The student voice: Medical Student Ioan Baxter share 3rd-year research project

As part of my course, I chose a research project to undertake based on my interests and what I thought would be exciting to learn about. Before starting my project, I had no experience with systematic reviews but was interested in researching an area related to primary care. For this reason, I approached our Department of Primary Care Health Sciences. I believe that the skills and knowledge I gained throughout the project will be invaluable to whichever area of medicine I choose to join.

Learning experience with the Oxford Centre for Evidence-Based Medicine

During my project, I received supervision from Dr David Nunan of the Centre for Evidence-Based Medicine (CEBM). My supervisor was extremely helpful in guiding me through my project, developing my understanding of the reasoning behind each step of the review process. I believe this was essential in allowing me to successfully complete my project.

What did I do?

During my first meeting, I learnt about what N-of-1 trials are and how they might be useful for investigating some of the side effects of statins. Briefly, N-of-1 trials involve randomly assigning an individual to periods of intervention (statin) and placebo (a dummy sugar pill) and then recording symptoms during this period. The key usefulness of this design is that individuals and practitioners do not know whether they are taking the intervention or placebo (and sometimes no treatment). This means you can tease out whether statins really are associated with symptoms more than a placebo/no treatment.

I learnt about the procedures involved in conducting a systematic review and the standards to which a high-quality review should be performed, outlined by PRISMA and CONSORT statements and the Cochrane handbook.

We developed and published a protocol for our study based on these guidelines and the methodological standards for systematic reviews of N-of-1 trials.

We then searched and screened for eligible studies reporting findings from N-of-1 trials investigating muscle symptoms in participants who had previously experienced muscle symptoms whilst taking a statin. I assessed the quality of the included studies and then collated their data to provide a combined estimate (meta-analysis) of the impact of the difference between statin use and placebo use on reported symptoms. 

What did I find?

After the studies returned by the search were screened, three studies with a total of 286 participants were included in our review. 

The results from each individual study showed no meaningful difference between the muscle symptom scores during statin and placebo treatment periods. We performed a random-effects meta-analysis which showed a trivial increase in mean muscle symptom score during the statin period compared to placebo that was not statistically or clinically significant.

Implications and discussion

The results suggest that taking a placebo tablet is just as likely as taking a statin tablet to induce muscle symptoms and therefore, muscle symptoms are likely caused by the act of taking a tablet rather than anything within the statin tablet itself. Importantly, after discussing the findings at the end of the study, the majority of participants chose to restart their statin treatment. N-of-1 trials should be introduced as part of routine care for people prescribed a statin and experiencing muscle symptoms.

What did I learn?

I found this research extremely interesting, and the process was a valuable learning opportunity. It provided me with 

tools on how to develop a method for a study as well as a greatly improved understanding of the research process used to produce scientific data. I was interested to learn in more detail about the clinical issues patients have with statins and methods that could be used in future to improve statin compliance. I feel this learning experience will massively impact my future career and help me to be a better clinician.

About the Final Honours Scheme (FHS)

The FHS for undergraduate students runs in years 2 and 3 and aims to teach the method of critical scientific enquiry and so facilitate thinking and adaptable doctors or research scientists. Students are required to complete an option module, a research project and an essay at various time points over the two-year period.

Find out more here.