Blitz Chess Chats #4 | Prof Liz Sturgiss | Primary Care Research Checklist
#blitzchesschats #interview #scotchgambit
Welcome to another Blitz Chess Chats! In this series, I speak to medical academics and researchers about their field of expertise and program of research… and we start the interview with an icebreaker of a game of 5-minute blitz!
Come for the chess and stay for the interview! ♟️🤪👍
On the 11th of August 2025, I spoke with Prof Liz Sturgiss, a Specialist General Practitioner (a “Family Physician” in North America) with a professorial appointment at Bond University, in the Gold Coast of Queensland, Australia. The interview took place at the Waterfront Campus of Deakin University in Geelong (Victoria, Australia).
We were both attending the AAAPC (Australasian Association for Academic Primary Care Inc.) annual research conference.
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Contents
5-min blitz: Goldsmith Defense
Full transcript of the interview
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The game
Prof Liz Sturgiss was a complete novice at chess, but she was a good sport to start with a game nonetheless! Her game, however, does provide insights on the suboptimal choices that are made by people unprimed by opening chess principles. I had the white pieces, and she responded with (1. e4 h5?), the Goldsmith Defense. Beginners may avoid the perceived conflict of challenging the centre with a flank pawn push, and we saw this on the second turn with (2. d4 g5?), which immediately hung the g-pawn (3. Bxg5). Diagonals are often harder to visualise than ranks and files — Prof Sturgiss herself noted that her favourite piece was the rook due to the relative ease in understanding its moves.
Prof Sturgiss then advanced the flank pawn on the opposite side of the board (3… a5?!) so my approach was relatively simple. That is, follow opening principles by developing the centre pawns, and then the minor pieces, and to move towards an attack when an opportunity arose.
On turn 6, I played the potentially tricky (6. d5!?) as I was hoping for (6… cxd5 7. Qxd5), lining up a bishop-queen battery targeting f7 and potential checkmate! However, Prof Sturgiss didn’t bite (6… c5?), and I had the next tricky tactic with (7. d6) and “putting pressure on the pinned piece”, which was Black’s e7-pawn. If Prof captured the pawn with (exd6), then my g5-bishop would capture her queen!
At this point in the game, Prof Sturgiss wasn’t actually sure how pawn captures worked, and this prevented her from making a mistake! I advanced my knight (8. Nd5), putting even more pressure on the e7-pawn. The following turn, I struck (9. dxe7), with the pawn forking the black queen and bishop on the back rank and after confirming how pawns captured, Prof took the pawn with her bishop (9… Bxe7).
I had intended to play (10. Bxe7 Nxe7) and then the absolute fork (11. Nf6+) winning Black’s h7-rook. However, I decided to play a tricky move (10. Bf4!?) as I saw that Black’s queen was potentially smothered and could be won. Serendipitously, Prof Sturgiss unsmothered her queen with (10… Bh4), but I still had an absolute fork on the queenside with (11. Nc7+). As it turned out, blindness to diagonals struck again and Prof lost her queen (11… Qxc7? 12. Bxc7).
From this point, it was a matter of not blundering back, simplifying, and going for the win. On turn 15, I played (15. Bxf7+), exposed Prof’s king and won tempo with a developing move of my queen (15… Kxf7 16. Qf3+). Then, I long castled to develop the queen’s rook (18. O-O-O), put the rook on the seventh rank (23. Re7) to deliver checkmate (24. Qh7#). Good game, GG!
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Interview synopsis
Note: click on the [timecodes] to go directly to the video at the timestamp
The interview started [09:46] with Prof Liz Sturgiss describing her recent work on the CRISP (Consensus Reporting Items for Studies in Primary Care) checklist [10:09], which are recommendations for researchers that enhance the description and communication of their research when writing up their work.
And that really started because we're looking at how we can enhance the reporting of primary care research. So often we write our papers as a researcher, but it doesn't really give the reader what they need in terms of understanding what you've done. But also, really importantly, the context of primary care and where the research was done.
— Prof Liz Sturgiss, 11th August 2025
She elaborated the reasons why this was important [12:09] and as compared to trials we might undertake in a laboratory, hospital, or a drug trial. Next, Prof Sturgiss explained some of the items on the checklist [14:55] that are especially important when reporting studies in primary care including context, the relationship between the patient and the provider [15:35], the description of the members of the health care team [15:47], the consumer-centredness of the outcome measures [16:37], and whether the research takes into account multimorbidity [17:01].
This led into a discussion [17:58] into one of the tensions in research design between the internal validity of the trial, and the applicability of such results in real world clinical medicine.
We then discussed [18:48] my favourite research methods paper, that was written by Prof Sturgiss:
… and we had a brief chat about critical realism as a research paradigm, and the wonderful analogy in the paper [21:32] using Mr Tickle! Note: all primary care researchers should read this paper even if you don’t typically use critical realism to inform your research!
We then briefly discussed [24:13] the concepts of context and mechanisms and their relationship with outcomes. Lastly, Prof Sturgiss noted [25:51] the impact of the CRISP checklist so far; that it had been recommended by a number of primary care journals, and also that it had been translated to a number of different languages.
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Post-game interview transcript
Interview only video:
Dr Michael Tam
I wanted to speak to you about some of your academic work. I know that you've been at a number of different universities in Australia, and as mentioned before, currently at Bond University. My understanding is that you've recently been publishing a set of… would you call it criteria? CRISP?
Prof Liz Sturgiss
Yeah, “recommendation” we’re going to go with. No one likes to be told what to do so. It's called the CRISP checklist, so it's Consensus Reporting Items for Studies in Primary Care; very nice acronym by Bill Phillips, my US colleague. And that really started because we're looking at how we can enhance the reporting of primary care research.
So often we write our papers as a researcher, but it doesn't really give the reader what they need in terms of understanding what you've done. But also, really importantly, the context of primary care and where the research was done.
Dr Michael Tam
And for the audience, when you speak of “primary care”, can you just flesh that out a little bit?
Prof Liz Sturgiss
Gosh, that's the ultimate question, isn't it? I guess, we're really talking about health care, where it's the first point of contact with the healthcare system. So, in Australia, that's often general practice, or other community settings like pharmacy, where you don't need a referral. You can just present yourself for healthcare, and either your healthcare happens there, or you get directed and coordinated with other services.
Dr Michael Tam
In the Australian setting, often we think of primary care as general practice, but in other parts of the world primary care is organised quite differently. A lot of the people who watch the show are from the United States: for example, you've got family physicians there, but you also have nurse practitioners which is a much larger proportion of primary care compared to here.
Prof Liz Sturgiss
Yes, yeah, but growing numbers of nurse practitioners, Australia for sure. But we're lucky in Australia in that we do have, in principle anyway, universal access to healthcare and our Medicare system that does help people to access care.
Dr Michael Tam
Now, with research in the primary care setting, what makes it different to other healthcare settings, let's say in hospital settings, such that we might want to have something like a checklist, so that the reader knows or is able to understand the study in its full context?
Prof Liz Sturgiss
There's actually a huge amount of work to get to the checklist. You look at this checklist, but it was five-years-worth of research, because we were asking researchers plus clinicians and patients, when you're looking at research, what do you want from it?
The biggest piece that was missing was that often… You might do a research project in, say, a hospital setting, but then trying to apply in primary care, or even the other way, it's done in primary care. But it doesn't take into account things like: lots of patients have more than one health condition, that it's not a first meeting of a provider — you've known the provider a really long time, there might be a team of people available to be part of your care. Often in research you know, we really like things to maybe be a bit more like chess, where it’s very clinical, black and white, and defined, whereas primary care is often not like that. It's a bit messy, and people don't fit in neat boxes with their health conditions, and we have to have research that reflects that in a better way.
Dr Michael Tam
Yeah. So, the way I understand this is… I know we talk about “messiness”, but it's really that reality is a bit complex. And, researching complex systems, if we treat the intervention, like it was a simple drug experiment…
Prof Liz Sturgiss
Or a lab…
Dr Michael Tam
… we can potentially misunderstand the way we should be interpreting the results.
Prof Liz Sturgiss
Absolutely. Yeah. My PhD was on obesity, and one of the things I really studied was the therapeutic relationship. So often if you're doing, say, a lab-based trial or a trial in a hospital setting, you might not see the same kind of mechanisms that we do in primary care. We know that if you have a trusted provider that you've known for a time, that they know your story and who you are, you actually have better health outcomes. And that kind of thing is becoming more captured in the data. But our checklist for primary care research reporting, therapeutic relationship is a really important part of that.
Dr Michael Tam
Now in terms of the checklist… I don't expect you to have memorised them, but what sort of items are in the checklist?
Prof Liz Sturgiss
It talks a lot about the context. And when we say context, we mean… Well if we do a research study in Australia, knowing a bit about how the healthcare system works, how you access primary care, how all the bits of the health system fit together, is really important because when we design an intervention here, it might not work in the same way as the US. Yes, so, the context.
We talk a lot about if the patient already knows the providers; if they've already got that ongoing relationship and who are the members of the team that are available. Really good descriptions of the team. The whole project started actually with Bill Phillips, and I had a conversation at NAPCRG [North American Primary Care Research Group], which is another big conference in North America. We're both trying to do a review, and the description of the providers in the studies was not really great. They just said, “primary care providers”. But that could have been someone with, you know, a layperson with six weeks training, versus a nurse practitioner, versus a pharmacist, versus a doctor. And if you don't know who's part of the intervention, when you try and take that person’s research and put it in your own setting, you can't build it in the same way because you don't know what they did.
Dr Michael Tam
What else is in the checklist?
Prof Liz Sturgiss
It really focuses in on patient and healthcare consumer voice, and what are important outcomes for them. When you've chosen your outcomes in your study, is it an outcome that's been used before in primary care and validated? And is it an outcome that patients have said is important for them? And then translation and thinking about what that looks like in other settings.
The other one I really like in it actually, is thinking around multimorbidity and whether the research takes into account that people have more than one condition. Either in the way it's set up, or the way that findings are interpreted.
Dr Michael Tam
So, that certainly has some implication about the transferability [of the results]… So, if the study is based on a population with the index condition, but they only have that index condition, where in reality people actually might have more than… where that condition will commonly co-occur with other things, so the people who only have that condition and nothing else may not actually be very representative of who you might see day-to-day in practice.
Prof Liz Sturgiss
Exactly. And a lot of the time, you know, as researchers we like to have things neat and sharp and nicely defined. And so, it is rarer to see studies that take that multimorbidity into account.
Dr Michael Tam
Yeah. I'm sure this is a philosophical discussion we have in research methods, where there's a challenge behind being able to identify causal things, which you need to control as many things as possible. But in doing that very often in health systems — yes, you demonstrate one thing causes another thing, but it's not relevant at all in actual clinical practice.
Prof Liz Sturgiss
Absolutely. Nailed it on the head there. I think that the CRISP initiative is actually trying to make us think about primary care methods and primary care research in a much bigger way, because it is a very special and unique specialty and sometimes just doing the methods and the way of research done in lab-based, or clinical, or pharmacological studies is not what our area of research needs.
Dr Michael Tam
Now, I've spoken to you about this previously. You've written one of my favourite methodological papers… actually it probably is my favourite methodical paper, on critical realism. Which I think was published… was it in Family Practice in Oxford [University Press]; The Oxford University Family Practice?
Critical realism is, I suppose a research paradigm. A way of seeing how to understand reality. Would you be able to talk a little bit about what critical realism is? And there's a great analogy in that paper, which I think might have a bit of relevance with your CRISP checklist.
Prof Liz Sturgiss
So, you're really testing me now, Michael! And I know there are lots of people who I would say are more highly qualified than me, so I hope I don't mince my words and make them more cranky because you know how researchers can be. I wrote that paper with Prof Alex Clark, who's now the current president at the University of Athabasca. I was lucky to spend some time in Canada for my PhD, and I went to a workshop that he delivered on critical realism. And I remember my mind being absolutely blown at that workshop with thinking about reality, and what is reality. And definitely as doctors and you know, biomedically minded people, we’re really trained to think very black and white; you know, there's one right answer. And critical realism says there is a reality, but that we will all have a different perspective of looking at that reality, and you'll never actually be able to know what is truly true because you can only see what you can see. That’s too philosophical there… I’m not sure what you think, Michael?
Dr Michael Tam
So, my understanding of critical realism, which has also been known as “scientific realism” is ontological reality. So, that there is such a thing as a real world and this real world is mind-independent. It doesn't depend on human observers. So, “stuff is there”. But potentially we take a critical approach to epistemology. So, in terms of how we as the would-be-knower engages with reality, is flawed and biased, it's filtered through our conscious minds, and we each only have a certain perspective of that. But that doesn't deny the existence of the real world…
Prof Liz Sturgiss
It's still there…
Dr Michael Tam
… That's right. But we only have a flawed understanding of it through our senses and our understanding.
Prof Liz Sturgiss
Yes, you put it much more eloquently than this than I did, Michael. And, are you thinking about the Mr Tickle?
Dr Michael Tam
Yes, the Mr Tickle analogy!
Prof Liz Sturgiss
So, that's Alex's analogy. And you know, we wrote that paper together, and I said: look, the analogy is just perfect, and it really needs to be written down somewhere. We put it in the paper, and he generously allowed it to go in that paper.
So, Mr Tickles, one of the Mr Men characters. He's got big, long, loopy arms, and he makes people happy by tickling them. It goes around tickling people. Yeah. And Alex tells the story that, you know, if we took Mr Tickle, and popped him at a bus stop in everyday suburban Australia and he just started randomly tickling people waiting at the bus stop, would that be an effective intervention? Would you make people feel happy and joyful? Probably not. He'd probably be arrested and carted off, so who knows where… poor Mr Tickle!
So, you can take your intervention which is, Mr Tickle, but if he's not in the right context, such as a bus stop (instead of being in Mr Men land or wherever they all live), then he can actually do harm, and have really poor outcomes. If we think about interventions as just this defined thing, that it doesn't matter where it is, then we have kind of missed the whole point. And it’s actually a really important thing to think about in primary care.
Dr Michael Tam
Yeah, certainly there is… I work in some health services research, and that it is very natural for people to place the power within the program. So, in this health setting, maybe in Western Australia or in Queensland, they did “this”, notionally this is what the program looks like, these people who work in it, and we made some sort of intervention that we've described to patients, and we've got this effect. And the belief that you can transplant that to a different health service and expect the same results without understanding the context.
Prof Liz Sturgiss
Absolutely. And we sometimes miss the active ingredients. Where it was something about that particular community and the relationships with the providers. Sometimes even something about the provider themself, and so that's not directly transferable.
Dr Michael Tam
And I’m trying to cast my mind back towards of integrated care type of terminology… rather than thinking of an intervention like a drug with power in-and-of itself, you need to understand the context. You need to understand what the potential mechanisms actually are. And the relationship between the two with the output or the outcomes.
Prof Liz Sturgiss
That's right. Yeah. So, you’re thinking then of a realist evaluation, which is probably the most well-known method with context, mechanisms, and outcomes. And yeah, I like to do lots of different thinking around, what is the context and what is the mechanism? Because sometimes it can be really hard to unpack the two when we're looking at what's happening in a setting. For an example, in primary care we talk about a lot about the therapeutic alliance and that really strong relationship, and we often think about it as a mechanism. But I wonder actually if it's actually a context. And it is important because if you're making a program, and it works within the context of a strong relationship, but if you're building the program to make the relationship, that might actually not work… if that makes sense.
Dr Michael Tam
Just again thinking within the mental health sphere, which is where I work, we have this some general understanding that if people follow up with their GP after a discharge from hospital that they have better outcomes. But it’s not the fact that they “have a GP” in inverted commas. And so, if you just create a program where we force patients to go to a random GP, there probably won't be better outcomes! That there’s something about that observation in… and probably about the relationship that makes that work. It's not the existence of the GP, it's actually the existence of the relationship and that's the actual mechanism.
Prof Liz Sturgiss
Yes, or maybe the context!
Dr Michael Tam
So, Liz, what's next with CRISP in terms of implementation? What’s the take up been like, and where do you think that’s going to go?
Prof Liz Sturgiss
Yeah. It's been amazing working with Prof Bill Phillips. So, he's an emeritus professor at Washington University in Seattle? And I've learnt so much about translation and dissemination from Bill; he's the master. So, he's really good at communicating — getting the word out. It's now recommended in a number of journals. So, when you publish a paper, the journal says, have a look at these checklists to make sure… A lot of journals in the primary care sphere of now recommended CRISP, which is fantastic.
And then translations. It's now in Turkish, German, Spanish, French, Chinese, [we have] got Japanese on the way… Portuguese. That's bringing a lot of new primary care researchers into our sphere and thinking about high quality primary care research.
Dr Michael Tam
Certainly, improving the quality of the knowledge dissemination just in terms of reporting, because the work's been done.
Prof Liz Sturgiss
That's exactly right. But it's interesting too… I've also been reflecting on there's a few people who teach primary care research using it for their novice researchers. You know, when you're developing a primary care research study, have a think about these. That’s sort of the backwards use of the checklist.
Dr Michael Tam
Yeah. So, a virtuous cycle, I guess. I have to admit that I do that with… I'm probably more familiar with the qualitative research checklist and often… Yeah, that does become: well have you actually thought of all these issues because you’re going to have to report on them.
Prof Liz Sturgiss
Yeah, exactly. So, you hope that eventually that people can use that to set up studies that are a bit more reflective of primary care.
Dr Michael Tam
Thank you very much for speaking with me today. It's actually remarkably chilly in Geelong. I'm gradually freezing but thank you so much for the game. Thank you for the chat and I'm sure we'll chat again and in future conferences.
Prof Liz Sturgiss
That's great, Michael. Thank you.
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