Project to Enhance Research Literacy (PERL) - Achieving Competency in Evidence Informed Practice: A Resource Guide for Educators

EP2. Describe common methodologies within the context of both clinical and mechanistic research, focusing on an assessment of your own field. 

Overview 

Research provides a systematic method to gather information and generate new knowledge. The type of research and study design will vary depending on the nature of the research question. For example, questions about how something works versus if something works will likely require different approaches of study. When determining what type of research is best suited to inform clinical decision making, providers must carefully weigh the various strengths and weaknesses of the study methodology. This competency focuses on the ability to recognize various types of research study designs, identify their strengths and weaknesses, and understand various ways to classify the applicability of these designs in clinical care. 

Goal- Recognize various types of research study designs, identify their strengths and weaknesses, and understand various ways to classify the applicability of these designs in clinical care. 

Learning Objectives

  • List common types of clinical research.
  • Identify strengths and weaknesses of various types of research design.
  • Recognize the conventional hierarchy of evidence.
  • Compare the study designs associated with each level of evidence.
  • Define the role of mechanistic research in clinical care.
  • Discuss integrative classifications for evidence.

Resources

Greenhalgh, T. (2014). How to read a paper: The basics of evidence-based medicine (5th ed.). West Sussex, UK: John Wiley & Sons. ISBN: 978-1-118-80096-6. This book (for purchase) walks the reader through various types of research papers with a focus on critical appraisal. Chapter 3 highlights research methods.

Menard, M. B. (2009). Making Sense of Research (2nd ed.). Curties-Overzet Publ. ISBN-13: 978-0968525661. This book (for purchase) reviews the basics of research literacy and evidence based practice for complementary and integrative providers. Chapter four focuses on research methods.

Lewith, G., Jonas, W.B., Walach, H. (2010). Clinical research in complementary therapies: principles, problems and solutions (2nd ed.). Churchill Livingstone. ISBN: 978-0-443-06956-7. This book (for purchase) discusses various research methodologies as well as unique issues in research conducted in integrative environments. Chapter 4 reviews mechanistic research.

Jonas, W. B. (2001). The evidence house: how to build an inclusive base for complementary medicine. Western Journal of Medicine, 175(2), 79. This now classic publication discusses a way to classify the strengths of various study methods from multiple stakeholder viewpoints.

Walach, H., Falkenberg, T., Fønnebø, V., Lewith, G., & Jonas, W. B. (2006). Circular instead of hierarchical: methodological principles for the evaluation of complex interventions. BMC Medical Research Methodology, 6(1), 29. This timeless publication explores the complexity of what is considered best available evidence, proposing a circular model applicable to integrative environments.

Foundations of Evidence Informed Practice Learning Modules This series of interactive learning modules (freely available through the University of MN Center for Spirituality & Healing website) offers an introduction to EIP and research designs.

Sullivan, B.M., Cambron, J.A. (2008). Appraising the Literature Overview of Study Designs This review, available through the National University of Health Sciences website, provides a concise summary of individual study designs.

Goodman, S. N., & Gerson, J. (2013). Mechanistic Evidence in Evidence-Based Medicine: A Conceptual Framework. This report explores the role that mechanistic research plays in making informed decisions about care.

Classroom Activity 

Medical Literature Overview: Study Design & "Hierarchy of Evidence" This laboratory worksheet (available through the National University of Health Sciences website) provides examples and questions to assist with identification of study design and understanding the hierarchy of research evidence. This could be modified to include literature relevant to your individual profession and completed during class either as an example by the instructor or as small group work.

Vignette

Joe is a patient in Sara's integrative clinical practice. Joe is an avid runner and often likes to run early in the morning. He recently heard a story on the evening news that running in the morning was associated with an increase in heart attacks. He downloaded the research article from the news story and brought it in during his most recent office visit to ask for Sara's advice. Upon reading the study, Sara notes the correlational study design. She informs Joe that while the study may show a possible association between morning runs and heart attack, there may be other factors involved that were not examined in the study. She tells Joe that it would be difficult from this particular study design to determine if the morning runs were the cause of the increased number of heart attacks and that further investigation would be needed before she could offer her advice on this association.