Leveraging collaboration to enhance quality in paramedicine research

Introduction

We have a quality issue in paramedicine research.

That is a confronting statement to write, and I suspect even more so to read. When I say ‘we’, I mean all of us, as we are all members of the paramedicine research community. This may not be a concern unique to our profession, but it is our own backyard that is of interest to us. Whilst there is certainly wonderful robust research happening in all regions, my sense is that many of us have persistent difficulty in moving our individual research agendas to where we would really like them to be, and to be of the quality we or others might see as optimal. There are many barriers that I propose may be impinging our efforts to produce high-quality research, including but not limited to: limited funding schemes that embrace or prioritise paramedicine research; difficulty in acquiring funding of sufficient magnitude that would facilitate larger and more definitive research; undergraduate and postgraduate research proposal assessment practices lacking adequate criticality to identify methodological deficiencies; inexperienced higher degree by research (HDR) supervision; difficulty accessing quality data from industry partners such as jurisdictional ambulance services; low editorial publishing standards that accept mediocrity and inadvertently promote ‘hurtful science’; and a failure to collaborate effectively.

All are important and are worthy of closer examination, but in this editorial, I seek to explore collaboration on the premise that it is central to our collective endeavours to improve quality in paramedicine research.

What is collaboration?

At its most basic level, research collaboration has been defined as ‘the working together of researchers to achieve the common goal of producing new scientific knowledge’. ¹ However, research collaboration might be more nuanced and may span a continuum of activities ranging in scale from simple discussions through to significant long-term partnerships. ² It can occur at an individual level between two researchers formally or informally and can be within or between institutions, domestically or internationally.

How can collaboration enhance quality?

Collaboration sits at the epicentre of research and is a key driver of research quality. ³ However, I believe we may not be embracing collaboration as well as we might in paramedicine research. An examination of submissions to Paramedicine and similar journals suggests a preponderance of small single-centre research, frequently authored by pairs or trios of researchers with the same institutional program affiliation. This in and of itself is not a fatal flaw; we develop strong professional relationships with those working in close proximity to us, and we feel comfort in working with regular co-authors where a pleasant and productive relationship has evolved. But working repeatedly within this professional comfort zone might be deleterious to our research quality in the longer term: collaboration might be a lever that facilitates better research through means I will now explain.

Through greater collaboration, we expose ourselves to new ways of thinking that may serve to enrich our conceptual and theoretical understanding of a problem or issue, and our capacity to articulate it. Engaging a new co-investigator from outside our normal circle of local collaboration brings in new perspective, challenging team dynamics phenomena such as ‘group think’ which create avoidance of conflict, debate and controversy. ⁴ Doing the same on HDR supervisory panels enrichens the quality of research training we provide our students by challenging our existing practices and exposing ourselves and our research students more regularly to constructive scrutiny. Expanding a journal's editorial board by collaborating internationally invigorates its mission, strengthens its expertise, widens its perspective and elevates publishing standards. Each of these may ultimately serve to enhance quality.

Through greater collaboration, we might mitigate feasibility or logistical constraints by pooling available resources to increase capacity and enhance complexity and sophistication in our research. ⁵ One small sum of funding might not be enough to conduct a research project with sufficient rigour, but the sum of two smaller amounts might make scaling up of a project feasible. This for example might facilitate purchasing of equipment that would otherwise not have been affordable, that now procured might enable measurement of an optimal outcome rather than a surrogate, therefore making the findings more robust. It may enable us to increase our capacity for collecting larger amounts of higher quality data. In the example of a survey to be conducted of participants at a single institution, new collaboration might open recruitment opportunities in other programs, increasing the likelihood of achieving an a-priori sample size that establishes the level statistical power required to move our work beyond hypothesis generation whilst increasing external validity. This will ultimately serve enhance quality.

Through greater collaboration, we can increase our connection to the broader health system that paramedicine is an integral part of. ⁶ Interdisciplinary collaboration serves to ‘…integrate information, data, techniques, tools, perspectives, concepts, and/or theories from two or more disciplines or bodies of specialised knowledge to advance fundamental understanding or to solve problems whose solutions are beyond the scope of a single discipline or field of research practice’. ⁷ Inviting researchers from neighbouring disciplines who might have transferrable expertise and or new insight to our research teams will increase the interprofessional tapestry of our research, potentially broadening the breadth and depth of our work and enhancing potential impact beyond paramedicine. This may ultimately serve to enhance quality.

Through greater collaboration, we can increase inter-professional representation in our research teams, making our projects more attractive to higher-level funding bodies and their larger competitive grants, and increasing the number of journals who might be interested in publishing the final work and readers interested in reading it. This will ultimately serve to enhance quality.

Through greater collaboration, we can become more self-aware of what we do and don’t know ourselves regarding research design by engaging methodological expertise not available within our existing network of colleagues. ⁸ If we apply the concept of the Johari Window, we can reduce our ‘blind spot’, that being what we don’t know we don’t know. By acknowledging our own research knowledge limitations, then reaching out and inviting collaboration from a person with specific established expertise, our work becomes more methodologically rigorous and we simultaneously nurture our own professional growth. This will ultimately serve to enhance quality.

Through greater research collaboration, we can more easily engage in scientific review of our research, reaching out to other researchers outside a research team and seeking their independent objective feedback on what we are proposing. This could increase the proportion of investigator-led research projects operating outside of formal grant processes where peer-review might normally be found, that receive methodological review through invitation. This will ultimately serve to enhance quality.

Through greater collaboration, we can reduce duplication in research, minimising wasteful expenditure of limited time, resourcing and capacity, whilst sharpening our individual and collective research foci. ⁹ We can reduce the amount of smaller inconclusive methodologically limited research, and increase the production of scientifically valid evidence of sufficient strength to warrant translation into practice or policy. This will ultimately serve to enhance quality.

How can we increase collaboration?

On first reflection, one's instinctive response might be that collaboration is easier said than done. It is true that many paramedic researchers might feel isolated, working in an organisation or institution or even a country that does not have an established paramedicine research culture, or that they don’t have a facilitator or mentor to help engage in greater collaboration; paramedicine research communities are not common in most regions whilst research siloing is. Further, collaborative research can pose a range of challenges, including the need to accommodate differing research cultures, specific research methodologies and research practices that exist across institutions. At a higher level, variations in regulatory and legal systems, and incompatibility of institutional funding arrangements and organisational structures, may add complexity that whilst problematic at times, is not insurmountable. ²

However, in practical sense, collaboration and connection may now be easier than ever; self-introduction via email or any one of the many social media platforms is almost instantaneous, whilst engaging via videoconference with someone in another country is no harder than doing so with a colleague down the hall in our own program (apart from the infernal issue of navigating time zones). We should not feel that we need a facilitated introduction to an academic in another state, province or country in order connect; it most likely just requires some professional boldness regardless of our personal research status or trajectory to reach out and say: ‘I’m here and I think we are some common research interests, perhaps we could talk?’.

Collaboration is also increasingly available through organised research networks, for example, the McNally Project for Paramedicine Research in Canada (http://mcnallyproject.ca/), Irish Paramedicine Education and Research Network ¹⁰ or the UCLA Prehospital Care Research Forum in the US (https://www.cpc.mednet.ucla.edu/pcrf), each of which seeks to increase collaboration and cooperation between paramedic researchers regardless of experience or seniority. These serve as communities of paramedicine research practice, grounded upon a spirit of collaboration.

Conclusion

At Paramedicine, we advocate for greater collaboration on its many levels within and outside of our profession as a means to move achieve higher quality research. We urge us to see ourselves as part of a national and international community of paramedicine researchers whose identities are not bound by academic level, institution or borders, and whose common goal is to produce high-quality research capable of achieving demonstrable and sustainable impact. We advocate to not restrict research connection to our own profession but to embrace interprofessional research collaboration. As we’ve previously written, paramedicine (the profession) is not an island separate to the rest of the healthcare system; we must look to integrate ourselves into that broader system in the research that we conduct and in how we position it. ⁶

Quality in paramedicine research is an issue we need to confront and address. ¹¹ Collaboration is not the panacea for these concerns, however a significant step in the quality improvement process might just involve us reaching out more often and letting others know we are here and looking for engagement and connection.