Strategies for Building Effective Clinical Trials Networks

Cameron Bosinski, MD, MS

At the 2026 Annual Meeting, presented by IARS and SOCCA, a dynamic roundtable, “Clinical Trials Roundtable Breakout Session,” on clinical trials network strategy brought together investigators across the world to talk about how to strengthen collaboration, overcome persistent barriers, and accelerate high-impact perioperative research. The conversation underscored both the power of personal relationships and the transformative potential of formal networks, while candidly addressing the structural challenges—particularly in the United States—that continue to limit trial scale and efficiency.

The expert investigators included:

• Allison Janda, MD, assistant professor of anesthesiology at the University of Michigan,
• Douglas Colquhoun, MB ChB, MPH, assistant professor of anesthesiology at the University of Michigan,
• Frederic Billings, MD, professor of anesthesiology, cardiothoracic anesthesiologist and intensivist physician scientist at Vanderbilt University,
• Joyce Yeung, MBChB, PhD, who leads the Emergency, Prehospital, Perioperative and Critical Care (EPPiC) Trials Group within the Clinical Trials Unit at Warwick Medical School, and is a consultant in critical care and professor of anaesthesia and critical care medicine at the University of Warwick, director of the Centre for Research and Improvement at the Royal College of Anaesthetists and NIHR National Specialty lead for anaesthesia, perioperative medicine and pain management,
• William Scott Beattie, MD, PhD, FRCPC, professor in the Department of Anesthesia, University of Toronto, Faculty of Medicine,
• Daniel McIsaac, MD, MPH, FRCPC, professor and vice chair (research and innovation) of anesthesiology & pain medicine at the University of Ottawa, a scientist at the Ottawa Hospital Research Institute, senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and an anesthesiologist at the Ottawa Hospital,
• Jessica Spence, MD, PhD, FRCPC, assistant professor of anesthesia at McMaster University, an Investigator at the Population Health Research Institute, and an anesthesiologist and intensivist at Hamilton Health Sciences,
• Ronald Pearl, PhD, MD, FCCM, Richard K. and Erika N. Richards Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University,
• Emilie Belley-Côté, MD, PhD, a cardiologist-intensivist and a clinical trialist at McMaster University, and
• Kimberly Rengel, MD, MSCI, an Assistant Professor of Anesthesiology in the Department of Anesthesiology, Division of Anesthesia Critical Care Medicine at Vanderbilt University Medical Center.

Personal Connections Remain the Foundation

Panelists repeatedly emphasized that successful trial participation begins with relationships rather than infrastructure alone. Attending meetings, presenting trial data, and following up with colleagues who express interest remain highly effective ways to identify motivated partner sites. One speaker noted that starting with smaller, per-patient-funded studies can build momentum before scaling to more complex protocols.

Formal networks add critical value by expanding the pool of collaborators beyond an investigator’s immediate circle. They provide access to new sites, mentorship for early-career researchers, and structured opportunities for secondary analyses. Several participants described how mentees or junior faculty have successfully led secondary-use projects from ongoing trials, creating additional engagement pathways even when a site is not the primary enrolling center.

Staffing and Infrastructure Realities Differ Markedly

A recurring theme was the stark contrast in operational models between the United States and peer nations. US sites often field large teams of coordinators, research assistants, and regulatory specialists, yet still struggle with high overhead, limited per-patient reimbursement, and difficulty retaining experienced staff. In contrast, Canadian and UK sites frequently accomplish comparable work with leaner teams, partly because government investment has prefunded research personnel and standardized master clinical trial agreements.

US investigators described the frustration of negotiating contracts for every study and the reality that even well-funded National Institute of Health (NIH) grants leave little margin after institutional F&A costs. One panelist running a device trial noted that paying approximately $1,000–$1,500 per patient still required sites to subsidize significant coordinator time, resulting in fewer patients enrolled and underpowered studies.

Creative staffing solutions were shared as practical workarounds. Several centers have successfully integrated:

• Surgical residents fulfilling mandatory research years
• Biomedical engineering students seeking clinical exposure
• Undergraduate thesis students for lower-complexity tasks
• Gap-year or postbaccalaureate students motivated for medical school applications

These trainees perform well when paired with seasoned research coordinators who maintain culture, quality, and regulatory oversight. Summer-only students, however, were generally viewed as inefficient due to the steep training curve required for complex protocols.

Lessons from Platform Trials and International Models 

The UK RECOVERY trial’s rapid success during the pandemic served as a compelling benchmark. By leveraging pre-existing “portfolio hospitals” with funded research staff and master agreements that minimized contract negotiation, the UK was able to answer multiple questions across dozens of sites in months rather than years. Australia has adopted a similar approach, attracting industry trials through operational efficiency.

Panelists advocated for analogous US investments—government or foundation support for a cadre of research nurses and coordinators that persists across funding cycles, much like the quality-improvement infrastructure already present in networks such as NSQIP, STS, or Michigan’s Empire collaborative. One participant observed that these quality networks demonstrate how stable staffing can be maintained when institutions view the personnel as core infrastructure rather than grant-dependent line items.

Pragmatic trial design was also highlighted as essential for efficiency. Collecting only the data required to answer the primary question (enrollment, intervention delivery, and key outcomes) avoids the “fluff” that inflates workload and cost. Several participants warned against the temptation to add extensive observational or biospecimen components that ultimately go unanalyzed.

Mentorship, Capacity Building, and Future Directions

The roundtable stressed the mentorship role networks can play. Presenting nascent ideas to experienced peers allows refinement before formal submission, turning networks into “idea incubators.” Self-selection then determines participation rather than top-down mandates, ensuring only feasible sites commit.

Looking ahead, participants called for:

• Searchable databases matching interested investigators with sites that have matching infrastructure and patient populations
• Greater institutional willingness to “spot the gap” during funding lulls to retain high-performing staff
• Continued advocacy for platform-trial frameworks that smooth the boom-and-bust cycle of individual grants

One senior investigator closed with a practical career lesson: early involvement in NIH study sections and grant review provides invaluable insight into what gets funded and builds the credibility that later proposals require.

Moving Forward Together 

The session concluded with a clear message: Clinical trials networks are not a replacement for personal relationships but a powerful multiplier. By combining the trust built through direct collaboration with the scale and efficiency of formal structures, the perioperative research community can overcome current constraints and deliver the large, rigorous trials needed to improve patient care. As one panelist aptly summarized, the goal is not merely to survive the current funding environment but to build systems that make high-quality research sustainable and scalable for the next generation of investigators.