Writing a Cochrane Review – the trainee experience

In this blog introduced by Rufaro Ndokera, trainees Eoin and David talk about their experiences of systematic review writing.

When I first applied for the job of Cochrane UK fellow, I knew that writing a review was going to be part of the role. I was excited for it and had incidentally been looking at updating the review I ended up working on many months before applying for the fellowship.

At the time I initially started looking into updating a review, I was naïve as to what was involved and the time it would take. However, I had also underestimated how much I would learn and the inspiring people I would meet along the way.

If you are reading this blog, I hope it is because you are a trainee interested in getting involved with the work of Cochrane. Maybe you have been considering how to get involved? And maybe you have decided to write a Cochrane review. If so, good on you, the first step is taken. Our previous blog looked at how Cochrane groups have previously engaged with trainees, with some hints, tips and words of warning. In this blog, we hear from 2 trainees who have gone down the route of writing a review, who tell us about their experiences so far.

Eoin O’Sullivan is a Renal Specialty Trainee in Edinburgh and a member of the Cochrane UK and Ireland Trainees Advisory Committee. Here, he talks about his experience so far at the beginning of his journey in systematic review writing and how he came to be involved:

“Maybe you should do a Cochrane review if you’re that interested?”

I was a little taken aback. I had been ranting to one of the consultants in our department about the importance of a proper evidence base and bemoaning the lack of high quality reviews to refer to when treating our patients that morning. I didn’t write systematic reviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research., that was for grey-bearded academics in ivory towers, wasn’t it?

As it turns out, many doctors in our department had been involved in reviews in the past, and not one of them had a beard. In fact, most were not even formal “academics” and were instead jobbing clinicians who wanted to get involved in generating a higher quality of evidenceThe certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty.  Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach. A short email to the Cochrane group in question and suddenly I was being guided through the process with simple instructions and walking a well-trodden path. The plan – find some likeminded individuals, plan out the workload, assign tasks, create a timetable, find somebody to help with stats, step by step by step.

Cochrane were on hand at every stage to advise and support us. We were initially asked to submit some ideas for reviews, but in the end the editorial board allocated us a topic in need of updating. This was, with hindsight, probably a gentler introduction to the world of systematic reviews than starting completely from scratch (next time…).

Right now, after a few painless meetings and email threads, we have our submission under review at Cochrane HQ and are poised to begin dataData is the information collected through research. collection. This will undoubtedly be the slightly more labour intensive part, but if its anything like the previous few steps, I must say I’m rather looking forward to it and know that Cochrane will be there to guide us through.”

David Roberts, a public health registrar spent 6 months with Cochrane UK. Here, he talks about his experience of being involved in a systematic review with the Cochrane Infectious Diseases Group (CIDG):

“I knew I was interested in evidence based public health, but wanted to combine that with infectious diseases whilst learning new skills, so I decided to do a placement with Cochrane UK and to write a systematic review whilst there.  I approached CIDG several months in advance to see if they had a vacancy for an author on a review team, and I was asked to join a team planning a review on the effect of mobile phone interventions to improve adherence to HIV and anti-TB medications.  This was on condition that I could scope out the studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. question and do lots of background reading on the topic to help best frame the question, a considerable amount of work before my placement even began.

All Cochrane reviewsCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. must start with a peer reviewed protocolThe plan or set of steps to be followed in a study. A protocol for a systematic review should describe the rationale for the review, the objectives, and the methods that will be used to locate, select, and critically appraise studies, and to collect and analyse data from the included studies. The protocols for Cochrane Reviews are available in the Cochrane Library., which are published in the Cochrane Library.  I spent the first few months of the placement finalising this before moving onto the review itself.  By the time I had finished my placement, the protocol was published, and the author team and I had selected all our studies and extracted the data.  But I am still working on the review now, in my own time, a year later. This is unsurprising given the average review takes at least 12 months to complete, and ours has a few more studies to include than is typical.  Once involved as an author, you are in for the long haul, but I’ve received some brilliant training in systematic review writing from Cochrane, and the first draft of the review is not far off!” 

Clearly, getting involved in a Cochrane review or update is a significant undertaking, one that is sometimes underestimated by trainees when getting started. However, it can be a great experience, and if you are game, one definitely worth exploring.

This is just the experience of 2 trainees but I am sure there are many more of you out there, working clinically and reviewing on the side, or even those who may be writing a review as part of an academic job. If you are involved with Cochrane, however big (full review), or small (testing the waters via Cochrane Crowd) we would like to hear your story for a future blog. Follow us at #CochraneTrainees, Eoin (@eoinrenal), David (@drdjrobs) and myself (@NdokeraR) would all love to hear from you on twitter and do subscribe to our newsletter at http://uk.cochrane.org/trainees.

Till next time.