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To misquote Isaac Newton, we all hope to see further by standing on the shoulders of giants. But which giants? In the early days of Emergency Medicine, we inherited the commonly accepted system of apprenticeships; practice was based not so much on what was known but on what our bosses thought they knew. Added to this the widely held but quite unfair view among other medical professionals that ‘casualty’ was for those who could not make the grade in a proper discipline and you had all the ingredients for an evidence-free specialty.
Our founding fathers were aware of this potential pitfall; they knew there were unknowns and even unknown unknowns in the path towards an evidence-based, scientific specialty—as we can read in the early papers of the Casualty Surgeons Association (CSA). The agenda for their meeting in Salford on 16 November 1973 contains wildly ambitious proposals: University Posts in A&E; a Diploma in A&E; creation of a Faculty; Senior Registrars—and even a change of name!
This paper chronicles the development of the concept of research from these early beginnings through to the present day, with our mandatory training in research methodology and universal acceptance of the benefits of evidence-based medicine.
In the 1970s, research was considered an optional extra, often impeding the main job of moving the patients through the department. Workloads were heavy but rarely measured, so it was difficult to argue for more resources when there were few markers of activity. Hence, some of the early ‘research’ was around trying to identify the boundaries of our responsibilities; ‘inappropriate attenders’ and the like. Case reports were popular, expanding the Curriculum Vitae but probably doing little to advance clinical practice. With handwritten notes and no computerisation, retrospective reviews involved tedious hand searching; prospective work, using hard copy proforma, was very labour intensive …
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