Meeting the Challenge of Urological Research in Ireland

Meeting the Challenge of Urological Research in Ireland DAVID GALVIN CHARTER DAY 2016

Importance of Research To Trainees • Research encourages Doctors to: – Think – Analyse – Question – Critique – Discuss – Collaborate – Publish • Without research, we loose these qualities.

Under Threat • Surgical Academic Research as we know it is under threat • Surgical training pathways no longer facilitate or encourage full time research • For most trainees, this eliminates access to Laboratory based research • Scientific and Translational research will suffer hugely without clinical input • Research will be clinical in nature and have to be squeezed in alongside the day job

Importance of Research To Trainees • Without providing ample opportunities for our trainees to do research are we not doing a huge disservice to our trainees • How will their CV look ? • Can they compete on the International stage ? • Will they get a Fellowship abroad ? Or a Consultancy ? • How will they mentor their trainees in the future without having done research themselves ? • This is the responsibility of the training body and they have abdicated their responsibility

ISU Abstracts Falling Abstracts 140 120 100 80 Abstracts 60 40 2014 2015

So What are the Proposed Research Opportunities in the Future ? • Run through training limits research • For very few, they may take time out to do a MCh or MD in the Laboratory • Most likely done by taking a year out during HST, but funding will be a huge problem • But for most trainees, how do we make the best out of Urological Clinical Research in Ireland ? • How do we make our trainees competitive ?

What are our Strengths ? • Strong history of clinical research and novel ideas (due to lack of disease databases) • Small number of Cancer centres with a degree of centralisation – evolving hospital groups • Small, largely homogenous population, ideal for clinical studies • Strongly supported by the profession • Motivated students and trainees

Training Survey • All trainees and trainers were invited to provide their views on research (email survey) – Current practices / levels of research activity – Shortcomings / obstacles – Vision for the future – Recommendations • 19 Sp. Rs: 14 responders / 5 non-responders • 5 Trainers (4 ROI, 1 NI) & P. I. from lab responded

Training Survey Problems with Training …. • Data – Lack of Prospective computerised Databases – Start projects “from scratch” for data collection, even when using same data – Chart access / manual data collection – time consuming & not accurate – Poor HIPE coding – not reliable • Statistics – Lack of access to biostatisticians (incl funding) • Lack of protected Research time / not getting half days • Lack of Consultant leadership / Absence of research leads • Decreasing interest in research at intern / SHO level

Training Survey Problems with Training …. • Projects are small and based in a single hospital • Rotations => must start/finish projects within their rotation • Only 1 unit presently has monthly formal Consultant-led research meeting • Few prospective trials – mainly small retrospective reviews – many duplicate projects • Little collaboration between hospitals • Scientific research for trainees no longer part of training

Others Experience … “ To attract and retain the best trainees to Urology, we have to provide them with an environment in which they will thrive and achieve their goals “

Others Experience … • Collaborate on research using the natural trainee network to establish multi-centre trials, achieving larger numbers and more significant results.

Can we Collaborate ? • Irish Urological research consists largely of small single institution retrospective series of questionable clinical value • The future of Irish Urological Research lies in larger multi-institution studies – need a presence on the International stage • To do this we need to form a collaborative network – aligned with the Irish Society of Urology (ISU-CRN)

PROPOSED SOLUTIONS …. SUPPORTING RESEARCH • ISU funding for research – Funding Data collection or co-ordinator – Funding Prizes, Grants or Awards • ISU / RCSI funded bio-statistician to improve data analysis in clinical publications • Statistics / Research course to be run for annually for Specialist registrars – A module to built in to their Training

PROPOSED SOLUTIONS …. FACILITATING THE TRAINEE • Protected time for Trainees must be observed – half day per week • A Statistics / Research module to be built in to HST • Trainees should produce a minimum amount of research per year – 1 publication – 1 audit – 1 International / National presentation • Possible Sanctions ? – for hospitals that do not protect research time – for trainees that do not meet the minimum requirement

COLLABORATIVE RESEARCH NETWORK • Ensure National Collaboration on research projects • Increase patient numbers – large multi-institutional studies • Decrease recruitment time • Compete for grants and funding • Eliminate overlap, duplication and reduce costs • Long term durable projects throughout a trainees career (the project does not move with the trainee)

COLLABORATIVE RESEARCH NETWORK • The Network would be governed by a steering committee – Individual hospital Research Leads (Urologist) – Other Specialties or University Collaborators • All trainees and Consultants are member of the Irish Network • Researchers present potential projects • Co-ordinate projects

TRAINING SITE RESEARCH LEAD Naturally an individual with a passion for research Act as a Mentor towards the trainees Ensure Trainees have protected Research time Hold Monthly Research meetings with trainees identifying projects and goals for the next meeting • Ensure that all trainees achieve regular publications and enhance their CV • Function as part of a Collaborative Network • •

How is the IPCOR study managed? Data Management Committee Project Management MMI Steering Committee Sustainability Working Group Scientific Advisory Board

Which hospitals are taking part in the IPCOR study? St Vincent’s University Hospital St James’ Hospital Beaumont Hospital Mater Misericordiae University Hospital Tallaght (AMNCH) Hospital University Hospital Waterford Cork University Hospital Galway University Hospital Mercy University Hospital Limerick Private hospitals Public hospitals Galway Investigators Clinic Bon Secours Hospital Cork David Galvin Mater Private Hospital Linda Sharp St Vincent’s Private Hospital Beacon. Frank Hospital. Sullivan Bon Secours Hospital Dublin Ray Mc. Dermott Bon Secours Hospital Galway We will identify men who have been newly diagnosed with prostate cancer and collect data from the 17 hospitals that care for over 88% of all prostate cancer patients

How can you find out more about the IPCOR study? @IPCOR_Ireland Investigators David Galvin Linda Sharp www. ipcor. ie Frank Sullivan Ray Mc. Dermott

ISU - Collaborative Research Network (ISU-CRN) Funding Statitician Multi-Institution / National Projects Hospital Research Lead University Partners / Collaborators Urological Trainee

Conclude • The establishment of a ISU CRN • The Identification of Site Specific Research Leads • Encourage and Mentor our Trainees by creating an environment where ideas, critical thinking and research thrive • Creates exciting new research opportunities for our trainees and for Urological research in Ireland

Discussion