STARTING IN RESEARCH

Research drives progress in ophthalmology. There are countless examples where a standard technique or procedure is first accepted, then questioned, challenged, rejected only to be replaced by a new approach. For example, intraocular lens implantation and refractive laser surgery both encountered incredible resistance from the medical establishment before gaining widespread acceptance. In contrast, refractive keratotomy might still be used today were it not for long-term research confirming its limitations. Research requires researchers, ophthalmologists who are full of curiosity and who enjoy solving problems. I recommend that any young doctor interested in research should start early in training. Ideally you will be in a training centre that already has a research group and the people and infrastructure to support research. You will find people who have ideas, the facilities and contacts with industry that allow you access to new designs of products and new tools for measuring – all essential for conducting research.

However, all is not lost if you are training at a site that doesn't have a lot of active research going on. This may be a bit more challenging, but not impossible. One thing you can do if you have a good idea is to try to win over the support of a senior surgeon, letting them know that you have an idea and that you will do the work. You might also find a mentor off site, even in a different country, with a bit of help from email. If you don't have a good idea, you will need to get one. Read journals and trade publications, attend conferences, listen to podcasts, keeping an eye out for unresolved questions. Very often during the discussion period at the end of a conference presentation you will hear people say there is something that hasn't been looked at. You can start small, working with an established researcher. Some people start with a case report, or series. But it is really best to get involved with a randomised clinical trial as soon as possible.

Naturally the first step is to do a literature search. Then, as you launch your project, it is essential to do it properly. You need a good question, the right method and the right equipment. You don't want to get in a situation where something is missing. For example, a common problem is not having enough patients in your study to really answer your question. Then you will have difficulty submitting your study to a conference or journal, and people won't take you seriously. This underscores the importance of consulting a statistician. You might find it difficult to explain to a statistician what you are trying to determine. But once you do, they will really help you define parameters such as how many patients you will need, and what should be your main outcome measures. People might hesitate to attempt a randomised trial, thinking the hassles of going through the ethics committee, enrolling patients, informed consent and so on would be insurmountable. It is worth the trouble. I believe it is far better to conduct one proper randomised trial, controlled, with sufficient number of patients, which could take a year or even two, rather than to do two or three series. That is where you need advice from a mentor. Nearly every training site has somebody on board with research experience that will be able to help you. Aside from satisfying scientific curiosity, there is a career-building aspect to research. In big universities and big teaching hospitals, many of the senior surgeons will have done research. That is the way in and the way up.

Whether or not you continue on the research track, the experience is extremely valuable. Through research, you will have to read a lot, and you will have extra knowledge and experience you wouldn't have had otherwise. This ultimately will put you in a better position to provide your patients with the best possible care.

Oliver Findl: oliver@findl.at