mfom protocol review
TRANSCRIPT
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March, 2012 FOM assessors 1
MFOM protocol review
Katherine Venables
Chief Examiner
(Research Methods)
Faculty of Occupational Medicine
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Processes
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Dissertations: process reminder
• Supervisor =educational supervisor, or other(s)
• Protocol and Form M2 (standard dissertations)
• FOM obtains two independent advisory reviews – Rapid feedback; formative, not summative
• Final submission and Form M3
• FOM obtains a joint assessment by two assessors – Accept
– Minor revisions
– Major revisions & reassessment
– Reject
• In difficult cases – Additional assessors, vivas
– Appeals process
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Supervision checklist for
standard dissertations • Educational supervisor
• Project supervisor (if different)
• Any contributors to the project (eg statistician, hygienist, data manager, technician, other)
• Confirmation of adequate resources for project (by educational supervisor’s signature) – Library and library support
– Data management/IT support
– Statistical support
– Other technical support
– Assistance in obtaining ethical approval
– Other permissions (eg to use a database, mail a questionnaires, access data etc)
– Training necessary for the candidate to complete the project
– Any necessary project expenses (eg mailing)
– Any other resources needed to complete the project
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Preparations in year 1 • Read FOM web links
• Choose general topic
• Begin literature review and reference management
• Agree academic supervision: by educational supervisor, MSc supervisor, other academic supervisor
• What additional advice or collaboration is needed? (eg statistical advice, occupational hygiene)
• Consider attending relevant course(s)
• Refine topic and specific objectives of research during discussions with supervisor
• Submit for ethics approval, if required
• Obtain other permission(s) required (eg to use data or facilities belonging to employer)
• Agree outline timetable with educational supervisor
• Apply for any funding or resources needed
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Protocols for standard dissertations
• 1,000 words limit
• Aims
• Background (context, justification)
• Study design
• Methods for data collection
• Outline of statistical methods (if any), including any power calculations
• Ethical issues (if any)
• Resources required (eg access to data, training, advice, collaboration, consumables, travel)
• Likely areas of policy or practice where work will lead to recommendations
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Protocol review proforma
• Scope
• Relevance
• Question
• Study design
• Methods of data collection
• Presentation of results and approaches to statistical analysis
• Ethical issues
• Permissions and resources
• Feasibility
• Major revisions
• Resources
• Other suggestions
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What is the question?
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What is the question?
• Engage the trainee’s imagination
• Relevant to the training organisation
• Is the “question” a question, or a design/
method? eg:
– “Study how the pass-rate of (a test of a work
competency) changes with age”
– Should older workers’ competency be
assessed more frequently than that of young
workers? Competency to do what task, and
to prevent what adverse outcome?
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FOM assessors March, 2012 10
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How will you set about
answering the question?
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Ways of answering questions • Literature review ± meta-analysis
• Observational study
– Survey of current practice and expert opinion
– Epidemiological study
• Longitudinal
• Cross-sectional
• Case-control
– Qualitative study
• Intervention/evaluation study ± economic
evaluation
– Experimental
– Non-experimental
• Clinical audit March, 2012 FOM assessors 12
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Should older workers’ competency be assessed
more frequently than that of young workers?
Examples
• Intervene (ie assess them more frequently) and evaluate
the outcome
• Literature review ± theoretical simulations
• Follow-up of a work cohort as it ages
• Survey of variation by age in current workforce
• Comparison of age distribution in cases of competency
“failure” and controls
• Survey of SOM members
• Qualitative interviews eg of managers, experts, workers
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How will you cover the basic
FOM research competencies?
Which competencies will your
dissertation cover?
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Basic experimental design
Study
group
Treatment
group
Untreated
group
(controls)
Double-blind follow-up & observations
Ra
nd
om
allo
ca
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Co
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ari
so
n +
te
st
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Strengths of experimental design
• Random allocation into sub-groups
• Inclusion of untreated control subjects
• Double-blind observation
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Basic longitudinal design
Target
population
Exposed
group
Comparison
group
Selection & survival
Se
lectio
n &
su
rviv
al
Co
mp
ari
so
n +
te
st
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Basic epidemiological design
Target
population
Exposed
group
Comparison
group
Selection & survival
Se
lectio
n &
su
rviv
al
Co
mp
ari
so
n +
te
st
X-section March, 2012 FOM assessors 18
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Selection and survival
• Selection into a job
– Workplace factors
– Worker factors
• “Survival” in a job
– Workplace factors
– Worker factors
• Selection into a study
– Availability of records
– Participation
• organisations
• Individuals
– Selection criteria
• inclusion
• exclusion
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FOM assessors
Longitudinal and case-control
designs
Exposed
group
Unexposed
comparison
group
Cases
Non-cases
Cases
Non-cases
Case Non-
case
Exp+ a b
Exp- c d
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FOM assessors
Longitudinal vs case-control design
• Longitudinal – how common is the disease
of interest amongst the exposed, relative
to unexposed?
• Case-control – how common is the
exposure amongst cases with disease,
relative to non-cases?
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What do you know about
your topic?
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Is there an accepted
study design or method?
• http://osh.cochrane.org/
• http://www.bmj.com/
– eg How to read a paper
– eg Clinical management
guidelines
• http://www.nres.npsa.nhs.uk/
• http://www.nice.org.uk/
• www.mrc.ac.uk/complexinter
ventionsguidance
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Networking for niche topics
• FOM database of MFOM abstracts
• Special interest groups
– eg ANHOPs
– eg ALAMA
• Industry/employer groups
• SOM, FOM, RSM meetings
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What data will you collect?
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FOM assessors
Types of variable
• Determinant
– eg exposure, OH intervention
• Outcome
– eg disease, sickness absence
• Modifying variables, including confounders
– eg age, sex, smoking
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FOM assessors
Measurement of variables
• Time relations?
• Natural format/scale of the variable
• Definitions
– Concrete, unambiguous
• Independent data collection
• Information quality
– Valid, repeatable
• Procedures
– Acceptable, safe, practicable
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MSc Radiation Biology 16.11.09
Occupational exposure indices
• Body burden eg kidney cadmium
• Measured personal exposure eg radiation film badges
• Area measurements eg asbestos fibre counts
• Modelled/estimated exposure
• Job-exposure matrices
• Ordinal scales of exposure
• Categories eg job titles
• Duration of job
• Ever/never worked in industry
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FOM assessors
Validity and repeatability of chosen index
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FOM assessors
Validity and repeatability of
chosen index
• Validity: does the index measure what it is
supposed to measure?
– eg criterion validity – compared with the “gold
standard”
– eg consensus validity
• Repeatability: does it give similar findings
on different occasions?
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FOM assessors
X X X X X X X X
X X
X X X X
X X X X X X
X X
X X
X
X
X X
X
X X X
X
X
X X
X X
X
X
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FOM assessors
Minimising unwanted variation
• Subject
– Design study to minimise sources of variation eg do tests at same time of day
• Instrument
– Same instrument, calibration, adjustment
– Use average of repeated tests
• Observer
– Eliminate where possible, simple instructions, training
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Planning and organisation?
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Speculate about the likely
study findings
• Implications of range of likely findings
• Skeleton tables and figures
• Headings & sub-headings (IMRAD)
– What did I do?
– How did I do it?
– What does it mean?
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It is never too early to think
about document presentation
• Word limit – 10,000 words
• Referencing software
• Indexing
• Pagination
• Appearance of tables and figures
• Photographs
• English style, grammar, spelling
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Timetabling
• Preparations
• Outline protocol FOM
• Data collection and analysis
• Drafting
• Final drafting
• Assessment by FOM
• Revision, resubmission
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Reserve slides
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FOM research competencies:
knowledge Be able to understand:
• How to design a research study.
• How to use appropriate statistical methods.
• The principles of research ethics.
• How to write a scientific paper.
• Sources of research funding.
• The principles and application of epidemiological methods in research and in problem solving
• The application of medical statistics and the interpretation of statistical analysis methods in scientific research.
• Computer based systems for data collection and analysis.
• Ethical considerations in research.
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FOM research competencies: skills • Be able to define a problem in terms of needs for an evidence base.
• Be able to undertake systematic literature search.
• Be able to undertake a systematic and critical appraisal and review of scientific literature.
• Be able to produce an evidence based digest of the literature.
• Be able to frame questions to be answered by a research project.
• Be able to develop protocols and methods for research.
• Be able to execute an appropriate study design.
• Plan data collection for simple surveys including sample selection and methods of recording and storing data.
• Be able to use databases.
• Be able to accurately analyse data statistically.
• Have good written and verbal presentation skills.
• Present investigation and results in the format of a research based report.
• Be able to write a scientific paper for peer-reviewed publication.
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March, 2012 FOM assessors 41
FOM research competencies:
attitudes • Demonstrate curiosity and a critical spirit of enquiry, and
where appropriate a critical attitude towards current practice.
• Acceptance of the need for critical review and for research so as to found a solid base for good practice.
• Ensure patient confidentiality.
• Demonstrate knowledge of the importance of ethical approval and patient consent for clinical research.
• Respect individual confidentiality when presenting data.
• Disposition to cooperation and liaison with statisticians and other research colleagues.