Research Director – Division of Emergency Medicine
Division of Emergency Medicine, University of Calgary
Andrew McRae is an emergency physician and clinical researcher. His doctoral dissertation focused on ethical challenges in cluster-randomized trials, a type of experiment used in health services and public health research that evaluates the effects of health interventions on groups of individuals such as communities, or on entire healthcare systems. He has also published extensively on ethical challenges relating to clinical research evaluating potentially life-saving therapies for critically ill patients. His clinical research includes studies evaluating the use of bedside ultrasound in the emergency department, treatments for skin and soft tissue infections, sedation for painful procedures, and interventions aimed at reducing emergency department overcrowding. He was a Postdoctoral Fellow at the Rotman Institute of Philosophy from 2009 – 2011.
My research program includes clinical research in emergency medicine, work on epistemic and methodological issues in clinical research, and work on ethical challenges in medical research.
Research projects in emergency medicine on which I am a principal or co-investigator are addressing the following research questions:
– What are the most meaningful metrics or indicators of emergency department overcrowding?
– What are the most effective intercentions for reducing emergency department overcrowding?
– What is the impact of bedside diagnostic testing, including ultrasonography, on the management of patients with critical illness?
– What patient or treatment factors are predictive of failure of first-line treatments for skin and soft tissue infections?
My Second area of inquiry is a joint project between colleagues at the Rotman Institute of Philosophy and the Ottawa Hospital Research Institute, funded by the Canadian Institutes of Health Research. The project addresses ethical and policy challenges posed by cluster randomized trials, a key technology in knowledge translation research. Since cluster trials randomize socially intact groups such as hospitals or physicians practices, it is unclear whether current ethical concepts in research ethics apply to such studies. The project aims to address key normative questions on the ethics of cluster randomized trials, with the end product being international ethics guidelines for cluster trials.
A future area of inquiry pertains to epistemic issues in clinical trials. Research plans include bringing prior work in philosophy of science to bear on questions about clinical research, including:
1. When is research evidence sufficiently convincing to motivate practise change among clinicians?
2. What are the implications of the conclusions of (1) for the design of clinical trials?
3. Should clinical trials be explanatory – that is designed to produce and accurate precise estimate of the efficacy of a particular treatment in ideal conditions – or pragmatic – that is, to provide a (possibly less accurate or precise) estimate of the effectiveness of a particular treatment in real-world clinical practice conditions?
A McRae, C Weijer, A Binik, A White, J Grimshaw, R Boruch, J Brehaut, A Donner, M Eccles, R Saginur, M Taljaard, M Zwarenstein. Who is the research subject in healthcare cluster-randomized trials? Trials. 2011. In press.
A Binik, A McRae, C Weijer J Grimshaw, R Boruch, J Brehaut, A Donner, M Eccles, R Saginur, M Taljaard, M Zwarenstein. Does clinical equipoise apply to cluster randomized trials? Trials. 2011. In press.
C Weijer, J Grimshaw, M Taljaard, A Binik, R Boruch, J Brehaut, A Donner, M Eccles, A Gallo, A McRae, R Saginur and M Zwarenstein. Ethical Challenges Posed by Cluster Randomized Trials in Health Research. Trials. 2011. In press.
M Taljaard, A McRae, C Weijer, C Bennett, S Dixon, J Taleban, Z Skea, J Brehaut, M Eccles, A Donner, R Saginur, R Boruch, J Grimshaw. Inadequate reporting of research ethics review and informed consent in cluster randomised trials: review of a random sample of published trials. BMJ. 2011. In Press.
A McRae, Z Skea, C Bennett, A Donner, M Eccles, J Grimshaw, M Taljaard, C Weijer. Features of cluster randomized trials associated with reporting of informed consent from patients. Manuscript in preparation. 2011.
A McRae, M Taljaard, J Belle Brown, C Weijer, J Grimshaw, J Brehaut, S Chaudhry, A Donner. Investigators’ experience with the ethics review process for cluster-randomized trials: a qualitative analysis. Manuscript in preparation. 2011.
A McRae, C Weijer, A Binik, J Grimshaw, R Boruch, J Brehaut, A Donner, M Eccles, R Saginur, M Taljaard, M Zwarenstein. When is consent required in cluster randomized trials? Manuscript in preparation. 2011.
M Taljaard, J McGowan, J Grimshaw, J Brehaut, A McRae, M Eccles and A Donner. Electronic search strategies to identify reports of cluster randomized trials in MEDLINE: low precision will improve with adherence to reporting standards. BMC Medical Research Methodology 2010, 10:15. (Published online 2 February, 2010).
M Taljaard, C Weijer, JM Grimshaw, J Belle Brown, A Binik, R Boruch, J C Brehaut, S Chaudhry, M P Eccles, AD McRae, R Saginur, M Zwarenstein and A Donner. Ethical and Policy Issues in Cluster Randomized Trials: Rationale and Design of a Mixed Methods Research Study. Trials. 2009; 10:61 (Published online 28 July, 2009).
AD McRae, H Murray and M Edmonds. Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review. Can J Emerg Med. 2009; 11(4) 355-364.
AD McRae and C Weijer. US Federal Research Regulations for Emergency Research: A Practical Guide and Commentary. Acad Emerg Med. 2008; 15(1): 88-97.
AD McRae, S Ackroyd-Stolarz and C Weijer. Risk in Emergency Research Using a Waiver of Consent: Implications of a Structured Approach for IRB Review. Acad Emerg Med. 2005; 12: 1104-12.
M Pauls, A McRae, S Campbell and P Dungey. Ethics in the Trenches Part 2: Case Studies of Ethical Challenges in the Emergency Department. Can J Emerg Med. 2004; 6(5): 363-6.
AD McRae and C Weijer. Lessons from Everyday Lives: A Moral Justification for Acute Care Research. Crit Care Med. 2002; 30(5): 1146-52.