Hello, my name’s Ryan Preece and I’m currently a 4th Year medical student. Today I’m here to talk to you about a new national student-led research collaborative called STARSurg and about how you as medical students, trainees and even more senior clinicians (eg. consultants) can get involved.
So recently, especially in the world of surgical research there has been big increase in the number of so-called “collaborative research projects”. And these initiatives basically involve lots of doctors from a number of different hospitals working together to answer one common question. And this collaborative design of research has numerous advantages in that... Firstly, because there’s lots of clinicians participating it allows large numbers of patients studied in a far short time period than if it was just a single-centre study. Secondly, as numerous centres are participating in the collaboration it prevents the same work being undertaken at simultaneously by rival institutions and thus avoids repetition and poor utilisation of finite research resources And finally, because it’s a multi rather than a single centre study, the results are generally more generalisable to the medical world.
Now historically, medical students have highly involved in research and indeed, some have been acknowledged as making some incredibly important research findings as you see on the slide here... For example the discovery of the anti-coagulant heparin, the invention of balloon angioplasty for clots and the unearthing of the heart’s sinoatrial node have all been made by medical students.
However, in an increasingly busy undergraduate curriculum, it’s hard for medical students to find time to conduct research and to also to produce research on large enough scale that it has any impact at all!
So STARSurg (or student audit and research in surgery) is a brand new research collaborative set-up by medical students... For medical students. And we’re currently in our second year of existence and have been very successful in running UK wide surgical research projects. Indeed, you can see on this map all the hospitals across the UK which currently have medical students participating in our current STARSurg research project! But ultimately our aims are to encourage students to become involved in high quality audit and research projects, instil a culture of EBM into the future generation of surgeons and finally to run an annual project of significant importance.
So the basic structure of STARSurg is that each medical students form a mini-team of 2-3 students in the hospital that they’re usually on placement at. Then with the support of surgical trainees and consultants they are responsible for registering the study at the centre they collecting from and also for data collection. Each student has to conduct 2 weeks of data collection, so not too long as to impact on their studies. All the hospitals in each medical school are then centrally co-ordinated by a local lead. Finally then at the top of the tree is a national steering committee composed of a few medical students and surgical trainees who are responsible for jobs such as designing research protocols, and also the final analysis and write-up of results.
So our first study back in 2013 was looking at the impact of post-operative NSAIDs (a commonly used pain relief medication) on adverse events after surgery). And it was a massive success which managed to pull together a massive 258 students from 31 medical schools which enabled us to achieve a large sample size of over 1500 patients across 109 hospitals! Highly successful, managed to get this work published in the British Journal of Surgery. Such a high impact journal really shows that the work we’re conducting has the potential to impact on clinical practice.
Now sadly I don’t have time to go into the details of our trial design, but I just wanted to show you that our large multicentre study showed that using these drugs such as ibuprofen actually reduced the overall number of complications... A result that could have important consequences for clinicians in the future.
All collaborators are Pubmed citeable
Currently, we’re coming to the end of our second study looking at the very topical issue of obesity. Current figures suggest that 30% of surgical patients are obese, however, there is conflicting evidence on the effect that obesity has complications in surgery. And so our study is aiming to
Massive increase in interest in STARSurg... You can see from the maps the increase in the number of participating hospitals.
I’m in charge of leading the project at Cardiff University so please get in touch with me if you’re interested in getting involved next year.
Student Audit & Research in Surgery
Cardiff University Local Lead
• Large number of patients studied in a
• It prevents repetition and poor
utilisation of finite research resources
• Greater generalisability across a multi-
“the working together of multi-centred researchers to
achieve the common goal of producing new
scientific/clinical knowledge” (Katz 1997)
Frequently cited obstacles to student research involvement were time constraints
(74%) and a perceived lack of interest from potential supervisors (63%)
Ali Nikkar-Esfahani et al Extracurricular participation in research and audit by medical students: Opportunities, obstacles, motivation and
outcomes. Medical Teacher 2012 34(5): e317-e324
What is STARSurg?
• Student Audit and Research in Surgery
• Novel student-led surgical collaborative
across the UK facilitating multi-centre
1. Enthuse medical students to become
involved in high quality audit and research.
2. Instil a culture of evidence-based practice
and build a future generation of research-
3. Deliver an annual, student-led, national
project capable of challenging current
National Steering Committee
Medical Students & Surgical Trainees
Medical School Local Leads
STARSurg I (2013)
• 258 student collaborators from 31 medical schools
• Data collected over a two-week period on a prospective
cohort of 1500 patients across 109 UK hospitals
• NSAIDs common post-op analgesic recommended by ERAS
– opiate sparing role
• Recent studies suggest NSAIDS increase risk of anastomotic
• This study aimed to determine the safety profile of
postoperative NSAIDs after major gastrointestinal resection
in current UK practice
1) Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative non-steroidal anti-inflammatory drugs and risk
of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg 2014; [Epub ahead of print]
Early post-op treatment
with NSAIDs was
• ↓overall complications
• Predominately, a
reduction in minor
complications with high-
(i) To establish compliance with NICE guidelines
requiring early identification of obese patients
(ii) To determine the role of obesity as a risk factor
for major postoperative complications