About the IDEAL Collaboration

The IDEAL Collaboration is an initiative to improve the quality of research in surgery to build up a robust evidence base about new procedures and devices.

The IDEAL Collaboration is an initiative to improve the quality of research in surgery and complex interventions to build up a robust evidence base about new procedures and devices.

Key principles of IDEAL are transparency, ethics, and reduction of research waste.

What we do

The Collaboration wishes to engage with all stakeholders involved in surgical and complex interventions research.

  • Provide tools/workshops to help train surgical researchers in study design, conduct and reporting
  • Undertake research projects to further develop IDEAL
  • Encourage implementation of IDEAL principles by working with various stakeholders. These include journals, policy-makers, regulators, industry and research funders.

You can find out more about our specific work in the Projects section.  This includes our new Advisory Service, which aims to help budding researchers plan good quality research studies in surgery and other non-pharmaceutical interventions.

History of the IDEAL Framework and Recommendations

The IDEAL Collaboration grew from a group of research methodologists and surgeons who held a series of meetings about improving surgical innovation research at Balliol College, Oxford during 2007-2008.

Their discussions culminated in the publication of a series of 3 papers in the Lancet in 2009. The papers outline a new Framework for describing 5 stages of development of surgical and interventional innovations and provide Recommendations about how studies at each stage should be designed and reported. The group also put forward Proposals about how specific groups including research publishers, funders, regulators, policymakers and professional organisations could contribute to improving the research and implementation environment for surgical innovation.

Peter McCulloch on the BMJ Talk Medicine podcast, March 2021.


The IDEAL Framework & Recommendations provide an explanation of the natural history or life cycle of new procedures and devices, and a road map for how they should be evaluated at each stage in the journey.

It explains why Randomised Trials have been so difficult to do in surgery and shows that there are at least 2 preliminary steps in research (Development and Exploration) which are necessary to ensure that an RCT has a good chance of success.

IDEAL is potentially useful in surgical research at all stages, but also in device regulatory science, decisions on approving new procedures at institutions and coverage decisions.

IDEAL is increasingly recognised and endorsed by major journals (Annals of Surgery, BMJ & Lancet) and professional groups (Royal College of Surgeons) and is being used by government agencies in several countries.

The IDEAL group continues to study and produce recommendations on difficult research issues such as: When is it OK NOT to do a randomised trial? How do we interpret studies using Real World Data? How should surgical robots be evaluated? And others.