The Two Pillars of Good Scientific Research

Abstract

We, as oral physicians, do an extensive literature search to find out the best diagnostic investigation or best therapeutic option for a disease that we encounter in clinical practice. But do we pause for a moment and look at the literature to see whether the researchers have formulated the most specific focused research question in their works? Failure in this first step to formulate the most appropriate research question would subsequently affect the entire research process. In the arena of research, there are numerous players whose expectations need to be taken into consideration before a good research question is formulated. Foremost among them are our clients – the patients for whom we are doing research. We need to initially ascertain what the patient is expecting from us as a treatment for his ailment and what changes he is expecting in his Quality of Life. The second is our (investigator) views about the intended endpoints for a particular problem we are trying to solve. Third, unfortunately, we often neglect to ascertain the opinions of our co-workers regarding our proposed work. They might have a different perspective on our thought process. Finally, if we have agencies to fund our work, we need to ascertain that they are on board with us to support our research, agreeing with the problem for which we are trying to find a solution. If we analyze from the point of each stake holder mentioned above, each view is logical and it becomes a herculean task for the investigator to formulate and evolve the most appropriate research question. As a guide, researchers could follow the following criteria[1]: - The most appropriate question which is important to patient well-being - The most appropriate question relevant to our knowledge levels - The most appropriate question that can be addressed in a specific time frame - The most appropriate question that would interest you, your team and your patients the most - The most appropriate question that is likely to repeatedly present itself in your practice. As a piece of advice, I would state that, the scientific community always recognizes and appreciates researchers who address problems of diseases faced in their own local community and not some diseases which are very rare in a particular geographic setting. A researcher should always formulate an “Answerable” question. Here, a large broad topic needs to be split into smaller manageable units, which can then be addressed through a standardized protocol.[2] A young researcher by nature would be too ambitious to make a path breaking research to solve all problems. But, seldom does it happen. If your research question is too wide, you end up, lacking rigor in methodology. If your question lacks focus, it is almost close to impossible to replace it with another question once your work is commenced or completed. All questions you want to answer should follow the PICO format. This format is suggested because it helps you to specifically narrow down, refine and formulate your question to address one specific problem. Though PICO format is meant to address interventions, other research questions (diagnostic, prognostic, patient expectations) can be reframed to follow PICO format. The next key element of good scientific research is choosing the appropriate study design. We need to mandatorily sit with trained “BIOSTATISTICIANS”, explain our intended work and zero in on the most appropriate study design. Researchers need to do a thorough data search to find out how a similar question was designed and studied. As you navigate this process you will find your primary research question getting more and more focused which would help you to reframe your PICO components. The above exercise is definitely time consuming and test your patience, but remember – the extra time spent in this stage would save you many hours later if you proceed with an irrelevant research question, inappropriate study design or work on a topic which has already been exhaustively analyzed. Researchers feel quantitative research where you can categorize all parameters with numerical data is superior to qualitative research. But we oral physicians deal with a plethora of disorders especially oro-facial pain where the need to address emotions, feelings are more important than aiming at numerical value changes as a proof of your successful patient management. Qualitative research design are better suited address research questions dealing with feelings and emotions.[3] The NHMRC evidence hierarchy categorizes the most appropriate study design for specific type of research questions – interventional, diagnostic accuracy, prognosis, etiology, and screening.[4] On the contrary, in qualitative research, it is advisable to follow a typical practice-based approach to analyze the data through either a case study, grounded theory, phenomenology, ethnography,ethno methodology and narrative research. To conclude, researchers need to focus on the two essential pillars – the most appropriate answerable focused clinical question and choosing the most appropriate study design to specifically answer the formulated question. However well a question is framed and study is designed, the results will open the door for a next question to be investigated. That is how science grows and progresses!!