Intended for healthcare professionals

Rapid response to:

Feature Essay

Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers

BMJ 2018; 363 doi: (Published 12 November 2018) Cite this as: BMJ 2018;363:k4645

Linked opinion

Is 85% of health research really “wasted”?

Linked opinion

Funders and regulators are more important than journals in fixing the waste in research

Rapid Response:

Collaborative Student Research Efforts Provide a Solution to Research Wastage

We read with great interest the recent article by Sharp and Curlewis (1), who provide a medical student’s perspective to Glasziou and Chalmers’ recent article addressing the topic of research waste (2). The authors discuss a recognised pressure amongst UK medical students to publish research ‘at all costs’. Research collaboratives such as STARSurg (STudent Audit and Research in Surgery) allow medical students to engage in robust and high-quality research, whilst gaining fundamental skills in study design and delivery. STARSurg uses a single corporate authorship model for all its publications, recognising all collaborators equally with PubMed citable co-authorship under group name: ‘STARSurg Collaborative’. This democratises the traditional publication model and flattens hierarchies within study delivery teams. We agree that the current Foundation Programme Application Service (FPAS) scoring system could be seen to encourage quantity rather than quality of publications; for example rewarding published letters and case studies with ‘points’, but leaving PubMed-citable collaborative authorship without recognition. (3).

STARSurg medical student collaborators have had fundamental roles in designing and delivering four national and international audits to date, including over 20,000 patients in 25 countries. Students have had leading roles in major studies across very diverse settings, for example GlobalSurg-2, investigating surgical site infection across eighty low-, middle- and high-income countries (4), and in complex randomised controlled trials, such as the West Midlands Research Collaborative (WMRC) ‘Dexamethasone reduces emesis after major surgery’ (DREAMS) trial (5). Increasingly, large publicly-funded studies with real potential for patient benefit are turning to single corporate authorship model to reflect the complexity of integrated nature of their delivery teams (2). Protocols for these studies undergo extensive internal and external pre-publication peer review, review by external grant committees, and scrutiny from multi-country audit or ethical approvals processes; Sharp and Curlewis therefore rightly highlight that collaborative research is not only a viable solution, but an invaluable method of avoiding research waste. Individual students may contribute several weeks to months of high intensive efforts to make meaningful contributions to these studies, and gain the status as a citable collaborating author.

We are saddened therefore that the UK Foundation Programme Office (UKFPO) maintains its firm stance on recognition of collaborative research within the FPAS scoring system, despite multiple attempts at discourse; an open letter to the UKFPO on behalf of over 900 signatories has failed to make headway (6). We strongly urge the UKFPO to update its position on appropriate recognition of collaborative research, as is seen in the academic foundation programme, both core and higher specialist training applications, Annual Reviews of Competence Progression (ARCP), and an increasing number of specialities for Certificate of Completion of Training (CCT). Modification of the FPAS scoring system has a crucial role to play in promoting a culture of engagement with multi-centre research, reducing research waste caused by falsely inflating the importance of low-level publications, and increasing the likelihood of patient benefit.

1. Sharp E, Curlewis K. Research waste is still a scandal—especially in medical students BMJ 2018; 363: k4645.
2. Paul G, Chalmers, I. Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers BMJ 2018; 363: k4645.
3. UK Foundation Programme Office (UKFPO). UK Foundation Programme 2019 Applicants’ Handbook. Available at:
4. GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18: 516–25.
5. DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017; 357: j1455.
6. STARSurg Collaborative. Students’ participation in collaborative research should be recognised. Int J Surg. 2017; 39: 234 –7.

Ahmed WUR* (University of Exeter Medical School, Exeter, UK, @WaheedURAhmed1)
Mills E (Brighton and Sussex Medical School, Brighton, UK, @Milye95)
Khaw RA (University of Manchester Medical School, Manchester, UK, @RachelAlys)
McLean KA (Academic Foundation Year 2, University of Edinburgh, UK, @Kenneth.McLean92).
Glasbey JC (Academic Clinical Fellow, University of Birmingham, UK, @DrJamesGlasbey).

*Correspondences to:

Competing interests: No competing interests

Competing interests: No competing interests

22 November 2018
Waheed-Ul-Rahman Ahmed
Medical Student
Emily Mills, Rachel Khaw, Kenneth McLean, James Glasbey
STARSurg Collaborative
University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU.