Multi-site clinical-research network using CRediT for surgical-research outputs

Profile

Composite institution profile

The challenge

What problem were they trying to solve?

Surgical research has a long-standing contributor-recognition problem: the lead surgeon-investigator is almost always the corresponding author and often the last author, the trial methodologist (frequently a non-clinical statistician or epidemiologist) is buried in the middle of the author list, the research nurse who recruited the patients may not be on the paper at all, and the data analyst who ran the analysis is variably credited. The network had signed up to ICMJE authorship guidelines, the CONSORT reporting standard (and SURGICAL-CONSORT extensions), and CRediT — but the three frameworks had not been operationalised together. The NIHR portfolio reporting requirement made the gap concrete: when the network reported a multi-site trial output to NIHR, the structured contribution data did not match the authorship order on the paper, and the network had no defensible process for resolving the difference. A senior surgeon-researcher commissioned a network-wide implementation that would handle CRediT, ICMJE, and CONSORT consistently, with explicit attention to the contribution patterns specific to surgical research.

The approach

How they implemented it

The network adopted CRediT at the protocol-design stage rather than at submission, which was the project's biggest single architectural decision. From 2025 onward, every new trial protocol included a CRediT-roles plan as part of the writing-group charter — that is, before any data was collected, the writing group agreed which contributors would take which CRediT roles, recognising that some roles (Investigation, Data Curation) would be distributed across many staff at multiple sites while others (Conceptualization, Funding acquisition) would be concentrated. The protocol-level plan became the source of truth; at publication time the writing group reviewed and amended it rather than constructing it from scratch. CRediT capture used the existing Symplectic Elements deposit workflow at the lead academic site, extended to consume the protocol-level plan as the default seed for each output. NIHR portfolio reporting was handled by a CRediT-aware reporting layer that emitted both the structured CRediT statement (for downstream Crossref deposit) and a CONSORT-compliant authorship-and-contribution paragraph for the published paper. The network added a research-nurse contribution policy explicitly: research nurses who met ICMJE substantial-contribution criteria became authors with the appropriate CRediT roles (Investigation, Project administration), and those who did not meet ICMJE criteria were credited in the acknowledgements with role descriptors drawn from CRediT vocabulary even though they were not in the authorship list — a deliberate use of CRediT vocabulary for non-author contribution recognition.

Timeline

Rollout phases

1. Months 1–3

   Protocol template + CRediT plan

   Trial-protocol template extended to include a CRediT-roles plan in the writing-group charter. Twelve in-flight trials retro-fitted; eight new trials launched with CRediT plans from day one.

2. Months 4–6

   Research-nurse contribution policy

   Network-wide policy on research-nurse authorship and acknowledgement. ICMJE-meeting nurses become authors with explicit CRediT roles; non-ICMJE nurses get CRediT-vocabulary acknowledgement language.

3. Months 7–9

   Symplectic + NIHR reporting integration

   Lead-site Symplectic deposit workflow extended to seed from the protocol-level CRediT plan. NIHR portfolio reporting layer emits both structured CRediT and CONSORT-compliant authorship paragraph.

4. Months 10–12

   First six publications under new process

   Six surgical-research outputs published with protocol-grounded CRediT statements. Writing-group reviews unanimously preferred the new process to the legacy "argue at submission time" approach.

5. Year 2

   Extension to 11 sites + training

   Network-wide adoption across all 11 hospital sites. Two-day training for site-level research coordinators run quarterly. CRediT-aware NIHR reporting now the network default.

Outcomes

Illustrative outcomes

Every metric below is illustrative — synthesised from observed patterns across multiple adoption journeys, not attributed to a single real institution.

Lessons learned

What they would tell the next institution

• 01Doing CRediT planning at protocol stage was the highest-leverage decision. Trying to construct contribution attribution at submission, after the data has been collected and the analysis done, almost always produces disputes. Doing it at protocol time, before data collection, produces a plan that gets refined rather than fought over.
• 02Research-nurse contribution recognition is a CRediT use case that surgical-research had been missing. Even where nurses do not meet ICMJE authorship criteria, CRediT vocabulary in the acknowledgements gives them defensible, structured credit.
• 03CONSORT and CRediT are complements, not alternatives. CONSORT structures the trial methodology; CRediT structures who did the work. Operationalising both together gave a fuller picture than either alone.
• 04Site-level adoption required quarterly training. Surgical research has high staff turnover, and a one-off training session at year one would not have held through year three.
• 05Honest acknowledgement language matters. The network deliberately did not use vague "thank you to the research team" phrasing; the new acknowledgements name research nurses, data managers, and trial coordinators with CRediT-vocabulary role descriptions.

What's next

Planned next steps

The network is now extending the CRediT-aware reporting to cover its perioperative-medicine quality-improvement registry (a non-trial output type with its own contributor patterns) and is working with NIHR to feed the protocol-stage CRediT-planning model into the NIHR funding-application template. The network is also contributing case-study data to the surgical-research discipline page at /for-authors/discipline/surgical-research so that other surgical-research networks have a reference implementation.

Q&A with the composite project lead

Composite project-lead Q&A

The questions and answers below are composite — synthesised from interview patterns across multiple real project leads. They are not attributed to a specific real person.

Why plan CRediT at protocol stage rather than at submission?

Because the contributors are present and the project is unwritten. At submission time, the data is in, the analysis is done, and one of the lead contributors has already drafted the paper — that is exactly the wrong moment to discover that two senior co-authors disagree about who Conceptualised the work. Planning at protocol time forces the conversation when it is cheap and the answers are easier to reach.

How do you handle a research nurse who genuinely meets ICMJE substantial-contribution criteria?

They become an author. Full stop. ICMJE is unambiguous on this point and we operationalise it: substantial contribution to acquisition (Investigation), drafting or revising (Writing — review and editing), and final approval and accountability — if all three are met, authorship is not optional. The policy change was politically harder than the technical change; some senior surgeons were not used to research nurses being on author lists. The network framed the change as ICMJE compliance, not as institutional preference.

What about contributions that do not fit ICMJE but should still be visible?

CRediT vocabulary in the acknowledgements. A research nurse who met two of the three ICMJE criteria gets a structured acknowledgement: "Nurse X led patient recruitment and data acquisition (Investigation)." That is more meaningful than the generic "thanks to the research team" the network used to publish, and it gives the contributor something they can cite on their own CV.

How does CONSORT fit alongside CRediT?

CONSORT structures the methodology disclosure; CRediT structures the contribution disclosure. They never compete. A surgical-trial paper now has a CONSORT diagram describing the trial design and a structured CRediT statement describing who contributed what. The two together give a reviewer everything they need to assess the work without the ambiguity that authorship-order alone produces.

Cited CASRAI resources

Internal CASRAI resources referenced

• ›Dictionary: CONSORT reporting standard
• ›Dictionary: ICMJE authorship criteria
• ›Dictionary: Clinical trial registry
• ›CRediT role: Investigation
• ›CRediT role: Project administration
• ›CRediT role: Methodology
• ›Discipline guide: Surgical research
• ›Discipline guide: Clinical trials
• ›NIHR CRediT statement guidance
• ›Implement: Elsevier Pure
• ›Medical research: clinical trials
• ›Implementation checklist: research integrity