Author: Cameron Bosinski, MD, MS
The Daily Dose
Large, high-quality clinical trials require more than a strong research question. They depend on trusted professional relationships, committed participating centers, experienced research personnel, efficient contracts, sustainable funding, and trial designs that can be implemented within real clinical workflows.
A roundtable at the 2026 IARS and SOCCA Annual Meeting brought together international investigators to discuss how clinical trial networks can strengthen collaboration, overcome structural barriers, and accelerate perioperative research.
Personal Relationships Remain Essential
Formal research networks can connect investigators and institutions, but successful collaborations often begin through direct personal relationships.
Investigators can identify potential trial partners by attending professional meetings, presenting preliminary data, discussing developing research ideas, and following up with colleagues who express genuine interest.
A network cannot replace trust. Investigators are more likely to commit their staff, patients, and institutional resources to colleagues who have demonstrated reliability and a willingness to collaborate.
Smaller per-patient-funded studies can provide an effective starting point. These projects allow sites to gain experience working together before attempting larger and more complex multicenter trials.
The Benefits of Formal Research Networks
Once relationships are established, formal networks can greatly expand the scope of collaboration.
Networks can provide:
• Access to additional enrolling centers
• Connections with investigators outside an individual’s existing professional circle
• Mentorship for early-career researchers
• Opportunities for secondary analyses
• Shared expertise in trial development
• Access to more diverse patient populations
• Faster evaluation of new research ideas
A participating institution does not always have to serve as a major enrollment center to contribute meaningfully. Junior investigators may lead secondary analyses, methodological studies, or projects using data generated through an existing trial.
These opportunities can increase engagement, develop future trial leaders, and produce additional scientific value from the original research investment.
Differences Between the United States and Other Countries
The panelists emphasized major differences in clinical research infrastructure among the United States, Canada, the United Kingdom, and Australia.
American institutions may employ large teams of coordinators, research assistants, financial specialists, and regulatory personnel. Despite these resources, trials frequently face high overhead expenses, repeated contract negotiations, insufficient per-patient payments, and difficulty retaining experienced staff.
In Canada and the United Kingdom, government-supported research infrastructure may provide personnel who remain available across multiple studies. Standardized or master clinical trial agreements can also reduce the time required to begin enrollment.
These differences allow some international centers to perform comparable research with smaller and more stable teams.
The Financial Challenges at American Trial Sites
United States investigators frequently must negotiate a separate contract and budget for every study.
Even a well-funded National Institutes of Health grant may provide limited support after institutional facilities and administrative costs are deducted.
One investigator described a device trial paying sites approximately $1,000 to $1,500 for every enrolled patient. Despite that payment, participating institutions still had to subsidize substantial coordinator time.
When reimbursement does not cover the actual cost of enrollment, sites may enroll fewer patients than expected. This can delay trial completion or leave a study underpowered to answer its primary question.
Experienced Staff as Core Infrastructure
One of the greatest challenges is retaining skilled research coordinators between grants.
When funding ends, institutions may eliminate coordinator positions. A new project must then hire and train new personnel, creating a repeated cycle of lost expertise, delayed trial activation, and inconsistent performance.
Panelists argued that experienced research staff should be considered permanent institutional infrastructure rather than temporary expenses attached to an individual grant.
Hospitals already support durable personnel for quality-improvement and clinical-data programs. Similar support could be provided for research nurses, coordinators, and regulatory specialists who work across multiple studies.
Institutions may occasionally need to “spot the gap” by funding high-performing staff during temporary periods between grants. Although this creates a short-term expense, it may prevent the much greater cost of losing experienced personnel and rebuilding the team later.
Creative Approaches to Research Staffing
Several centers have incorporated trainees into clinical research teams, including:
• Surgical residents completing required research years
• Biomedical engineering students seeking clinical experience
• Undergraduate students completing thesis projects
• Gap-year students preparing for medical school
• Postbaccalaureate students pursuing research experience
These individuals may assist with recruitment, data entry, chart review, follow-up, or other appropriate tasks.
However, trainees should work under the supervision of experienced research coordinators who maintain protocol quality, regulatory compliance, and team culture.
Summer-only students were generally considered less efficient for complex studies because much of the summer may be spent training them before they become independently productive.
The Success of Platform Trials
The United Kingdom’s RECOVERY trial demonstrated the value of pre-existing research infrastructure during the COVID-19 pandemic.
The trial used a network of portfolio hospitals with established research staff and master agreements. This allowed investigators to evaluate multiple treatments across many institutions in months rather than years.
The platform model permits several therapies or research questions to be evaluated within a continuing trial structure. New treatment groups can be added while ineffective ones are stopped.
Advantages may include:
• Faster trial activation
• Shared control groups
• Lower administrative costs
• Standardized procedures
• Established data systems
• Continuous use of research personnel
• More efficient evaluation of multiple treatments
Australia has developed similar operational efficiencies and has attracted industry-sponsored research partly because trials can be started and completed more quickly.
Applying International Lessons in the United States
Panelists advocated for government, foundation, or institutional support for a permanent group of clinical research nurses, coordinators, and regulatory personnel.
This structure would reduce the boom-and-bust cycle created when each grant must independently establish its own research team.
Existing quality networks demonstrate that stable infrastructure is possible. Programs such as the American College of Surgeons National Surgical Quality Improvement Program, the Society of Thoracic Surgeons database, and established regional quality collaboratives maintain personnel and data systems across many years.
Comparable infrastructure could support pragmatic perioperative trials without requiring every investigation to build an entirely new system.
The Importance of Pragmatic Trial Design
Efficient trials collect the information necessary to answer the primary research question without adding excessive secondary requirements.
At its simplest, a pragmatic trial may need to document:
• Enrollment eligibility
• Treatment assignment
• Delivery of the intervention
• A limited number of clinically important outcomes
Investigators may be tempted to add extensive observational data, laboratory testing, biospecimen collection, imaging, or exploratory questionnaires.
Although these additions may appear scientifically valuable, they increase costs, staff workload, participant burden, and the risk of missing information. In many cases, the additional data are never fully analyzed.
A trial should not become so complicated that participating sites cannot reliably follow the protocol or afford to enroll patients.
Networks as Idea Incubators
Research networks can also help investigators refine early concepts before formal grant submission.
Presenting an initial idea to experienced colleagues may help determine:
• Whether the question is clinically important
• Whether sufficient patients are available
• Whether sites are willing to participate
• Whether the intervention is practical
• Which outcomes are most meaningful
• Whether the proposed budget is realistic
• What regulatory problems may arise
Participation should generally be voluntary. Self-selection allows institutions with the appropriate patients, personnel, expertise, and enthusiasm to commit to the project.
Mandating participation may result in nominal involvement from sites that lack the resources or genuine interest needed to recruit successfully.
Searchable Databases and Better Site Matching
The panelists suggested developing searchable databases that match investigators with institutions possessing the appropriate patient population, equipment, personnel, and clinical expertise.
Such systems could reduce the reliance on personal contacts alone while still preserving the importance of trust and collaboration.
A searchable network could help investigators identify:
• Sites with the necessary patient volume
• Centers with specialized equipment or clinical services
• Investigators interested in specific research areas
• Institutions with experienced trial personnel
• Sites capable of rapid regulatory and contract approval
This could make trial planning more efficient and expand participation beyond the same small group of frequently used academic centers.
Mentorship and Capacity Building
Clinical trial networks can provide important mentorship for early-career investigators.
Experienced researchers can help junior investigators refine questions, develop realistic protocols, avoid unnecessary data collection, prepare grant applications, and identify appropriate collaborators.
Networks also create opportunities for junior faculty and trainees to lead secondary analyses or smaller projects connected to larger trials. These experiences can help them develop the publications, skills, and professional relationships needed to lead future studies.
One senior investigator emphasized that participating in NIH study sections and grant-review panels can be an especially valuable career-development experience.
Reviewing grants provides insight into:
• Why some proposals are funded
• Which weaknesses concern reviewers
• How successful investigators frame their questions
• What level of preliminary data is expected
• How budgets and study designs are evaluated
This experience can strengthen an investigator’s future grant applications and increase credibility within the research community.
Building Sustainable Research Systems
Clinical trial networks should not merely help investigators survive the current funding environment. They should create systems that make high-quality research sustainable and scalable.
Achieving this goal will require:
• Stable research staffing
• More standardized contracts
• Realistic per-patient reimbursement
• Institutional support between grants
• Efficient, pragmatic trial designs
• Strong mentorship programs
• Searchable site and investigator databases
• Government and foundation investment in research infrastructure
• Wider adoption of platform-trial models
Formal networks are not replacements for personal relationships. They are multipliers that allow trusted collaborations to operate across larger numbers of institutions and patients.
The central message from the roundtable was clear: successful perioperative research depends on combining the trust created through personal collaboration with the scale, consistency, and efficiency of formal clinical trial networks.
By investing in stable personnel, pragmatic methods, mentorship, and shared infrastructure, the perioperative research community can conduct the large, rigorous studies needed to improve patient care and train the next generation of clinical investigators.
Thank you to The Daily Dose and the International Anesthesia Research Society for allowing us to summarize this important session.