Session 2 of the Open Mind Initiative by AMSUN. Peter Kitunguu takes us through the initial thought process that goes into developing a question from near nothing :) Peter Kitunguu holds First Class Honors in Anatomy and graduated valedictorian of the University of Nairobi in 2006. He has research and clinical interest in Neurosurgery. He is currently based at the Kenyatta National Teaching and Referral Hospital.

1. Open Mind Forum Basic Tenets Of Question Formulation Peter K. Kitunguu BSc (Hons), MBChB

2. Objectives Be honest with yourself, not necessarily with everyone else What do you hope to achieve? I’m a researcher….but do I say Earn a living Create a reputation in your specialty Genuine curiosity about the research question Lower your head modestly while passing, and you will harvest bananas- Congolese proverb

3. Modes of Question Formulation Retrospective Prospective Case Reports Case Series Experimental Studies

4. Normal Ward round Michael Wanjau 35 yr old construction worker Admitted 4 days ago with a history of “assault” by a falling brick Admitted in ED in unconscious state with 1 episode of convulsion, vomiting CT scan - right parietotemporal EDH with midline shift and associated depressed skull fracture Neuro consult recommended evacuation

5. Mary Kamulu 21 year old para 4+0 Admitted 3 days ago with urinary incontinence as a referral from……. Hx of prolonged labour, 40 hours, attempted forceps delivery at peripheral hospital and fetal demise Married off customarily at the age of 13, Physical attributes: height 4’ 9”, weight 48 kg

6. Not necessarily unique scenarios What are the possible reactions Clerk, present and pull all stops to impress consultants Read around the topics “That could be the compulsory essay!!” How many others have similar conditions? How do we manage them in our setup? How does our outcome compare with other centres? No person is born great; great people become great when others are sleeping – Ashanti proverb

7. Possibilities Prospective Retrospective Case series

8. But where do I start? Literature Review Google scholar Blackwell synergy Pubmed Hinari Research-Engine.com Most crucial in early phases of Research development May initially appear daunting- stick to principles The cattle is as good as the pasture in which it grazes.- Ethiopian Proverb

13. Concentrate your efforts Success and intellect is more in the realm of intensity than extensity Create an objective, a single goal a single task and beat it to submission Proposal writing- your road map for the journey

14. How many ways to skin a Cat? Why would you want to do that? What about rare clinical conditions?

15. Rachel Wefwewe 11/2 year old Admitted with history of multiple fracture of long bones, allegedly following fall from her first attempted steps Previous history of fracture right radius ulnar Xray confirms Dx and demonstrates old fractures Examination shows poorly formed dental enamel and blue sclerae

16. Angela Gathie 46 year old RVD patient currently on ARVs with a history of non compliance Admitted with history of painless lump in right breastx2/12 Lump hard, overlying skin tethered, uneven surface Ultrasound shows irregular mass, patches of calcification and spiculated margins Biopsy results show areas of caseation necrosis, on AFB staining positive

17. Ann Kinyau, 78 year old Admitted with back pain was and left leg radicular pain Lower limb weakness, urinary retention and bowel incontinence On examination she had a superficial cyst in the lower lumbar region Plain x-ray showed spina bifida occulta. MRI scanning showed a cystic intradural lesion compressing the conusmedullaris

20. How to balance with academic work? The solution? Create a retreat within yourself For more concentrated forms of thought or action Consistent effort Goals with deadlines

21. So what? Try it for your self Identify an area of interest Find someone with some experience and work with them Challenge yourself to do a study by year’s end The sheep that wants to grow a long horn must have a strong skull- Ethiopian proverb

22. Asante