Research in Emergency MedicineMedical School Aspect

Boriboon Chenthanakij MD.

Family Medicine Department

Faculty of Medicine Chiangmai University

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Why Research?

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Why Research?• to improve QUALITY of our mission.

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Why Research?• to improve QUALITY of our mission.

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Why Research?• to improve QUALITY of our mission.

• Our Mission

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Why Research?• to improve QUALITY of our mission.

• Our Mission

–Patient care

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Why Research?• to improve QUALITY of our mission.

• Our Mission

–Patient care

–Teaching

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Why Research?• to improve QUALITY of our mission.

• Our Mission

–Patient care

–Teaching

•Undergraduate program

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Why Research?• to improve QUALITY of our mission.

• Our Mission

–Patient care

–Teaching

•Undergraduate program

•Postgraduate program

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Why Research?• to improve QUALITY of our mission.

• Our Mission

–Patient care

–Teaching

•Undergraduate program

•Postgraduate program

–Research 2

From Mission

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From Mission

• We have many PLANs

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From Mission

• We have many PLANs

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From Mission

• We have many PLANs

• How can we know that our plans are good ?

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From Mission

• We have many PLANs

• How can we know that our plans are good ?

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From Mission

• We have many PLANs

• How can we know that our plans are good ?

• We run Deming Cycle

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From Mission

• We have many PLANs

• How can we know that our plans are good ?

• We run Deming Cycle

–Plan Do Check Act

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Check

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Check

• To ensure that things are in the way we would like to see.

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Check

• To ensure that things are in the way we would like to see.

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Check

• To ensure that things are in the way we would like to see.

• To find some problems that can occur in our process.

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Check

• To ensure that things are in the way we would like to see.

• To find some problems that can occur in our process.

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Check

• To ensure that things are in the way we would like to see.

• To find some problems that can occur in our process.

• Can help us find the way to improve our process.

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Research

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Research

• can come from any plan check or any question to improve our quality.

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Patient Care

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Patient Care• We have STEMI fast tract, Stroke fast tract.

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Patient Care• We have STEMI fast tract, Stroke fast tract.

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Patient Care• We have STEMI fast tract, Stroke fast tract.

• Many resources were use in fast tract policies.

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Patient Care• We have STEMI fast tract, Stroke fast tract.

• Many resources were use in fast tract policies.

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Patient Care• We have STEMI fast tract, Stroke fast tract.

• Many resources were use in fast tract policies.

• Were these policies really improve quality of life for our patient?

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Patient care

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Patient care

• We have 5 triage level for patient in Emergency Department.

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Patient care

• We have 5 triage level for patient in Emergency Department.

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Patient care

• We have 5 triage level for patient in Emergency Department.

• But in the past we use only 3 level triage.

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Patient care

• We have 5 triage level for patient in Emergency Department.

• But in the past we use only 3 level triage.

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Patient care

• We have 5 triage level for patient in Emergency Department.

• But in the past we use only 3 level triage.

• Is 5 level triage improve quality of care compare to 3 level triage ?

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Teaching

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Teaching

• Undergraduate

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Teaching

• Undergraduate

– In the past, before Tsunami attack in 2004, we seldom teach about disaster for medical student.

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Teaching

• Undergraduate

– In the past, before Tsunami attack in 2004, we seldom teach about disaster for medical student.

–we now have 2 weeks selective program about disaster medicine for medical student in 4th year.

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Teaching

• Undergraduate

– In the past, before Tsunami attack in 2004, we seldom teach about disaster for medical student.

–we now have 2 weeks selective program about disaster medicine for medical student in 4th year.

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Teaching

• Undergraduate

– In the past, before Tsunami attack in 2004, we seldom teach about disaster for medical student.

–we now have 2 weeks selective program about disaster medicine for medical student in 4th year.

– Is our selective program can actually improve our medical student performance when disaster occur?

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Teaching

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Teaching

• Postgraduate

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Teaching

• Postgraduate

–We look for an advance life support manikin for our resident to practice in Central line placement before they perform in real patients.

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Teaching

• Postgraduate

–We look for an advance life support manikin for our resident to practice in Central line placement before they perform in real patients.

–The price of manikin is around 1 or more million B.

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Teaching

• Postgraduate

–We look for an advance life support manikin for our resident to practice in Central line placement before they perform in real patients.

–The price of manikin is around 1 or more million B.

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Teaching

• Postgraduate

–We look for an advance life support manikin for our resident to practice in Central line placement before they perform in real patients.

–The price of manikin is around 1 or more million B.

– Is advance life support manikin can actually improve our resident’s skill?

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POLICY

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POLICY

• Chiangmai University concern about Global warming and Energy crisis.

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POLICY

• Chiangmai University concern about Global warming and Energy crisis.

• We should know how much energy we use and how much plastic garbage we produce.

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POLICY

• Chiangmai University concern about Global warming and Energy crisis.

• We should know how much energy we use and how much plastic garbage we produce.

• And how much we can reduce them.

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Interest

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Interest

• Some questions come from ourself.

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Interest

• Some questions come from ourself.

• May be we interest in some specific topic.

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Interest

• Some questions come from ourself.

• May be we interest in some specific topic.

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Interest

• Some questions come from ourself.

• May be we interest in some specific topic.

• We know that IV beta blockers is very helpful to control heart rate in AF patients, but we don’t have this medication form in ED.

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Interest

• Some questions come from ourself.

• May be we interest in some specific topic.

• We know that IV beta blockers is very helpful to control heart rate in AF patients, but we don’t have this medication form in ED.

• So, which medication can be used when we don’t have this medication.

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Question

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Question• Many questions occur in our daily life practice.

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Question• Many questions occur in our daily life practice.

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Question• Many questions occur in our daily life practice.

• How can we answer these questions?

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Question• Many questions occur in our daily life practice.

• How can we answer these questions?

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Question• Many questions occur in our daily life practice.

• How can we answer these questions?

• Some questions can be answered easily, but many are not.

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Question• Many questions occur in our daily life practice.

• How can we answer these questions?

• Some questions can be answered easily, but many are not.

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Question• Many questions occur in our daily life practice.

• How can we answer these questions?

• Some questions can be answered easily, but many are not.

• We need evidences before we can do evidence based ............

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How strong is our evidence?

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How strong is our evidence?• We must have good methodology while looking for evidence.

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How strong is our evidence?• We must have good methodology while looking for evidence.

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

–Experimental study

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

–Experimental study

–Clinical trial

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

–Experimental study

–Clinical trial

• Which statistics is/are appropriate for our data?

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

–Experimental study

–Clinical trial

• Which statistics is/are appropriate for our data?

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How strong is our evidence?• We must have good methodology while looking for evidence.

• Which methodology is best for our question?

–Descriptive study

–Experimental study

–Clinical trial

• Which statistics is/are appropriate for our data?

• Epidemiologist is our good friend in this situation.14

When we have subjects

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When we have subjects

• We should learn about ICH/GCP

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When we have subjects

• We should learn about ICH/GCP

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When we have subjects

• We should learn about ICH/GCP

• International Conference on Harmonization

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When we have subjects

• We should learn about ICH/GCP

• International Conference on Harmonization

• Good Clinical Practices

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ICH GCP

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ICH GCP

• An international ethical and scientific quality standard in

–Designing

–Conducting

–Recording

–Reporting

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ICH GCP

• An international ethical and scientific quality standard in

–Designing

–Conducting

–Recording

–Reporting

trials that involve human subjects.16