Writing up an Action Research Project can be just a pain in the gluteals. And worth every minute.
I walked away from my masters program (Concordia, Portland, M.Ed), not really knowing if I would ever again do anything akin to my “capstone” project. But here I am, a few months after graduating, and I’ve done another one it seems.
Let me see. Twelve pages. One data chart. Days of ANGST. Darned near another one. No, that’s a gross exaggeration. It lacks length, polish, and is just too, I don’t know… observational, even for this kind of almost descriptive study. There’s no end point it seems. There’s no measurement on both ends, really.
So why did I do it? To open my eyes.
Angst isn’t all bad. Those days spent do not count the time setting this up, or implementing, documenting changes. I’m just talking writing the thing up. Writing up an Action Research Project. Why bother? I had the data; it was even on a spreadsheet. Hadn’t I thought it through when I was doing it? Wasn’t I making observations and conclusions on the fly?
You see, there’s thinking you know enough, and then there’s reality. This is an annoyingly common situation for a physician. You graduate, do your residency, then realize the ground you’re standing on is ever shifting. If there’s one thing for certain, it is that there is no certain truth. I’ve talked about it before, but look at HRT. Mitral valve prolapse. Carotid endarterectomy. Laminectomies. For heaven’s sake, we’ve even changed policy on not only vaccination, but infant feeding umpteen times in the last 25 years.
Everything changes. So you practise medicine with your heart, and your soul, and hope that you’ve read enough. That you’ve kept up. That’s why some people become hangnail-ologists. It’s easier to be certain.
But here I’m talking about my little homemade study, the one I’m doing, or have just finished to be more precise. Implementation of the 2013 US Lipid Guidelines Changes in a Canadian Family Practice: a four week experience. It will be on my website, under QIP archive. What an eye opener. And what I learned really wasn’t the Guidelines. It’s about how I think, and learn, and apply material.
I read the Guidelines, like many of you, when they came out in the fall of /13. I was drawn to them because of the furor. It hit the news like any other medical news story these days, and was on air for maybe 3 minutes, then forgotten about by the news hounds. But us? No lipid targets? WHAT? Lower is not better? I had to read it.
After a pot of coffee, and several hours, I thought I had it.
I was probably using those US Lipid Guidelines, in a halfhearted, incomplete and probably overall WRONG manner, when I decided to try to really look at what I was doing. In my masters program, they called it, “Action Research.” It’s the sort of thing that a teacher does with his little cohort of 30 students. He identifies a problem in the group, tries to measure it somehow (often a teacher does tests… we’d look at questionnaires, lab data, clinical outcomes…) does background reading, comes up with possible solutions, introduces the chosen maneuver, and then measures the outcome. That’s the whole thing, the sort of same mantra that OntarioMD pushes. “Plan, Act, Study, Do”, or something like that. I have an issue with the order of those components, but it’s the same thing. It’s sort of a research wheel that keeps turning. You try to keep jiggering the thing to get better outcomes.
This, what I was proposing, seemed easy, a way to ease into the whole thing. I would just look at changes I made, using the guidelines. Observational… Almost ex post facto. Well, that’s pushing the parameters of that definition. Really no measurable start point, except the patient’s current treatment path. Really no end point, just an observation of an intervention. I would compare the current treatment, the path the patient was already on, with where we decided to change. I was interested if these calculations, these new defined groups of patients where statins were well proven to help, would change my decision making.
Well, they did. Riding the implementation wave was just fun, playing with numbers, and filling in boxes in my excel spreadsheet with different colours.
Writing it up was a different manner.
I was forced to reread, and to read supporting documents. What I felt was a reasonable understanding of the Guidelines fell far short when it came for a write up. So there was the definition of the problem, the reading, the thinking, the doing, and then came the writing.
Is writing even in that OntarioMD mantra? I suppose the Ontario government has made it so, by mandating QIP’s. That’s what Action Research is, a Quality Improvement Project.
Here, I’ll have to thank the Concordia program for the structure that was taught. I stood by that, and things fell more or less into place.
Would my current effort be accepted as a capstone?
I have no delusions about that. If there is any Concordia faculty reading this, my apologies, and realize I’m covering my face with my hands. It falls far short of academic standards.
But it fits my standards. For my work. And writing up this Action Research Project forced me to be better. To think better, to understand better, to become aware of how I made mistakes in implementing new scientific information. That’s where the real learning came. Learned the new Guidelines while I was at it.
That capstone was also a pain in the gluteals. I cursed it as I wrote it. And I’m glad I did.
Writing up an Action Research Project. Days of ANGST, worth it.