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The WMS Student-Resident Education Committee is committed to fostering quality wilderness medicine education and opportunities for learners. The committee has put together this introduction to wilderness medicine research projects as a reference for those interested in pursuing scientific endeavors. 

Wilderness medicine research projects often start with a simple idea; however, taking that idea from inception to publication can sometimes be challenging or intimidating. Several key steps are required in the process, whether it be turning a research question into a testable hypothesis, recruiting a research team, or gathering information for a review article. Identifying potential areas of study, collaborating with different stakeholders, allocating funds, and logistical hurdles such as IRB approval can be seen as barriers to initiating a project. Furthermore, the inherent austere nature wilderness medicine can also lead to challenges in completing high-quality research as these illnesses and injuries often occur in remote areas with variable environmental factors. Other challenges include wide variations in techniques and approaches and diverse patient populations which can introduce bias, difficulty in blinding, and loss of standardization. Additionally, the rarity of some of these medical conditions (e.g. lightning strike or arterial gas embolism) and challenges in data collection (e.g. difficult access to patients or transporting proper data recording equipment) has led to a paucity of scientific research in some areas. However, overcoming many of these challenges is part of the resourcefulness that wilderness medicine providers and researchers pride themselves on! Our goal is to help demystify, clarify, and explain the first steps in approaching the research process.

What do you want to examine?
Clearly defining your research question or objective is the first crucial step in project organization. By clearly defining your research question, you establish the direction and purpose of your study and ensure its relevance in the field of wilderness medicine. This process involves identifying a single, specific question you would like to answer that can be used to generate a hypothesis. The PICO framework can provide a structured approach to creating a research question:

- Patient/Population (P): Defining the population narrows the question and allows for information application.
- Intervention (I): Specific and measurable.
- Comparison (C): By contrasting an intervention with an alternative strategy, the comparison enables researchers to assess the relative effectiveness of the intervention.
- Outcome (O): The outcomes are clear and relevant to the research question, highlighting the benefits that the intervention may provide.

Weak PICO Research Question Example: In drowning patients, does oxygen administration improve outcomes? 
P: Drowning patients
I: Oxygen administration
C: Standard care
O: Better outcomes

Strong PICO Research Question Example: In adult drowning patients, does heated high-flow nasal cannula oxygen compared to standard nasal cannula oxygen therapy lead to improved neurological outcomes based on the Cerebral Performance Categories Scale?
P: Adult drowning patients (18–70 years old) 
I: Heated high-flow nasal cannula oxygen 
C: Standard nasal cannula oxygen therapy
O: Improved neurologic outcome based on the Cerebral Performance Categories Scale 

A comprehensive literature review can help you understand the current knowledge landscape and identify areas where your study can contribute. Significant research pitfalls include not asking a pre-identified question, simply collecting data and trying to draw conclusions afterwards, attempting to ask multiple questions in a single manuscript, examining too focused of a question that will not generate enough data, or asking a question that could be impractical or too difficult to execute. 

What kind of study should you do?
A clear research question can help you decide what study type will be best suited to answer your question. There are multiple types of research studies, including, case series, retrospective reviews, cross-sectional surveys, and prospective randomized controlled trials. Your initial steps will vary based on the type of project you pursue. Prospective trials are considered the gold standard, but they often require substantial amounts of time and funding and can be difficult to perform in some wilderness environments. As a result, when starting off, retrospective studies are often more feasible. Use your team, especially your mentors and your statistician (if you have access to one), to make sure your study design will address your hypothesis from your PICO framework. 

Who do you want on your research team?
Collaborating with experts in the field is crucial for a successful research project. Assembling a research team allows you to tap into the knowledge and experience of faculty mentors or colleagues who can provide guidance and support throughout the project. By involving individuals with diverse backgrounds and expertise, you can benefit from differing perspectives, skills, and insights, enhancing the quality of your research. Depending on your individual strengths and the needs of your project, you may need to consider including a statistician, a topic expert, an expert on grants and research funding, or an expert in medical writing, especially if you are submitting an article in your non-primary language. By including these people from the start of your project, you can address potential problems beforehand, increasing your chance of success. 

Do it right the first time!
Effective project management is vital for the smooth execution of your research. It is important to make sure you go through the appropriate process to gain institutional approval, which is typically the institutional review board (IRB). Research involves meticulous data collection and analysis while adhering to standardized protocols. It is important to do this in an ethical and secure manner if using protected health information. Maintaining a comprehensive record of your research methods ensures reproducibility and accuracy. By utilizing appropriate statistical methods to analyze your data, you can draw meaningful conclusions and validate your findings. 

Starting the writing process.
The writing process involves several key steps. Creating a clear outline for your manuscript by including sections such as introduction, methods, results, discussion, and conclusion, will provide a structured framework for presenting your research findings. Ensuring logical flow as well as clear, concise, and coherent writing throughout the manuscript will enhance both readability and comprehension. Former Editor-in-Chief of the Journal of Wilderness and Environmental Medicine, Dr. Neal Pollack, has put together his best advice for writing manuscripts in this practical guide for authors.

After completing the first draft, expect multiple rounds of revisions and editing by both your team and the publication’s editors. Seeking feedback from multiple sources will help identify areas for improvement, refine your arguments, and strengthen the overall quality of your manuscript. It is also very important to refer to the publication style guides for your intended journal and article type, which may specify length, section headings, formatting details, and reference styles.

What is your timeline?
Creating a realistic timeline is essential for effective project management. A well-structured timeline outlines the different stages of your project, including applying for IRB approval, data collection, analysis, and manuscript preparation. By breaking down the project into manageable tasks and assigning timeframes, you can ensure that each phase is completed within the designated time frame, minimizing delays and maximizing productivity. Your timeline will vary based on the complexity of your project and your team’s availability, but projects often take longer than expected. Even a straightforward project such as retrospective chart review can take well over a year from initial idea to publication! One example timeline for such a project is three months for a literature review and IRB submission, three months for data collection, three months for data analysis, and four to six months for drafting, submiting, and revisions of the manuscript. Working with your mentors to set a realistic timeline can help avoid the frustrations that come with missing deadlines.

Where should we think of publishing? 
 Scientific medical journals and related publications can vary greatly on their intended  audiences, scope of topics, acceptance rate, submission fee structure, and impact factor. The WMS publishes both the Journal of Wilderness and Environmental Medicine as well as the Wilderness Medicine Magazine, both with different missions. There are also many additional types of outlets for publications, including medical blogs, podcasts, as well as specialty-specific publications, outdoor magazines, and public education venues such as news organizations. A proper selection of where you want to publish your work is imperative. Start early by targeting a specific publication and reviewing the submission guidelines, prior similar research that has been published, as well as the goals and scope of the publication to ensure that your work aligns with their mission statement. 

By aligning the project with your interests and knowledge gaps in the literature, you ensure enthusiasm and dedication throughout a successful research process. Collaborating with additional wilderness medicine experts can also open up innovative research avenues and funding, as well as build collaborative communities to help design and execute experiments, collect and analyze data, and contribute to the scientific knowledgebase in wilderness medicine. If you are interested in learning more about how to initiate a research project, please check out these previously recorded fireside chats available to WMS members: 

May 10, 2022: Developing a Path to Publishing  
April 12, 2022: Wilderness Medicine Writing  
March 15, 2022: Preparing a Research Presentation  
Jan. 18, 2022: Preparing a Research Abstract  
Nov. 9, 2021: Research from a Mentees Perspective  
Sept. 14, 2021: Developing a Research Project  
June 1, 2021: Mixed Method Research in Wilderness Medicine  
March 16, 2021: Basic Science Research in Wilderness Medicine
Jan. 12, 2021: Clinical Trials in Wilderness Medicine
Nov. 10, 2020: Preparing a WMS Abstract  
Sept. 9, 2020: Finding a Research Mentor & Preparing a WMS Grant

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