Why Your Clinical Observations Are Worth More Than You Think

You have probably noticed something in your work that made you curious, and it may be the start of a research question. Maybe you own an ambulatory practice and your patients keep asking the same question after their appointments. Perhaps your professional association is hearing the same concern from members across different organizations or geographic regions. Maybe you developed an educational program and participants consistently tell you that it changed how they approach their work. Or perhaps you have spent years working with a particular population and have begun to recognize a pattern that you cannot find adequately addressed in the literature.

These observations can feel like an ordinary part of doing your job, and they can also be the beginning of research. Meaningful questions can emerge from the people who are close enough to a patient population, profession, program, or practice to recognize patterns and opportunities that deserve further exploration.

Your proximity gives you perspective, and that perspective is valuable.

Research Questions Can Start With “We Keep Seeing or Hearing This”

There is an established research model built around this very idea. Practice-based research networks, or PBRNs, bring ambulatory practices and clinicians together to investigate questions that arise from community-based practice. The Agency for Healthcare Research and Quality (AHRQ) describes PBRNs as drawing on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve primary care.[1] More than 120 active PBRNs are currently registered with AHRQ across the United States and internationally.[1]

The model is important because it demonstrates that practice does not simply receive research findings; practice generates the questions that lead to research. AHRQ specifically describes PBRNs as engaging practicing primary care clinicians in asking and answering both clinical and organizational questions central to healthcare.[1]

There is evidence that clinicians generate questions frequently. A systematic review published in JAMA Internal Medicine examined 72 studies of questions arising during patient care. Across 11 studies involving 7,012 questions, clinicians generated an average of 0.57 questions per patient seen. Yet they pursued only about 51% of those questions. When they did pursue them, they found answers approximately 78% of the time.[2]

Not every unanswered clinical question represents a research opportunity, of course. Many can and should be answered by existing evidence. The findings reinforce an important point: healthcare professionals are surrounded by questions. The challenge is recognizing which ones deserve to be carried forward.

What perspective is your proximity giving notice to?

A private practice owner may notice that patients receiving a particular service or treatment repeatedly express the same concern. An association leader may see the same professional challenge emerging across member conversations, conference evaluations, and committee discussions. An educator may hear that participants love a program and realize that the organization has never examined what happens after participants complete it.

These observations become more powerful when we move beyond simply acknowledging them and begin asking what they might tell us.

Consider an ambulatory practice that has changed how it educates patients with chronic conditions. The team believes the new approach is useful, and patients appear engaged. Instead of stopping at that observation, the practice might ask:

• How confident are patients in managing their condition after receiving our educational intervention?
• Which components of education do patients report as most useful?
• Does the delivery of the education make a difference?
• What barriers do patients experience when trying to apply the information at home?
• Are there differences in patient understanding based on age, health literacy, language, or other characteristics?
• How do patients prefer to receive ongoing education after their visit?

Now consider a professional association that repeatedly hears about an emerging workforce issue from its members. The association may be uniquely positioned to ask:

• How prevalent is this experience among professionals in our specialty?
• What factors are associated with professionals’ intent to remain in the field?
• How prepared do early-career professionals feel for a particular aspect of practice?
• What professional development resources do members report needing most?
• How do experiences differ by role, career stage, practice setting, or geographic region?
• What emerging issue do members believe will have the greatest influence on their practice over the next three years?

An organization offering education or professional development might have another set of questions:

• How does participants’ self-reported confidence change after completing the program?
• Which program components are most frequently applied in practice?
• What barriers influence participants’ ability to implement what they learned?
• How are participants using the knowledge six months after program completion?
• What characteristics are associated with successful implementation of the skills taught?
• How do participants describe the program’s influence on their professional practice?

The observation is the starting point. The research question gives it direction.

Your Access to a Population May Be an Asset

Sometimes what makes an observation particularly valuable is not only what you notice. It is who you are in a position to learn from.

A specialty practice may have longstanding relationships with a patient population that is difficult for outside researchers to reach. A professional association may connect thousands of individuals within one profession or specialty. An educational organization may have participants who have experienced the same program or intervention. A community clinic may serve a population whose experiences are not adequately represented in existing literature.

This is part of what makes practice-based research so valuable. AHRQ describes PBRNs as groups of ambulatory practices committed to investigating questions related to community-based practice and improving primary care.[3] These networks connect the experience of practicing clinicians with rigorous research methods, helping produce findings that are relevant to the environments in which care is actually delivered.[1]

Access does not automatically make a population appropriate for a study, nor does an existing relationship eliminate the need for thoughtful research design and appropriate human-subject protections. It does, however, mean that practices, associations, and professional organizations may have opportunities to pursue research questions and contribute knowledge from populations and settings that deserve to be better understood.

The Questions That Keep Coming Back Can Lead to Research

One isolated observation may simply be interesting. A pattern deserves more curiosity.

Think about the conversations that repeatedly occur within your practice or organization. What do patients continue to ask about? What are members discussing year after year? What assumptions are being made about the effectiveness of a program? What changes have you implemented without fully understanding how people experience them?

You may hear yourself or your colleagues saying things like:

• “Our patients keep asking…”
• “Our members keep telling us…”
• “We have noticed that…”
• “Every time we offer this program…”
• “This group seems to experience…”
• “We changed this process and now…”
• “We assume this is helping, but…”
• “I wonder whether anyone has actually studied this…”

When those phrases keep appearing, there is another question worth asking before you plan any research:

What do we know about this?

That question is often the bridge between observation and inquiry.

Before You Design a Study, Find Out What Is Already Known

Recognizing an interesting observation does not mean the next step is immediately creating a survey. One of the most important steps is exploring existing literature.

Suppose you own a specialty clinic and repeatedly hear the same concern from patients. Search for it. Has the issue already been studied? Has it been studied recently? Were the populations like yours? Were the studies conducted in comparable settings?

You may discover strong evidence that answers your question. That is valuable. The opportunity may be to use that evidence to inform practice rather than conduct another study.

You may also discover that the evidence only partially answers your question. Perhaps most studies were conducted in hospital environments while your population receives care in an ambulatory setting. Maybe the literature examines clinician perceptions when you are interested in patient experiences. Perhaps your particular specialty, profession, geographic area, or population is not well represented.

Now the observation becomes more interesting.

You have moved from “We keep seeing this” to “We know something about this, and there is still something we need to understand.”

That is a much stronger foundation for a research question.

From Observation to Research Question

One of the most useful research skills is learning how to make a question more specific. A broad observation usually needs refinement before it becomes something you can realistically study.

Here are some examples of moving from an observation to a research question:

Observation: Our patients frequently call after their appointments because they still have questions.

Early question: Why don’t patients understand their instructions?

More researchable question: What information needs do adult patients report during the first seven days following an outpatient procedure?

Or:

Observation: Our association keeps hearing that new leaders feel unprepared for their roles.

Early question: Why aren’t new leaders prepared?

More researchable question: What challenges do first-time healthcare leaders report experiencing during their first year in a formal leadership role?

Or:

Observation: Participants consistently rate our professional development program highly.

Early question: Is our program effective?

More researchable question: How do participants describe applying the knowledge and skills gained from the program six months after completion?

Or:

Observation: Patients in our specialty practice seem to prefer virtual follow-up visits.

Early question: Do patients like telehealth better?

More researchable question: What factors influence patient preferences for virtual versus in-person follow-up visits in an ambulatory specialty practice?

Or:

Observation: Members are increasingly asking our association for resources related to artificial intelligence.

Early question: What do our members think about AI?

More researchable question: What are healthcare professionals’ current levels of confidence, use, and perceived educational needs related to generative artificial intelligence in professional practice?

Notice what happens in each example. The observation is not discarded. It is refined into something specific enough to investigate.

A Simple Framework for Moving From Observation to Inquiry

When you notice something that feels worth exploring, start by writing down exactly what you are seeing or hearing. Resist the temptation to immediately decide what the answer is. “Our patients do not understand their education” already contains a conclusion. “Patients frequently contact our practice with questions following education” is an observation you can explore.

Next, ask what you genuinely want to understand. Are you interested in people’s experiences? Their knowledge? Preferences? Behaviors? Barriers? Confidence? Outcomes? Differences between groups? The answer begins to define the research question and eventually helps determine the appropriate methodology.

Then examine what is already known. A good literature search may answer your question, help you refine it, reveal an existing measurement instrument, identify a gap, or show you that your population or setting has not been adequately represented.

Finally, consider who could answer the question and what information you would need. You might discover that a survey makes sense. Interviews may provide richer information. Existing records or previously collected data may contain what you need. The methodology should follow the question rather than the other way around.

Research is More Accessible Than You Think

When people hear the word research, they may picture clinical trials, laboratories, large academic teams, and major federal grants. Those are important forms of research, but they represent only part of the research landscape.

Human subjects research can include approaches such as surveys, interviews, educational research, and certain types of secondary research using existing information. Under the revised Common Rule, 45 CFR 46.104 identifies eight exemption categories, although the applicability of an exemption depends on the specific design and circumstances of the research.[4]

For example, one exemption category addresses certain research involving educational tests, survey procedures, interview procedures, or observation of public behavior when the regulatory criteria are met.[4] This is particularly relevant to many of the questions that arise within professional associations, education programs, and ambulatory settings.

Importantly, minimal risk and exempt are not interchangeable concepts, and simply using a survey does not automatically make a project exempt. The Office for Human Research Protections (OHRP) recommends that investigators not independently determine that their own human subjects research is exempt because of the potential for conflict of interest.[5] Appropriate exemption determination helps ensure that the project fits the applicable regulatory category and that the appropriate protections are in place.

The important point for someone with an idea is not to determine the regulatory pathway before developing the research question. Start with what you want to understand. Then build the right study and determine the appropriate review pathway.

Not Everything You Notice Needs to Become Research

Sometimes investigating an observation leads somewhere other than a research study. You may find that your question is better addressed through quality improvement, evidence-based practice, program evaluation, a needs assessment, or another organizational activity.

That is still progress.

The purpose of paying closer attention to your observations is not to turn every interesting experience into a publication. It is to recognize that everyday practice contains information. Asking better questions helps you decide what to do with it, including whether it calls for research at all.

Start a “We Keep Noticing…” List

Consider creating a simple document called “Things We Keep Noticing.” If you lead a practice, association, educational program, or professional organization, invite others to contribute.

What questions keep coming up? What patterns are you seeing? What are patients asking? What are members talking about? What assumptions are you making about your programs that you could actually examine? What has changed in your field that you wish you understood better? What do you know from years of experience that you have never seen adequately explored in the literature?

You do not need to answer all of those questions today.

Choose one.

Look at the evidence.

See what is already known.

Then decide whether there is still a question worth asking.

The People Closest to the Work Have Research Questions Worth Asking

Healthcare research needs rigorous methods, ethical oversight, thoughtful analysis, and appropriate interpretation of findings. It also needs good questions.

The people closest to healthcare practice, professional communities, educational programs, and patient populations are often in a valuable position to recognize those questions. You understand your patients, your members, your specialty, your programs, your profession, or your community in ways that someone outside that environment may not.

The next time you find yourself saying, “We keep seeing this…”, pay attention.

Write it down. Look at the literature. Ask what you really want to know.

Because an observation that feels routine to you may point toward a question that has not yet been adequately answered.

And that question may be worth studying.

References

1. Agency for Healthcare Research and Quality. Practice-based Research Networks. National Center for Excellence in Primary Care Research. Content last reviewed September 2025. https://www.ahrq.gov/ncepcr/communities/pbrn/index.html
2. Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med. 2014;174(5):710–718. doi:10.1001/jamainternmed.2014.368. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1846630
3. Agency for Healthcare Research and Quality. History and Funding of Practice-Based Research Networks. National Center for Excellence in Primary Care Research. https://www.ahrq.gov/ncepcr/communities/pbrn/history/index.html
4. U.S. Department of Health and Human Services, Office for Human Research Protections. 45 CFR 46: Protection of Human Subjects. 45 CFR §46.104, Exempt Research. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.104
5. U.S. Department of Health and Human Services, Office for Human Research Protections. Exempt Research Determination FAQs. https://www.hhs.gov/ohrp/regulations-and-policy/guidance/faq/exempt-research-determination/index.html