Method and Written Report Guidelines
Analytical Essay on the Clinical implications of basic research and basic implications of clinical observations
The New England Journal of Medicine (NEJM) has a series of publications that explores the bi-directional relationship between basic science and clinical practice.1 This is based on the premise that the path between the laboratory and bedside runs both ways: basic science research can lead to clinical advances; and clinical observations can pose new questions for basic science, that can subsequently inform clinical practice (aka the “bedside-to-bench” flow of information).
Residents may choose to develop an example of basic science research findings that have led to insights relevant to clinical practice, or clinical findings that pose questions or reveal insights relevant to the basic sciences.
A scholar project in these areas should include a directed, comprehensive literature review, and critical appraisal of the evidence. Basic science literature should be derived (at least in part) from preclinical journals. Although a single basic science concept may be of interest, there should be an effort to seek out the body of evidence on this topic where multiple laboratory studies of the same concept are included. This type of scholar project should involve hypothesis generation, in other words the resident should propose an idea of how a relationship between basic science and clinical practice occurs. If this hypothesis has already been proposed and tested, the resident should include this literature and critically appraise it.
Box 4: Recommendations for a scholar project examining clinical observations > basic science
1) Description of clinical encounter(s)/observation(s) of interest.
2) Research question
3) Description of the basic science literature search strategy. The search should include (but does not have to be limited to) papers from preclinical journals.
4) Critical appraisal of the basic science evidence. Ideally a body of evidence would be considered as opposed to a single study.
5) Application of basic science evidence to the clinical findings. This should include an exploration of whether or how the laboratory evidence provides insights into the clinical context; whether gaps remain (e.g., in explaining the clinical observations); and how future research might address these gaps.
6) If research evidence has already tried to evaluate the hypothesis you are exploring, this should be presented and once again critically appraised.
7) Conclusion/Summary: directly relating to the answers found to the research question.
Box 5: Recommendations for a scholar project examining basic science > clinical observations
The purpose of this is to highlight laboratory research that could lead to advances in clinical therapeutics.1
1) Description of basic science finding(s) of choice. These should be derived from preclinical journals.
2) Research question
3) Description of the search strategy to identify literature to inform consideration of the relationship between the basic science findings a clinical practice issue. Ideally this will produce a body of evidence.
4) Critical appraisal of the evidence.
5) Discussion of the application of evidence to a hypothesized relationship between the laboratory and clinical context. This should include an exploration of whether or how the laboratory evidence can inform insights into clinical therapeutics; whether gaps remain; and how future research might address these gaps.
6) If research evidence has already tried to evaluate the hypothesis you are exploring, this should be presented and once again critically appraised.
7) Conclusion/Summary: directly relating to the answers found to the research question.
Published examples of each of these categories are provided below, although it should be noted that a scholar project would need to explore the issue more comprehensively than these brief published works.
Example of article examining basic science > clinical implications:
Friedland JS. Targeting the inflammatory response in tuberculosis. New England journal of medicine 2014; 371(14).
Example of article examining clinical implications > basic science:
Loscalzo J. Basic implications of clinical observations: venous thrombosis in the nephrotic syndrome. New England Journal of Medicine 2013; 368(10).