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:

  1. 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.
  2. Most research projects are met with problems of know-how on research methodology, number of clinical subjects, and lack of motivation.

 

Basic Concept:

  1. Action research proposal drafted by a secretariat
  2. Recruitment of centers/people in centers to participate
    1. Discussion of action research proposal
    2. Implementation of proposal, particularly recruitment or accrual of clinical subjects
    3. Submission of results to secretariat
  3. Writing of the final paper by the secretariat (with approval of all concerned)
  4. Publication of the final paper

 

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:

    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

 

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.