European Journal of Obstetrics & Gynecology and Reproductive Biology 215 (2017) 213–214
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European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
Review article
All for one and one for all: The value of grassroots collaboration in clinical research Bassel H. Al Wattara,b,* ,1, Jennifer Tamblync,1 a
Wawrick Medical School, The University of Warwick, United Kingdom Women's health research unit, Blizard institute, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom c Institute of Metabolism and systems research (IMSR), University of Birmingham, United Kingdom b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 19 April 2017 Received in revised form 3 June 2017 Accepted 7 June 2017 Available online xxx
Collaboration in health research is common in current practice. Engaging grassroots clinicians in the evidence synthesis and research process can deliver impactful results and reduce research wastage. The UKARCOG is a group of specialty trainees in obstetrics and gynaecology in the UK aiming to promote women’s health research by delivering high-quality impactful research and national audit projects. The collaborative enables trainees to develop essential academic skills and roll out multicentre research projects at high cost-effectiveness. Collective research work can face a number of challenges such as establishing a joint authorship style, gaining institutional support and acquiring funds to boost networking and deliver large scales studies. © 2017 Elsevier B.V. All rights reserved.
Keywords: Research Collaboration Obstetrics and gynaecology Grassroots
Contents Introduction . . . . . . . . . . . . . . . Current format and experience Value of collaboration . . . . . . . Challenges . . . . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . .
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Introduction Collaboration among health researchers became quite popular in the last two decades with single authored manuscripts rarely produced nowadays. The simple act of two or more researchers working towards a shared goal has evolved along the increased sophistication of knowledge acquisition and research methodology [1]. This paved the way for establishing dedicated “research groups”, where team members share research tasks to answer a defined question, deliver impactful results and reduce research wastage [2].
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Practicing evidence-based medicine requires large involvement from health professionals in the synthesis and appraisal of evidence. This uniquely favours engaging clinicians in the study development and delivery process on a large scale, to increase research productivity and reduce associated cost. The shape of such “grassroots” approach to research collaboration, while appealing, remains underdeveloped [3]. We report on the experience of the UK Audit and Research trainee Collaborative in obstetrics and gynaecology (UKARCOG), highlighting the benefits and challenges of the grassroots approach to research collaboration. Current format and experience
* Corresponding author at: Women's health research unit – Blizard institute – Barts and the London School of Medicine, Queen Mary University of London, London E1 2DD, United Kingdom. E-mail address:
[email protected] (B.H. Al Wattar). 1 UK Audit and Research trainee Collaborative in Obstetrics and Gynaecology (UKARCOG). http://dx.doi.org/10.1016/j.ejogrb.2017.06.015 0301-2115/© 2017 Elsevier B.V. All rights reserved.
The UKARCOG was formed in 2014 by a group of specialty trainees in obstetrics and gynaecology aiming to promote women’s health research amongst their peers. The collaborative’s primary objective is to deliver high-quality impactful research and audit
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projects led by specialty trainees nationally. Initially, research projects were developed and discussed at virtual meetings using free video-conferencing platforms, such as Google Hangout to bypass geographical boundaries. The structure of the collaborative has since evolved. A central committee now serves as the pillar that delivers the administrative workforce, formulates policy, design projects’ protocols and seek ethical approval when needed following the NHS health research authority guidelines. Calls for new projects are issued periodically, targeting the trainees’ community via established email lists and regional study days. Submitted proposals are shortlisted centrally against their judged feasibility and scientific merit. Shortlisted projects are then disseminated and executed by an established network of regional (deanery level) and local (hospital level) trainee representatives. (Fig. 1) To date, the UKARCOG has delivered two large-scale national projects reporting data on over 4000 pregnant women and involving more than 200 specialty trainees [4,5]. Value of collaboration Engaging clinicians in such research collaborative yielded many benefits. Establishing a common platform to debate interesting questions and assess research need provided trainees with valuable opportunities to develop their academic skills and acquire hands-on experience in evidence synthesis. Trainees, a large body of practitioners in any health system, remain largely absent from the research activity often performed by dedicated research staff. Following a broad-base approach enabled us to roll out multicentre projects achieving high recruitment rate. Trainees’ activity on the shop-floor provided access to acute clinical areas such as the delivery suit; in contrast to access amenable to classical academics. Coupled with a nationwide vision, such approach delivered large projects in a short timeframe. Our first project looked at the management of postpartum haemorrhage prospectively against established national guidelines [4]. Once a national network of associates was established, we launched a call for data collection to all participating unit and gathering data on 3400 women from 98 maternity units in one calendar month. [4] Data were anonymised at local level (protecting patient confidentiality), aggregated at regional (using standardised database), and analysed at central level. The decentralised structure of the UKARCOG helped to harness local talent across different domains (academia, quality improvement, project management and informatics) to boost productivity and reduce associated research cost. To date, all projects were delivered at virtually no cost.
Fig. 1. The structure of the UK Audit and Research trainee Collaborative in obstetrics and gynaecology.
Challenges Like any start-up, the collaborative witnessed many pivots in its structure and functionality with a steep trial-and-error learning curve. Validating the UKARCOG name was a major challenge to roll out projects nationally and ensure local units’ approval. A supporting sponsorship from the Royal College of Obstetrician and Gynaecologists has greatly helped us to gain momentum and boost recruitment. Acquiring support from similar health-policy makers and research governing institution is likely to facilitate future endeavours. Vetting and shortlisting submitted ideas required advanced academic skills and experience. Seeking help from established senior academics was essential to guide grassroots members in this process until the ‘in-house’ experience matured. Publishing our research findings was also complex due to the large number of collaborators involved. Acknowledging individuals’ contribution to each project is essential to boost the collaboration spirit. Thus, we adopted a transparent authorship style citing collaborators in alphabetical order [5]. This, however, is not widely supported with many publishers imposing restrictions on the total number of co-authors permitted for each publication. Such practice is restrictive to future collaborative research and is not justifiable by logistic and commercial limitations. Future development of the collaborative structure requires additional logistic and financial support to enable the delivery of high-quality studies (e.g. randomised trials). While certain funders now support research networking efforts, no established scheme currently exists to support start-up collaboratives with no track record. Although current setting is cost-effective, future development requires serious funding. We aim to sustain the collaborative by attracting networking funds to sustain the network as well as project-specific funds to answer more complex questions and cover research costs. Conclusion Grassroots collaboration provides a unique paradigm to increase productivity and impact in health research. Institutional support is needed to enable further collaboration and to address the highlighted challenges. References [1] Cummings JN, Kiesler S. Collaborative research across disciplinary and organizational boundaries. Soc Stud Sci 2005;35(5):703–22. [2] Chalmers I, Bracken MB, Djulbegovic B, Garattini S, Grant J, Gülmezoglu AM, et al. How to increase value and reduce waste when research priorities are set. Lancet 2016;383(9912):156–65. [3] Jeffrey P. Smoothing the waters. Soc Stud Sci 2003;33(4):539–62. [4] Al Wattar BH, Tamblyn JA, Parry-Smith W, Prior M, Van Der Nelson H. Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK. Risk Manage Healthcare Policy 2017;10:1–6. [5] The UK Audit and Research trainee Collaborative in obstetrics and gynaecology (UKARCOG)(http://ukarcog.org/) Accessed 03/06/2017.
