram out here. This is known as a uh forest plot, a forest plot is something that's very commonly used in a meta analysis because it, it shows you all the statistics, all the results from different, different studies and you can put it on the in a picture format and it helps you to see um the re the results in a more of a picture diagram. So systemic reviews, systematic reviews top of the pyramid, they have, they are basically the highest quality of evidence you can provide in terms of research. OK. So the last part that uh type of research is what is known as lab based research. Now this is something as junior doctors or basically, even at a consultant level we don't dwell into because this is mostly done by biochemists or biomedical um backgrounds, ologists, physicists, they do lab based research and we might be asked to interpret the findings of it, but we don't really work within the lab. We don't look at it. It's more to do with microscopes and things like that. But that's also a type of research that does happen in the NHS. So the last part I wanted to touch upon is what would your role be? So when you approach a junior do, uh when you approach your consultant, um what sort of roles will you be given in that particular research projects? Because obviously research is huge and there's only so much we can do um as junior doctors. So if you're gonna take part in a clinical outcome. Like for example, all the case reports, case studies, uh cohort studies trial, you might be asked you to do take part in data collection and database management. What that basically means is just doing the brink part of the research which means just going through papers after papers or sometimes it means going through patients records, picking out the important information and creating an Excel sheet out of it, putting it in the table, maybe putting it in a bar chart or a pie chart. So you might be in charge of the data gathering part of the research. Sometimes you will also be asked to do statistical analysis. Now, statistical analysis. Um uh uh although it's a very uh grim topic, it is something that you are expected to know. Um as a, as a junior doctor in the NHS, they will ask you to find out the mean mode median standard deviation pay values and things like that. And obviously, if you don't know, then you would have to spend some particular time um learning about the calculations, the max behind it and then doing it with your own data. And you might also be asked to do a manuscript drafting, manuscript drafting, basically means writing up the paper. So you might be asked to draft out the paper, give it to your consultant. He'll go through it, he'll give you corrections and he'll give it back to you. And then you make the corrections and you go back. So this goes for a number of rounds before you finally come up with your research paper that might be sent out for publication. If you're doing a systematic review again, very similar thing to what you, how you will do a, a clinical outcome or like a trial or a cohort study, except in a systematic review, you will spend a lot of time um chasing research papers maybe within your trust or maybe you contacting other trusts and asking if you have that particular paper because you want the data from that paper and you so that you can write up your own paper. And this is very interesting for me. So that if you are working in the NHS and your trust has a library, maybe you have a medical uh education center that has a library, feel free to contact the librarians for any paper you want because a lot of um database papers out there, like for example, Pubmed Google scholar uh Research Gates, they will not give you access to all of the research paper they have and a lot of them require institution logins. So your institutions can actually help you get that paper if that paper is not visible for you. And the way to do that would be to email your library and they are there to do that job for you. You can contact them and say you want this, this, this paper, could you please help me with it? And they will definitely retrieve it for you. Now, if you, if you want to do an audit, that's slightly different so that you might be asked to register the audit. So every trust has its own uh software or it has its own system where you go and you register the audit that you're going to do in your hospital. So when you, when I say register, it's like putting in an application where you write out the aim, what you're trying to find out which ward you're trying to do. Who are you doing it with what you're trying to find out? Basically. So you might be asked to register, uh you might be asked to register your audit or you might be able, you might be asked to, you know, uh gather the data again, go through patient's records, um create your own Excel sheet, create your own database system, store it and you might be responsible for it and also presenting it. And in audit, you will be also asked to do powerpoint presentations as well related to um your audit topic. And you might have want to have to present that in your local meetings or departmental meetings as well. So that brings us to the end of today's session. Any questions. So, um well, while we wait for any questions to pop up, um these are the upcoming sessions that we have in the teaching series So obviously, if you find it, uh if you find today's session useful and you are interested in any of the topics out here, the next two sessions will be on research methodology here. I'll talk about the process of research, how to approach it. One of the different steps in research. And I'll also talk about clinical trials as well. The dates for those are confirmed with the timings and the rest of them will also be um confirmed in um as time goes by. Um if you, you don't have to attend all. So whichever ones you find quite interesting, you can attend and see, you know, um if you might be interested in learning any of these, if you are interested, uh feel free to join our teaching community in meal. Um Along with joining it, I'm gonna put out a form in the chat box. So if you could fill out this form, this will help you. I mean, help us to add you to um as a member in our group. So you will get notifications. Um Every time we conduct a session, uh it will be easy for you to join as well. So the form is in the chat box, if any of you want to fill it in, if you, this is for those who haven't filled it in already. So that brings us to the end of today's session. Um If you have any questions, if you, if you have any questions after the session, free feel to um, email me regarding any of those as well. Ok. And I'm gonna quickly put up the feedback form. Um It would be really nice if you could fill out the feedback forms for uh today's session so that I can get, get back to you guys. Um Hopefully in an improved manner, please do fill out the feedback form. So if we, you don't have any questions, I think we can end today's session here. Thank you for coming. Thank you for attending and listening on a Sunday afternoon and um, I'll see you all in the next session. Thank you.