Critical Care Research in Saudi Arabia: Onward and Upward

The Saudi Critical Care Society (SCCS) established the Saudi Critical Care Trials Group (SCCTG) as the first investigator-driven clinical research consortium in the discipline of critical care in Saudi Arabia. The group strives to promote trustworthy critical care trials, facilitate collaboration in national and international clinical research, and align these initiatives with the National Vision 2030.[1,2] Its ultimate goal is to improve the outcomes of critically ill patients. Since its inception, several studies by the SCCTG have been published in renowned medical journals. In September 2023, the SCCTG held a hybrid (onsite in Riyadh and virtual) meeting of a focused group of researchers to lay down future strategies for elevating critical care research in Saudi Arabia. Eleven researchers with different levels of research experience and from various institutions across Saudi Arabia presented and discussed their perspectives on the current state of critical care research in Saudi Arabia and its strengths and barriers. Additional four provided written input. This manuscript outlines the key points that were raised during the meeting [Table 1].Table 1: Strategies to promote critical care research in Saudi ArabiaImproving Research Infrastructure Research infrastructure comprises resources and services for research communities, including human capital, research funds, patient participants, information and data processing systems, and regulatory pathways. Despite the substantial achievements in Saudi Arabia in recent years, improving research infrastructure remains a crucial strategy. The group members highlighted several areas for improvement, including policy on medical research, human capital (e.g., trained researchers, methodology experts, biostatisticians, and research coordinators), large datasets, and funding opportunities [Table 1]. The focused researcher group emphasized the need to focus on efficiency as part of the national policies and procedures for scientific and medical research. The group also recommended implementing national clinical registries, akin to the Case Mix Program of the National Health Service in the United Kingdom.[3] These registries could result in large clinical datasets, which can be used to improve the quality of healthcare and offer opportunities for clinical research.[4] Funding opportunities for medical research should support multicenter clinical research, particularly clinical trials.[5,6] Building Research Capacity Building research capacity involves expanding the pool of individuals with expertise in designing, setting up, and delivering high-quality research. This is essential for scientific development in Saudi Arabia and for increasing the medical knowledge in general. The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak in Saudi Arabia highlighted the importance of national research efforts in understanding the disease and determining the optimal care for MERS-CoV patients.[7,8] Capacity building often begins with incorporating research into college curricula and continues after graduation. The identification of potential investigators or research coordinators among the existing health-care workforce is often performed by senior researchers. This is usually supplemented by additional education on research methodology as well as training on relevant research tasks and skills.[1] The SCCTG has offered specialized courses and workshops to educate and train intensive care unit (ICU) health-care providers on clinical research. Critical care residency and fellowship programs in Saudi Arabia require each resident to complete a research project with publication for successful completion of residency. Residents were encouraged to present their research projects at national and international conferences. Over the last several years, several of these projects were presented at the annual SCCS conference and other international critical care conferences.[9,10] This could create competition and motivation for future research participation. Residents and fellows received training, assistance, and supervision in scientific writing and submission to medical journals.[11] Other areas for improvement to promote research by ICU residents and fellows are shown in Table 1. Further enhancement of the research curriculum for the residency/fellowship and training rotations will help facilitate the completion of research projects before graduation. Another key strategy to build research capacity is to establish critical care research fellowships. These fellowships can prepare the next generation of leaders in critical care research in Saudi Arabia, by providing structured training in research design, methodology, statistics, and ethical considerations specific to critical care research. To make these fellowships successful, multidisciplinary collaboration is essential. Universities, credentialing authorities, major hospitals, and academic groups all have a role to play. By working together, these stakeholders can create a robust ecosystem that fosters the growth of critical care research in Saudi Arabia. Establishing a Teamwork Environment Collaborative research is generally more effective than local investigative research in addressing research questions and completing large studies. The work of the Saudi critical care community during the MERS-COV outbreak, and the coronavirus disease 2019 (COVID-19) pandemic which demanded extensive networking and collaboration, and effective team creation, underscores the importance of teamwork in clinical research.[7,12–15] Building a team involves bringing individuals together and developing a common research goal while establishing psychological safety for all team members.[16] Key points in establishing a teamwork environment include identifying the right people for the research team, utilizing the individual team members’ strengths, investing in mentorship and education, maintaining open communication within the team, and fostering a collaborative attitude.[16] Learning and using team science[16] to establish research teams, learning management skills by research leaders, and engaging trainees in major research activities are interventions that would enhance the team environment [Table 1]. Networking to Foster Multicenter Research Networking is vital for multicenter research. It involves collaborative efforts and coordination between multiple centers to address common research questions. The benefits of multicenter research include study efficiency, enhanced generalizability of findings and shared resources and expertise. Multicenter research may facilitate learning about team building and research processes, especially when the principal research center has a strong track record in conducting research. However, multicenter research is complex and requires active participation and engagement from all centers as well as clear and frequent communication throughout the collaboration period. The success of networking through the SCCTG has been demonstrated through multiple projects, such as the multicenter registry for critically ill patients with MERS-CoV,[7] the multicenter quality improvement NASAM project,[17] the multicenter trial Helmet-COVID-19 trial,[15] and the ongoing REPLENISH trial.[18] Promoting SCCTG during national meetings and presenting research projects may attract new investigators and expand the SCCTG network. A national research network that links academic medical centers as well as community hospitals should be a primary goal [Table 1]. Networking with regional and international research groups is an essential step in promoting national research. Multiple presenters reported that the partnership between Saudi research teams and such groups was growing.[7,12,13,15,17,18] Addressing Other Research Barriers The focused research group discussed how to give more weight to the importance of clinical research in busy clinical practice, as both excellence in clinical practice and research complement each other [Table 1]. Another important consideration is how to enhance training in research among different health-care providers. Although trainees are required to undertake research projects during their training, clear regulations, and expectations should be set. The question of whether research requirements should be implemented for all ICU residents and fellows, or only for a subset of them, was debatable. This issue warrants further investigation, particularly through an evaluation of the research productivity of the current ICU residents and fellows. By assessing their research output, we can better understand their research capabilities and interests, which could inform a more tailored and effective approach to research education within the ICU training programs. This could ultimately aid in the development of an effective policy that fostered research growth while also considering the diverse interests and capacities of the trainees. Another area that would likely facilitate research is improving the skills in application for grants and research grant proposal writing.[19] Senior SCCTG members may serve as valuable resources for junior investigators to gain such skills. As research funding opportunities were increasingly accessible to researchers in Saudi Arabia, offering specialized workshops on grant writing and submission could prove highly beneficial. Moreover, a clear mechanism for handling funds from sponsored research, including clinical trials would be very important. Building capacity in qualified research personnel, including experienced clinical trial coordinators and trial managers, is an important goal. This challenge pertained to capacity building which was discussed in a previous section of this article. Some research groups have implemented checklists to ensure compliance with relevant institutional approvals, data protection and sharing policies, and other regulations. However, the heavy workload in the ICU and the lack of protected time for research continued to be significant barriers. Ensuring a protected time for research, financial compensation and recognition were potential ways to overcome this barrier. The group also emphasized the need for a more efficient approval process to reduce the complexity of multicenter research and increase efficiency.[20] As critical care research grows in Saudi Arabia, new strategies should be created to facilitate this growth. This would be achieved by further improvement of research infrastructure, capacity building, establishment of research teams, and more effective networking and by addressing research barriers. By addressing these areas, we can strengthen the role of research in improving patient care and outcomes, ultimately leading to the advancement of healthcare. Moreover, these efforts could serve as a model for critical care networks globally. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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