Mistakes in ... Booklet 2020 - 32

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Mistakes in... 2020

Mistakes in epidemiological study design in gastroenterology
and how to avoid them
Tomer Adar† and Kate M Fleming
Conducting primary research and creating new knowledge is how we push the
boundaries of science, how we assess new and/or alternative treatments, and
ultimately what underpins decisions on who to treat, when, and how to treat them.
It is fundamental to the concept of evidence-based medicine (EBM). Many people
working within the field of gastroenterology will be directly involved in conducting
epidemiological research. In this article, we discuss some of the common pitfalls that
may render such research less useful than hoped. This is, of course, a brief overview
and if we were able to stress one thing from our experience of conducting research it
would be to ensure that you have the right mix of people and skills in place from
the outset of your project. Collaborative research allows people with different
backgrounds and knowledge bases to address a single problem from different angles,
and ultimately makes for better, and more enjoyable, research.
Mistake 1 Asking an irrelevant or
unoriginal research question
What makes us want to conduct a piece of
research? Have we seen something unusual, or
all too common, in the clinic? Is there something
that is a major issue of clinical or public health
importance? Has there been particular media
interest in a specific disease and/or treatment?
Is there a call for research funding into a specific
When something piques our interest, it is
crucial to find what other research on the topic
has already been done and what is underway.
This knowledge helps to determine whether or
not we should pursue our interest. We may wish
to apply the 'FINER' criteria to our work-is our
study feasible (see mistake 8), interesting, novel,
ethical (see mistake 9) and relevant?1

Collate all relevant literature

Critique or critically analyse
the data in the published studies

Create or synthesise the findings
from your analysis
Figure 1 | Researching your research question.

© UEG 2020 Adar and Fleming.
Cite this article as: Adar T and Fleming KM. Mistakes in
epidemiological study design in gastroenterology and how to
avoid them. UEG Education 2020; 20: 20-24.
Tomer Adar (deceased July 30, 2018) was an Advanced Fellow in
IBD at Massachusetts General Hospital, Harvard Medical School,
Boston, Massachusetts, USA.



If we begin with the assumption that our initial
thought is highly unlikely to be novel, then the
logical first step is to find out what has already
been done on the topic, what the results were, and
in what setting or populations was it performed.
Doing such due diligence will generate ideas
regarding the appropriate methods of enquiry
and potentially identify limitations in previous
research that could be improved on. Essentially,
a thorough search of the existing literature and
knowledge of ongoing research in the field of
interest allows a broad area of interest to be
refined into a specific and well-formulated
question (see mistake 2).2
Frequently, people assume there are only
two steps to a literature review-gathering
information and then synthesising it-but there
is more to it than that (figure 1). Crucial to a good
scientific literature review (systematic or
otherwise) is to critically analyse the literature
before synthesising it.3 Only by critiquing the
literature can you assess its validity and context
in terms of your specific research question. This is
increasingly important in the world of science
and medicine, characterised as it is by
information overload and the proliferation of
journals, some of which have questionable
peer-review processes. By identifying gaps and
weaknesses in the research that has gone before,
you are more likely to be able to refine your own
study question into a relevant and answerable

It is not always necessary to perform a
systematic review, although doing so, particularly
if you are embarking on a larger programme of
primary research, can be extremely beneficial and
potentially justify publication in its own right.4
Remember that not all research is published in
paper form, so knowing who is doing what
(perhaps from conference attendance) means that
you can find out more information and also see
what the current trends are in your research field.5

Kate Fleming is a Senior Lecturer in Social Epidemiology at the

Illustrations: J.Shadwell

Institute of Population Health, University of Liverpool, Liverpool, UK.
Acknowledgements: This article was written as a collaboration
between a clinical gastroenterologist and a nonclinical
epidemiologist, with grateful thanks for the opportunity to learn,
to debate and to write together. It is dedicated to the memory of
Tomer Adar.

Correspondence to: kate.fleming@liverpool.ac.uk

Mistake 2 Failing to frame a clear research
Spending a great deal of work, time and resources
on a research project before the question of data
analysis is raised (as may commonly occur during
abstract submission deadline season) is extremely
detrimental to its chances of success. By not
prioritising the formulation of the precise
research question, it can become obvious that
the data collection was incomplete, or that the
question cannot be answered without the need
for additional work that may or may not be
feasible (e.g. the patients filling a questionnaire,
etc.) (figure 2).
Framing a clear, well-defined research
question is key to a successful research project.
Such a question should be generated in the early
stages of the research project and provide the
rationale for most of the decisions subsequently
made during the study design process.

Conflicts of interest: The authors have no conflicts of interest

to declare.
Published online: October 2, 2020.


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