from learning sets to doctoral fellowship fiona kerr respiratory research physiotherapist
TRANSCRIPT
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