I think someone should be sending Professor Norman Williams a very large Congratulations card.
Under his leadership, the Royal College of Surgeons have embarked on unprecedented series of initiatives to encourage and promote clinical research in surgery. The College have of course supported surgical research for many years through the Fellowship programme, but this new strategy is particularly welcome because it focuses very much on the study of surgery by surgeons, something which is vitally necessary to the future of the profession, but which has perhaps not received enough attention in the past.
The College have worked closely with the NIHR to develop a one-off funding initiative for surgical research in 2012, and have launched a strategy of developing surgical trials units to help clinicians overcome the recognised difficulties of setting up good quality studies of surgical techniques. In doing so, I believe that they have pointed the way for other Colleges and professional bodies to play a larger role in promoting research as an natural part of the surgeons’ role, whether officially in an Academic department or not.
We will always need Academic departments with high quality laboratory programmes to investigate the biology of surgical diseases, and the patho-physiological consequences of operations, but the vast majority of practising surgeons find studies of clinical practices and outcomes more directly relevant to their work. If surgery is to remain a scientific discipline, I believe all surgeons need to understand the principles of good research, preferably by being involved in its practice.
The IDEAL collaboration exists to work for improved standards in surgical research and to promote and develop these. If future generations of surgeons are going to take advantage of the opportunities offered by the surgical trials units now being developed, they will need grounding in evidence-based surgery, and an understanding of the ways in which surgical research inevitably differs from that on medical treatments. The College’s new Trials Units are tasked with providing some of this grounding, and we believe IDEAL can help here.
Other Royal Colleges, general and specialist surgical societies should take note of the College’s new initiative. Whilst laboratory research may nowadays be presented mainly at scientific meetings where there is little clinical input, professional and specialist societies for surgeons are still vital to the development of clinical research in surgery. Through these bodies, mentoring and training take place, and many of them have an effective licensing function, for example through recognising practitioners as specialists if they register cases on their database.
Databases and registries themselves are an important research tool for clinical research in surgery, and the specialist societies have played a vital role in promoting these and maintaining them. Surgical society meetings are the forum for presentation of early-phase surgical studies and provide opportunities for the development of collaborations.
For all of these reasons I believe it is important that such societies engage with the difficulties of research in surgery and seriously consider what their attitude should be to the IDEAL framework and recommendations. Societies (including the Royal College of Surgeons) could further benefit the development of surgical research by endorsing the framework and recommendations in principle, and recommending that databases, registries and presentations at their society meetings should take account of the framework and follow the recommendations.
The quality of science supporting surgery needs improvement, and we do need help from sympathetic funders, editors and regulators, but surgeons can do a great deal for themselves by promoting best practice through the specialist societies where most surgeons conduct, present and learn about the research that matters most to them.
Chair, IDEAL Collaboration