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CEBM Medical Students: Taking a systematic review from concept to publication

8 hours and 44 minutes ago

Holden Eaton (left), Kate Eastwick-Jones (centre) and Archie Watt (right) recently graduated from the undergraduate medical education programme at the University of Oxford. During their studies, they participated in a two-week Special Study Theme (SST) with the Centre for Evidence-Based Medicine (CEBM). In this blog, they share about their experiences of the SST and publishing their work.

Holden Eaton (left), Kate Eastwick-Jones (centre) and Archie Watt (right)

About the authors 

Holden Eaton (left), Kate Eastwick-Jones (centre) and Archie Watt (right) recently completed their medical student education at the University of Oxford. Holden and Kate are now working as doctors in Oxford, and Archie is working as a doctor in Edinburgh.

How our project began 

In our fourth year, we took part in the Centre for Evidence-Based Medicine (CEBM) two-week Special Study Theme (SST), where we developed a systematic review protocol.  

Rather than stopping there, we decided to complete the full systematic review. Nearly two years later, with the invaluable guidance of Dr Annette Plüddemann and Dr Elizabeth Thomas, we have published our findings in the Family Practice journal and are working as doctors in Oxford and Edinburgh.

In this blog, we will be sharing our experiences of the SST including developing our research question, conducting the systematic review and navigating the process of publication. 

Choosing a research question 

Choosing a research question as an inexperienced medical student is challenging. It is difficult to judge feasibility and relevance without deep knowledge of the field. We explored various topics of interest that had scope for a systematic review, drawing inspiration from our experiences in General Practice, particularly seeing the prevalence of iron deficiency anaemia among women. Combining this with our shared interest in public health and nutrition, we ultimately decided to focus on prophylactic iron supplementation during pregnancy. 

Iron deficiency is very common, especially during pregnancy. There was ongoing debate on whether the benefits of supplementation outweigh the potential side effects. Some countries recommended routine iron supplements while others, including the UK at the time, only advised them for anaemic women. When developing our review question, we hoped this inconsistency would mean a systematic review would be useful (and publishable!). Despite some close calls, the gap in the literature remained unaddressed across the two years, and our question remained relevant to the discussion around prophylactic iron supplementation. 

infographicofthestudyofwhetherironsupplementsbenefitpregnantwomenwithoutaneamia.png

Conducting the systematic review 

Once our research question was set, we started working on the many steps of a systematic review. Each stage required learning new skills and a lot of work. Screening thousands of abstracts was made even more laborious by reading about AI tools that might soon be able to do the job in seconds. Learning R for the meta-analysis whilst repeatedly checking the Cochrane Handbook at every decision was also a steep learning curve. This process was an incredible learning experience for all of us – full of challenges and a fair share of mistakes! 

Perhaps the best example was that we didn’t include the rate of anaemia as an outcome in our protocol. Somehow we missed it in our preliminary searches, and so we had to include it as a post-hoc addition. Ultimately, it didn’t make a big impact on our conclusions, but it shows the difficulties inherent to designing a research project without expertise in the field of interest. It is undeniable that the process of a systematic review can be frustrating at times but overcoming the many challenges and hurdles as a team was hugely rewarding. 

The challenge of publishing 

Publishing was the most difficult part of the project. We received extensive feedback from reviewers. Some comments improved our paper, particularly those related to analytical methods. Others were more subjective, leading to new or conflicting suggestions in subsequent rounds of review. One of the most difficult moments came after submitting a heavily revised version to the first journal, only for it to be rejected. After investing so much time into revisions, this was so demoralising. However, the process ultimately strengthened the final version of our paper which was accepted for publication (just in time for our final exams!). 

Advice for future SST students 

  • Be prepared for a long process. We started before our first clinical placement and were accepted for publication just before finals – nearly two years later. 

  • Expect to make mistakes. The learning curve is steep, but you will be surprised how many skills you've gained by the end. 

  • Publishing is difficult. Don't be too disappointed if it takes many rounds of reviews. It is not unusual, and the process will ultimately only make your paper better. 

We are very grateful to the support of our supervisors, Annette and Elizabeth, without whom this project wouldn’t have been possible (and publishable). 

Click here to read our publication in the Family Practice journal. 

 

References:

Watt A, Eaton H, Eastwick-Jones K, Thomas ET, Plüddemann A. The benefits and harms of oral iron supplementation in non-anaemic pregnant women: a systematic review and meta-analysis. Fam Pract. 2025;42(1):cmae079. doi:10.1093/fampra/cmae079