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Claudia Ashton

The IDEAL Collaboration is an initiative to improve the quality of research in surgery. It is:
-A model that describes the stages of innovation in surgery: Idea, Development, Exploration, Assessment, Long-term study.
-A set of recommendations at each stage of the model that have been developed by experts in evidence-based surgery, for example on improving methodology and how to address the challenges of randomized controlled trials in surgery.
-A international group of surgeons, researchers, journal editors, methodologists, statisticians, and other people who are committed to producing, disseminating, and evaluating quality research in surgery.

Critical appraisal of the surgical literature: Application of the IDEAL framework

09:00 Wednesday june 21st

Background: Evaluation of new surgical procedures is complex. In contrast to pharmaceuticals for which valid evidence of safety and efficacy must be provided via a robust pathway of randomised controlled trials before licensing, surgical innovations frequently gain acceptance following a series of biased observational studies. This relative lack of regulation, together with the unique characteristics of these complex interventions, has resulted in persistent difficulties in obtaining high-quality evidence for surgical innovations. Assessment of new surgical interventions is complicated by a specific set of problems. These include the difficulty in defining surgical procedures precisely, iterative modification of procedures by surgeons during development, lack of agreed standard outcomes in surgery, operator learning curves, variable procedural quality (dependent on training and operative capabilities), as well as strong treatment preferences among patients and clinicians. Recognition of these difficulties led to the development of the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) Framework and Recommendations, in an attempt to establish a more scientifically rigorous and ethical evaluation pathway. [1,2]

The aim of this workshop is to use the IDEAL Framework as a tool to critically appraise the surgical literature to help understand and identify the key features of evaluation needed at each stage of innovation.

Target audience: Surgeons and non-clinical professionals involved in planning, conducting and publishing surgical studies as well trainees from all disciplines.

Learning objectives:

  • Understand the purpose of IDEAL and why it is necessary
  • Understand each stage of the Framework and relevant questions at each stage
  • Appraise a surgical study by identifying the IDEAL stage of the procedure described in the paper
  • Learn how to apply the IDEAL framework and recommendations practically by designing studies to progress through the life-cycle of a surgical innovation


  1. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC et al., No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009 Sep 26;374(9695):1105-12
  2. Pennell, C.P., et al., Practical guide to the Idea, Development and Exploration stages of the IDEAL Framework and Recommendations. British Journal of Surgery, 2016. 103(5): p. 607-615.

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