Interview with Grégoire Boulouis, MD MSc, Fellow of the ESO, Department of Neuroradiology, Université Paris Descartes, Sainte Anne Hospital, Paris, France

Interviewed by Johannes Kaesmacher MD, from the Department of Radiology and Neuroradiology, Bern University Hospital, Bern, Switzerland.

Dear Greg, first of all, many thanks for agreeing to do this interview. Would you mind telling us a little bit about your career, current position, level of training and what your main fields of interest in stroke and neurovascular research are?

Thanks a lot Johannes for the invitation. I completed my residency in Radiology in Lille and I am currently finishing a clinical fellowship in diagnostic interventional neuroradiology at Sainte Anne Hospital in Paris, with part time activity in pediatric INR at Necker Children’s Hospital. In between I was a research fellow in Boston, at the JP Kistler Stroke Research Center. My main research focus is on neuroimaging biomarkers of stroke prognosis, mostly in the acute phase.

Together with your colleagues, you have recently founded the Jeunes En Neuroradiologie Interventionelle (JENI) Research Collaboration. Can you tell us a little about this collaboration? What were your main ideas and motivations behind the establishment of such research collaboration? How did you manage motivating young colleagues to join?

The JENI-RC is a recently launched trainee-led research collaboration, federating young neuro-interventionists, stroke neurologists and neurosurgeons in France and Switzerland. At the heart of the JENI is the will to foster collaboration and multi-center synergies, and carry the interests of all junior practitioners with the ultimate goal to improve patients’ outcomes. As of today, we are 75 trainees, covering almost all neuro-intervention capable French centers.

The JENI was born from the, not so original, idea that in the modern research environment, collaboration is not an option and also from a “good planet alignment” at the national level, which I’ll elaborate below.  Initial discussions surrounding the establishment of the JENI-RC, have also been catalyzed by the dynamism of trainee led networks in the UK, which proved to be at the heart of novel cooperative approaches to research, driving substantial additional research involvement across Great Britain and yielding high quality research reports and trials. In some sense, the way was already paved, and we followed the example of successful trainee led research collaborations.

It is fascinating to note that trainee led research collaborations solve many of the tensions that trainees may encounter in their early career paths. First, the frequent department rotations make it more complicated for trainees to launch and conduct mid-term research projects at a single institution. Second, the inherently multicentric nature of these networks allows for more ambitious projects with ultimately less frustration on the path to publication and positive research experiences. Third, the oldest trainees may act as intermediate mentors to catalyze productivity and positive accompaniment, as they become independent investigators, allowing younger trainees to gain research experience with more direct training interactions. Fourth, there is a strong generational will to federate and build cooperative projects, rather than battling for one’s own professional development (a trait that Y generation trainees probably tend to consider as less meaningful). Last but very not least, the key ambitions that support the creation of a trainee led research collaboration are all virtuous: improving patients outcomes, high quality research output, collaboration, exchange, sharing… and these goals are fundamentally appealing for trainees that consider a career in academia, as well as those who only want to follow a purely clinical path. So to answer your last question, the only challenge for motivating our young colleagues was to distinctly enumerate these points and the advantages for patients, research, their respective institutions, and their career.  Then when the wick was ignited, I’d say that there was such a global enthusiasm, that there was not much challenge before launching the first projects. It is important to note that modern information and communication systems make it so much easier to conduct multicenter research, and that technological aspects are not an issue in 2019, as it could have been one decade ago.

What were the main obstacles to overcome during the foundation phase? What are main problems you encounter today, e.g. maintaining an active participation of the members?

We waited almost a year before writing the JENI-RC constitution and engraving the principles, missions and objectives of the collaboration. Like most collaborations, I guess, everything cannot happen virtually, and the foundations cannot be laid on piles of email threads. Many discussions took place during national neuroradiology courses, conferences, or informal meetings and I think that a strong core based on friendship and trust overcomes all main obstacles in the elaboration of a trainee led research collaboration.

This being said, we all agreed that to set bases for a virtuous dynamic and perennial environment, we needed to put down in writing some key functioning principles, which we did in our constitution. The principles are very simple. First, if a trainee would like to become a member of the JENI-RC, she/he should be fundamentally willing to collaborate (e.g. not use the network to serve his interest). The distinction is subtle but, we hope, will insure the sustainability of the system through a global understanding of the collaborative nature of the network. Second, there are clear prespecified authorship rules (a common matter of frustration amongst trainees), and an executive instance to prioritize research propositions and arbitrate potential tensions. Very importantly, the JENI-RC would not exist without the benevolent aegis of our national neuroradiology society (www.sfnr.net), and the support of many accomplished neuro-interventionists. Since the aim of the network is to conduct high quality research, the role of mentors is absolutely central and should be prioritized when laying the foundations of such collaboration.

To answer the second question, since we are really at the beginning of our development as a research collaborative, I’d say that there are not many problems in maintaining active participation. So far we’ve conducted 3 national surveys, 2 multicentric retrospective studies, and are on the way to launching 2 randomized controlled trials and 2 national audits, so everyone is busy, and enthusiastic. Our hope is that once we see the first research outputs, hopefully soon, this will renew enthusiasm amongst the JENI-RC members, and that this system will enhance growth and a global increase in research involvement amongst trainees. One question that we also addressed in our constitution is what should happen to trainees when they are not trainees anymore (we defined this as after 10 years following specialty diploma). It is clear that to maintain an active network of trainees, as members become fully trained investigators or clinicians, they may not actively participate in the research network anymore but will serve as advisors and mentors in a virtuous training/mentoring circle.

What is your idea of how such collaborations can be implemented at a multi-national level?

The only drawback I see could be regulations, but with good counseling and the benevolent will of the scholarly societies, this is definitely the way to go. This would only work though if the projects are pragmatically thought, simple, and cherry picked amongst most relevant and timely research topics, so to enhance participation. The ESO Conference would be a great platform to meet and discuss opportunities for massively multicentric, trainee-led, research projects and how to articulate a supra national trainee-led research collaborative with the YSPR ESO committee. Many thanks Johannes, and the ESO-blog for this platform for the JENI-RC.

Once again, congratulations on the initiation of a very important research collaboration. We are definitely looking forward to see great analyses coming from the JENI-RC group, which will certainly help to answer important research questions in contemporary acute endovascular stroke care.

Twitter:

@sfnr_jeni

@gboulouis

Links :

http://www.sfnr.net/neuroradiologie-quotidien/jeunes-en-neuroradiologie-interventionnelle-jeni

https://www.em-consulte.com/en/article/1226575