“If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.”
The duck test is a form of abductive reasoning. The common expression goes: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” The duck test implies that a person can identify an unknown subject by observing that subject’s habitual characteristics. We often apply this principle in our daily lives, in everyday context, without even realizing it.
There are, in general, three types of studies, or work, within an academic medical center: (1) case studies, (2) quality improvement work, and (3) research. Sometimes, the line between these three can become blurry, causing the investigator and study staff to falter when it comes to institutional and regulatory requirements. Is it still just quality improvement if there are patients involved? Is it considered research or a case study if I’m just observing a patient with an unusual diagnosis? As with all things in research administration, the answer is often, “it depends.”
- The dictionary defines a Case Study in medicine as “a process or record of research in which detailed consideration is given to the development of a particular person, group, or situation over a period of time; a particular instance of something used or analyzed in order to illustrate a thesis or principle.” As you can see, this implies that a case study is a means of medical communication. Its sole purpose is to disseminate knowledge gained from clinical practice out to other practitioners. Case studies often start as unusual observations or perhaps a combination of conditions leading to confusion, which has never been fully documented before.
Quality Improvement is defined by the AAFP as “a systematic, formal approach to the analysis of practice performance and efforts to improve performance.” As stated above, QI has a final and very specific goal around improving local performance. QI is a systematic process by which individuals work together to improve systems and processes, often with the intention to improve local outcomes.
Research is defined in the dictionary as “diligent and systematic inquiry or investigation into a subject in order to discover or revise facts, theories, applications, etc.” Research is a detailed and careful examination, testing, and evaluation of a hypothesis with the intent to develop or contribute to generalizable knowledge. This is a knight’s quest for facts. It is systematic—a complex system, method, or plan—often over several years. And all of this careful work is specifically designed to answer a hypothesis or contribute to the knowledge base of a field of study
What type of project am I doing?
The question of the day is – how do I know if my project is a case study, quality improvement work, or research? The best way to answer this question is with some additional clarifying questions.
How many patients/subjects are involved with your study? Typically, if you are looking at 3 or fewer cases to answer your question, you are not performing research. If you are looking at more than 3 cases, then you are probably performing research. While this is not a hard and fast rule, it’s a good indication of the direction you’re headed in.
Is your project goal to improve care at your institution? Often, if you are trying to make an immediate impact within your local department or section, then you are doing Quality Improvement work. The turnaround for a good QI project is often 4-6 months, and you begin to see improvement sometimes within just a few weeks.
Goal to contribute to defining new standards of care? If your project is attempting to define a new standard of care that has never been looked at before, or you are trying to fill an existing gap in the literature surrounding a specific topic, then you are probably doing research.
QI v. Research
In the past, the main indicator of QI vs. Research was if you wanted to publish your findings. However, this is no longer the case as QI journals and publishing your QI findings, has become more and more popular. Now, one of the biggest issues that comes up when you are trying to decide what type of project you are doing is the regulatory requirements that will govern your project while you are doing the work. Different regulatory and institutional requirements will effect a QI project vs. a research project. For example, if you are doing quality improvement, it’s likely that federal regulatory requirements will not affect your work. If you need further help deciding if your project is a QI project or a research project, consult your IRB staff—they will be able to help you figure out which is the best direction based on your final goals.
It can be difficult to figure out whether your project is a case study, quality improvement, or research. Define your project goals and determine early in your project development what type of study you want to do. This will save you a lot of time and effort in the end.