Achieving RCEM SLO 10: Participate In Research and Manage Data Appropriately
Executive Summary
Specialty Learning Outcome (SLO) 10 of the Royal College of Emergency Medicine (RCEM) curriculum frames research not as an academic option, but as a core component of clinical excellence for the modern Emergency Medicine (EM) clinician. The fundamental goal is to transition trainees from passive consumers of evidence into active, proficient participants within the research ecosystem. Mastery of SLO 10 is assessed continuously and requires demonstrated proficiency across three key domains: Critical Appraisal, Active Research Participation, and robust Data Management.
Critical Takeaways:
- Core Requirement: Trainees must provide evidence of proficiency in interpreting data (Critical Appraisal), contributing to studies (Active Participation through recruitment and consent), and managing data in compliance with legal and ethical standards (Good Clinical Practice, General Data Protection Regulation).
- Standard Evidence: Achieving a standard rating requires specific portfolio evidence, including the Applied Critical Appraisal Form (ACAF), Journal Club Feedback (JCF), a valid Good Clinical Practice (GCP) certificate, and recruitment logs for National Institute for Health and Care Research (NIHR) portfolio studies.
- Path to Excellence: Excelling beyond the mandatory requirements involves assuming leadership roles. High-impact strategies include completing the NIHR Associate Principal Investigator (PI) scheme, acting as a site lead for a Trainee Emergency Research Network (TERN) project, and disseminating original work through regional or national presentations and peer-reviewed publications.
- Data Governance: Adherence to the Caldicott Principles and GDPR is non-negotiable and must be evidenced through training and reflective practice. A working knowledge of specific EM research ethics, such as Deferred Consent, is essential.
1. Strategic Overview of SLO 10
SLO 10 is designed to ensure that EM clinicians can effectively navigate the evolving landscape of evidence-based medicine. It is a key component of the 2021 RCEM Curriculum and is assessed continuously from ACCS through to Higher Specialist Training (HST) (3). Progression is expected year on year, with entrustment decisions made annually by the Educational Supervisor and the ARCP panel.
The Three Key Capabilities
To successfully complete this SLO, trainees must provide portfolio evidence covering three distinct capabilities:
- Appraise, Synthesize, and Use Research Evidence: The ability to find, critically evaluate, and apply published evidence to the direct care of patients.
- Actively Participate in Research: The requirement to engage directly with research activities, such as recruiting patients for multi-centre trials within the department.
- Manage Data Appropriately: The proficiency to handle sensitive patient data ethically, securely, and in accordance with UK law.
2. Core Components and Evidence Requirements
To achieve a "Standard" performance rating, trainees must populate their portfolio with specific, high-quality evidence for each capability.
2.1. Critical Appraisal and Evidence Synthesis
This capability requires demonstrating the ability to construct a clinical question, search the literature, and evaluate the validity and applicability of research studies.
- Required Evidence:
- Applied Critical Appraisal Form (ACAF): Considered the gold standard evidence for demonstrating this skill, completed for a paper relevant to a clinical case.
- Journal Club Feedback (JCF): Evidence of presenting a paper at a departmental meeting, with feedback recorded.
- Topic Review: A written summary of the evidence base informing a specific clinical guideline or protocol update.
- Evidence of Literature Search: Documentation of the process of searching for relevant research.
2.2. Active Research Participation
Passive observation is insufficient. Trainees are expected to actively engage with NIHR portfolio studies running in their department. This requires rotating through an ED that is actively involved in research.
- Required Evidence:
- Good Clinical Practice (GCP) Certificate: Mandatory, in-date certification on the ethical, scientific, and practical standards for clinical research.
- Recruitment Logs: Anonymised logs of patients screened or consented for ED-based studies (e.g., TERN studies, CRASH-4).
- Certificates of Participation: Official documentation from research bodies like the Trainee Emergency Research Network (TERN) or from local research nurses.
2.3. Data Management and Governance
This capability bridges clinical research with Information Governance (IG), ensuring data is handled with the utmost security and ethical consideration.
- Required Evidence:
- Information Governance Training Certificates: Evidence of completion of annual NHS statutory and mandatory training.
- Audit/QIP Data Handling: Reflection on the methods used to anonymise and handle data during a Quality Improvement Project (which has overlap with SLO 11).
- Reflective Entry: A written reflection on a data breach, a "near miss" in patient confidentiality, or the ethical complexities encountered during the consent process for vulnerable patients in the ED.
3. Assessment and Progression Through Training
Assessment of SLO 10 is a continuous process involving both formative and summative components.
3.1. Assessment Methods
Evidence is collected via a range of workplace-based assessments and formal evaluations:
Formative Evidence | Summative Assessment |
Multi-Consultant Report (MCR) | FRCEM OSCE |
Multi-Source Feedback (MSF) | Educational Supervisor's Report |
GCP Certification | ARCP Panel Overview |
ACAF / JCF Forms | |
Evidence of Research Activity | |
Trainee Observation (TO) |
3.2. Entrustment Expectations by Training Stage
- End of Core Training: Expectations are currently under development by the ACCS intercollegiate board.
- End of Intermediate Training: Trainees are required to provide clear evidence of critical literature appraisal activity, including evidence synthesis and the formulation of a ‘clinical bottom line’.
- End of HST: Trainees must show evidence of journal club activity with feedback on their presentation. Evidence of work towards a higher degree or presentation at national or international meetings is also accepted for this SLO.
4. Strategies for Excelling in SLO 10
To achieve an "Excellent" rating or demonstrate high-level entrustment (Level 4/5), trainees must move beyond participation and assume leadership roles within the research environment.
- The Associate PI Scheme: Registering as an Associate Principal Investigator for an NIHR portfolio study formally recognises a trainee's contribution to study delivery and management. This is typically a six-month commitment (1).
- TERN Involvement: Taking on the role of a site lead for a Trainee Emergency Research Network (TERN) project is a powerful way to demonstrate leadership and collaborative research skills.
- Strategic Dissemination: Actively disseminating the results of audits, QIPs, or case reviews is a key differentiator. A tiered approach is recommended:
- Bronze: Departmental presentation.
- Silver: Regional poster presentation.
- Gold: National/International oral presentation or a peer-reviewed publication.
- Academic Professionalism: Using formal academic writing styles, such as Vancouver referencing, when presenting evidence in the portfolio demonstrates professional polish.
5. Data Management: The Legal and Ethical Framework
A proficient understanding of the legal and ethical principles governing medical data is mandatory.
- The Caldicott Principles: The seven principles governing the use of patient-identifiable information. Key rules include that access should be on a strict "need-to-know" basis.
- General Data Protection Regulation (GDPR): Trainees must understand the critical differences between anonymised, pseudonymised, and identifiable data.
- Consent in Emergency Research: A specific area of EM research ethics is the concept of Deferred Consent, where a patient lacking capacity (e.g., in cardiac arrest) can be entered into a trial before formal consent is obtained from a legal representative. This is permitted under specific ethical guidelines (2).
6. Learning Aids and Resources
6.1. Mnemonics for Practice
These frameworks can be used to structure clinical questions and the critical appraisal process.
Mnemonic | Purpose | Components |
PICOT | Forming clinical questions | P - Population, I - Intervention, C - Comparator, O - Outcome. T - Time frame |
RAMboMAN | Rapid appraisal of a study | R - Recruitment?, A - Allocation?, M - Maintenance?, bo - blind/objective M - Measurement?, AN - ANalysis |
6.2. Key Statistical Concepts
A basic guide to interpreting common statistical outputs:
- p-value < 0.05: Indicates the result is statistically significant and unlikely to have occurred by chance.
- Confidence Interval (CI): If the CI for a ratio (e.g., Odds Ratio) crosses 1, or the CI for a difference crosses 0, the result is not statistically significant.
- Number Needed to Treat (NNT): Calculated as 1 / Absolute Risk Reduction. A lower NNT is generally better.
6.3. Recommended Resources for Ongoing Learning
Resource Type | Examples |
Guides & Frameworks | The Doctors guide to critical appraisals, GATE analysis tools, EQUATOR guidelines. Cochrane Handbook for systematic reviews and bias analysis tool. |
RCEM Resources | RCEM Learning modules on critical appraisal, the RCEMLearning virtual journal club, TERN resources. |
Online Updates | JournalFeed, The Bottom Line, St Emlyns, SGEM, First10inEM, EM nerd, REBEL EM. |
7. SLO 10 Descriptors for CPD
The following descriptors from the RCEM should be used to guide CPD diary entries and demonstrate development across all facets of SLO 10 (4):
- Manages clinical information/data appropriately.
- Understands principles of research and academic writing.
- Demonstrates ability to carry out critical appraisal of the literature.
- Understands the role of evidence in clinical practice and demonstrates shared decision making with patients.
- Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches.
- Demonstrates appropriate knowledge of research principles and the translation of research into practice.
- Follows guidelines on ethical conduct in research and consent for research.
- Understands public health epidemiology and global health patterns.
- Recognises the potential of applied informatics, genomics, stratified risk, and personalised medicine.
References
- National Institute for Health and Care Research. Associate Principal Investigator (PI) Scheme. NIHR; 2023. Available from: https://www.nihr.ac.uk/health-and-care-professionals/career-development/associate-principal-investigator-scheme.htm
- General Medical Council. Good practice in research and written guidance. GMC; 2010 (Updated 2024). Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-practice-in-research
- The Royal College of Emergency Medicine. RCEM Curriculum 2021: Specialty Learning Outcomes. RCEM; 2021. Available from: https://rcemcurriculum.co.uk/specialty-learning-outcomes-slos/
- Kaizen Portfolio. SLO 10: Participate in Research and Managing Data Appropriately. RCEM; 2021.
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