Research Skills for Medical Students
Publication Year: 2012
The revised Tomorrow's Doctors makes it clear that doctors need to be aware on their responsibilities as a scholar and scientist and it is therefore vital that students develop excellent critical thinking and research skills. While there are many ‘research skills’ books, medical students frequently struggle with understanding the difference between the practices of research, audit, service evaluation, systematic and narrative reviews and when and how to apply them. This book addresses the kinds of questions novice investigators always ask and helps students utilize study designs, data collection tools and analyze effectively. Key Features: • Builds an understanding of which approach is more appropriate in a specific context • Acknowledges the diverse types of investigation a doctor may become involved with • Addresses the questions ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Doing Research
- Chapter 2: Doing a Literature Review
- Chapter 3: Critical Appraisal
- Chapter 4: Evaluation and Research Methods
- Chapter 5: Data Collection and Information Gathering
- Chapter 6: Data Processing and Analysis
- Chapter 7: Interpreting the Implications of Research
- Chapter 8: Communicating the Outcomes of Research and Evaluation
- Chapter 9: Audit
- Chapter 10: Doing Health Service Evaluation and Quality Improvement
An imprint of Sage Publications Ltd
1 Oliver's Yard
55 City Road
London EC1Y 1SP
SAGE Publications Inc
2455 Teller Road
Thousand Oaks, California 91320
Sage Publications India Pvt Ltd
B 1/I 1 Mohan Cooperative Industrial Area
New Delhi 110044
SAGE Publications Asia-Pacific Pte Ltd
3 Church Street
#10–04 Samsung Hub
© Ann K. Allen 2012
First published 2012
Apart from any fair dealing for the purposes of research or private study or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
Library of Congress Control Number: 2012938955
British Library Cataloguing in Publication data
A catalogue record for this book is available from the British Library
ISBN 978-0-85725-601-0 (pbk)
Editor: Becky Taylor
Development editor: Ros Morley
Production controller: Chris Marke
Project management: Swales & Willis Ltd, Exeter, Devon
Marketing manager: Tamara Navaratnam
Cover and text design: Code 5 Design Associates
Typeset by: Swales & Willis Ltd, Exeter, Devon
Printed by: MPG Books Group, Bodmin, Cornwall
Foreword from the Series Editors[Page vi]The Learning Matters Medical Education Series
Medical education is currently experiencing yet another a period of change, typified in the UK with the introduction of the revised Tomorrow's Doctors (General Medical Council, 2009) and ongoing work on establishing core curricula for many subject areas. Changes are also occurring at Foundation and postgraduate levels in terms of the introduction of broader non-technical competencies, a wider range of assessments and revalidation requirements. This new series of textbooks has been developed as a direct response to these changes and the impact on all levels of medical education.
Research indicates that effective medical practitioners combine excellent, up-to-date clinical and scientific knowledge with practical skills and the ability to work with patients, families and other professionals with empathy and understanding; they know when to lead and when to follow and they work collaboratively and professionally to improve health outcomes for individuals and communities. In Tomorrow's Doctors, the General Medical Council has defined a series of learning outcomes set out under three headings:
- The doctor as a scholar and a scientist;
- The doctor as a practitioner;
- The doctor as a professional.
The books in this series do not cover practical clinical procedures or knowledge about diseases and conditions, but instead cover the range of non-technical professional skills (plus underpinning knowledge) that students and doctors need to know in order to become effective, safe and competent practitioners.
Aimed specifically at medical students (but also of use for Foundation doctors, teachers and clinicians), each book relates to specific outcomes of Tomorrow's Doctors (and, where relevant, the Foundation curriculum), providing both knowledge and help to improve the skills necessary to be successful at the non-clinical aspects of training as a doctor. One of the aims of the series is to set medical practice within the wider social, policy and organisational agendas to help produce future doctors who are socially aware and willing and prepared to engage in broader issues relating to healthcare delivery.
Individual books in the series outline the key theoretical approaches and policy agendas relevant to that subject, and go further by demonstrating through case studies and scenarios how these theories can be used in work settings to achieve best practice. Plenty of activities and self-assessment tools throughout the book will help readers to hone their critical thinking and reflection skills.
Chapters in each of the books follow a standard format. At the beginning a box highlights links to relevant competencies and outcomes from Tomorrow's Doctors and other medical curricula, if appropriate. This sets the scene and enables readers to see exactly what will be covered. This is extended by a chapter overview which sets out the key topics and what students should expect to have learnt by the end of the chapter.
There is at least one case study in each chapter which considers how theory can be used in practice from different perspectives. Activities are included which include practical tasks with learning [Page vii]points, critical thinking research tasks and reflective practice/thinking points. Activities can be carried out by readers or with others and are designed to raise awareness, consolidate understanding of theories and ideas and enable students to improve their practice by using models, approaches and ideas. Each activity is followed by a brief discussion on issues raised. At the end of each chapter a chapter summary provides an aide-mémoire of what has been covered.
All chapters are evidence-based in that they set out the theories or evidence that underpins practice. In most chapters, one or more ‘What's the evidence?’ boxes provide further information about a particular piece of research or a policy agenda through books, articles, websites or policy papers. A list of additional readings is set out under the ‘Going further’ section, with all references collated at the end of the book.
The series is edited by Professor Judy McKimm and Dr Kirsty Forrest, both of whom are experienced medical educators and writers. Book and chapter authors are drawn from a wide pool of practising clinicians and educators from the UK and internationally.
About the Authors
The support given from the inception of this book by Dr Sharon Mayor, Senior Lecturer in Healthcare Improvement, Institute of Primary Care & Public Health Cardiff University, is gratefully acknowledged.
The author and publisher would like to thank the following for permission to reproduce copyright material:
BMJ Books/Wiley-Blackwell for excerpt from How to Read a Paper: The basics of evidence-based medicine, 4th edition.
Journal of the American Society for Information Science and Technology for Table 5.3 from Meho, LI (2006) E-mail interviewing in qualitative research: a methodological discussion. Journal of the American Society for Information Science and Technology, 57(10): 1284–95.
Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked the publisher will be pleased to make the necessary arrangements at the first opportunity.[Page x]
A possible co-occurrence or relationship between two variables. Does not mean a cause-and-effect relationship has been established.
The management process whereby organisations evaluate various aspects of their processes in relation to the best practice, usually within their own sector.
The moral principle of doing good.
A type of observational analytic epidemiological investigation in which subjects are selected on the basis of whether they do (cases) or do not (controls) have a particular disease. The groups are then compared with respect to the proportion having a history of exposure or characteristic of interest.
A series of patients with a defined disorder. The term is used to describe a study reporting on a consecutive collection of patients treated in a similar manner, without a concurrent control group. For example, a surgeon might describe the characteristics of and outcomes for 100 consecutive patients with cerebral ischaemia who received a revascularisation procedure.
Chapter 6 of the 1997 White Paper The New NHS: Modern, dependable (Department of Health, 1997) described the means of improving clinical standards at local level throughout the NHS. It involves:
- action to ensure that risks are avoided;
- rapid detection of adverse events which are openly investigated and lessons learned;
- disseminating good practice;
- establishing systems to ensure continuous improvements in clinical care.
A prospective controlled study involving patients, i.e. one in which an intervention is allocated and patients are followed up.
An interventional design which attempts to make inferences about individuals but where the intervention is allocated to clusters of individuals.
Coding is an analytical process in which data are categorised to facilitate analysis. One code should apply to only one category and categories [Page 232]should be comprehensive. The coding framework is the clear guidelines for coders (individuals who do the coding) to ensure that code is consistently applied.
A group of individuals who share a characteristic (such as age, gender). In a cohort study, individuals are followed for a period of time to determine disease incidence at different ages.
A factor which is significantly associated with both the occurrence of a disease in a population and with one of the causes or determinants, but is not itself a cause. Confounding variables can result in erroneous conclusions. For example, vegetarians have a lower incidence of obesity than non-vegetarians, but the lower incidence of obesity may be due to the confounding factor that vegetarians tend to be more active as a population than non-vegetarians rather than the lower incidence being due to difference in diet.
Research studies in which variables are controlled. Typically one group receives a treatment and another (the control group) does not. The groups are similar in every characteristic except for the treatment so that differences in the groups can be attributed to the treatment.
A form of discourse analysis that studies social interaction, embracing both verbal and non-verbal conduct, in situations of everyday life.
A measure of the association between two or more variables. The measurement scales used should be at least interval. Correlation is not causation but it may imply that link is worth further investigation. The most widely used type of correlation coefficient is Pearson r, also called linear or product moment correlation.
A cross-sectional study is a descriptive study in which disease and exposure status are measured simultaneously in a given population. Such a study provides a snapshot of the frequency and characteristics of a disease in a population at a particular point in time.
In the world of technology, crowd-sourcing means inviting a group to collaborate on a solution to a problem. It was coined by Jeff Howe of Wired magazine in 2006 to refer to the widespread internet practice of posting an open call requesting help in completing some task.
The whole body of data collected.
Another word for a table where data are entered into individual cells.
The sample from a data corpus that you select for scrutiny for a particular purpose.
The process of arguing from a general to a specific instance (from a theory to an empirical situation, for instance).
With the Delphi technique, individual participants are asked to give their views in response to a series of questions. These views are [Page 233]collated and are then fed back to the participants, who rank them in order of importance to them. This second round is collated and fed back to all the participants again. This creates an opportunity for individuals to revise their judgements on the basis of this feedback and gives some degree of anonymity for their individual contributions. Although time-intensive and somewhat expensive, it is a useful tool for establishing a consensus about priorities relevant for a particular target group (such as elderly people or those with disabilities) who are most knowledgeable about their specific needs.
A general term for a number of qualitative approaches to analysing written, spoken or signed language use.
This occurs when you extrapolate from group data to draw conclusions about individuals.
How well a treatment works in practice (as opposed to the controlled conditions present in a clinical trial, where efficacy is measured).
An economics concept that relates to the optimal use of resources.
Description of behaviour or a belief in terms meaningful (consciously or unconsciously) to the person within the culture.
A theory of knowledge that asserts that knowledge comes only or primarily via sensory experience.
The branch of medicine dealing with the study of the causes, distribution and control of disease in populations.
A network of professionals with recognised expertise and competence with an authoritative claim to knowledge within a particular area. Although an epistemic community may consist of professionals from a variety of disciplines and backgrounds, they have a shared set of normative and principled beliefs.
When two treatments are regarded as an equal bet in prospective terms.
A qualitative study design that entails indepth study of a society's or an organisation's culture and social structure. It uses both qualitative and quantitative methods to do this.
The assessment and determination of the quality or value of something (for purposes both of accountability and for learning).
Aims to apply the best available evidence gained from the scientific method to clinical practice.
A systematic testing process that is carried out in order to verify, falsify or establish the validity of a hypothesis.
A group interview where people who are strangers to each other but have experience of what is being investigated are invited to contribute their [Page 234]views and ideas. The hope is that as wide a range of differing opinions or experiences as possible will be expressed.
Looks for areas for improvement in a service.
This exists when the results of the research can be applied more generally and more widely than the research study itself.
Any document that seeks to standardise processes associated with an activity and thus make employees‘ actions accountable. By definition, following a guideline is never mandatory. ‘Protocol’ would be a better term for a procedure that is mandatory. They are part of the wider process of governance. The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies.
The predominant political economic and ideological influence (of a state, region or group) over others so that its way of seeing things is perceived as natural and common-sense.
In systematic reviews, heterogeneity refers to variability or differences between studies in the estimates of effects.
A frequency distribution by means of rectangles whose widths represent class intervals and whose areas are proportional to the corresponding frequencies.
Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality (effectiveness, reliability, safety, appropriateness, equity, efficiency) of healthcare. It includes the study of influences on healthcare professional and organisational behaviour (www.who.int/reproductivehealth/topics/best_practices/greatproject_glossary/en/index.html).
A designated group of persons, assembled at a common time early in the development of a specific clinical disorder (for example, at the time of first exposure to the putative (i.e. supposed) cause or at the time of initial diagnosis), who are followed thereafter.
The process of inference from a finite number of particular cases in order to make a generalisation.
This paradigm starts from the view that people construct meanings through language and interaction with others in their daily lives. Thus any attempt to establish cause-and-effect relationships is misguided because meanings will change in different situations and over time.
Any activity or object whose purpose is to improve health or alter the course of disease.
Formal talk where questions are asked by the interviewer to obtain information from the respondent in order to collect data to answer the research question.[Page 235]
A formal list of precoded questions that must be asked in the same order and in the same way by an interviewer who writes down on it the answers given.
Anyone who can provide detailed information and opinion based on his or her knowledge of a particular issue.
A set of ideas in political and social thought which underlines the importance of individual rights. The role of the state is primarily to protect these rights (referred to as neoliberalism when it includes market-driven ideas of the efficiency of private enterprise justifying the diminishment of the public sector).
A process whereby an activity or idea becomes popularised or adopted as policy that attracts routine funding.
The average where you add up all the numbers and then divide by the number of numbers.
Another form of average that is the numerical value separating the higher half of a sample (or population) from the lower half.
The statistical analysis of data from more than one study of the same intervention (or association) in an attempt to summarise the current state of knowledge.
Another measure of average that is the value that occurs most often.
Discusses and summarises the literature on a particular topic, without generating any pooled summary figures through meta-analysis. This type of review usually gives a comprehensive overview of a topic, rather than addressing a specific question such as how effective a treatment is for a particular condition. Narrative reviews do not often report on how the search for literature was carried out or how it was decided which studies were relevant to include. Therefore, they are not classified as systematic reviews.
National Institute for Health and Clinical Excellence (NICE)
Provides guidance, sets quality standards and manages a national database to improve people's health and prevent and treat ill health. It uses research evidence as well as economic information and consultation with service users for policy-making.
A group interview where the aim is to establish consensus about the issue being investigated. Nominal group technique is a structured method for group brainstorming that encourages contributions from everyone.
The moral principle of not doing harm. It is one of the four principles in medical ethics proposed by Beauchamp and Childress (2001).
The proposition to be tested statistically, that the experimental intervention has ‘no effect’.
In 1947 an international tribunal declared the Nuremberg Code the standard by which a group of doctors in Nazi Germany should be judged.[Page 236]
One of a range of statistics used to assess the risk of a particular outcome (or disease) if a certain factor (or exposure) is present.
Something that follows as a result or consequence of an intervention. Measurable outcomes need to be specified as a part of the design of evaluation research. They are the higher-level results.
A shared stable commitment to key theories, instruments, values and underpinning assumptions that form the discipline, thus facilitating the cumulative generation of knowledge. It was a concept used by Thomas Kuhn in The Structure of Scientific Revolutions (1962).
Following on from the 1997 White Paper The New NHS: Modern, dependable (Department of Health, 1997), NHS trusts became required to report on the following six areas:
- health improvement;
- fair access to services;
- effective delivery of appropriate healthcare;
- patient/carer experience;
- the health outcomes of NHS care.
A world view that values the meaning of occurrences, rather than measuring observable events.
A chemically inert substance which has a psychologically suggestive effect and is used in place of an active drug. It may be used as a control in a clinical trial to determine whether improvement and/or side effects can be attributed to the active substance.
A world view that values measurement and observable events.
A social science approach studying how people construct meaning through social interaction.
The power of a statistical hypothesis test measures the test's ability to reject the null hypothesis when it is actually false – in other words, to make a correct decision. It is the probability of not committing a type II error (failing to recognise a difference when in fact there is one – which can happen when a sample size is too small).
The activities that can be identified that feed into an outcome. They can be monitored to ensure work is on track to achieve its objectives.
A research design that follows respondents into the future (also called longitudinal).
A formal and explicit treatment regimen for care. A clinical trial will have two or more such protocols along with a description of the research design or method, eligibility requirements and the proposed method of analysis. It can [Page 237]also be used to describe the comprehensive written document detailing all procedures to be followed in a trial.
A tendency to publish results that appear significant, rather than negative or near-neutral results, which are almost never published. This can distort the true picture of research findings if a meta-analysis is performed as the success of an intervention is overrepresented.
Q-squared (Q2) methods
Also known as mixed methods, Q-squared methods refer to a study design that incorporates both quantitative and qualitative methods. Data is analysed severally. Such an approach deepens understanding.
An approach that aims to form an indepth understanding of human behaviour and the reasons that govern such behaviour.
Measures of excellence in either a service or product.
Randomised controlled trial (RCT)
An epidemiological study where people are randomly allocated to receive (or not receive) a particular intervention (this could be two different treatments or one treatment and a placebo). This experimental study design is used to determine whether an intervention or treatment is more effective than the alternative control.
Risk of an event (or of developing a disease) relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group.
The consistency of a set of measurements or of a measuring tool (interview schedule, for example). Reliability is necessary but not sufficient for validity.
The extent to which sample data reflect accurately the characteristics of the population from which they are drawn.
A study that examines events that have already taken place; a study on previously collected data.
A comprehensive list of names and contact details.
A statistical bias that can arise through the method of choosing the individuals or groups to take part in a scientific study.
Being mindful of the emerging social concerns and priorities of internal and external stakeholders (patients, community, employees, governmental and non-governmental organisations, management and owners).
A paradigm interested in how an individual's learning takes place because of his or her interactions in a group.
A person, group or organisation that has direct or indirect stake in an organisation because it can affect or be affected by the organisation's actions, objectives and policies.
Both governance and quality issues. Organisations publish practical guidance and examples of good practice to which they wish employees to adhere and for which sanctions apply if they are not followed.[Page 238]
A series of questions asked to individuals to obtain statistically useful information about a given topic that may be posted to people/be online and so be self-completed, or may be asked by an interviewer (referred to as interview schedules).
Forms a judgement of the value and merits of whatever is being evaluated, usually for decision-making and accountability purposes.
Observational or descriptive, non-experimental study in which individuals are systematically examined for the absence or presence (or degree of presence) of characteristics of interest.
Different words with almost identical or similar meanings – a thesaurus can be used to identify such words.
A synthesis of medical research on a particular subject to represent the current stage of knowledge about what is effective clinical practice. It uses thorough methods to search for and include all or as much as possible of the research on the topic. Only relevant studies, usually of a certain minimum methodological quality, are included.
The resources needed (time, money, expertise, for example) to deliver a product or service. In healthcare this would include costs arising from different governance structures of local and health authorities when a patient's care entails crossing organisational boundaries.
Translational research or implementation science
Promotes the uptake of research findings into routine healthcare in both clinical and policy contexts. It is multidisciplinary research that scientifically studies methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, so as to improve the quality and effectiveness of healthcare. It includes the study of what influences healthcare professional and organisational behaviour.
This involves using more than one method to produce different forms of data (or the same method to gather data from different sources). The data can be compared, and similar findings from different methods may support the validity and comprehensiveness of the research findings.
Type II error
The false acceptance of the null hypothesis (a false negative). The type I error (false positive) is more serious: it wrongly rejects the null hypothesis.
The metric corresponds accurately to what it claims to be occurring in the real world.
The name given to a category that can change its value.
A White Paper issued by the government lays out policy, or intended action, on a topic that is of current concern. It signifies an intention to issue new law, and in the UK is also known as a Command paper. White Papers are often preceded by Green Papers, which are consultation documents.
References[Page 239]The Academy of Medical Royal Colleges (2012) Foundation Programme Curriculum 2012. www.foundationprogramme.nhs.uk/pages/home1998) Independent Inquiry into Inequalities in Health Report. London: The Stationery Office.(2011) The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards. Clinical Medicine, 11(6): 524–8., , , and (2011) The problem of plagiarism. Urologic Oncology: Seminars and Original Investigations, 29(1): 90–4., and (2011) Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. British Medical Journal, 343: d7157., , , and (Antithrombotic Trialists‘ Collaboration (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet, 373(9678): 1849–60.2000) Pumping iron: compliance with chelation therapy among young people who have thalassaemia major. Sociology of Health & Illness, 22(4): 500–24., and (1984) Structures of Social Action: Studies in conversation analysis. Cambridge: Cambridge University Press., and (eds) (2001) A graphic framework for teaching critical appraisal of randomised controlled trials. Evidence Based Medicine, 6(3): 68–9., and (2009) The Use of Antipsychotic Medication for People with Dementia: Time for action. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108302.pdf(2001) Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? British Medical Journal, 322(7294): 1115–17.(2004) Health Inequality: An introduction to theories, concepts and methods. Cambridge: Polity Press/Blackwell Publishing.(2003) An Introduction to Quality Assurance in Health Care: Avedis Donabedian. Oxford: Oxford University Press.(ed.) ([Page 240] (2003) Manual or electronic? The role of coding in qualitative data analysis. Educational Research, 45(2): 143–54.2001) Principles of Biomedical Ethics (5th edition). Oxford: Oxford University Press., and (2007) Writing for Social Scientists: How to start and finish your thesis, book or article. Chicago, IL: University of Chicago Press.(2010) Leadership with a small “l”. British Medical Journal, 340: 265.(2010) How much searching is enough? Comprehensive versus optimal retrieval for technology assessments. International Journal of Technology Assessment in Health Care, 26(4): 431–5.(2005) Handbook of Health Research Methods: Investigation, measurement and analysis. Maidenhead: Open University Press., and (2007) Research and teaching from the students‘ perspective. International policies and practices for academic enquiry: an international colloquium held at Marwell Conference Centre, Winchester, UK, 19–21 April.(2009) Qualitative researchers‘ understandings of their practice and the implications for data archiving and sharing. Sociology, 43(6): 1163–80., , and (2010) Undergraduate medical research: the student perspective. Medical Education Online, 15: 5212., , and (2010) Developing email interview practices in qualitative research. Sociological Research Online, 15(4): 8(1996) The Mind Map Book. Harmondsworth: Penguin Books.(2011) Breaking the rules: understanding non-compliance with policies and guidelines. British Medical Journal, 343: 5283., , , , and (1981) Human excretion behaviour in a schistosomiasis endemic area of the Geizira, Sudan. Transactions of the Royal Society of Tropical Medicine and Hygiene, 84: 101–7., and (Clinical Governance Support Team NHS (2005) Practical Clinical Audit Handbook. London: NHS.1972) Effectiveness and Efficiency. London: Nuffield Provincial Hospitals Trust.(1989) One Man's Medicine. London: British Medical Journal, 61–72., and (2011) Research Methods in Education, 7th edition. Abingdon: Routledge., , and (1993) The Audit Handbook: Improving healthcare through clinical audit. Chichester: John Wiley., , , and ([Page 241], , , , , and (1993) Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility. Bulletin of the World Health Organization, 71(1): 23–32.2009) Tricks of the trade in community mental health research: working with mental health services and clients. Evaluation & the Health Professions, 32(1): 38–58., and (2008) Evidence-based medicine and the NHS: a commentary. Journal of the Royal Society of Medicine, 101(7): 342–4.(2008) Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one. Journal of the Royal Society of Medicine, 101(10): 493–500., , and (2005) Evaluation Methodology Basics: The nuts and bolts of sound evaluation. London: Sage Publications.(2008) Qualitative research to improve RCT recruitment: issues arising in establishing research collaborations. Contemporary Clinical Trials, 29(5): 663–70., , , and (2009) The elephant in the living room: or extending the conversation about the politics of evidence. Qualitative Research, 9(2): 139–60.(1994) Handbook of Qualitative Research. London: Sage., and (Department of Health (1989) Working for Patients: Medical audit working paper no. 6. London: HMSO.Department of Health (1997) The New NHS: Modern, dependable. Cm 3807. London: The Stationery Office.Department of Health (1998) A First Class Service: Quality in the new NHS. London: Department of Health.Department of Health (2000) An Organisation with a Memory: Report of an expert group on learning from adverse events in the NHS. London: The Stationery Office.Department of Health (2002) Learning from Bristol: The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984–1995. Command paper CM 5363. London: The Stationery Office.Department of Health (2005) Research Governance Framework for Health and Social Care, 2nd edition. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4108962.Department of Health and Social Security (1980) Inequalities in health: report of a research working group (the Black report). London: DHSS.1997) The Evidence Based Medicine Workbook: Critical appraisal for evaluating clinical problem solving. Oxford: Butterworth-Heinemann., , and (eds) ([Page 242], and (2000) Comparing two forms of an e-mail survey: embedded vs. attached. International Journal of Market Research, 42(1): 39–50.1966) Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly, 44(3): 166–206.(1978) The quality of medical care. Science, 200(4344): 856–64.(2003) An Introduction to Quality Assurance in Health Care. New York: Oxford University Press.(2011) Men's experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study. British Medical Journal, 343: d5824., , , , , and (2011) The place of the literature review in grounded theory research. International Journal of Social Research Methodology, 14(2): 111–24.(2011) A qualitative study of the experiences of people who identify themselves as having adjusted positively to a visible difference. Journal of Health Psychology, 16(5): 739–49., , and Antithrombotic Trialists‘ Collaboration (2010) Fresh or frozen? Classifying ‘spare’ embryos for donation to human embryonic stem cell research. Social Science & Medicine, 71(12): 2204–11., , and (2006) ‘Rigour’, ‘ethical integrity’ or ‘artistry’? Reflexively reviewing criteria for evaluating qualitative research. British Journal of Occupational Therapy, 69(7): 319–26.(1967) Studies in Ethnomethodology. New York: Prentice Hall.(2010) Undergraduate medical student attitudes to the peer assessment of professional behaviours in two medical schools. Education for Primary Care, 21(1): 32–7., , , and (General Medical Council (2006) Good Medical Practice. www.gmc-uk.org/guidance/good_medical_practice.aspGeneral Medical Council (2009) Tomorrow's Doctors.GfK NOP Social Research (2011) NHS Staff Tracking Research – Winter 2010 (Research Wave 5). London: Department of Health.1967) The Discovery of Grounded Theory: Strategies for qualitative research. Chicago: Aldine., and (Global Health Education Consortium. globalhealtheducation.org/resources/Pages/default.aspx2011) Delayed cord clamping and improved infant outcomes. British Medical Journal, 343: d7127.(2006) Writing narrative literature [Page 243]reviews for peer-reviewed journals: secrets of the trade. Journal of Chiropractic Medicine, 5(3): 101–17. www.ncbi.nlm.nih.gov/pmc/articles/PMC2647067, , and (2009) Gerontology and the Construction of Old Age. New Brunswick: Aldine Transaction., , and (2010) How to Read a Paper: The basics of evidence-based medicine, 4th edition. London: BMJ Books/Wiley-Blackwell.(2005) Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. British Medical Journal, 331(7524): 1064–5., and (2010) Why do evaluations of ehealth programs fail? An alternative set of guiding principles. PLoS Medicine, 7(11): e1000360., and (2010a) The Devil's in the Detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes. London: University College London., , , , , , and (2010b) Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study. British Medical Journal, 340: c3111., , , , , and (1994) Competing paradigms in qualitative research, in , and (eds) Handbook of Qualitative Research, Beverly Hills, CA: Sage, 105–17., and (1992) Introduction: epistemic communities and international policy coordination. International Organization, 46(1): 1–35.(2012) Getting doctors to clean their hands: lead the followers. British Medical Journal Quality and Safety doi: 10.1136/bmjqs-2011–000396., , , , and (2006) Internet recruitment and e-mail interviews in qualitative studies. Qualitative Health Research, 16(6): 821–35., and (1998) Doing a Literature Review. London: SAGE Publications.(2011) Video in Social Science Research. London: Routledge., and (Healthcare Quality Improvement Partnership (HQIP) (2009) What is Clinical Audit? www.hqip.org.uk/assets/Images/Uploads/HQIP-What-is-Clinical-Audit-Nov-09.pdfHealthcare Quality Improvement Partnership (HQIP)/Cambridge Institute for Research, Education and Management (CiREM) (2011) Challenges in evaluation of quality improvement methodologies: the example of clinical audit, via link on www.hqip.org.uk/literature-on-the-effectiveness-of-clinical-audit[Page 244]House of Commons Health Committee (2005) The Prevention of Venous Thromboembolism in Hospitalised Patients. HC 99. London: The Stationery Office.Howard Hughes Medical Institute and Burroughs Wellcome Fund (2006) Making the Right Moves: A practical guide to scientific management for postdocs and new faculty, 2nd edition. www.hhmi.org/labmanagement.1974) Medical Nemesis. London: Calder & Boyars.(2006) What is protocol-based care? A concept analysis. Journal of Nursing Management, 14(7): 544–52., , , , and (1994) Handwashing: the Semmelweis lesson forgotten? Lancet, 344(8933): 1311–12. www.sciencedirect.com/science/article/pii/S0140673694906874(1988) Perfecting the World: The life and times of Dr. Thomas Hodgkin 1798–1866. Boston: Harcourt Brace Jovanovich., and (2006) Evaluating Training Programs, 3rd edition. San Francisco, CA: Berrett-Koehler., and (2000) To Err is Human: Building a safer health system. Washington, DC: National Academies Press., , and (eds) (2011) The effect of mystery shopper reports on age verification for tobacco purchases. Journal of Health Communication, 16(8): 820–30., , , and (1970) The Structure of Scientific Revolutions, 2nd edition. Chicago: University of Chicago Press.(2000) The insight of emotional danger: research experiences in a home for older people, in , and (eds) Danger in the Field: Risk and ethics in social research. London: Routledge.(2009) How to read and understand and use systematic reviews and meta-analyses. Acta Psychiatrica Scandinavica, 119(6): 443–50., , and (2007) A brief history of vaccines and vaccination. Revue Scientifique et Technique Office International des Epizooties, 26(1): 29–48., , and (2011) Research ethics committees: values and power in higher education. International Journal of Social Research Methodology, 14(5): 391–405., and (2008) Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT). Journal of Hospital Infection, 68: 222–9., , , , , , and the NOSEC/FIT group (2007) To what extent is the management of norovirus outbreaks [Page 245]in hospitals in the United Kingdom evidence-based? MPh dissertation, Cardiff University.(2005) Coronary Heart Disease: Are the National Service Framework (NSF Wales) targets for angiography waiting times in 2004/5 being met in South Wales? SSC report. Cardiff: Cardiff Medical School., , , , , , and (2002) Annotated bibliography on equity in health, 1980–2001. International Journal for Equity in Health, 1(1): 1., and (1983) The critical attitude in medicine: the need for a new ethics. British Medical Journal, 287(6409): 1919–23., and (2011) Professional Practice for Foundation Doctors. Exeter: Learning Matters., and (eds) (2005) Social determinants of health inequalities. Lancet, 365(9464): 1099–104.(2005) Primary Care Service Evaluation Toolkit. www.camstrad.nhs.uk/documents/Researchers/evaluation_toolkit.pdf?preventCache=08/08/2005%2015:16 (accessed November 2010)., and (2008) High Quality Care for All: Briefing on NHS Next Stage Review final report. The King's Fund. www.kingsfund.org.uk/publications/briefings/high_quality_care.html (accessed August 2011)., and (1984) Quality assessment in health. British Medical Journal, 288(6428): 1470–2.(1967) The Art of the Soluble. London: Methuen.(2006) E-mail interviewing in qualitative research: a methodological discussion. Journal of the American Society for Information Science and Technology, 57(10): 1284–95.(1994) Qualitative Data Analysis: An expanded sourcebook, 2nd edition. London: Sage Publications., and (1961) Oral treatment of pernicious anaemia: further studies. British Medical Journal, 1(5221): 232–5., and (2010) What do medical students understand by research and research skills? Identifying research opportunities within undergraduate projects. Medical Teacher, 32(3): e152–60., , , , , , . (2004) An interpretative phenomenological analysis of the embodiment of artificial limbs. Disability & Rehabilitation, 26(16): 963–73.(2004) The meaning and experience of being a stroke survivor: an interpretative phenomenological analysis. Disability & Rehabilitation, 26(13): 808–16., and ([Page 246]National Institute for Health and Clinical Excellence (NICE) (2002) Principles for Best Practice in Clinical Audit. Oxford: Radcliffe Medical Press.National Institute for Health and Clinical Excellence (NICE) (2008) Prophylaxis Against Infective Endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. NICE clinical guideline 64. www.nice.org.uk/CG0642011) Research skills, in , and (eds) Professional Practice for Foundation Doctors. Exeter: Learning Matters.(2010) Reporting and presenting information retrieval processes: the need for optimizing common practice in health technology assessment. International Journal of Technology Assessment in Health Care, 26(4): 450–7., and (2011) IBM SPSS Statistics 19 Guide to Data Analysis. Upper Saddle River, NJ: Pearson.(1992) Prostitutes and their clients: a Gambian survey. Social Science & Medicine, 34(1): 75–88., , , , and (2002) Transcription quality, in , and (eds) Handbook of Interview Research: Context and method. Thousand Oaks, CA: Sage.(1998) Rationale and standards for the systematic review of qualitative literature in health services research. Qualitative Health Research, 8(3): 341–51., , and (1959) The Logic of Scientific Discovery. London: Routledge.(2010) Design an effective PowerPoint presentation. Education for Primary Care, 21(1): 51–3.(2004) Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews, Issue 4. article no.: CD003248., , and (2002) Should health professionals screen women for domestic violence? Systematic review. British Medical Journal, 325(7359): 314., , , , and (2011) The involvement of users and carers in health and social research: the realities of inclusion and engagement. Qualitative Health Research, 21(5): 704–13., and (2010) Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. British Medical Journal, 341: c4564., , , , , , . ([Page 247] (2000) Small-scale Evaluation. London: Sage Publications.2011) Open-source genomic analysis of Shiga-toxin-producing E. coli O104:H4. New England Journal of Medicine, 365(8): 718–24., , , , , , . (2004) Evaluation: A systematic approach. London: Sage Publications., , and (1996) Evidence based medicine: what it is and what it isn't. British Medical Journal, 312(7023): 71–2., , , , and (1984) Notes on methodology, in , and (eds) Structures of Social Action: Studies in conversation analysis. Cambridge: Cambridge University Press.(2004) Data analysis and interpretation: concepts and techniques for managing, editing, analyzing and interpreting data from epidemiologic studies. www.epidemiolog.net/evolving/DataAnalysis-and-interpretation.pdf(2008) What errors do peer reviewers detect, and does training improve their ability to detect them? Journal of the Royal Society of Medicine, 101: 507–14., , , , , and (Secretary of State for Health (2008) High Quality Care for All. NHS next stage review final report. CM 7432. www.dh.gov.uk/en/Healthcare/Highqualitycare-forall/index.htm2010) Community members as recruiters of human subjects: ethical considerations. American Journal of Bioethics, 10(3): 3–11. www.ncbi.nlm.nih.gov/pmc/articles/PMC3139466/pdf/nihms212939.pdf, and (2007) Assessing the health and health needs of off-street male sex workers in Britain. MPH dissertation. Cardiff University.(2008) Behind the scenes in health care improvement: the complex structures and emergent strategies of implementation science. Social Science & Medicine, 67(10): 1530–40., , and (2011) Taking stock: a rapid review of the National Child Measurement Programme. Thomas Coram Research Unit, Institute of Education, University of London. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_129372.pdf, , , and (2005) Sharing patient data: competing demands of privacy, trust and research in primary care. British Journal of General Practice, 55(519): 783–9., , , and (1984) The genesis of the Registrar General's social classification of occupations. British Journal of Sociology, 35(4): 523–46.([Page 248], and (1988) The next best thing to being there: conducting the clinical research interview by telephone. American Journal of Orthopsychiatry, 58(3): 418–27.2007) Doing Conversation Analysis: A practical guide, 2nd edition. London: Sage Publications.(2011) The art and science of knowledge synthesis. Journal of Clinical Epidemiology, 64(1): 11–20., , and (2005) Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Systematic Review, Jul 20, (3): CD004655., , , , , , . (2010) Patient Safety, 2nd edition. Oxford: Wiley-Blackwell.(2009) Constructing and re-constructing narratives of patient safety. Social Science & Medicine, 69: 1722–31.(2006) A systematic review of the use of simulated patients and pharmacy practice research. International Journal of Pharmacy Practice, 14: 83–93., , and (1996) Unhealthy Society: The afflictions of inequality. London: Routledge.(World Health Organization (1994) International Statistical Classification of Diseases and Related Health Problems (ICD-10). Geneva: WHO.World Health Organization (2003). Quality and accreditation in health care services: a global review, in Department of Health Service Provision. Geneva: World Health Organization.World Health Organization (2004) Style Guide. http://thailand.digitaljournals.org/community/download/6World Health Organization (2010) Assessing and tackling patient harm: a methodological guide for data-poor hospitals. Geneva: WHO.World Health Organization (2011) Waist Circumference and Waist–Hip Ratio. Report of a WHO expert consultation, Geneva, 8–11 December 2008. Geneva: WHO.