|Year : 2022 | Volume
| Issue : 4 | Page : 61-62
How to ensure rigorous research in an era of rapid technological advances?
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||14-Aug-2022|
|Date of Decision||16-Oct-2022|
|Date of Acceptance||20-Oct-2022|
|Date of Web Publication||8-Nov-2022|
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. How to ensure rigorous research in an era of rapid technological advances?. MRIMS J Health Sci 2022;10:61-2
The tools of empirical research are observation and measurement. Rigorous research revolves around refining these tools. Astute and uncontaminated observations together with accurate and precise measurements will lay a strong foundation in medical research. This has the potential to bring about a paradigm shift in the prevention and management of the vast number of emerging and re-emerging diseases.
Advent and access to automobiles led to sedentary lifestyles resulting in a lack of exercise and poor physical fitness in people. Similarly, advances in technology are likely to lead to the atrophy of the observation skills of present-day physicians. With noninvasive diagnostics and telemedicine, doctors are literally losing touch with their patients. This not only adversely affects our research skills but also our communication with patients putting strain on the increasingly fragile doctor–patient relationship. Clinical work and research are closely linked and both will suffer if we mindlessly surrender ourselves to technology.
If judiciously employed, technological advances are definitely a boon to medicine and research. However, laziness should not allow them to lull us into blunting of our observational skills. We should rather enhance these skills with aid of technology. Doctors and particularly medical students in training should be encouraged to first diagnose with the aid of the five senses and then confirm their diagnostic acumen against the machine. This is the way chess grandmasters enhance their analytical skills by practicing with chess engines to their advantage.
Doctors should similarly keep enhancing their powers of observation. Many will have to regain the powers of observation they had as a child. Every child is born a researcher as observation, the first step in the research is keenest in the child. To be a good observer, one should rediscover and retain the childlike curiosity, creativity, and exploration all are born with but later these qualities get blunted due to formal education. Knowledge can at times become a barrier to unbiased observation. No wonder, double blinding of clinical trials which eliminates prior knowledge to avoid observer bias is an important maneuver.
Observation is an art, often difficult to teach and quantify. In research, art has to be complemented by science, i.e., measurements. Accurate measurements can be ensured by good quality control. Instrument errors can lead to a lack of internal validity in a research study. Calibrated and validated instruments, including questionnaires, if any, is essential for reliable research. Similarly, observer errors should be eliminated by proper training of the investigators. Efforts made to eliminate instrument and observer errors should be explicitly described in the material and methods section of a research paper.,
Besides observations and measurements which can lead to biases and measurement errors in research, the sample selected for the study is also important. The more the representativeness of the sample, the better is the external validity or generalization of the study results to a wider target population. There are two types of sampling errors. The first one is sampling bias when a convenient or unrepresentative sample is studied. How well the results from such a sample can be generalized is a matter of judgment and not of statistics. The second type of sampling error is a random error which is partly dependent on the sample size. The smaller the sample, the larger is the random error. The latter can be quantified to some extent by stating the 95% confidence intervals. Smaller samples will yield wider confidence intervals.
The most challenging bias to account for is confounding bias. A cause–effect relationship may be spurious or modified by a third factor, called a confounder, which if not taken into account can lead to wrong inferences. For instance, if we study the protection, a vaccine offers against infection and find that the vaccinated have lower rates of infection compared to the unvaccinated we should not jump to the conclusion that vaccines protect against the infection without first adjusting for socioeconomic status. In this context, we can think of lower socioeconomic status as a possible confounder as it is likely to be related to both the cause (vaccine) and the effect (catching infection). People lower down in the socioeconomic gradient may have poor access to vaccines due to poverty or ignorance and are also likely to live, work, and travel in crowded environments which may make them more vulnerable to catch an infection.
Such confounders which are known or can be logically conceptualized can be controlled during the planning or analysis of the research project. However, there are many unknown confounders which cannot be deliberately controlled or adjusted. These will always be the “noise” in observational studies. To overcome the influence of unknown confounders, a randomized clinical trial is considered the gold standard in evidence-based medicine. In addition to blinding as mentioned earlier, random allocation of participants either to the intervention or control group can by play of chance, ensure that both unknown and known confounders have been equally distributed in the groups. This eliminates their influence in the final analysis and inference from the study.
These are some of the core issues which can help us navigate our way to robust and reliable research in an environment of glitz and glamor of rapid technological advances and high-pressure marketing of new diagnostics and interventions. These can also provide referees and readers with quick and ready guidelines for appraising the quality of emerging research and its claims.
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