Enhancing surgical research at the hospital level: a new model

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A range of distinct challenges are faced by those within the surgical research community that have been well recognized. These include time constraints, difficulties recruiting patients, utilization of particular research methodologies, limited research funding, a lack of collegiate support and research culture, few exemplars or mentors, low‐level requirements for research within surgical training and an absence of a defined training programme for surgical trainees seeking an academic pathway.1 Collectively, these challenges have resulted in a perceived lower academic standing and output for surgical research compared to other medical disciplines.4
In considering solutions for enhancing surgical research, a study recently published described the outcomes of a comprehensive needs assessment undertaken to establish the baseline of surgical research at the public tertiary referral hospital level.5 Undertaken following a protracted period of time where two notable events occurred including the devolution of surgical training by the Royal Australasian College of Surgeons to the nine surgical specialties and the decentralization of the Discipline of Surgery to be under the administrative management of multiple smaller clinical schools by the university, the study highlighted there are considerable opportunities to make improvements in surgical research output and culture. Using the baseline study results, a new model for supporting surgical research at the hospital level is being trialled that may be of interest to other teaching hospitals and universities.
This involved the establishment of the first hospital‐based surgical institute in Australia dedicated solely toward enhancing academic surgery. Created in early 2014 as a collaboration between the Local Health District and current Surgical Research Institutes, the goal of the institute is to be the primary hub of surgical research and education at the hospital through the development of academic surgical departments that pioneer best surgical practice and patient care. The mechanism of action is to utilize enthusiastic leaders from surgical departments with strong academic output to support and mentor the majority of departments that do not. Different departments were found to have varying numbers and levels of academic baseline to develop.
The institute has commenced implementing a wide range of strategies and although it is too early for a formal evaluation, it is anticipated that many of the strategies outlined could be transferred to other hospitals or modified to fit a local setting, and are detailed for consideration.
Institute governance: Reporting directly to the Chief Executive of the Local Health District, the institute is supported by an Advisory Council with representation from the hospital, the Health District, the University and surrounding Surgical Research Institutes. This has ensured organizational engagement and the provision of critical guidance and feedback.
Institute leadership: The organizational structure has been created to ensure identified leaders within key research portfolios including laboratory, clinical, education and surgical nursing research. Funding has been provided by the hospital for each of the surgeon leaders to support their work.
Research leads: A hub (the institute) and spoke (the surgical departments) model has been established with each department identifying a surgeon to be the dedicated ‘Research Lead’ who liaises closely with the institute and is responsible for driving the research plan of their department.
Research think tanks: Each Research Lead has been supported to hold a multidisciplinary and multispecialty Research Think Tank meeting for their department each year to facilitate departmental engagement in research.
Half‐time academic positions: Strong promotion of 0.5 FTE academic positions has occurred to provide surgeons with protected time for research whilst still enabling adequate time for clinical practice. The model requires one full day of face‐to‐face surgical research at the institute and one day equivalent of surgical research in the surgeon's own time.
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