Surgical research in the public hospital

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In this issue of the journal, McBride et al.1 describe a novel approach to promote surgical research in a public hospital system. This model is to be applauded in the current Australasian context where academic surgery is seen by many to be imperilled.
Integration of patient care, surgical research and surgical training is not a novel concept. For example, in the United States, where funding models are different, universities often own and operate the hospitals, they employ the surgeons and select and train their own trainees. All surgeons are employed as academics with dedicated research time and are often supported by a well‐established research infrastructure and close collaboration with basic scientists. The system allows for high‐volume surgeons to be productive academics and surgical trainers.
Despite its many attractions, it will be a challenge to replicate the streamlined and well‐organized structure described by McBride et al. in many centres in Australasia. The hospital system in which the described surgical institute is located is a tertiary referral centre with a number of preexisting resources and an academic culture that has allowed for this concept to be developed and implemented – in other words, it could be argued that it is coming from a position of strength.2 The trouble is that in most places the challenge is not so much to ‘utilize strong surgical departments with strong academic output and leadership to support and mentor’ as it is to find any such departments. Therefore, a critical test for this approach will be to successfully establish a surgical institute in a centre without a previous strong academic background.
The model of surgeon's part‐funding research infrastructure is a novel and interesting concept that in the long term may provide substantial benefit to the unit. However, at some level, this lack of support for research infrastructure is discouraging. The use of REDCap is a great initiative. However, the system is still heavily reliant on data entry and clinician enthusiasm for data upkeep may not last long, and often a data manger to update and maintain the database is necessary.
Based on the current government funding models, our public hospital systems and universities have different priorities and utilize different metrics for measurement of success. The challenge of any new scheme will be to find common targets to encourage participation of all stakeholders. Basic science and laboratory studies provide the foundation for original clinical research and the significance of translational studies should not be overlooked when debating the future of surgical research. Ultimately, partnership should go beyond internal hospital departments and prospective surgical institutes must endeavour to collaborate with scientists to develop meaningful clinical projects that can ultimately impact patient care.
The College's ongoing efforts to promote academic surgery should also not be discounted and the new initiative described here should be viewed as complementary to such efforts. With the availability of many College funded grants and scholarships and the exponential growth of the Academic Section, academic surgery is undergoing something of a resurgence in Australasia3 and the achievements of young surgeons are showcased annually in the Surgical Research Society meetings.4 The establishment of the Developing a Career in Academic Surgery (DCAS) course is another important college initiative. DCAS is a tailor‐made course for prospective academics in Australia and New Zealand, and aims to promote academic surgery, provides insight and guidance into career paths and delivers many essential tools for young academics.5
This paper has been submitted prior to the first metrics of outcome being available. It will be useful for other institutions to see these results before widespread implementation. The strategies outlined are excellent and exciting.
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