Establishing the research priorities of emergency medicine trainees, patients and carers across the UK and Ireland: the TERN Delphi study

Introduction: The Trainee Emergency Research Network (TERN) was established in 2018 by the Royal College of Emergency Medicine (RCEM) to improve research engagement and demystify clinical research within emergency medicine (EM). The first studies involved over a hundred EDs across the UK and Ireland. These were selected through discussion and voting at early TERN meetings. Understanding the research priorities of trainees is important. The priorities perceived as important to clinicians reflect their daily working practice, and differ between junior and senior medical staff. Previous research prioritisation exercises have favoured senior input and there have been no previous trainee-specific research prioritisation exercises. It is important for research engagement that trainees are interested in projects they work on. A Delphi technique is often used to determine research priorities and was selected here. Methods A two-stage modified Delphi process surveyed UK and Ireland EM trainees using an online survey platform over a four-week period in November 2020. Stage 1 invited respondents to submit up to six research priorities they thought most important to their practice. These were refined by a panel of RCEM professors who provided an overview of ongoing trials and the wider research landscape. Duplicate entries, entries not from UK or Ireland trainees, previously answered questions or those outside the scope of EM were removed and refined to produce a shortlist for stage 2. In stage 2, a panel of EM trainees holding roles as TERN regional representatives participated in a five-round Delphi process to determine consensus between February 2021 – July 2021. The shortlisted priorities were rated on a five-point Likert scale asking trainees to rate their relative importance and comment upon these, suggesting amendments to be presented in the following round. Priorities reaching a predefined consensus (≥75%) after each round were included or excluded, with a predefined maximum of five rounds. After the five-round process, a collaborative online workshop between three clinicians, three patient and carer representatives and an independent facilitator was held to refine and rank the priorities which had attained consensus. Lay summaries explained each priority and the groups discussed, commented, amended, and ranked each priority, using a collaborative model of PPI to co-produce a list of research priorities. The methods are outlined in full (Supplementary Material 1). Results: For Stage 1, 60 responses with 162 entries were received. Shortlisting refined these to 64 questions which were amalgamated to produce 31 research priorities for Stage 2. Stage 2 involved a panel of 16 EM trainees. Each round had a response rate of 100%. 7 priorities were introduced during the five-round Delphi process which produced 12 priorities which attained consensus (Table 1), 12 priorities which were excluded and 14 priorities which did not attain consensus. The collaborative workshop refined these priorities. The full reported scores for each priority and items not attaining consensus are demonstrated in the supplementary material. Discussion: The research priorities attaining consensus reflect clinical dilemmas, life-threatening diagnoses, and the optimal delivery of care, reflecting priorities that trainees face daily. There were some limitations. The initial survey received submissions from 60 participants, fewer than other research prioritisation exercises. The usage of RCEM Professors to guide initial priority selection may have introduced bias toward their research interests. The decision not to hold a final meeting for the panellist group limited the ability to produce an ordinally-ranked list of trainee priorities, although the co-produced list incorporated the patient & carer voice into this process. The research priorities of EM trainees across the UK and Ireland have been identified and will help guide the direction of TERN and EM trainee research.