Establishment of research units: A perspectives/proposal towards enhancing the prospective research studies among general surgery trainees

Mohammed Yousef Aldossary; Mohammed Saad Alqahtani

doi:10.4103/SJL.SJL_17_19

ORIGINAL ARTICLE

Year : 2020 | Volume : 5 | Issue : 1 | Page : 12-17

Establishment of research units: A perspectives/proposal towards enhancing the prospective research studies among general surgery trainees

Mohammed Yousef Aldossary, Mohammed Saad Alqahtani
Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia

Date of Submission	20-Nov-2019
Date of Acceptance	21-Nov-2019
Date of Web Publication	3-Oct-2020

Correspondence Address:
Dr. Mohammed Yousef Aldossary
Department of General Surgery, Building 7, 2^nd Floor, King Fahad Specialist Hospital, Dammam
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/SJL.SJL_17_19

Abstract

Background: Education, clinical care, and research are the three main foundations of academic health centers in the world. The research environment has always been riddled with ebbs and flows, depending on the availability of funding resources. Prospective research studies are limited for the residents in Saudi Arabia because most of them are doing rotations outside the center or changing the surgical unit after 1–3 months and joining another team.
Objectives: This article discusses the creation of research units to provide research support in prospective studies and presents the advantages and disadvantages of these units. The project is based on the acknowledged importance of establishing research facilities in general surgery training centers of the kingdom with the aim of helping regions move in the same pace with the rest of the world.
Conclusion: This project proposes establishing research units and development of prospective research studies in all general surgical centers in the Kingdom of Saudi Arabia. The goal of the project is to provide data and research materials to general surgery residents so that they can improve their performance and also increase their satisfaction in the field.

Keywords: Prospective studies, research units, residency programs, residents

How to cite this article:
Aldossary MY, Alqahtani MS. Establishment of research units: A perspectives/proposal towards enhancing the prospective research studies among general surgery trainees. Saudi J Laparosc 2020;5:12-7

How to cite this URL:
Aldossary MY, Alqahtani MS. Establishment of research units: A perspectives/proposal towards enhancing the prospective research studies among general surgery trainees. Saudi J Laparosc [serial online] 2020 [cited 2023 Mar 23];5:12-7. Available from: https://www.saudijl.org/text.asp?2020/5/1/12/296781

Introduction

Improving the quality of health-care services has become one of the main objectives of the healthcare sector around the world. Countries and the world in general continue to strive to achieve this objective to ensure that patient care is improved and the costs remain under control. Prospective research studies are limited for the residents because most of them are doing rotations outside the center or changing the medical or surgical unit after 1–3 months and joining another team. However, all the residents are involved in the hospital on-call duty and facing emergencies. Essentially, the development of prospective research studies in the residency programs will not only contributing to the existing knowledge in the surgical profession in the Kingdom, but it will also reduce rodents' burnout and increase resident's satisfaction in their profession.

The project aims to make units of research to establish prospective studies related to surgical emergency patients, and most of the residents can be included in the study even if they are in different teams or rotations. Surgical residents are an important component of quality health care, with statistics indicating that emergency general surgery contributes to (approximately 80-90% ).^[1] This number is alarming, bearing in mind that these are emergencies general surgery of all operations.^[1] The available research in this sector is mainly global, and there are limited materials that address Saudi Arabia. Introducing prospective research studies among the residents will improve the effectiveness of the general surgery residents and in return increase the reliability of healthcare in the region. Research is an important component of health care since it significantly improves patient care outcomes. Precisely, research provides an evidence-based approach to treatment as well as information critical for building skills of health-care practitioners. Research can be defined as a systematic exploration of study materials and sources to establish facts and reach new conclusions.^[2] Notably, research is the basis of good clinical practice, which is the foundation for the quality and safety of human subjects in every research. Good clinical practice provides the guidelines to be adhered to by the researchers throughout the research process. In other words, good clinical practice sets the standards to be followed by the researchers to ensure quality and acceptable outcomes of any study. However, in cases where there is insufficient information, the practitioners are left with no option but to apply personal judgment which at times affects the quality of health-care outcomes. Overall, good clinical practice is essential in conducting research effectively to ensure a quality outcome.

Research units are of great importance to medical institutions. According to Koski et al. study,^[3] establishing clinical research units is crucial as it builds public confidence that the accredited institution is ready and willing to follow the agreed-on set of values. In addition, limited quality research in some areas such as general surgery poses a lot of challenges for improving health-care outcomes of patients and also the quality of services provided. In a study by Aldossary et al.,^[4] focusing on resident's satisfaction of surgical training programs in the Eastern Province of Saudi Arabia, the overall results indicatedthat the majority of the residents are largely dissatisfied with the residency programs in the region, especially in the research activities. Further, the study showed that this dissatisfaction grows as the resident's progress in their training programs. In light of this, there has been increasing for the establishment of voluntary accreditation of clinical research facilities.^[3] These clinical research units help in accelerating the dissemination of standards and processes which in return accelerate the design and development of therapeutic products and processes. In other words, clinical research facilities are important in improving the quality of medical training program outcomes, as well as contributing to overall health-care quality.

Similarly, when it comes to general surgery residents, research plays a crucial role in equipping the residents with the necessary skills and preparing them to handle the most challenging scenarios in their career. The Accreditation Council for Graduate Medical Education guidelines strongly recommend the establishment and maintenance of the environment of inquiry and scholarship with an active component. In other words, the body recognizes the establishment of research facilities that provide general practitioners with relevant materials that will help them develop quality skills in their field of study and career. As of 2016, statistics in the United States indicated that approximately 36% of general surgery residents completed a dedicated research time of between 1 and 3 years where they are usually supported by departmental funds and research fellowships.^[5] For regions such as the Eastern Province of Saudi Arabia, such scholars have to look for research facilities that meet their needs, which means that they have to leave to travel to other places for years to conduct their studies.

Objectives

To discuss the importance of research units, prospective studies, and how they will help to improve the satisfaction of general surgical residents and the effectiveness of training programs
To establish a research unit in every general surgery center. The research should be headed by one director, who will be assisted by one or two consultants depending on the resources and workload available
To ensure developing and publication of at least 2 prospective research studies from each research unit
To provide a general guideline for publishing research articles depending on the duration or intervals of research rotations
To provide a framework for general surgical residents to work together with a chosen number of patients in each unit
To provide a framework of the workload in the research units and the expectations.

Goals

To identify the need for development prospective research studies among general surgical residents in Saudi Arabia
To shed light on how the research units will help in improving health-care outcomes in the Kingdom
To provide a brief overview of the activities or expected outcomes for each research unit.

Methods

The project is based on the acknowledged importance of establishing research facilities in general surgery training centers of the kingdom with the aim of helping regions move in the same pace with the rest of the world. Research indicates that although reliability is a critical part of health-care improvement as it is expected to ensure failure-free medical processes, the lack of enough infrastructure and research facilities has made this goal impossible to be achieved.^[1]

Targeted physicians

The regions have many general surgery centers which are recognized by the Saudi Commission for Health Care Specialists (SCFHS). The research should be composed of a director who is a senior general surgeon with enough experience in the research field. The director will be assisted by one to two consultants who can be alternating or be in the facilities at the same period. These administration personnel will be responsible for setting the standards and requirements to be met for any resident who will be applying to conduct research in these centers. However, the target of these research centers is general surgical residents, which means that for one to be accepted in the centers, they will have to belong to this category of medical practitioners. The project recognizes that most of the general surgical residents are usually on-call duties or they keep rotating due to high demand. However, the research facilities will give an opportunity to every resident where their facilities will partner with other research centers in the country. Therefore, the residents will have an opportunity to continue with their research even if they get rotated in another teams or specialty before they complete their study. In addition, the research centers will allow other teams rotated and brought to the location, especially plastic, vascular, and thoracic surgeons, to join the institutions and conduct their study.

Research center design and components

The research units should be established in each general surgical center in Saudi Arabia. Each region falls under the jurisdiction and responsibility of the Scientific Council of General Surgery Program of SCFHS. Consequently, the Scientific Council of General Surgery Program should be the main stakeholder and should oversee all activities that will be running in the centers. Precisely, the Scientific Council of General Surgery Program of SCFHS should liaise with the respective centers where the research units will act as a steward to ensure that all the standards and legal regulations are met and observed. The Scientific Council of General Surgery Program of SCFHS and respective research centers should be responsible for financing the maintenance of the facilities, as well as any research projects which the government has vested interest in.

The facility will be all-inclusive for all general surgical residents who are conducting research for both educational purposes and self-satisfaction in building knowledge in the field of general surgery. The researchers will handle their proposals of the subject of their interest to the research institutions' boards or committee who will then give their approval or rejection depending on the attractiveness of the topic and its contribution to the society. In addition, the research administration, which is composed of the director and one to two consultants, will be responsible for overseeing daily operations of the research and providing consultation services to residents who would like advice from more qualified personnel. Besides, the research unit administration will coordinate all activities with the respective research teams and also with other research units. Importantly, the research administration will ensure that all the ethical standards for handling research participants are observed and the required procedures have been followed accordingly. In other words, the purpose of the research is to provide resources for development application and implementation of government, industrial, and investigator-sponsored general surgery studies and that all studies are in compliance with good clinical practice and research ethics.

Similar to the clinical setting where the general surgical residents work as a team to achieve the best outcomes in an operation, the research units will act as platforms for residents in the same field to exchange ideas and work as a team. The development of research centers will not only be important in supporting knowledge sharing but also a great idea for pooling and centralizing resources from different stakeholders and sectors that support general surgery in different centers of the Kingdom. Since the research centers will bring together most qualified surgical professionals from different parts of the Kingdom and even beyond, the team-based model will be used to create first-class teams of professionals. The team will play a crucial role in providing other upcoming general surgeon residents with mentorship. In addition, these first-class teams will be helpful in developing protocols, and regulating services in the research units, as well as coordinating high-level research studies. Although the researchers will be the authors of the published research reports. The Scientific Council of General Surgery Program of SCFHS should be included among the stakeholders as it will be responsible for providing legal support and other necessary resources.

Building on existing infrastructure

Although the research units will be a new project, the plan is to establish them in the already existing surgical centers, which mean there will be existing facilities and infrastructure in place that will support the development. This approach of sharing infrastructure will ensure the sharing of resources, hence reducing the funds required for establishing and running research centers. As a result, the extra funds that will be saved through the sharing of resources will be directed toward hiring and paying well-trained and highly qualified research coordinators. In return, the research centers will be able to publish high-quality and reliable reports within the shortest period possible. On top of that, this design will bring together researchers who have funds and do not have research ideas with those who have research ideas but lack funds; hence, they can work together for mutual benefit. The idea is to publish two research reports every 1–3 years so that they do not take too long as the residents might get rotated in their normal routine which might disrupt their research.

Currently, there is a shortage of research centers in the Kingdom, but there are individual studies conducted by experienced surgical residents. The purpose of establishing the research units is not to suppress these individual researches but to supplement and support them with the necessary resources, guidelines, and mentoring. Once the research centers have been established and become successful, the plan is to establish clinical trial units which will accommodate other researchers who have funding but lack resources. Unlike in the initial research centers which will be self-funded by the individual institutions depending on the importance and uniqueness of the research units, the clinical trial units will be based on fee-for-service, which means that the researchers who have funds but do not have resources will have an opportunity to pay and conduct their research. There will be two benefits for the clinical trial units; first, the visiting researchers will be able to complete their research in high-level research centers. The second benefit is that the fees paid by these private researchers will supplement the funding from other sources and contribute toward self-sustaining research centers. Overall, establishing clinical trial units will be beneficial to the visiting as well as private researchers as they will be able to use the available sources to complete their projects accordingly.

Key elements for research unit designs

Scientific mentorship and navigation

The research units should be headed by a highly qualified and experienced individual in general surgery to head the centers as the director. The most important qualifications of the director are that they must portray quality leadership skills and have a research database so that they can effectively mentor junior researchers and coordinators. The director together with the two consultants will mainly guide the novice researchers to develop their ideas into a study that can generate adequate and quality data. In addition, the director must also be conversant with the surgical centers where the research units will be located. This is due to the fact that the director will not only be responsible for providing mentorship but also help the new researchers to navigate through the institutions and find their way around the research centers. Besides, it will be the director's responsibility to advise the prospective researchers on funding issues and how they can tackle the barriers involved. Generally speaking, the director will play a leading role in mentoring researchers but also in guiding them appropriately, specifically in helping them become familiar with the location.

Supervision and mentoring of research staff

The director in the institutions should be responsible for overseeing overall activities in the research centers. This responsibility can be overwhelming, which means that there is a need for assistants to ensure that things are handled according to expectations. Therefore, the consultants should work closely with directors to oversee and guide the research staff, as well as help them navigate through the research regulatory process. Overall, the research staff should be guided or supervised and mentored by highly experienced personnel to help them deliver the best.

Innovative leading-edge programs

The purpose of the research units should be to conduct research and provide data on emerging issues in the field of general surgery. Based on this, the research units will be designed to support different programs and provide general surgery residents with the necessary innovation that they can work with to guide them on the most controversial topics in health-care sector in order to facilitate the growth of health care in the regions and improve patient outcomes.

Results

[Table 1] summarized the expected results and the outcomes in the future, if the research centers have been established.

Table 1: Outcomes of the research centers/results

Click here to view

Discussion

Improving satisfaction of general surgery residents

The main objective of starting the research centers is to provide the general surgical residents with facilities and resources necessary to develop their field and improve the health outcomes of their patients. In a study conducted by Symons et al.,^[1] the results showed that although the general surgical unit receives approximately half patients' admission in the surgical unit, the mortality rate is estimated to be between 80 and 90%. This number is a clear indicator that there is something missing or that is not done right to improve patient outcomes. Lack of adequate research in general surgery is one of the main challenges that affect the quality of health-care outcomes as there is a lack of enough data that the residents can rely on.^[3] Although the information about the lack of research units is not specifically from the Eastern Province of Saudi Arabia, the problem seems to be even worse in this region. The existing study from the region shows a lot of dissatisfaction among surgical residents in the region.^[4] Of all the resources analyzed on the issues affecting general surgical centers and residents, there was only one research report on the Eastern Province of Saudi Arabia. The scarcity of literature on the area could mean that the information is not readily available to the public, or there no studies in the area.

Considering this, the project will play a critical role in solving the problem of scarcity of research data in the Kingdom. After the research units have been established and everything has been put in place, the plan will be to publish at least two researches in 1–3 years from each unit, which means that within a short period of time, there will be enough data and literature materials that will be resourceful in general surgery training institutes and also in medical centers. On top of that, the general residents will have a platform where they can meet and exchange ideas and share their experiences as they conduct their research. The research facilities will give the surgical residents an increased level of job satisfaction as they can share their experiences with their colleagues and get to contribute in improving their area of specialization. Apart from improving satisfaction through interaction among residents, the research units will provide reliable data that will help the general surgery residents build their skills and move a step closer toward solving main issues that face their specialties in the Kingdom.

Improving patient care outcomes

The main objective of the healthcare sector is to improve the outcomes of patient care and achieve the best results in all departments. This goal can only be achieved through reliable health care that is failure-free and applies the best procedures and tools in handling health problems. However, achieving a failure-free health care is far from being achieved since there have been incidences where mistakes led to a loss of lives. Besides, statistics indicate that general surgery centers report among the highest number of deaths in hospital. This poor performance in these centers can be argued to be among the main challenges in improving patient outcomes in most health-care institutions. The purpose of this project is to ensure that this problem is tackled with all the resources available. The research centers will work together with patients who will agree to participate in the studies to provide data on various emerging conditions in the field that require attention. The article published inspire the evidence-based approach in general surgery centers and among the residents as they will have adequate information and data on prospective studies and outcomes conducted in different fields. As a result, the residents will be well informed on the most effective and appropriate procedures to apply in handling various medical conditions.

Conclusion

This project proposes establishing research units and development of prospective research studies in all general surgical centers in the Kingdom of Saudi Arabia. The goal of the project is to provide data and research materials to general surgery residents so that they can improve their performance and also increase their satisfaction in the field. The research units should be established within the already existing research units so that they can share resources and reduce the operation costs required and funds for establishing the centers. The centers should be headed by a director who will be assisted by two consultants, all of whom should possess excellent leadership and professional skills and experience. All the research centers should be under the ownership of the surgical centers where the Scientific Council of General Surgery Program of SCFHS in Saudi Arabia should be the overall regulator. The expected outcomes of the research units are that they will help provide general surgical residents with the appropriate skills and data that they can use in executing their tasks in their fields, as well as improving the patient outcomes in the Kingdom.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Symons NR, Moorthy K, Vincent CA; London Surgical Research Group. Reliability in the process of care during emergency general surgical admission: A prospective cohort study. Int J Surg 2016;32:143-9.
2.	Croghan IT, Viker SD, Limper AH, Evans TK, Cornell AR, Ebbert JO, et al. Developing a clinical trial unit to advance research in an academic institution. Contemp Clin Trials 2015;45:270-6.
3.	Koski G, Kennedy L, Tobin MF, Whalen M. Accreditation of clinical research sites-moving forward. N Engl J Med 2018;379:405-7.
4.	Aldossary MY, Alnaimi M, Almabyouq F, Alsofyani T, AlJahdali A, Al-Buainain H. Resident satisfaction regarding surgical training programme in Eastern Saudi Arabia: A cross-sectional study. Int J Surg Open 2019;17:15-9.
5.	Shah PM, Edwards BL, Dietch ZC, Sawyer RG, Schroen AT. Relationship of a second professional degree to research productivity of general surgery residents. J Surg Educ 2017;74:124-30.