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Would you choose to be a psychiatrist again?

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Would you choose to be a psychiatrist again?

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Abstract

Formulation of research question (RQ) is an essentiality before starting any research. It aims to explore an existing uncertainty in an area of concern and points to a need for deliberate investigation. It is, therefore, pertinent to formulate a good RQ. The present paper aims to discuss the process of formulation of RQ with stepwise approach. The characteristics of good RQ are expressed by acronym "FINERMAPS" expanded as feasible, interesting, novel, ethical, relevant, manageable, appropriate, potential value, publishability, and systematic. A RQ can address different formats depending on the aspect to be evaluated. Based on this, there can be different types of RQ such as based on the existence of the phenomenon, description and classification, composition, relationship, comparative, and causality. To develop a RQ, one needs to begin by identifying the subject of interest and then do preliminary research on that subject. The researcher then defines what still needs to be known in that particular subject and assesses the implied questions. After narrowing the focus and scope of the research subject, researcher frames a RQ and then evaluates it. Thus, conception to formulation of RQ is very systematic process and has to be performed meticulously as research guided by such question can have wider impact in the field of social and health research by leading to formulation of policies for the benefit of larger population.

INTRODUCTION

A good research question (RQ) forms backbone of a good research, which in turn is vital in unraveling mysteries of nature and giving insight into a problem.[ 1, 2, 3, 4] RQ identifies the problem to be studied and guides to the methodology. It leads to building up of an appropriate hypothesis (Hs). Hence, RQ aims to explore an existing uncertainty in an area of concern and points to a need for deliberate investigation. A good RQ helps support a focused arguable thesis and construction of a logical argument. Hence, formulation of a good RQ is undoubtedly one of the first critical steps in the research process, especially in the field of social and health research, where the systematic generation of knowledge that can be used to promote, restore, maintain, and/or protect health of individuals and populations.[ 1, 3, 4] Basically, the research can be classified as action, applied, basic, clinical, empirical, administrative, theoretical, or qualitative or quantitative research, depending on its purpose.[ 2]

Research plays an important role in developing clinical practices and instituting new health policies. Hence, there is a need for a logical scientific approach as research has an important goal of generating new claims.[ 1]

"The most successful research topics are narrowly focused and carefully defined but are important parts of a broad-ranging, complex problem."

A good RQ is an asset as it:

Details the problem statement

Further describes and refines the issue under study

Adds focus to the problem statement

Guides data collection and analysis

Sets context of research.

Hence, while writing RQ, it is important to see if it is relevant to the existing time frame and conditions. For example, the impact of "odd-even" vehicle formula in decreasing the level of air particulate pollution in various districts of Delhi.

A good research is represented by acronym FINERMAPS[5]

FINERMAPS

Feasible

Feasibility means that it is within the ability of the investigator to carry out. It should be backed by an appropriate number of subjects and methodology as well as time and funds to reach the conclusions. One needs to be realistic about the scope and scale of the project. One has to have access to the people, gadgets, documents, statistics, etc. One should be able to relate the concepts of the RQ to the observations, phenomena, indicators, or variables that one can access. One should be clear that the collection of data and the proceedings of project can be completed within the limited time and resources available to the investigator. Sometimes, a RQ appears feasible, but when fieldwork or study gets started, it proves otherwise. In this situation, it is important to write up the problems honestly and to reflect on what has been learned. One should try to discuss with more experienced colleagues or the supervisor so as to develop a contingency plan to anticipate possible problems while working on a RQ and find possible solutions in such situations.

Interesting

This is essential that one has a real grounded interest in one's RQ and one can explore this and back it up with academic and intellectual debate. This interest will motivate one to keep going with RQ.

Novel

The question should not simply copy questions investigated by other workers but should have scope to be investigated. It may aim at confirming or refuting the already established findings, establish new facts, or find new aspects of the established facts. It should show imagination of the researcher. Above all, the question has to be simple and clear. The complexity of a question can frequently hide unclear thoughts and lead to a confused research process. A very elaborate RQ, or a question which is not differentiated into different parts, may hide concepts that are contradictory or not relevant. This needs to be clear and thought-through. Having one key question with several subcomponents will guide your research.

Ethical

This is the foremost requirement of any RQ and is mandatory to get clearance from appropriate authorities before stating research on the question. Further, the RQ should be such that it minimizes the risk of harm to the participants in the research, protect the privacy and maintain their confidentiality, and provide the participants right to withdraw from research. It should also guide in avoiding deceptive practices in research.

Relevant

The question should of academic and intellectual interest to people in the field you have chosen to study. The question preferably should arise from issues raised in the current situation, literature, or in practice. It should establish a clear purpose for the research in relation to the chosen field. For example, filling a gap in knowledge, analyzing academic assumptions or professional practice, monitoring a development in practice, comparing different approaches, or testing theories within a specific population are some of the relevant RQs.

Manageable (M): It has the similar essence as of feasibility but mainly means that the following research can be managed by the researcher.

Appropriate (A): RQ should be appropriate logically and scientifically for the community and institution.

Potential value and publishability (P): The study can make significant health impact in clinical and community practices. Therefore, research should aim for significant economic impact to reduce unnecessary or excessive costs. Furthermore, the proposed study should exist within a clinical, consumer, or policy-making context that is amenable to evidence-based change. Above all, a good RQ must address a topic that has clear implications for resolving important dilemmas in health and health-care decisions made by one or more stakeholder groups.

Systematic (S): Research is structured with specified steps to be taken in a specified sequence in accordance with the well-defined set of rules though it does not rule out creative thinking.

Example of RQ: Would the topical skin application of oil as a skin barrier reduces hypothermia in preterm infants? This question fulfills the criteria of a good RQ, that is, feasible, interesting, novel, ethical, and relevant.

Types of research question

A RQ can address different formats depending on the aspect to be evaluated.[ 6] For example:

Existence: This is designed to uphold the existence of a particular phenomenon or to rule out rival explanation, for example, can neonates perceive pain?

Description and classification: This type of question encompasses statement of uniqueness, for example, what are characteristics and types of neuropathic bladders?

Composition: It calls for breakdown of whole into components, for example, what are stages of reflux nephropathy?

Relationship: Evaluate relation between variables, for example, association between tumor rupture and recurrence rates in Wilm's tumor

Descriptive-comparative: Expected that researcher will ensure that all is same between groups except issue in question, for example, Are germ cell tumors occurring in gonads more aggressive than those occurring in extragonadal sites?

Causality: Does deletion of p53 leads to worse outcome in patients with neuroblastoma?

Causality-comparative: Such questions frequently aim to see effect of two rival treatments, for example, does adding surgical resection improves survival rate outcome in children with neuroblastoma than with chemotherapy alone?

Causality-Comparative interactions: Does immunotherapy leads to better survival outcome in neuroblastoma Stage IV S than with chemotherapy in the setting of adverse genetic profile than without it? (Does X cause more changes in Y than those caused by Z under certain condition and not under other conditions).

How to develop a research question

Begin by identifying a broader subject of interest that lends itself to investigate, for example, hormone levels among hypospadias

Do preliminary research on the general topic to find out what research has already been done and what literature already exists.[ 7] Therefore, one should begin with "information gaps" (What do you already know about the problem? For example, studies with results on testosterone levels among hypospadias

What do you still need to know? (e.g., levels of other reproductive hormones among hypospadias)

What are the implied questions: The need to know about a problem will lead to few implied questions. Each general question should lead to more specific questions (e.g., how hormone levels differ among isolated hypospadias with respect to that in normal population)

Narrow the scope and focus of research (e.g., assessment of reproductive hormone levels among isolated hypospadias and hypospadias those with associated anomalies)

Once question has been framed, one should evaluate it. This is to realize if these would be effective RQs or if they need more revising

Is RQ clear? With so much research available on any given topic, RQs must be as clear as possible in order to be effective in helping the writer direct his or her research

Is the RQ focused? RQs must be specific enough to be well covered in the space available

Is the RQ complex? RQs should not be answerable with a simple "yes" or "no" or by easily found facts. They should, instead, require both research and analysis on the part of the writer

Is the RQ one that is of interest to the researcher and potentially useful to others? Is it a new issue or problem that needs to be solved or is it attempting to shed light on previously researched topic

Is the RQ researchable? Consider the available time frame and the required resources. Is the methodology to conduct the research feasible?

Is the RQ measurable and will the process produce data that can be supported or contradicted?

Is the RQ too broad or too narrow?

Create Hs: After formulating RQ, think where research is likely to be progressing? What kind of argument is likely to be made/supported? What would it mean if the research disputed the planned argument? At this step, one can well be on the way to have a focus for the research and construction of a thesis. Hs consists of more specific predictions about the nature and direction of the relationship between two variables. It is a predictive statement about the outcome of the research, dictate the method, and design of the research[ 1]

Understand implications of your research: This is important for application: whether one achieves to fill gap in knowledge and how the results of the research have practical implications, for example, to develop health policies or improve educational policies.[ 1, 8]

Brainstorm/Concept map for formulating research question

First, identify what types of studies have been done in the past?

Is there a unique area that is yet to be investigated or is there a particular question that may be worth replicating?

Begin to narrow the topic by asking open-ended "how" and "why" questions

Evaluate the question

Develop a Hypothesis (Hs)

Write down the RQ.

Writing down the research question

For example, Evaluation of reproductive hormonal profile in children presenting with isolated hypospadias)

Divide your question into concepts. Narrow to two or three concepts (reproductive hormonal profile, isolated hypospadias, compare with normal/not isolated hypospadias-implied)

Specify the population to be studied (children with isolated hypospadias)

Refer to the exposure or intervention to be investigated, if any

Reflect the outcome of interest (hormonal profile).

Another example of a research question

Would the topical skin application of oil as a skin barrier reduces hypothermia in preterm infants? Apart from fulfilling the criteria of a good RQ, that is, feasible, interesting, novel, ethical, and relevant, it also details about the intervention done (topical skin application of oil), rationale of intervention (as a skin barrier), population to be studied (preterm infants), and outcome (reduces hypothermia).

Other important points to be heeded to while framing research question

1. Make reference to a population when a relationship is expected among a certain type of subjects

2. RQs and Hs should be made as specific as possible

3. Avoid words or terms that do not add to the meaning of RQs and Hs

4. Stick to what will be studied, not implications

5. Name the variables in the order in which they occur/will be measured

6. Avoid the words significant/"prove"

7. Avoid using two different terms to refer to the same variable.

Some of the other problems and their possible solutions have been discussed in .

Table 1

Once RQ is formulated, a Hs can be developed. Hs means transformation of a RQ into an operational analog.[ 1] It means a statement as to what prediction one makes about the phenomenon to be examined.[ 4] More often, for case-control trial, null Hs is generated which is later accepted or refuted.

A strong Hs should have following characteristics:

RQ determines study design, for example, the question aimed to find the incidence of a disease in population will lead to conducting a survey; to find risk factors for a disease will need case-control study or a cohort study. RQ may also culminate into clinical trial.[ 9, 10] For example, effect of administration of folic acid tablet in the perinatal period in decreasing incidence of neural tube defect. Accordingly, Hs is framed.

Appropriate statistical calculations are instituted to generate sample size. The subject inclusion, exclusion criteria and time frame of research are carefully defined. The detailed subject information sheet and pro forma are carefully defined. Moreover, research is set off few examples of research methodology guided by RQ:

Incidence of anorectal malformations among adolescent females (hospital-based survey)

Risk factors for the development of spontaneous pneumoperitoneum in pediatric patients (case-control design and cohort study)

Effect of technique of extramucosal ureteric reimplantation without the creation of submucosal tunnel for the preservation of upper tract in bladder exstrophy (clinical trial).

The results of the research are then be available for wider applications for health and social life

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Formulation of Research Question - Stepwise Approach

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Formulation of research question (RQ) is an essentiality before starting any research. It aims to explore an existing uncertainty in an area of concern and points to a need for deliberate investigation. It is, therefore, pertinent to formulate a good ...

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How to Develop a STRONG Research Question | Scribbr 🎓

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Clinical questions arise continuously in daily clinical practice. It is important that these questions are answered in an evidence-based manner. Clarifying the key elements of the question is a critical first step toward providing an answer to inform a decision, or for a researcher to frame the research to be done.

The PICO (Population, Intervention, Comparator, and Outcomes) model captures the key elements and is a good strategy to provide answerable questions.[1]

Population: who are the relevant patients or the target audience for the problem being addressed?
Example: In women with nontubal infertility

Intervention: what intervention is being considered?
Example: ...would intrauterine insemination...

Comparator: what is the main comparator to the intervention that you want to assess?
Example: ...when compared with fallopian tube sperm perfusion...

Outcomes: what are the consequences of the interventions for the patient? Or what are the main outcomes of interest to the patient or decision maker?
Example: ...lead to higher live birth rates with no increase in multiple pregnancy, miscarriage, or ectopic pregnancy rates?
A clear and focused question is more likely to lead to a credible and useful answer, but a poorly formulated question can lead to an uncertain answer and create confusion. The population and intervention should be specific, but bearing in mind that if any or both are described too narrowly, it may be difficult to find relevant studies or sufficient data to demonstrate a reliable answer. For the population, this might refer to people with a medical condition, or at risk of illness, and it may be important to specify stage of disease or clinical context. Interventions might range from a diagnostic or screening test to a therapeutic intervention of any kind. It might be necessary to clarify the intervention and comparator in some detail, including mode of administration, dosage, duration of treatment, or the different elements that make up a complex intervention. The most appropriate comparator might be no treatment or placebo, variations of normal care, or alternative competing interventions. The outcomes should be those judged most important to patients or other decision makers, and surrogate outcomes (such as bone density) should usually not be considered, unless they can be shown to be directly linked to patient important outcomes.[2] For complex questions a logic framework is frequently crucial to clarifying likely pathways of action.[3][4]

Clarifying a good question will help to determine a credible answer, but another important issue to be addressed is that of the certainty of the answer. To that end, the use of the GRADE approach to assess certainty (or the quality of a body of evidence) is a critical element.[5] This should be considered from the outset in relation to any research question. The first step consists of highlighting those PICO elements, and in particular comparisons and outcomes that are critical for decision making and differentiating these from those that are important but not critical and those that are not important. In addition, for many outcomes it will be useful to predetermine what constitutes a minimum important difference or effect, in order to support interpretation of the results of the analysis and inform decision making.

A key part of the GRADE approach is related to the nature of the studies that are contributing data to help answer the question. For therapeutic interventions, the randomized controlled trial remains the most reliable means of determining effectiveness in most cases. Accordingly, within the GRADE approach, RCTs are initially considered to provide high-quality evidence and observational studies low-quality evidence. This evidence rating may subsequently be lowered or (for nonrandomized studies) raised according to different factors (lower: limitations of design, inconsistency, indirectness, imprecision, or publication bias; and raise: large effect, dose response, plausible confounding). The final GRADE rating of the evidence for each outcome (from high, where we are very confident that the real effect lies close to the effect estimate, to very low, where we are very uncertain about the estimate) will determine how we use the data obtained in response to our question.

In a world where health data are increasingly available, designing a well-constructed question is a key element to get credible answers, although, as data are increasingly coming from different and multiple sources (from regulatory agency databases and repositories rather than scientific journals, or wearable devices, smartphone apps, and social-networking sites), building a clear and focused question may be only the first step in a complex sequence of events that lead to a desired answer. New methods of combining and synthesizing information from different sources will have to be developed in the near future but meanwhile, a good use of the resources at hand may help to guide clinicians' daily work.[6]
Author: David Tovey [updated May 2022 by Caroline Blaine]
References

1. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club 1995; 123: A12-3.

2. Guyatt G, Montori V, Devereaux PJ, Schunemann H, Bhandari M. Patients at the center: in our practice, and in our use of language. ACP J Club2004;140:A11-2.

3. Booth A, Noyes J, Flemming K, Moore G, Tuncalp O, Shakibazadeh E. Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Glob Health. 2019;4:e001107.

4. Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021;374:n2061.

5. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ; GRADE Working Group. What is "quality of evidence" and why is it important to clinicians? BMJ 2008; 336:995. doi: https://dx.doi.org/10.1136/bmj.39490.551019.BE

6. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, Rind D, Montori VM, Brito JP, Norris S, Elbarbary M, Post P, Nasser M, Shukla V, Jaeschke R, Brozek J, Djulbegovic B, Guyatt G. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol. 2013 Jul;66(7):726-35. doi: 10.1016/j.jclinepi.2013.02.003.

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How to Clarify a clinical question | BMJ Best Practice

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Clarifying the key elements of a clear and focused clinical question

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Read any study you choose. Choose one from this Padlet if you choose. Complete the workshop worksheet as if you intend to replicate your study of choice at Kaweah Health.

Attend the PICO/FINER workshop, either synchronously (live) or asynchronously (recorded)

Complete workshop worksheet with (3) deliverables (PP slide 22) and upload to NI portfolio, folder OOR-PICO/FINER for credit.

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A single center evaluation of applicant experiences in virtual interviews across eight internal medicine subspecialty fellowship programs

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Insert your title and/or abstract here: (or, click here to search using keywords) Have you recently written a paper, but you're not sure to which journal you should submit it? Or maybe you want to find relevant articles to cite in your paper?

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I want to conduct a literature review on the efficacy of antidepressants compared to cognitive behavioral therapy