MCCCARS – History and
2003 Report
Reynaldo O. Joson,
MD, MHA, MHPEd, MS Surg
January 15, 2004
On May 16, 2002, I established the MCCCARS, which stands for
Multi-center Cooperative Collaborative Action Research Study based on the
following rationale and concept:
Situation:
Basic
Concept:
Secretariat
– Department of Surgery of Ospital ng Maynila Medical Center under Dr. Reynaldo
O. Joson
Output
expected: Multi-center cooperative and collaborative action research papers
Impact
expected:
Who can join:
Anybody, at
any stage of training or experience, who is interested, can communicate through
email with the secretariat, and willing to follow rules and regulation of the
secretariat.
As of October, 2002, 17 surgeons subscribed to the e-group of the MCCCARS and these surgeons were affiliated with 8 different centers distributed over Metro Manila, other parts of Luzon, the Visayas, and Mindanao (Ospital ng Maynila Medical Center; Philippine General Hospital; Manila Doctors Hospital; Zamboanga City Medical Center; Davao Regional Hospital; Visayas Community Medical Center, Batangas Regional Hospital; Region 1 Medical Center).
As of December, 2003, about 70 surgeons are now subscribed
to the egroup of the MCCCARS.
An e-group (mcccars@yahoogroups.com)
and a website (http://mcccars.tripod.com)
were set-up to facilitate communication among members of MCCCARS.
For the year 2002, there were two multi-center cooperative
and collaborative action research studies completed, namely:
1. Reducing the discrepancy of clinical and pathological
tumor and nodal evaluation in patients with breast cancer
2. Is a recumbent plain abdominal x-ray (without an upright
film) sufficient in the evaluation of patients with acute intestinal
obstruction?
These two papers were presented in various research forums
and contests. See Table 1.
Table 1. Research forums and contests joined.
Action research
study |
Research forums and
contests |
Recognition |
1. Reducing the discrepancy of clinical and pathological
tumor and nodal evaluation in patients with breast cancer |
August 12, 2002 – Manila Doctors Hospital Research Paper
Contest |
|
|
August 13, 2002 – Ospital ng Maynila Medical Center
Department of Surgery Research Paper Contest |
3rd prize |
|
September 27, 2002 – Philippine Society of General
Surgeons’ Regional Research Contest |
Finalist – no prize |
|
September 28, 2002 – Philippine College of Surgeons’ Regional Research Paper Contest |
2nd prize |
|
December 1, 2002 – Philippine College of Surgeons’ Annual
Research Paper Contest |
Finalist- no prize |
|
|
|
2. Is a recumbent plain abdominal x-ray (without an upright
film) sufficient in the evaluation of patients with acute intestinal obstruction? |
August 12, 2002 – Manila Doctors Hospital Research Paper
Contest |
3rd prize |
|
August13, 2002 – Ospital ng Maynila Medical Center Department
of Surgery Research Paper Contest |
|
|
September 27, 2002 – Philippine Society of General
Surgeons’ Regional Research Contest |
Finalist – no prize |
|
September 28, 2002 – Philippine College of Surgeons’ Regional Research Paper Contest |
3rd prize |
|
December 1, 2002 – Philippine College of Surgeons’ Annual Research Paper Contest |
2nd prize |
The paper “Reducing the discrepancy of clinical and pathological tumor and nodal evaluation in patients with breast cancer” has already been published in the Philippine Journal of Surgical Specialties, July-September, 2003.
The other paper “Is a recumbent plain abdominal x-ray
(without an upright film) sufficient in the evaluation of patients with acute intestinal
obstruction?” will be submitted for publication in journal which subscribed to
action researches.
For the year 2003, there were three multi-center cooperative
and collaborative action research studies completed, namely:
1.
A Quality Study
on Fibrocystic Breast Changes Operations
2.
A Survey on
Mammography Utilization in the Philippines with Focus on Certain Quality
Parameters
3.
A Quality Study
on Mammography-guided Needle Localization Biopsy of Non-palpable Breast Lesions
These three papers
are being prepared for publication.
Evaluation:
The
multi-center cooperation and collaboration was able to solve the logistic and
technical problems encountered by some centers in data gathering, patient
accrual, and validity testing of proposed solutions.
The multi-center cooperative and collaborative action research studies have been producing the following impact:
1.
Utility
(problem-solving and improvement in patient care) not only in one institution
but also in multiple institutions and simultaneous at that
2.
Learning
of research methodology by participants in the process of cooperating and
collaborating
3.
Motivation
to do research in the process of cooperating and collaborating
Unlike in 2002, in 2003, the papers were focused on centers
in Metro Manila. Hopefully, in 2004,
centers outside Metro Manila will again participate.
Reflection:
1.On the action
research
Action research is a methodology that pursues action (change) and research (understanding) at the same time and which consists of four basic themes: empowerment of participants; collaboration of participants; acquisition of knowledge; and social change.
From the 2 action research studies completed, evident were
the empowerment and collaboration of the participants in instituting change at
the same time acquiring better understanding of the problem being solved.
The action research methodology used in these two projects
followed the concept as defined by Cohen and Manion (1), that is,
"small scale intervention in
the functioning of
the real world and a close examination of the effects
of such intervention." It is
situational in that it is concerned with diagnosing a problem in a specific
context and attempting to solve it in that context. Usually collaborative teams of researchers and practitioners work
together on a project. It is participatory in the sense that the team members
themselves take part directly or indirectly by implementing the research. Lastly, it is self-evaluative in that
modifications are continually evaluated within the ongoing situation, the
ultimate objective being to improve practice in some way or another.
While experimental research is
concerned mainly with establishing relationships and testing theories, action
research has, as a focus, a specific problem in a specific setting. It makes no
attempt to identify one particular factor and study it in isolation divorced
from the context giving it meaning.
As Margules(2) points out, "in combining action
processes (planning, implementation, and evaluation) with research processes
(problem identification, hypothesis formation, and testing), the result is a
sequence of steps and activities that identify the relevant events that must
happen in the initiation and implementation of change."
The essential steps in action research are the following:
analysis of the problems, research designs on how to solve the problems,
implementation of an action plan and evaluation of results of implementation.
In the Philippines, most of the medical researches done are
not of the action research type. Thus,
their utility just ends in being published in journals. They are not being used by the people in the
institution of origin of the research papers.
More so, they are not being used by people outside the institution of
origin.
The other problems in conducting research projects in the
country are the number of clinical subjects and lack of resources.
These action researches have shown how a real world problem was being solved systematically, cooperatively, and collaboratively. The multi-center cooperative and collaborative effort has illustrated the advantages of sharing of resources. The ultimate impact of this action research consists of solutions of problems and implementation of improvement measures in patient care being simultaneously undertaken in several centers in the country.
Unfinished tasks:
1.
Continuous search and incorporation of new data to
refine and strengthen the information on hand
2.
Institutionalization of the validated clinical practice
guidelines in participating centers
3.
Dissemination of the results to promote changes in
other centers in the country
2. On the email group
and website
The use of email and a website definitely facilitated communication
among the members of the MCCCARS who were stationed in various parts of the
country.
The use of email group or egroup (mcccars@yahoogroups.com)
facilitated surveys and focused group discussion. An email sent by a member of the group is seen simultaneously by
all the members of the group. An answer
to a question or any reaction posted by a member is seen simultaneously by all
the members of the group.
The website (http://mcccars.tripod.com)
posted all the synthesized discussions of the group.
The difficulties encountered in the egroup were not with the
email system but with the members. The
silence of the members tended to bog down the schedule and progress of the
action research study. Silence may be
due to members not opening their emails regularly and at least once a week as
agreed upon or if they do, they were shy to give feedback and would rather
watch the interactions of the other members. To keep the interactions and
project continuously running and progressing, the secretariat or moderator had
to be patient and perseverent in sending emails at least once a week to keep
the flame burning, setting deadlines for each activity, sending out reminders,
and other strategies that would make research relatively easy for the
members. Fortunately, in the end, there
were adequate number of centers and members who participated for the action
research studies to be completed. In
the future, more effective and efficient strategies would have to be worked out
to make the tasks of the secretariat easier.
REFERENCES:
1. Cohen L, Manion L. Research Methods in
Education. London, Croom Helm, 1980.
2. Marguiles N. Managing change in health
care organization. Medical Care 1977;15:693-704.