From learning sets to

Doctoral Fellowship

Fiona Kerr

Respiratory Research Physiotherapist

Apply to Learning Sets

Support of your line Manager

Negotiate time off work to attend the learning sets

What is a learning set?

“ Learning sets give the individuals time to

explore issues that they need to resolve in an

environment which is empowering and which

helps the individual to find a solution”

www.library.nhs.uk

The 1st Meeting

• 6 sessions

• 4 Facilitators

• 4 participants

• Introductions

• Developed and agreed ways of working

• Set agenda for each session

The learning sets• Objectives for each session

• Completed sections of application form

• Presented to the group each week

• Constructive feedback

• Identify training needs

• Financial and Ethical considerations

• Focus/ Deadlines

The end…but a new beginning

• Applied for Fellowship Award

• Attended interview

• Successful

• Started Doctoral Fellowship in October 2008

Defining a pulmonary exacerbation in adults with cystic fibrosis (CF)

Supervisors: Dr Judy Bradley and Dr Brenda O’Neill Prof Stuart Elborn (External)

Funding: R&D Doctoral Fellowship

‘Defining a pulmonary exacerbation in adults with CF’

No Agreed Definition

Research

Develop a Standardised Criteria for Defining a Pulmonary Exacerbation in Adults with CF

Clinical

Step 1: Literature Review

Clinical Markers

Signs & Symptoms

CurrentDefinitions

PROM

Step 2: Delphi Technique

Increased cough is indicative of a pulmonary exacerbation

Example:

Strongly Agree

Agree Disagree Strongly Disagree

Step 2: Delphi

Round 1 Round 2 Round 3

GOAL = CONSENSUS

Adult CF Patients –VS – CF Health Prof. (n=56-84) (n=56-84)

Data Collection: Web Survey

Why?• Appeal to a modern society• Increased response rates• Track participants• Ensures surveys are completed• Practical and efficient• Low cost• Facilitate data collection across UK and Ireland

Clinical Judgement Analysis

Step 3: Clinical Judgement Analysis

Example:

Mary Jones has arrived at her CF clinic for a routine

appointment. For the past week she has found her

sputum to be thicker and difficult to clear. She also has

had an increased cough. She is feeling sad at the minute

because her sputum is so difficult to clear. She reports

no weight loss, no change in exercise capacity and no

other symptoms.

Step 3: Clinical Judgement Analysis

Is an exacerbation occurring?

Is it mild, moderate or severe?

Step 4: Development and testing of Questionnaires

Adult CF Patient Exacerbation Questionnaire

CF Health ProfessionalExacerbation Questionnaire

PART AReproducibility study

(n=30)

CF Health Professional A-VS-

CF Health Professional B

PART BMethod Comparison Study

(n=60-80)

CF Health Professional-VS-

CF Patients

Step 4: Development and testing of Questionnaires

Dev

elop

men

t & T

estin

g

of Q

uest

ionn

aire

s

CF

Exac

erba

tion

Def

initi

on &

Que

stio

nnai

res

Clinica

l Jud

gem

ent A

nalys

isTh

e D

elph

i Tec

hniq

ueLi

tera

ture

Rev

iew

Task Year 1 Year 2 Year 3

Ethics and Governance

Oct 2008

Feb 2009

Systematic Review

Oct 2008

Feb 2009

Delphi Study Feb 2009

Jan 2010

Clinical Judgement Analysis

Feb 2010

Jul 2010

Development and Testing of Questionnaires

Aug 2010

Mar 2011

Write up Apr 2011

Aug 2011

Dissemination of findings

Aug 2011

Sep 2011

Time scale

Important points

• If you haven’t started developing your idea – start now!

• Have an idea that you are passionate about

• Identify supervisors

• Apply for learning sets

• Take a look at the application form (look at last years)

• Timetable – to keep on schedule

References

1. www.library.nhs.uk/nldocs/NLH_STG_Introducing_Learning_sets.doc [Accessed: 16/02/2009]

2. Britto MT, Kotagal UR, Hornung RW, Atherton HD, Tsevat J, Wilmott RW. Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis. CHEST. 2002;121:64-72

3. Elaffi M, Vinsonneau C, Coste J, Hubert D, Burgel PR, Dhainaut JF, et al. One year outcome after severe pulmonary exacerbation in adults with cystic fibrosis. Am J Resp Crit Care Med. 2004;158-64

4. Goss CH, Burns JL. Exacerbations in cystic fibrosis. 1: Epidemiology and pathogenesis. Thorax. 2007;62:360-7

5. Dakin C, Henry RL, Field P, Morton J. Defining an exacerbation of pulmonary disease in cystic fibrosis. Pediatr Pulmonol. 2001;31:436-442

6. Goss C and Quittner AL. Patient –reported outcomes in cystic fibrosis. Proc Am Thorac Soc. 2007; 4:378-386

7. Mayer-Hamblett N, Ramsey BW, Kronmal RA. Advancing outcome measures for the new era of drug development in cystic fibrosis. Proc Am Thorac Soc. 2007; 4:370-377

8. FDA. Guidance for industry: Patient reported outcome measures: Use in medical product development to support labelling claims. U.S. FDA 2006 Available from: http://www.fda.gov/cder/guidance/5460dft.pdf (Accessed 13th September 2007)

9. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-15

References

10. Keeney S, Hasson F, McKenna H. Conculting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006;53(2):205-12

11. McKenzie B. Using the internet for surveys and health research. J Med Internet Res. 2002; 4(2):e13

12. Huq SZ and Karras BT. A proposed ontology for online healthcare surveys. AMIA 2003 Symposium Proceedings. 2003; p. 304

13. McCabe SE, Couper MP, Cranford JA, Boyd CJ. Comparison of web and mail surveys for studying secondary consequences associated with substance use: Evidence for minimal mode effects. Addictive Behavious. 2006; 31:162-168

14. Cooksey RW. Judgement analysis. Theory methods and applications. London: Academic Press; 1996

15. Kee F, Jenkins J, McIlwaine S, Patterson C, Harper S, Shields M. Fast and frugal models of clinical judgement in novice and expert clinicians. Med Dec Making. 2003; 23:293-300.

16. Jenkins J, Shields M, Patterson C, Kee F. Decision making in asthma exacerbation: a clinical judgement analysis. Arch Dis Child. 2007; 92:672-677

Questions