Trainee led research collaboratives: pioneers in the new research landscape
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5084 (Published 09 August 2012) Cite this as: BMJ 2012;345:e5084
- David Bartlett, specialist registrar, surgery12,
- T D Pinkney, specialist registrar, surgery12,
- K Futaba, specialist registrar, surgery12,
- L Whisker, locum consultant breast surgeon13,
- G Dowswell, research fellow, primary care clinical sciences14,
- on behalf of the West Midlands Research Collaborative
Abstract
David Bartlett and colleagues explain why joining a research collaborative can help your career
The continuing growth of evidence based medicine has meant a pressing need for clinicians to engage with research as an important aspect of developing medical professionalism. For specialist registrars this was formalised by the need to report experience in research or academic medicine as part of the annual record of in-training assessment. Similarly, evidence of research activity is a core requirement of the annual review of competence progression for newer core and specialty trainees. Royal colleges generally require trainees to be familiar with research, and several specialties formally assess this knowledge in vivas as part of trainees’ exit examinations. The extensive literature on training of junior doctors is unanimous in relation to the importance of gaining first hand research experience. This same literature, however, is often silent on how to achieve this.
Historically, doctors in training have worked independently on small, irrelevant, and often unpublished ad hoc research projects. Most trainees experience considerable anxiety, frustration, and wasted efforts in relation to research, partly because of the need to rotate every four, six, or 12 months from post to post. This requirement is incompatible with the time needed for planning, management, and follow-up of high quality studies. Many trainees discover that finding research funding, obtaining ethical approval, and navigating the labyrinthine research management and governance process within NHS trusts is not simple. To achieve this while delivering patient care and fulfilling clinical training needs is extremely challenging.
A growing literature on the “science of science” has described and explored the ways in which successful projects are delivered. Teamwork is becoming increasingly important not only for research but also for clinical practice.1 In England, several National Institute for Health Research funding streams have been set up in recognition of the longstanding observation that research needs to be relevant, appropriate, and of sufficient quality. At a national research and development level, the recipe seems to be strongly in favour of engaging clinicians, academics, patients, and the public to ensure the necessary combination of rigour and relevance. The National Institute for Health Research for Patient Benefit programme is a good example of this approach. From a quality perspective, the Medical Research Council has increasingly recognised the need for bigger studies, meaning that collaboration is not an option but a necessity for obtaining funding. Indeed, most of the studies that have changed practice in recent years have been large multicentre studies.
As a way to overcome these barriers, to meet these needs, and to develop new structures to deliver high quality research, there has been a recent rapid growth in research collaboratives that have been set up and run by surgical and other trainees. These collaboratives provide a framework within which motivated doctors in training can develop, manage, and deliver far better research than was possible in the past, and they are already proving highly successful. The English and Welsh research landscape has seen several research collaboratives appear in a very short time period, and you may be able to find one in your geographic area (box 1). Although most of these are currently run by general surgical trainees, other specialties are also coming on board.
Box 1: Examples of research collaboratives
London Surgical Research Group—www.lsrg.co.uk
Mersey Research Group for General Surgery—www.merseysurgery.com
Severn and Peninsula Audit and Research Collaborative for Surgeons—www.sparcs.org.uk
West Midlands Research Collaborative—www.wmresearch.org.uk
See the Association of Surgeons in Training for further details—www.asit.org/resources/collaboratives.
How research collaboratives work
At the simplest level, research collaboratives are networks of interested people who recognise the benefits of working together to get research done. They act together as a filtering mechanism to identify studies that are likely to be attractive, relevant, and deliverable. They also act as a “dating agency”—matching trainees to other trainees with similar interests who have gained greater experience of research, and putting both groups in touch with academic support.
Research collaboratives quickly build links with local trials units and methodology experts. This is important for trainees, because all randomised controlled trials are now expected to be run in association with a registered clinical trials unit. These units are relatively new organisations that are based in the most research active universities, and they are keen to develop strong links with the next generation of researchers, so you may find you are pushing at an open door. There may be more than one trials unit in any locality—for example, in Birmingham, there is a cancer trials unit, a clinical trials unit, and a primary care clinical research and trials unit. Each unit has slightly different expertise and interests, but all have staff who often help research collaboratives (box 2). Other organisations, such as the research design service or protocol development services, which are funded by the National Institute for Health Research, will help with funding applications.
Box 2: Studies currently being managed by research collaboratives
ROSSINI trial—This was the first trainee led multicentre randomised controlled trial to be run by the West Midlands Research Collaborative. A total of 769 patients having a laparotomy were randomised to either use of a wound edge protection device or standard care (no wound edge protection device). Twenty one hospitals participated, and recruitment was completed over two months early in January 2012. We are currently in the analysis phase.
DREAMS trial—The second trainee led multicentre randomised controlled trial from the West Midlands Research Collaborative in association with the Birmingham Clinical Trials Unit is investigating the effect of preoperative single dose intravenous dexamethasone on postoperative nausea and vomiting in patients undergoing gastrointestinal surgery. We have so far opened 14 sites and recruited over 80 patients in the ongoing feasibility study, which will continue into a full phase IV trial recruiting a total of 950 patients.
Multicentre appendicectomy audit—This venture is currently under way. All of the surgical research collaboratives across the UK are undertaking a concurrent prospective audit of appendicectomy operations over a set two month period. We have up to 60 hospitals set to participate and hope to provide a true snapshot of current practice, including negative appendicectomy rates and the variability in provision of, and relative efficacy of, laparoscopic versus open appendicectomy.
CANOES I—This multicentre retrospective study with the West Midlands Cancer Intelligence Unit aims to investigate whether survival after breast cancer differs among ethnic minority patients in the West Midlands in comparison with white patients. Data analysis is complete, and we are currently in the final stages of publishing our findings.
Why get involved?
Research can be lonely, but in a research collaborative you have an instant network of people to work with. This network acts as a strong motivation to get things done—if you are working on your own project, you might put things off for a week or two, but if 30 people are waiting for you to do whatever you promised, this means you all get more done, and more quickly. This collective momentum means you will have faster and better publications for your portfolio and CV.
Studies can be published “on behalf of the collaborative,” and all contributors will be searchable on PubMed as members of that study group. Having a publication looks great on your CV, and teamwork and management experience in a research setting as opposed to a clinical setting are a big plus on a trainee’s CV.
Research collaboratives also save everyone time—you don’t have to engage with every part of the research process yourself, unless you are the lead researcher. This means that someone else will have designed the case report forms, got ethics approval, got research and development clearance, found a local primary investigator, or written the statistical analysis plan.
On the downside, the reality is that even in a collaborative a lot of blood, sweat, and tears will still be needed to successfully complete a research project. The benefits of working together, however, and the sense of achievement more than make up for this.
How to get involved
You may be able to join an existing study if it is of interest to you and your senior clinicians. Most research collaboratives meet regularly. Contact the secretary via the research collaborative website and ask for details of the next meeting (agenda, minutes, time, and place) or look at the meeting details on the website.
When you attend, get there a little early and begin the process of meeting other interested trainees. It’s probably best not to rush in and propose new ideas or projects until you have found out what is currently happening and what is going well or what is running into difficulties. Find out from the web, members, or officers of the research collaborative what trials or epidemiological studies are currently proposed, are recruiting, or are in need of completion. Think hard about how you can contribute to the existing portfolio of the research collaborative before coming up with anything new.
Conclusions
Research collaboratives produce high quality publications from large scale multicentre trials, cohort studies, and database mining while at the same time building research capacity and giving members a taste of research success. The collaboratives provide a framework for support but still have to attract motivated individuals who buy into shared enterprise and collective learning. Collaboratives have to tap into local support and expertise to function properly.
Involvement in collaboratives teaches collaboration, peer review, accountability, responsibility, and teamwork. Success leads to success, and there is big potential for regional, national, and international ventures. Stay out of collaboratives at your peril—you will be left behind by people taking the collective way to research success.
Footnotes
Competing interests: DB is funded by the Medical Research Council. Studies run by the West Midlands Research Collaborative have received funding from the National Institute for Health Research for Patient Benefit programme and the Bowel Disease Research Foundation. The views expressed in this article are those of the authors and not necessarily those of the NHS, National Institute for Health Research, the Bowel Disease Research Foundation, or the Department of Health.