28/11/2017 – Newsletter #1 – Interview with the new EuroSurg Chairs

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  1. Why participate in a collaborative research network?

 

Research collaboratives (RC) allow medical students, trainees and young surgeons to develop further their scientific skills, participating in high-quality studies.  All participants are recognized as collaborating authors in the resulting publications and on PubMed, with clear benefits in term of CV and research skills.

Students and trainees can access courses and congress at reduced or no fee, and present data at international meetings.

The development of research skills is supported and fostered by RC, with specific initiatives directed to understating students and trainees, e.g. courses to improve knowledge of RCT and how to speak to patients  (GRANULE) or biostatistic abilities (BOSTIC). Participants can develop communication skills, with patients and colleagues, and build up managing skills.

RC create networks that last beyond a single project and can generate individual connections independent from RC themselves, and encourages exchanging opportunity for training purposes, ideally supported by Societies. RC stimulate curiosity, social events/networking, opening to different cultures.

They can overcome divisions and individualisms caused by political issues.

 

  1. Biggest difficulties? Biggest victory?

 

“Red-tape” consisting of all the logistic requirements behind a study (e.g. local ethics requests for approval, further specifications by local medical authorities) represented without any doubt the biggest difficulty with RC. The incredibly wide range of variability observed not only between different countries, but also between cities within the same country, has required and still requires a significant amount of work to deal with it. However, the power of RC also relies on a solid system specifically developed to overcome such difficulties. As an example, EuroSurg has dedicated teams in charge of tackling issues with ethical committees and queries from local institutions in each different country, so that studies can be run smoothly and all requests are promptly addressed. This allows trainees and young investigators to develop organisational skills.

The biggest victory, besides showing that organised trainees and supervised students can deliver international studies compliant with the highest scientific standards, has been the birth of National Research Collaborative and committees, a trend that has been increasingly steadily over the last years.

In Italy, ItSURG (Italian Surgical Research Group)- the collaborative we found after the EuroSurg-1 study – has recruited over 800 patients from 49 centres during its first study (RIFT) and most of the investigators were students and junior doctors, unbelievable only a few years ago. In several academic environments, medical students and trainees are still considered passive consumers of academic resources: the “research collaborative model” has showed that they can be protagonists and lead high-quality projects.

These networks can ensure easier planning of studies and more effective enrolment of patients. Moreover, National RC can mature the necessary skills to deliver their own studies and projects – which could be relevant for country-specific issues.

 

  1. How will surgical research collaboratives evolve from now?

 

It is currently difficult to predict the actual evolution of RC, but few considerations are allowed.

We see the growth of RC as bi-dimensional: the birth of National RC and the strengthening of RC collaboration and National networks could be considered as an “horizontal” process, distributed over time independently from other aspects. This phase has no real end or aim, because it always need more energy, inputs, triggering, and support. The scientific value and impact on the scientific community of the delivered studies and initiative would rather be identified by a vertically-distributed pattern. We imagine this growth as pyramid, with observational studies at the bottom, slightly moving up through studies that, even if still observational, bring in new challenges and attempt to widen the horizons of the collaborative (i.e. inclusion of countries from different continents), eventually reaching the top with interventional studies. Following this scheme, randomised controlled trials would represent the actual top of the pyramid. The process is obviously bi-directional or self-repeating – as long as new ideas are developed and based on the available level of evidence. The continuous growth and fostering of the collaborative described as horizontal constitute the basement and the pillars of the pyramid.

This concept of evolution might require a long time, but RC involving trainees have shown some characteristics that offer cautious optimism:

– data are collected and stored in secure online databases; recent interest in “bigdata” analyses suggest that these long-lasting information are a goldmine that can be of use for many purposes apart from a single study for which data were collected.

– data are checked for reliability by local validation,

– RC embraces members with organisational and management skills, allowing for reproducibility and repeatability of the studies in different populations

– the output of data analyses is interpreted by a wide panel of experts, ensuring that a critical insight is provided, resulting in the highest level of scientific quality that might be achieved according to the study design and setting

 

Obvious difficulties of such RC are caused by the rotation and frequent interchange in people in charge of specific tasks, especially considered the academic commitment that students and trainees need to face. However, RC are constantly growing, suggesting that application for grants and setting up of dedicated, salaried units might not be very far in the future. This also constitute a pivotal part of the evolution of RC, for which the external, unconditioned support of International Scientific Societies and Entities has been crucial so far and stands there to confirm the validity of RC asset.