graduate school for health research share self evaluation ......8 graduate school for health...

6 Graduate School for Health Research SHARE Self evaluation 2003 - 2008

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SHARE at the institutional level

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1 I nt ro d u c t io n

This report describes the development of the Graduate School of Health Research SHARE (formerly known as the Northern Center for Healthcare Research (NCH)) and the results obtained over the 2003-2008 period. The aim of this report is to take stock of our situation in the light of the 2004 site visit, which covered the 1997-2002 review period, and thereby to describe the developments, content and quality, as well as the output of our work over the 2003-2008 period. We will also discuss several aspects of the (changing) situation up until the summer of 2009 and the developments planned for the coming years. To some extent, this chapter may be regarded as following on from our earlier response to the site visit. In this introductory chapter we will thus refer and react to the report of the Peer Review Committee as formulated in autumn of 2004 and describe a great number of concrete activities which have been undertaken since 2004. In box 1 the summary statement of the Peer Review Committee (PRC) is shown. This chapter will introduce some of the elements described in the next seven chapters and, in addition, will present and comment on the input and output figures aggre-gated over the institution as a whole.

Box 1 Peer Review Committee (PRC) evaluation

Assessment of the mission, strategy, organization and management of SHARE

The Institute management staff is small but respected; the management control does not have a top-down structure, with the exception of management on the quality aspect of the research. The management style can be appreciated as a balance between steering and pushing researchers in a certain direction, trying to let them keep their well-appreciated independence and not to over-organize things at the same time. By organizing institute meetings and seminars SHARE creates possibilities for and facilitates interdisciplinary research within and between the different programs. Administrative procedures and external communication are rather sophisticated (as can be concluded from the SHARE website, the newsletter, etc.). By a combination of specific group expertise and theory-driven research, management aims at formulating meta questions, or to come up with a meta theory that exceeds the level of a research project and even a research program. The added value of joining and organizing research within SHARE is primarily driven by pragmatism and politics. Given the limited size of the participating research groups, SHARE is applied as a vehicle to create a research environment and to enhance visibility within the faculty. Furthermore, as a research institute SHARE receives faculty funding, including PhD scholar-ship funding and means for technical support / equipment (in competition with others) from the faculty. The disciplinary grouping of the research within the six SHARE programs seems arbitrary but can be explained by the history of the institute. The institute has a strong tradition in research on quality of life and the related tools. In future, SHARE wants to be recognized for their research on quality of life issues concerning chronic diseases such as fundamental research on adaptation to chronic disease for both the patient and people surrounding the patient. SHARE distinguishes itself from other Dutch institutes by its firm embedding in the academic hospital. By bringing researchers into close contact with clinicians a more multidisciplinary approach is made, which is complicated

9Chapter 1 SHARE at the institutional level

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to achieve but also more relevant. Good international contacts exist, but seem to develop on a more pragmatic basis; internationalization is not supported by a clear strategy. Although SHARE topics are focused on the Dutch healthcare system, comparison with systems in other countries would be an interesting approach. No clear criteria are set for entering SHARE as a full member. The management however, intends to take steps in the near future to do so and will formulate admission criteria for becoming a full or associated member. The insti-tute has access to both medical students and psychology and sociology students, mainly by participation in graduate and undergraduate education, and tries to involve them in SHARE research.

Analysis of strengths, weaknesses and opportunities of SHARE by the PRC

Strengths• The upcoming merger of the medical faculty with the academic hospital is not

seen as a threat by SHARE researchers and will be a good opportunity to facili-tate access to patient groups. Moreover the main research areas of SHARE − chronic diseases and shared-care − will be on the political agenda of the hospital and will stimulate clinicians to actively seek collaboration with SHARE groups, in contrast to the situation a decade ago

• There is a strong link with the general practitioners (through the EBM-P program)

• Merger of the academic hospital with the rehabilitation center ‘Beatrixoord’ strengthens the existing link

• The unique situation of the stable (patient) population in the northern part of the Netherlands without other universities nearby creates a lot of opportuni-ties for research

• There is collaboration with the proper national groups in the various research areas

Weaknesses• The link with the public health infrastructure in Northern Netherlands (GGD’s,

thuiszorg, etc.) is weak and needs to be reinforced and maintained• International links and collaborations are primarily ‘pragmatic’ and could be

more actively pursued

OpportunitiesOn research strategy• The research field that is covered by SHARE seems to include the core disci-

plines except for health economics and clinical epidemiology. Input on the latter field exists but is scattered and resides in different groups and institutes. The committee recommends considering the start of such a group within SHARE, and thinks it will strengthen both the quality and the sustainability of the institute as a whole

• The committee advises the SHARE to focus its research on chronic and musculo-skeletal diseases, complementary to the hospital policy


• The committee suggests that the SHARE takes optimal advantage of the unique Groningen population by performing large cohort studies

• To achieve this, systematic data collection is necessary, needing both struc-turing of the existing information systems and investments to upgrade and expand the possibilities for data collection

• The committee supports the SHARE proposal to found expert groups around central SHARE themes in order to facilitate collaboration by crossing the boundaries of different SHARE groups and profit from each others’ expertise

On PhD training• The committee strongly advises formalization and strengthening of the PhD

training by developing a sufficient mix of courses (tailor-made to the different types of students) and to anticipate a Research Master’s education

• The committee specifically advises training PhD students on qualitative research methods

OverallThe PRC rates the quality of the different SHARE programs from satisfactory to excellent, indicating that there is a difference in quality between groups. Taken together with the abovementioned the SHARE receives an overall score of very good. Some recommendations are made to maintain and develop the quality of the programs and are summarized in the assessments of the six individual programs.


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2 Re s e a rc h at t h e UMCG – a n ove r v iew

M i s s i o n a n d v i s i o n o f t h e UMCGThe most important event over the past decade has been the formation in January 2005 of the University Medical Center Groningen (UMCG) from the University Hospital Groningen and the Faculty of Medical Sciences of the University of Groningen.1 This new organization combines the best of both worlds, allowing the development of integral policy measures covering care, research, teaching, and training.

In 2007, the first discussions were held about the mission of the UMCG, which resulted in a policy document detailing the road ahead: ‘The UMCG has in recent years acquired a good reputation, on a regional, national and also, more and more, on an international level. Work is carried out in care, medical research, training and education at the highest level, without neglecting basic skills, basic knowledge, and basic care. Standing in the midst of the society, as the UMCG does, brings with it the major task of thinking ahead. The UMCG is responsible for an important share of the new developments in healthcare and, with that, is also respon-sible for the increase in, and distribution and application of medical and other knowledge surrounding care. Issues involving both healthy people and people with acute or chronic diseases are involved. This translates into the mission which underpins our existing strengths: Building the Future of Health. We can only fulfill this mission with sufficient and well-trained personnel. People make the UMCG, and for them it must therefore be an attractive place to work. This also requires a style of leadership which leaves sufficient responsibility and space for employees to excel’2.

The UMCG has selected ‘healthy aging’ as its main theme, within the framework of its mission of covering Healthcare, Research, Teaching and Training. All aging-related research has been brought together in the UMCG Institute for Healthy Ageing. The Institute forms the framework within which the other UMCG activities are embedded in the field of Healthy Aging, namely the cohort study LifeLines, the UMCG Center for Geriatric Medicine (UCO), and the impending European Research Institute on the Biology of Ageing (ERIBA).

L e a d e r s h i p The formation of the UMCG (see also the section on Organization below) has substantially improved the ability to lead. Within the Board of Directors of the UMCG (Chairman: B Bruggeman, MSc), the Dean (prof F Kuipers) is responsible for research and education. The further appointment of a Vice-Dean for Research (prof L de Leij) has led to research becoming a top priority from the level of the Board of Directors down to the lowest levels of the organi-zation.

Leadership areas affected are: recruitment of scientific talent (e.g., tenure-track policy, Rosalind Franklin Fellowship program), financial support in both the pre-award and post-award phases for scientists applying for prestigious grant schemes, development of state-of-the-art facilities (GMP, Genomics, Biobanking, mouse clinic, etc).

1 Declaration, June 2005: On behalf of the Academisch Ziekenhuis (University Hospital) Groningen, Hanzeplein 1, 9713 GZ Groningen Mr. J. Hamel (MA), the Chairman of the Board of Directors declares that as from 1 January 2005, the Academisch Ziekenhuis Groningen and the Faculteit der Medische Wetenschappen (Faculty of Medical Sciences) of the Rijksuniversiteit Groningen (University of Groningen) have entered into a collaboration under the name: Universitair Medisch Centrum Groningen (University Medical Center Groningen, University of Groningen).2 Source: ‘Building the Future of Health’. Translated from: Bouwen aan de toekomst van gezondheid, visie 2007-2011. October 2007. Copyright UMCG 2007. URL http://www.umcg.nl/Nieuws/persberichten/Documents/Visiemissie.pdf


Board of Directors UMCGLC Bruggeman (President)

JFM Aartsen

FCA Jaspers

Prof F Kuipers (Dean)

Board University of GroningenProf F Zwarts (Rector Magnificus)

Prof S Poppema (President)

Prof K Duppen

Dean of ResearchProf LFMH de Leij

SHARE Prof R Sanderman

GUIDEProf AJ Moshage

BCN-BrainProf A Aleman

Kolff InstituteProf HJ Busscher

Q u a l i t y a n d s c i e n t i f i c r e l ev a n c e Scientific Quality is most easily measured by proxy through bibliometric analysis. Analyses have been carried out annually as part of a national effort of the NFU (www.nfu.nl), the Netherlands Federation of University Medical Centres, which incorporates all eight Dutch academic medical centers. This analysis was carried out by the Centre for Science and Technology Studies (CWTS) (www.socialsciences.leiden.edu/cwts/). The most striking feature of these analyses is the substantial rise in scientific output, with a near doubling over the past decade and a steady rise in scientific quality to significantly above the world level (CPP / FCSm = 1.26 over the period 1997-2008). The concurrent increases in (competitive) research funding imply that these trends will continue for at least the next five years.

Several policy measures were developed to assess the quality of science at the level of the individual for the purpose of evaluating the strength of research programs as well as stimu-lating excellence through various financial measures. A definition of a principal investigator (PI) was established, employing several criteria, for instance an average of six publications over a period of three years, ranked in the top thirty percent of the ISI subject area. Furthermore, in 2008 a pilot project was started to analyze quantity and quality on a per-person basis as part of policy measures to explore assessments of scientific quality at the lowest level of the organiza-tion, that is, below the level of departments, research institutes, and programs. The aim of this assessment was to establish a baseline of individuals involved in research, using a minimalist definition. Having identified both the excellent researchers (PIs) as well as the entire ‘popula-tion of researchers’ will prove highly valuable in the implementation in years to come of the policy measures mentioned above.

O r g a n iz a t i o n Research at the UMCG is characterized by a combination of fundamental research and patient (clinical) research. The research is organized around four profiles, each of which has a founda-tion in a Graduate School. • Health Research (SHARE)• Chronic Diseases and Pharmaceuticals (GUIDE)• Human Brain (BCN-Brain)• Biomaterials (Kolff Institute)

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3 A d e s c r ip t io n o f S HAR E

This institution was established in the 1980s as a Research Institute mainly to carry out applied contract research. Over the course of time it evolved into an institution with its own lines of research and ultimately into a Graduate School (2006). For a summary of the development of SHARE, see box 2.

M i s s i o nThe mission of SHARE is:

To elucidate factors related to health, notably healthy aging. This is achieved by research on the determinants and consequences of aging, incident disease, quality of life, care and cure, as well as by training researchers in the area of health research.

The mission is implemented through the use of the many resources which UMCG / University of Groningen can allocate for research done in connection with tenured positions. This allows for a great many possibilities in terms of continuity, autonomy in the choice of research questions, and the recruiting and retaining of highly skilled researchers. In the Dutch system this concerns research done by staff members who also teach. Resources allocated to tenured positions are supplemented by temporary positions (especially PhD positions and occasionally postdoc positions), financed by UMCG / University of Groningen (mainly in the form of PhD scholarship positions), and especially with research funds obtained elsewhere for which research proposals are submitted. The system in the Netherlands is set up in such a way that there is little opportunity for large-scale long-term programs. In general, research proposals request funding for a PhD student per project, with some additional support to carry out the project.

O r g a n iz a t i o n The core of SHARE is formed by the research programs (i.e. the Research Institute). The permanent staff have an appointment in a department and conduct their research within that department in collaboration with other staff members and PhD students. In that sense one does not work for SHARE, but is a member of SHARE. At the moment more than 200 people (staff and PhD students) are members of SHARE. Researchers furthermore are members of a research program that often will have clear links to a particular department, but also with members in other departments. Besides this – and in conjunction with the mission – the insti-tution has recently begun a two-year Research Master’s program in Clinical and Psychosocial Epidemiology for training young researchers and there is also a PhD training program that – in collaboration with other research clusters in the UMCG – will be further professionalized in coming years.

In section 4, the activities that take place within SHARE and how they are organized will be examined further.

Re s e a r c h a c t i v i t i e sThe Graduate School presently has the following research programs, that will be extensively described in chapters 3 through 7: • Health Psychology Research (HPR)

The aim of the Health Psychology Research program (HPR) is to gain insights that will be useful in resolving the psychological problems experienced by people with chronic somatic illness, and to add to the body of knowledge on psychological and social processes that enable or impede people’s adaptation to chronic somatic illness

• Public Health Research (PHR) The mission of the Public Health Research (PHR) program is to contribute to healthy aging. It does this through research into the prediction and (early) detection of adverse health and


Box 2 History of SHARE

From applied to strategic and fundamental research

In the mid-1980s a number of departments within the Faculty of Medical Sciences had attuned their respective research activities. After a while, the departments merged into what is now called the Department of Health Sciences. The sections involved were: Medical Sociology, Medical Psychology, Social Medicine, Social Pharmacology and Epidemiology. These sections were all specialized in the field of Healthcare Research. Many of their research projects had practical applications. Gradually, in part due to the growth of projects, the parties involved realized that they needed to cluster their research and to provide facilities to adequately support research efforts. As a result, in 1989, the Northern Centre for Healthcare Research (NCH) was established. The initiators were primarily moti-vated by the desire to obtain more knowledge about the behavior of both patients and professionals in order to optimize care. It was felt that new developments in the social sciences could contribute to more sophisticated research and encourage improvement in medical care. Researchers in this area within the institution felt that they should not simply act as critical bystanders in relation to medical care, but try to come up with solutions and improvements based on sound and valid research. The research was in fact dealing with issues related to Quality of Life of patients and Quality of Health Care. Hence the research dealt with patients both inside and outside the treatment setting and with the behavior of healthcare professionals. Over time the playing field changed and new topics appeared, while others were resolved or were left aside. It will, however, be seen from this report that in fact, over the years, the research has been continuously focused on these two key concepts. The results and their implications support the notion that this kind of research in medicine makes a real difference in achieving optimal care. The institution started out as a ‘traditional’ research institute, in which people were actually employed by the institute. This changed when the Dutch Government passed the Modernization of Universities’ Administration Act (MUB Act) in 1998. The Act acceler-ated changes that had germinated at an earlier date. At NCH, for example, there had been a shift towards more strategic and fundamental research from the early 1990s on. This was evident by the increased number of publications in journals with impact and a growing number of dissertations. In part, this move had been prompted by the development of healthcare research into a fully-fledged research field, which generated more interest in fundamental aspects. For another part, however, the shift had been encouraged by the Board of the Faculty of Medical Sciences, which believed in the strategic value of a stronger focus on strategic and fundamental research. New research groups were thus added to the Institute. The most important result of the MUB act, however, was that researchers’ appointments were transferred from the Institute to the Departments. The NCH thus became a completely different type of organization, even though it retained its name and many of the same staff members, both permanent and temporary. More attention was given to raising funds for PhD programs, to the education of PhD students or trainee research assistants, to transforming management, and to communication with the ‘inside’ and the ‘outside’ world. In 2006 the Institute was transformed into a Graduate School for Health Research retaining the groups who were already incorporated before, and given its mission and visibility other researchers from the UMCG to join as a member. The name ‘NCH’ was changed in Graduate School for Health Research, SHARE.


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disease, and into social participation in chronic diseases. These research themes are part of prevention and societal participation, that is, of the core themes of public health

• Evidence-Based Medicine in Practice (EBM-P) The mission statement of the research program is to provide evidence for clinical practice, based on epidemiologic studies, implementation research, and economic evaluations. Moreover, researchers of the program constitute the expertise center for support and improved methodology and quality of clinical research in the UMCG, along with related primary care settings (general practitioners and community pharmacists)

• Rehabilitation Programs Research (RPR) The mission of Rehabilitation Programs Research (RPR) is to help people with disabilities to return to society, using the patient as a ‘partner’ in the treatment. Research focuses on disorders of extremities such as amputation of upper and lower extremities, prosthetics and orthotics, and other problems of the extremities such as tendon or muscular problems and, furthermore, on specific and a-specific (chronic) pain syndromes such as low back pain, complex regional pain syndromes or phantom pain

• Interdisciplinary Center for Psychiatric Epidemiology (ICPE) The objectives of the research program of the Interdisciplinary Center for Psychiatric Epidemiology (ICPE) are to unravel (i) the etiology of common mental disorders (in partic-ular internalizing disorders) and (ii) their consequences for somatic health and disability throughout life

The institution also has a number of groups at the level of working groups or still being formed, which is why these groups are not assessed separately. With an eye to the future, we do however feel that the content and potential of these groups should be demonstrated, in order to show the potential for further strengthening Health Research in the near future within the UMCG. This concerns the following research groups, that will be described in chapter 8:• Ethics in Care and Society (ECS)

The aim of the research program Ethics in Care and Society is to analyze and reflect on the philosophical, ethical and sociocultural aspects of moral issues in medicine and health care. Their studies are characterized by practice-oriented analysis and provide recommendations relating to current moral questions and problems

• Center for Research and Innovation in Medical Education (CIOMO)The aim of CIOMO is to innovate medical training programs. The research focuses on learning and assessment in the clinical context. Within this topic, three research lines have been categorized: the learning environment, student and resident perspectives, and teacher / supervisor characteristics. In practice, these lines are integrated into most of the research projects. To date the main focus has been on undergraduate medical training

• Rob Giel Research center (RGOc) Research within the Rob Giel Research center (RGOc) focuses on mental disorders (mainly schizophrenia and the severely mentally ill) in regard to pharmacological as well as psycho-logical and psychosocial interventions, and also focuses on the evaluation of mental health services in terms of inpatient, outpatient and community care facilities, by means of, inter alia, the Groningen Psychiatric Case Register (PCR) covering the northern three provinces

• GROningen Unit for Perinatal Studies (GROUPS) Within GROUPS, several lines of research regarding pregnancy and childbirth come together to improve health for pregnant women and their offspring, including their long term health. The group focuses on screening, early detection and evidence-based interven-tion programs in the UMCG and in collaboration with others


• Orofacial Research Group (ORG) The research carried out in the Orofacial Research Group (ORG) concerns epidemiological research and clinical effectiveness regarding oral health, and focuses primarily on effective-ness of care and disease management in patients with chronic diseases in the orofacial area and in specific oral care groups

M a j o r C h a n g e s i n t h e r e s e a r c h p r o g r a m s i n r e c e n t ye a r sVarious major and sometimes conspicuous changes have occurred in our research programs. A program on motor behavior was transferred from SHARE to the Research Institute BCN-Brain in 2005. Most of the research conducted within the Movement Sciences Department was already the responsibility of the BCN-Brain, and when a second professor (prof E Scherder) was appointed in addition to prof T Mulder, it seemed opportune to expand the program even more and include all research activities of this department within BCN-Brain.

Epidemiology has been given a much more prominent position within the UMCG. With the arrival of prof RP Stolk (Head of the department of Epidemiology), new staff members were appointed, while current staff was concentrated within a new department of Epidemiology. Part of the research conducted by this group was included in the EBM-P program (see chapter 5) as from January 2006, onward. The Social Pharmacy, Pharmacoepidemiology (prof LTW de Jong-van den Berg) and Pharmacotherapy (prof JRBJ Brouwers) research has also been included in this program. The group was formally established on January 1, 2006, under a new name, Evidence Based Medicine in Practice (EBM-P). This development dovetails perfectly with the comments made by the PRC in 2004, in the sense that they noted the lack of an Epidemiology component within the UMCG and within SHARE in particular. With these changes, Epidemiology now is a force very much welcomed and to be reckoned with within our institute attracting other groups as well.

Furthermore, the PHR program reoriented the focus of the program which was both necessary given comments in 2004 by the PRC and enabled by the appointment of prof SA Reijneveld in 2004 and the subsequent appointment of new staff. Finally, the research group of prof J Ormel (ICPE) intensified links with SHARE and the group joined SHARE officially in 2008.

G r a d u a t e S c h o o lSince the site visit in 2004, graduate schools have been set up at various universities in the Netherlands. The University Medical Center Groningen (UMCG) has designated SHARE in 2006 as a research cluster that is sufficiently large and has sufficient quality to become an inde-pendent Graduate School (GS). This means that we were able to provide the entire research training track (for both Master’s and PhD students). A condition for the awarding of the GS status is that the School should also offer a Master’s degree program in its own field. For this reason, we have given priority to setting up such a program (See chapter 2) and having it accredited.

Comments made by the PRC in 2004 on further improvements in the PhD degree program are being taken up by a committee that drafted a plan for its content and practical implemen-tation. This also dovetails with the PRC’s opinion that the PhD training in the GS should be formalized and strengthened, which requires SHARE to develop a balanced teaching program of high quality and to monitor the performance and progress of its PhD students. The modules that are part of this initiative will be set up and offered in close cooperation with the two other UMCG Graduate Schools, GUIDE / Kolff Institute and BCN. As of 2009 the existing Graduate Schools (GUIDE / Kolff Institute, BCN and SHARE) are starting to get integrated into one Graduate School of Medical Sciences. However, they will retain their identity and profile within the UMCG as separate profiles.


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4 O r g a n iz at io n a n d int e r n a l p ro ce s s e s

In this section we will provide a brief overview of the organizational structure of SHARE, and how internal processes with respect to membership and the monitoring of output are orga-nized. Furthermore, we will provide some information about our Dutch newsletter and website (which includes information, news (i-SHARE) and access to fulltext PDFs of most of our publi-cations, the so-called Repository site).

S t r u c t u r e a n d m a n a g e m e n tThe institution is led by a scientific director (prof R Sanderman) who has been allocated time to do so (0.3 fte). He works together with the following staff: T van Ittersum (0.4 fte as informa-tion retrieval specialist), dr FLP van Sonderen (0.4 fte as methodological and policy advisor) and R Kroese (0.8 fte as management assistant). Furthermore, for the coordination of the Research Master’s program in Clinical and Psychosocial Epidemiology, support is provided by dr DF Jansen, who combines this task with the coordination of two other Research Masters offered by the UMCG.

This team deals with the recurrent matters of the institution and formulates policy and carries out a variety of matters involved, such as: providing members with information, orga-nizing research meetings (twice a year), SHARE seminars (monthly), membership registration and monitoring input and output, support in the organizing of training (including establishing and running the new competence-based training scheme for PhD students), coordination of work with the other graduate schools within the UMCG and, more recently, working on the integration of duties in the new Graduate School of Medical Sciences, maintaining the website, editing the Dutch-language newsletter ‘Follow Up’, preparing and carrying out work involved in site visits and midterm reviews.

In figure 2, the structure of SHARE is shown. Besides the staff office, SHARE has a manage-ment team, a PhD council, a Research Master’s Board, and a degree program advisory committee both for Research Master’s and PhD programs.

The management team comprises the scientific director, the policy advisor and the program directors of the various programs. The group meets four times a year, to discuss developments within SHARE, decide on policy and implement changes. The PhD council is a group of PhD students with members from various SHARE research programs. For a number of years now, they have organized the research meeting in spring (SHARE’s Spring Meeting), organized the informal get-together for SHARE members twice a year as well as informal meetings for PhD students on a regular basis, they provide information for new PhD students and contribute to the design and implementation of the PhD program, which is why they are also represented on the degree program advisory committee. In addition, to oversee the training program, there is a Board for the Research Master’s chaired by prof RP Stolk. Finally, we have a degree program advisory committee for both the Research Master’s and the PhD programs under the supervi-sion of prof E Buskens and prof FM Haaijer-Ruskamp, respectively.


Graduate School for Health Research

SHARE

Scientific director

Prof R Sanderman

Research

Master

Admission

committee

Educational

committee

Examination

committee

PhD training

Admission

committee

Educational

committee

Research

Public Health Research

Prof SA Reijneveld

Health Psychology Research

Prof AV Ranchor

Evidence Based Medicine in Practice

Prof FM Haaijer-Ruskamp

Prof RP Stolk

Rehabilitation Programs Research

Prof JHB Geertzen

Interdisciplinary Center for

Psychiatric Epidemiology

Prof J Ormel

Upcoming groups

ECS – Prof MA Verkerk

CIOMO – Prof J Cohen-Schotanus

RGOc – Prof D Wiersma

GROUPS – Dr MG van Pampus and

– Dr JJHM Erwich

ORG – Prof B Stegenga

Management

team

PhD council

M e m b e r s h i p a n d q u a l i t y a s s u r a n c eThe PRC (box 1) criticized the SHARE membership criteria, which it felt were not sufficiently clear and possibly not strict enough either. We have, therefore, tried to develop criteria that are clear and can also be applied throughout the UMCG. These criteria came into effect on January 1, 2006, and they were in fact applied in all UMCG Research Schools. The central prin-ciple in the development of these criteria was that SHARE members must produce a sufficient number of articles of good quality. An article is regarded as being of good quality when it is accepted by a journal that is considered to be among the top thirty percent of journals within a particular ISI-field. Staff who wishes to be tenured members of SHARE must have authored or co-authored at least six of such top publications within a period of three years. When this criterion was applied, it appeared that it was met by fifty percent of the tenured staff as of January 1, 2006, while twenty-five percent, although they failed the strict test, had authored

Figure 2


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or co-authored at least two top publications in the previous three years and could thus be awarded an affiliate status. The membership of the other twenty-five percent was terminated on January 1, 2006. All members were informed of the new membership criteria and of the extent to which their publications met them. With these new rules, we have seen that our researchers have become much more aware of the importance of high-impact publications.

S H A R E r e g i s t r a t i o n p r o c e d u r e s a n d p r o c e s s e sIn order to accommodate the scientific process within SHARE, quality control and other proce-dures and processes have been developed to collect, register and analyze various types of information concerning:• People (SHARE members)• Programs (which members take part in a particular research program)• Projects (e.g., title and summary) • Publications

Clear membership criteria and a well-developed registration system have become more and more relevant as the Graduate School gradually expands. Additionally, these registration procedures have proven to be very useful in presenting relevant information for a midterm review in 2005 / 2006 and for this self-evaluation report.

PeopleSHARE, like all graduate schools, is a virtual organization. Researchers can be members, but they have no appointment in SHARE. Most of them are appointed to the UMCG; others have appointments elsewhere in the University of Groningen, and some are ‘external researchers’ with other appointments (e.g. Public Health organization). Researchers who wish to apply for membership of SHARE must do so through the program leader. He or she will approve the application if the project fits into the program. The program leaders are regularly informed about the members registered within their program.

SHARE registers memberships, and is charged with collecting information about the type and location of appointments from other sources. Information on roles is added, such as the roles of members in various projects. They can be researchers, project leaders, etc. With PhD projects, the various roles related to PhD tracks are also registered, such as being a PhD student, promotor, and co-promotor. And, obviously, tenured staff and post-docs can be related to more than one project.

ProgramsThis is defined as a research unit within SHARE with research projects that fit into the domain of that particular research program. The various programs have been described above in section 3.

ProjectsTitles and abstracts (both in English and Dutch) of projects are registered, as well as the source of funding and the size of the grant.

Publications and analyses concerning outputTo report the output (i.e., journal articles, books, book chapters, and dissertations) of SHARE members properly, we have developed a procedure to be able to track them down, and register and assess them with respect to quality on the basis of the source in which a particular article has been published.


In Pubmed and Web of Science, search strategies have been developed for each and every research program, listing all its members and the statement that at least the name ‘Groningen’ should appear in order to retrieve publications in scientific journals. To compare the authors to the list of SHARE members, a database of names and initials is used, since many researchers have more than one combination of surname and initial(s). Monthly updates are checked. Twice a year (July and January) an e-mail is sent out to all SHARE members for their personal overview of the publications registered so far. They are asked to check and add information on missing publications (for example in non-ISI journals), books, book chapters and dissertations that they have been involved in. In addition, the results are imported into a reference manager database, which allows us to create bibliographies according to the formats we choose.

Information from this database (with full-text versions of the journal articles attached) is also shared with the University Library of the University of Groningen, where it is converted to fill our Repository which now contains SHARE publications as of 1997, a total of over 2100 records. From the Repository (http://share.eldoc.ub.rug.nl/) access to SHARE output is free to all interested parties for about 90% of all journal articles.

Hence, only a very small number of publications are not added to the Repository, mostly due to legal restrictions. When all information has been registered, it is possible to relate the different types of information, for instance, between persons and publications, or between research programs and its projects, so that they can be visualized and analyzed.

To analyze SHARE output even further, the reference manager database is converted to SPSS. Information is added concerning the important ISI parameters of each journal per year. This makes it possible to create reports on the impact factors of the journals and the relative position of the journals within their ISI subject categories (top-10%, top-30%, etc). When a journal is classified in more than one category, the highest relative position is determined.


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SHARE membership is determined by the quantity and the quality of the output. Publications have to be linked to individual SHARE members. This step is computerized. For each article (and other types of output, such as books, book chapters, dissertations), every co-author is compared to the list of SHARE members. In this process the position of the SHARE member(s) in the list of authors is also registered. We distinguish special positions such as first author, second author and last author. It is expected that in the near future additional criteria will be formulated for PI membership in the Graduate School, at least for those who will have a preferred position, for example, as an established investigator. It is expected that researchers with that kind of qualification will receive additional funding, and it is likely that their member-ship will, among other things, be based on these authorial positions.

In the criteria for principal researcher, it is stated that they should publish at least six top thirty percent articles in three years, meaning that the journal’s position in its ISI category / categories should be in the top thirty percent of that category.

The database has enough information to produce, for example, the following information:• In how many articles is a specific researcher registered as author or co-author• How many articles are published in top journals (top-30%, top-10%)• How many articles are published with this researcher as first, second, or last author• How many articles are published with a SHARE member as first, second, or last author• In which ISI subject categories have the top-10%, top-30% publications been published• Aggregation of the type of information listed here at a program level in order to produce

tables as provided in this report (See, for example, section 6)


Software for collecting and monitoring key informationFor the registration of people, projects and programs as described above, we use a self-developed program created in ACCESS, an advanced system for presenting information and how data is interrelated. Reports can be created to view, for example, all the projects within a research program, or to see, for example, in which PhD projects a SHARE member is involved and in what role. We also keep track of changes in the information registered in this ACCESS database (‘historical’ reports). Publications are registered in a reference manager database. In order to be able to link SHARE members to the publications they authored or co-authored, the reference manager database is transformed to ACCESS as well. For analyses of output, we imported all the information (memberships, projects, programs, publications) into an SPSS database. Whereas the tables shown in this report are very simple, the process of retrieving and analyzing them is quite complex. However, it is necessary in order to provide members with adequate information on how they personally and we (at program and institutional levels) are doing. We feel that by giving this kind of feedback this will be of help in furthering strate-gies to improve the quality of the research.

I n f o r m a t i o nInformation is exchanged in several ways – using Blackboard, a website and a newsletter – among members of the graduate school, and for those interested in our research that are from outside the institution.

BlackboardAt the end of 2008 we started setting up a Blackboard facility for members of the institution. Course information is entered and groups can exchange information on it themselves. As is usual with Blackboard, only members of the institution with a login can use it. Blackboard is a facility that is currently being used rather sparingly by members. For the teaching program especially, it would seem to be an excellent facility for disseminating information and for main-taining the PhD portfolios.

WebsiteThe institution has a website within the University of Groningen web portal (www.rug.nl/share).

Information is presented on programs, members, projects and about teaching activities. Two separate websites can be accessed via this website. The first is the Repository site (http://share.eldoc.ub.rug.nl/) already introduced above which gives an excellent overview of most of the publications and dissertations written by SHARE members. The second is a news site (i-Share) we set up in 2009 (www.rug.nl/share -> news button) where short articles on the work and people in SHARE are presented. This site still primarily comprises English translations of pieces that appeared in our Dutch-language newsletter ‘Follow Up’ (see below). It is our intention to also put short films on it which show results of our work.

Follow Up – Dutch-language Newsletter‘Follow Up’ (our newsletter in Dutch), that appears two or three times a year, is meant to present our work to a wide audience of interested professionals and colleagues. There are around 1500 addresses on the mailing list – colleagues within the UMCG and the University of Groningen as well as others such as policymakers throughout the country, health insurance firms, politicians and colleagues from other universities and research institutions. ‘Follow Up’ has been printed in full color in the past few years, and we have noted that people truly appre-ciate the way we keep others abreast about on-going research within SHARE. The newsletter began a decade ago.


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5 Tr a in in g o f re s e a rc h e r s – o ur t e a c h in g p ro g r a m s

In this section, we will provide a short description of the teaching activities related to research where SHARE is involved, that is, the Honors Bachelor degree in Medical Sciences, the Research Master’s in Clinical and Psychosocial Epidemiology, and the SHARE PhD training program. In chapter Two, a more extensive description of both our Research Master’s and PhD training programs is provided.

H o n o r s B a c h e l o r d e g r e e i n M e d i c a l S c i e n c e s a n d M D / P h D p o s i t i o n sIn addition to our own Research Master’s students (see below), we are also trying to make SHARE better known to medical students and to streamline our contribution to the Junior Scientific Master’s (JSM) program. A Bachelor’s Honors program has been set up in the Faculty of Medical Sciences which focuses on the training of research skills in particular. SHARE has responded to this development by offering modules within this program, for example, the Patient-related Research module (4 ECTS) for second-year medical students, which has been running now for several years and has attracted an increasing number of students (the maximum of 20 students has been reached for three years in a row), exemplifying the increasing interest in health research among medical students. We will be expanding this contribution, which we believe will lead to more medical students enrolling in the SHARE programs, by applying for MD / PhD positions. The MD / PhD positions are meant for medical students who, in addition to their MD program, are allocated dedicated time to do research and get their PhD as well, after completing the MD program. They have to apply for the program by submitting a grant proposal to a special committee of the UMCG. If successful, they receive a (paid) expansion of their MD program for two years (i.e., 8 years in total). SHARE programs have at this moment four students who have such MD / PhD scholarships.

Re s e a r c h M a s t e r ’s i n C l i n i c a l a n d P s yc h o s o c i a l E p i d e m i o l o g y In 2005, SHARE submitted a plan for a top Research Master’s degree program. In 2006, this program was accredited by NVAO (a special Dutch and Belgian institution to assess the quality of new (educational) programs). After that, the Ministry of Education and Sciences approved the program, which led to its inauguration in September 2007. The name of the program is Clinical and Psychosocial Epidemiology. Starting this program represents an important incen-tive for our institution, since we will now be able to train our own researchers. This will have a positive effect on the research conducted within the various programs. Prof RP Stolk is the program director. The other members of the management team are prof R Sanderman, prof SA Reijneveld and prof J Ormel. Dr DF Jansen has been appointed program coordinator. Right from the start, we attracted (in three years) a total of 12 students (six in the last year) with about 40% foreign students. The number of new students will, we believe, rise over the years, with the intention of having around 15 students entering each year in the near future.

S H A R E P h D p r o g r a m At the end of 2006, SHARE started formalizing its PhD training. Before that date PhD students were also trained, but matters were left more to the individual supervisor and there were no formal requirements in place, in line with the traditional approach in the Netherlands. SHARE’s role was limited to offering a limited set of courses and to acting as ‘knowledge broker’ concerning good courses provided elsewhere. The need for a more formal approach was clearly pointed out by the Review Committee in 2004. In January 2008, the training program with clear requirements was implemented. All PhD students starting with a PhD project after that date are required to follow the training program. Students who started earlier can also enter the program by taking into account their training up to that date. The aim of our PhD training program is: (1) to support PhD students while carrying out PhD research, (2) to enable SHARE


to guarantee the high quality of SHARE PhD researchers, that is, to develop the knowledge and skills needed to be an excellent researcher and, more generally speaking, to prepare the PhD student for a scientific career, and (3) to lighten the burden of the supervisors in the sense that more general knowledge (not limited to a specific project) is provided in the courses.

S H A R E s e m i n a r sAn important activity set up in recent years is the SHARE seminar series. Although meant for all members who are interested in different subjects in particular relevant for both PhD students and Research Master students.

SHARE seminars 2007 - 2009

Speaker Title

2007

Prof Rob Krueger University of Minnesota, USA

The externalizing spectrum of personality and psychopa-thology

Prof Bob GutinColumbia University, USA

The pediatric obesity epidemic can be reduced by emphasizing vigorous physical activity rather than restriction of energy intake

Dr Stefan WüstUniversity of Trier, Germany

From conception to birth - early life and later stress regulation

Dr Galina VelikovaCancer Research UK Clinical Centre, St James’s University Hospital, Leeds, UK

Monitoring of patient self-reported symptoms and functioning in oncology practice

Prof Jim Coyne University of Pennsylvania, USA

How I get my papers cited…and what I do when one is rejected

2008

Prof Paul EmmelkampUniversity of Amsterdam, NL

Virtual reality exposure therapy in anxiety disorders

Prof Diederick GrobbeeJulius Center for Health Sciences and Primary Care, UMC Utrecht, NL

Clinical epidemiologic observations on atherosclerosis and its consequences

Dr Roman KotovStony Brook University, New York, USA

Personality and psychopathology: Moving toward an integra-tive science


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Dr Renee-Louise FranchePublic Health Sciences, Faculty of Medicine, University of Toronto, Canada

The Canadian Work Disability Prevention Research Agenda: Looking ahead towards mental health, stay-at-work processes, and chronic health conditions

Prof Hans OrmelInterdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, NL

Main and moderating effects of pre-adolescent temperament and social stress on mental health in adolescence

Prof Hajo Grundmann National Institute for Public Health and the Environment (RIVM) and Professor Medical Microbiology, UMCG, NL

Cross-transmission of hospital infections in intensive care units: Implications for the understanding of the spread of pathogens

Prof Ronald Stolk University Medical Center Groningen, NL

Universal risk factors for multifactorial diseases: The LifeLines study

Dr Benjamin Amick IIIUniversity of Texas, School of Public Health, Houston, USAInstitute for Work & Health, Toronto, Canada

Towards a new generation of leading and lagging indicators in work disability research

2009

Prof Inge HutterFaculty of Spatial SciencesUniversity of Groningen, NL

Demography and epidemiology: Where the two will meet?

Prof Susan MichieUniversity College London, UK

Improving health by changing behavior: Some problems and ways forward

Dr Yvonne SteinertFaculty of Medicine, McGill UniversityMontreal, Canada

A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education

Dr Geert van der HeijdenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, NL

Medical evidence management at the Medical School at University Medical Center Utrecht

Prof Merel KindtClinical Psychology, University of Amsterdam, NL

Is it possible to achieve long-term reduction of undesired emotion?

Dr Kate ScottUniversity of Otago, Wellington, New Zealand

Childhood adversity, early-onset mental disorders and chronic physical conditions

Dr Wolfgang RathmannHeinrich Heine University Düsseldorf, Germany

Prediction of type 2 diabetes: Clinical, biological, and genetic approaches


6 A re f l e c t io n o n in p ut a n d o ut p ut

In this section a number of tables concerning input and output at the institutional level can be found. These same tables will appear again in chapters 3 through 7 at the research program level. We will therefore at this point give a brief explanation about the tables, of what is in the tables and how they relate to the tables at the program level. An outline of the tables is given in box 3. So, how do these tables relate to the tables in the chapters? Although it is in fact a kind of aggregation of information at the program level, there are two important differences. First, we have removed double information about publications. Double information occurs because sometimes people from different programs are involved with the same articles. Naturally, they are included as output for each program, but at the institutional level no double information is presented.

Box 3 Explanation of key tables in the self-evaluation report

Table 1 As seen – a distinction among tenured staff is made in this table between full professors, and asso-ciate and assistant professors. The research time allocated is included in the appointment (0.4 of a full-time appointment and 0.3 for clinicians). If people have a smaller appointment or an extra task beyond teaching and clinical work, then the research time is proportional to the size of the appoint-ment. For non-tenured staff and for PhD students in a fulltime position research time is 0.7, and 0.9 for postdocs. It should be remembered that PhD students with a scholarship or a different appoint-ment (‘external’ PhD students) are not included in the non-tenured staff figures regarding appoint-ment size (they are calculated as 0.0). However, they are included in tables 3 and 4 in the calculations regarding the number of people engaged in a PhD program (see below). Furthermore it has to be noted that number of employees (n) is not a simple summing up and therefore does not always lead to ‘total tenured’ or ‘total staff ’, because of changes in appointment within one year.

Table 2 Table 2 shows the number of PhD students in the institution, including figures on the type of PhD candidate, the number that defended their dissertation, the number still working on their PhD, and those who have stopped. Clarification: an AIO is a PhD candidate who – minus the time spent taking classes – spends the remainder of the time in PhD research. However, clinicians generally have very limited time as do those externally funded and the external PhD students (who are quite comparable with clinicians). Table 3 This table provides an indication of the amounts of money allocated for research. The table is based on the input table for tenured and non-tenured staff. A few matters must be noted. There are stan-dard sums for the various positions. This gives the actual amounts spent on research quite precisely, but only in the form of money allocated to appointments or scholarships. Material resources and support staff, however, are not included. Thus, the de facto total amount spent on research should be a bit higher. Reliable figures are quite difficult to give, but it would only be a small proportion of the whole, because in our type of research it is rarely a matter of expensive equipment (usually desk research with not much supporting staff). The data presented does provide a realistic picture of the scale of tenured staff resources and financial resources acquired otherwise and their proportionate sizes.


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Table 4In table 4, the output is shown by the articles included in the ISI (Web of Science) where distinc-tion is made for the top-30% of an ISI field, and those below the top-30%. The number of articles in the top-10% was also computed. In addition, the number of non-ISI articles is found here – these are peer-reviewed publications (we have omitted professional publications), books, book chapters in scientific publications (usually of nationally and internationally recognized publishers) and PhD theses. The latter are published in the Netherlands in book form and include chapters not published elsewhere, besides the chapters already published and / or submitted. We have included the number of PhD theses written by SHARE members (where SHARE thus is ‘leading’ the PhD research) and PhD theses not written by SHARE members but where a tenured staff member (generally a professor) was supervisor or co-supervisor. The top thirty figure per tenured staff member in the table is the ratio of staff time divided by number of top thirty articles standardized to a 0.4 appointment. This gives an impression of how tenured staff perform at the institutional level and at the program level. There is a requirement of two top thirty publications per tenured staff member (= 0.4 research time) per year. By aggregating staff within the figure, results do not increase in direct proportion to staff size as staff are of course at times jointly involved in publications. However, an indicator of 2 in this table may still be reasonably assumed. If it is higher, this is an indication that a group is doing better than is asked of individual tenured staff members according to the criteria. In detail: • A distinction is made between ISI and non-ISI articles• For ISI articles a distinction is made between articles published in top-30% journals (that is

journals that, according to their Impact Factor are among the highest 30% in their category of research) and articles published in journals that are not in the top-30%

• We choose for top-30% instead of the top-25% as prescribed in the SEP, because the top-30% criterium corresponds to the UMCG requirement for being considered Principal Investigator.

• According to the SEP, the number of articles in top-10% journals is presented • Non-ISI articles are articles that are peer reviewed. Conference papers, professional publications

and publications aimed at the general public are not registered and thus not presented• A distinction is made between SHARE theses and non-SHARE theses. The former are theses by

PhD researchers, who are members of SHARE and whose project is accomodated by SHARE. The latter are other PhD researchers who were (co-) supervised by at least one of the SHARE tenured staff members

• The number of top-30% articles per 0.40 fte research time (equivalence of a full-time researcher) is presented

Table 5This table is only shown on the institutional level. It is rather speculative, but we thought it would be interesting to view possible trends in attracting both (external) funds and staff in relationship to output in terms of top thirty publications.


Another important discrepancy involves information available at the program level for the EBM-P and the ICPE programs. Because new groups and subgroups will at times join, we have chosen in this chapter to make changes in time in the input and output at the institutional level clearly visible by including input and output at the time that new groups join. In fact, for the EBM-P program this means that the Epidemiology group, which only really began to take shape in 2006, has been added from that point on, as was the Pharmacoepidemiology group. However, the chapter on the EBM-P program also presents data from the Pharmacoepidemiology group for the period from 2003 through 2005. This has to do with the fact that the researchers were also active as a group during this period, and we think it’s a good idea to also use this information when assessing them. The ICPE joined SHARE officially in 2008, and this group – active as a group for the entire period of 2003 through 2008 – also needs to be assessed as a group for that time as well. We thus include them in the tables only for the more recent time period to give a true picture of the changes at the institutional level over time.

I n p u t – s ize o f t h e r e s e a r c h s t a f fBased on table 1 (see box 3 for an explanation), and taking into account developments in the various programs, the following can be noted. Tenured staff grew from 2006 on through the inclusion of the Pharmacoepidemiology group and through additional deployment of the extra tenured staff appointed by Epidemiology. Furthermore, we see a significant increase in 2008 resulting from the inclusion of the ICPE group. As for the postdoc time in 2008, compared to the years before, this certainly can mainly be ascribed to the fact that the ICPE group includes relatively many postdocs, but also because of the major increases in the Health Psychology program. Finally, PhD time is a result of new groups joining as well as an increase in the older existing programs. All in all, we see a clear increase in tenured staff time while postdoc time has more or less tripled, the PhD time has doubled and the total time spent on research has doubled as well. This is a remarkable development and, with an eye to the viability of the institution, a very good one. Given that focus was maintained during this growth, much more critical mass has been created, which will support viability over time.

Table 1 Research staff

2003 2004 2005 2006 2007 2008

fte n fte n fte n fte n fte n fte nTenured staff Professor 2.85 11 2.71 11 2.37 11 3.89 16 4.93 20 6.73 24 Associate prof 0.72 2 0.77 3 1.12 4 2.22 8 2.58 9 2.77 10 Assistant prof 4.83 15 5.21 17 5.21 17 5.27 17 4.36 15 4.86 18

Total tenured 8.40 28 8.69 30 8.70 31 11.38 40 11.87 42 14.36 50

Non tenured staff Post doc 2.63 7 2.46 7 2.22 7 2.16 6 1.58 6 8.13 20 PhD 17.41 78 15.77 77 14.38 85 18.86 108 24.00 114 35.75 144

Total staff 28.44 110 26.92 114 25.30 123 32.40 154 37.45 162 58.24 214


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P h D s , t y p e s a n d p r o g r e s sAn essential task of a research institute / graduate school such as ours is to do research that involves a relatively large proportion of the junior researchers who are also in training, who ultimately complete a PhD. The figures in table 2 show that, if we compare 2003 with 2008, we have almost doubled the number of PhD students. Although the number of research assistants and scholarship students has risen, and externally funded PhDs and external PhD students have also increased, the number of clinicians that are writing a PhD remains stable and low. We do not see very many PhDs which are not finished. Sometimes stopping has to do with the failure of the project, causing the PhD candidate to leave, but it may also have to do with very personal circumstances leading to a PhD candidate choosing to do something else. With an eye to conclusions and possible policy consequences, we have taken a look at a number of PhD students within the institution and in the programs, divided by the available tenured staff time. For the institution as a whole, this gives a figure of 9 for 2003 and in 2008 the figure 10.2, while in the years between the figure was usually 10 or slightly under. So despite the doubling of the institution and the preservation of and improvement in quality, this figure is quite stable. This does interestingly, however, differ per program. HPR and RPR are clearly above it (between 11-15 over the years) EBM-P is about average, while ICPE and RPR are a bit below (i.e. 5.5 and 5 over the whole period respectively). Notably, there is no clear relationship with the quality of the programs. There are two matters worth noting however. RPR is primarily a clinical research group with its own clinic and seems to do research with relatively few PhD students, given the net tenured research time, while ICPE has more postdocs than other groups do which are involved in big cohort studies. In our opinion, this ICPE has an extremely strong research profile, especially in terms of high value output. Perhaps this teaches us that if we wish to improve quality and quantity, we should not be thinking so much in terms of more PhD students for the available tenured time, as there is no clear relationship with quality. Moreover, most programs are already at a high level and any further demands would probably unduly increase pressure on the tenured staff. More postdocs, on the other hand, might be a more obvious solution. Postdocs can help supervise juniors and are more capable of functioning independently as first author of high-quality publications.

Table 2 PhDs, types and progress

2003 2004 2005 2006 2007 2008

n n n n n n

Total 78 77 85 108 114 144

Type: AIO, MD/PhD 22 21 19 24 38 48 Bursary 22 22 27 32 28 37 Clinical 7 7 6 7 5 6 Ext. funding 7 8 10 11 10 16 External 20 19 23 34 33 37

Progress: Graduated 6 14 12 19 13 15 In progress 71 63 68 88 99 128 Stopped 1 5 1 2 1


F u n d i n gAs explained in box 3, what has been spent on research is shown in table 3. For tenured staff this is more or less proportional to the increase in staff size. However, there is some shift in costs that can be attributed to, among other things, the successful tenure policy – we see an increase in the number of professors. Traditionally the number of professorships per depart-ment was seriously limited; in most cases it was set out in the staffing plan that only one or two professorships were available per department. Even well-qualified staff were thus unable to move on to such a position. The University of Groningen and the UMCG have broken with this tradition by giving people the chance to move into a professorship on the merits of their qualifications. Looking back at the programs, we see that the increase on the institutional level cannot just be explained by new researchers joining. Interestingly, the increase in 2008 in particular is quite sharp (from EUR 2.6 million to EUR 4.1 million). Except for the RPR program, we see a very sharp rise among all programs specifically for the year 2008 – this also holds true for the ICPE program, although this is only evident in the table in 2008, but within this program there was also a remarkable rise from 2007 to 2008 (see chapter 7). In other words, the insti-tution as a whole – based on successful acquisition – has grown quite a bit as a result. Among other things, this says something about how the research groups rank with the competition, as funding for research in the Netherlands has certainly not increased in recent years.

O u t p u t – p u b l i c a t i o n s a n d d i s s e r t a t i o n s For SHARE as a whole, we see more than a tripling of output in terms of ISI publications (see table 4), while the total research time has doubled – which is quite remarkable. On top of that, we see an overall increase in quality, as measured by top ten and top thirty publica-tions. What is striking about this is that the increase in staff time in relation to the volume of publications in top journals represents a clear increase (cf. an increase in top thirty articles per tenured staff member); thus there is not only a greater increase in the number of articles placed in prominent journals vis-à-vis the increase in staff time, but also in terms of total research time. It is important to realize that this parameter has only been made explicit for researchers since 2006, as a result of the changes in the PI position in the UMCG. Although researchers have only had a limited time to make changes visible in output, we can already see a clear trend. If we include the performance of individual programs, we can – to our great satisfaction – conclude that the increase in volume and quality can be attributed to a high level of continuity (the RPR and HPR programs), a highly remarkable improvement (PHR program), plus the addition of new researchers to the EBM-P as well as the addition in 2008 of the ICPE program, all of which are of a high level. Furthermore, the number of non-ISI articles has not really grown, given the marked increase in research time, which also shows that emphasis has clearly shifted to publishing in the peer-reviewed journals of a higher quality. The number of dissertations, although variable, has increased slightly. The increase, as one might hope, should

Table 3 Funding

2003 2004 2005 2006 2007 2008

€ % € % € % € % € % € %

Tenured staff 737.490 42 783.003 43 785.586 42 1.051.957 44 1.178.106 45 1.476.571 36

Other research input 1.035.779 58 1.038.184 57 1.081.589 58 1.313.155 56 1.446.783 55 2.591.219 64

Total 1.773.269 100 1.821.187 100 1.867.175 100 2.365.112 100 2.624.889 100 4.067.790 100


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be set to continue. In 2009 more than 20 SHARE PhD candidates will defend their disserta-tions. The rather large increase in PhD students (see table 2) obviously took some time to result in substantially more PhD candidates defending their dissertations. In the Netherlands, it often takes somewhat more than four years to complete a PhD, when working full-time. Those with other work besides their PhD as well, of course take longer. Besides the number of PhD students in SHARE (that is, the PhD student is a member of SHARE as well as at least his supervisor), there are also quite a few dissertations where the PhD student is not a member of SHARE, but their supervisor – either a professor or other tenured staff member – is (35 in six years). Also not shown in the table is the fact that from the total of 78 SHARE dissertations, 12 dissertations were defended in which two SHARE programs were involved.

In conclusion, while staff time as well as the number of non-tenured staff has doubled, we have succeeded in tripling growth as seen in ‘ISI articles.’ There is also growth in the percentage published in better journals. This means that it can be expected that the research groups should do even better in terms of citations over the coming years.

Costs per top-publicationFinally, in table 5 we gave a rough indication what the costs are per top-30% article. In accor-dance with the other parameters it is not unexpected to see that this figure seems to get lower over time reflecting a more efficient use of resources.

Table 4 Output

2003 2004 2005 2006 2007 2008 Tot

n % n % n % n % n % n %ISI articles top-30% 40 56 64 68 51 50 125 65 115 61 171 64 566 other 32 44 30 32 52 50 68 35 75 39 95 36 352 Total 72 100 94 100 103 100 193 100 190 100 266 100 918 (top-10%) (10 14) (30 32) (25 24) (59 31) (43 23) (89 33) 256

Other refereed articles 33 30 30 36 35 55 221Book chapters 13 21 23 9 11 24 101Books 8 3 7 2 2 4 26PhD theses SHARE theses 5 14 12 19 12 15 77 Others, (co-)supervised 3 6 4 8 7 4 32

# Top-30% articles per 1.9 2.9 2.3 4.4 3.9 4.8tenured staff member

Table 5 Costs per top-30% article 2003 2004 2005 2006 2007 2008

N top-30% 40 64 51 125 115 171

Tenured staff € 18.437 € 12.234 € 15.403 € 8.415 € 10.244 € 8.635

Total staff € 44.331 € 28.456 € 36.611 € 18.920 € 22.825 € 23.788


7 A re f l e c t io n o n t h e q u a l it y a n d re l ev a n ce

Q u a l i t y As applies to a great deal in this introduction, it is difficult to judge the institution as a whole, as everything mainly hinges on the reputations of the individual research programs, which operate in disparate fields. However, in terms of the institution as a whole, this can in part be found in the observations of the previous Peer Review Committee in 2004. We thus would like to refer to box 1. A number of points mentioned at the time concerning where improvement was warranted, have already partially been discussed. In summary the following issues are of importance to note. • We applied for a Research Master and were able to get an accreditation and to start the

program• We have taken important steps in profiling, setting up and implementing a clear PhD

training structure• The membership of researchers is based on clearer cut criteria and is of a higher standard• The PRC in 2004 missed out epidemiology. It is important to note that both the Board

of the UMCG and of the University have taken the effort to build a department of Epidemiology. Furthermore we see that smaller existing groups with an epidemiological profile are commissioning them to SHARE

• Intensifying links with public health organizations in the northern region• All programs haves extended their international collaboration and have intensified interna-

tional links • Emphasis has been put on the quality of the output which can be seen clearly from the data

shown

In addition to the observations of the PRC in 2004, other matters also reflect the institution’s standing. In the UMCG / University of Groningen, more and more researchers are doing research dealing with social science and / or epidemiology and express their interest to join SHARE. This is clear acknowledgment of the research already done within SHARE and suggests that researchers feel that joining SHARE would have its benefits. This will be further illustrated in chapter 8 where, among other things, a number of groups will be presented that have recently brought their research to the institution or are involved in integrating their research. An important consideration is that researchers feel that their work will certainly benefit from exchanges with others in the institution. This is also very important for PhD students now that we have developed a clear vision regarding the PhD program.

The reputation can also be measured by the clear successes achieved by the programs in obtaining grants. We refer to the trend which indicates a rise in acquiring external funding. In addition our senior staff have taken important positions in important bodies as for example review committees of granting organizations and (ad-) hoc advisory committees (e.g. the Health Council of the Netherlands). Finally, the reputation of the different research programs can also be measured by the ever greater visibility through the increasing number of high-impact international articles and the response they get through increasing number of citations.

Our internationalization should steadily become more pronounced. First, the reports of the various research programs describe initiatives and developments that are already making significant contributions to the internationalization effort. Clearly, now that we have made internal adjustments on several fronts, we will continue to give much attention to this aspect in the coming years. Second, in order to be more visible we have improved our website, which will raise our profile and professional level in the eyes of other research groups; both through the addition of the Repository site as well as the the Newsite i-Share. Thirdly, research programs have invited many more esteemed researchers to Groningen and the various groups intensified collaboration by sending out both PhD students and tenured staff to groups elsewhere.


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Re l ev a n c e The relevance of our area is evident from the very point that there is a sharp increase in patients with a chronic disease. This is due to both the success of medical sciences which makes people live longer and to the aging of the population. Hence, questions arise even more prominent with respect to the determinants of diseases in order to compress morbidity by prevention and early interventions. Furthermore we want to know more about the impact of chronic diseases on people’s lives and the extent to which they affect healthcare. Moreover, we need to know more about effective ways how to respond to the increasing health burden in the population. So, both innovating healthcare as well as the reflection on how to organize our medical system are at stake. Another important issue – not only applicable to chronic condi-tions - deals with the value and effectiveness of a wide variety of medical and psycho-social intervention programs to prevent illness, enhance health, compress morbidity or educate patients to effectively cope with the disease and foster self-management. By and large these questions are focussed on the quality of life of patients and the quality of health care. The importance of our area of research is also recognized by the Board of the UMCG and has lead to significantly increased resources for different research groups of SHARE. This – among others - has given health research a stronger position in the UMCG and made it more visible. In the next section (8) a few examples are given. Furthermore, the chapters will continue to illus-trate the relevance of our area and the input of each and every research program. In sum, from these chapters it becomes evident that both the quantity and the quality of our scientific work and its spin-off is, as we see it, of a high level.

Graduate School for Health Research Self evaluation 2003 - 200834

Netherlands Congress on Public Health

in Groningen - Conference organized by

the Public Health research group

Even two Ministers were in attendance: Piet-Hein Donner from the Ministry of Social Affairs and Employment, and André Rouvoet from the Ministry of Youth and Families. This signified the importance of the congress. Menno Reijneveld, chair of the Health Sciences discipline group at the UMCG was closely involved in the organization of this event. He is proud that Groningen was able to act as host this year. ‘This is the congress in the field of public health. It has been held in Rotterdam for many years, which is a very long way for our regional cooperation partners.’

Visitors to the Martiniplaza could opt for lectures or workshops given by more than eighty speakers. The subjects all revolved around the theme of ‘The earlier you start, the better’. Reijneveld: ‘This theme is really the essence of the research we carry out. On the one hand, it focuses on prevention, for example swiftly identifying problem behavior in young people. And it focuses on participation on the other hand: how can you help people who have dropped out of the employ-ment process to resume employment?’

T h e N e t h e r l a n d s C o n g r e s s o n P u b l i c H e a l t h h a d n eve r b e e n h e l d i n G r o n i n g e n .

At l e a s t n o t u n t i l 2 0 0 8 , w h e n o n We d n e s d ay 9 a n d T h u r s d ay 10 A p r i l

a r o u n d a t h o u s a n d v i s i t o r s t r ave l l e d t o t h e M a r t i n i p l a z a t o l i s t e n t o t h e l a t e s t

i n s i g h t s i n t h e a r e a o f p r eve n t i o n a n d p a r t i c i p a t i o n .

Box 4

Chapter 1 SHARE – an overview 35

Work and reintegrationMinister Rouvoet opened the congress with a speech about the problems of today’s youth. He expressed his concern about growing alcohol abuse among young people. Haske van der Vorst’s research will perhaps help him devise prevention policy in this area. That afternoon, she was awarded the V&W Public Health Prize 2007 for her pioneering research into the influ-ence of parents on the drinking habits of children.

The theme of the second day was employment partici-pation. Reijneveld: ‘Work and reintegration always officially featured on the congress program, but the organizers never really made much of it. So we were new.’ Minister Donner stressed the importance of this subject. In his address ‘All for one, and one for all’, he focused on the growing number of young people claiming Wajong, unemployment benefit for young people. Donner chose the congress as the place to unveil his plans for reforming the Wajong system.

The organizers in Groningen received a lot of positive feedback during and after the congress. Reijneveld: ‘We are more than satisfied.’ Jan Huurman, chair of the national organization for the congress, is also pleased with the choice of Groningen as venue for this congress. He was initially concerned that a congress in the north of the country would not attract enough participants. ‘We spent some time debating the risks of opting for Groningen. However, more people attended than we had expected. The entire congress was pleasant and relaxed. In short, our compliments to Groningen!’


8 A re f l e c t io n o n v it a l it y a n d f e a s ib i l it y a n d v i s io n f o r t h e f ut ure

Over the past 15 years the institution has experienced considerable growth, putting more and more emphasis on conducting research with a view to the results being published in ever better journals. We have been successful as evidenced by the figures for the period 1997 to 2002. As previously stated, the research cluster has become more and more prominent within the UMCG, so that more and more researchers want to join. Thus, Health Research has an increasingly strong position in the UMCG and can therefore raise its profile outside as well. The description of the results earlier in this chapter regarding output as well as the presentation of various research programs show, on the one hand, that there are a great many scientific articles in good journals, while on the other hand, they show that the programs are producing results that are important in terms of societal impact, for instance in playing an important role in the training of medical professionals by guiding them through a PhD research project (e.g., the Rehabilitation Group and the Public Health Group), or the results of research that are directly reflected in professional guidelines or manuals (e.g., Evidence-Based Medicine in Practice program, Health Psychology Research program). A good example of putting scientific knowl-edge into the limelight for both academics and professionals in the field is the organization of the conference ‘Vroeg erbij, beter meedoen’ [‘Catch it early, get better results’] (Dutch Health Congress) by the PHR program (see box 4).

The high level of ambition that the leadership of both the UMCG and the University of Groningen direct towards research is a great strength. This is coupled with the maintaining and extending excellent facilities (such as labs and Healthy Aging research). The choice of an umbrella UMCG theme such – i.e. ‘healthy aging’ - offers great opportunities for those in Health Research. As a result, the ‘biobank’ LifeLines research was set up. The highly successful launch of LifeLines (see box 5) is a good example of where ambition and focus can lead. It is of great benefit to researchers working in Health Research that in LifeLines we not only collect biomedical material, but also interview people about their mental functioning and have them complete a great many questionnaires on lifestyle, personality and quality of life. In addition to the baseline and repeat baseline data that the project with a planned duration of 35 years will yield, an excellent opportunity is being created to carry out cohort studies within it.

The working arrangements of the researchers from various disciplines within the UMCG and their working side-by-side, make it easy for an epidemiological researcher or social scien-tist to plan research together with clinicians. This happens frequently, as evidenced by the large number of PhDs outside SHARE involving professors from SHARE, where SHARE professors share supervision, while clinicians or basic researchers from other groups also contribute to a large number of PhDs within SHARE. In addition to the way the UMCG is constructed with regard to the working arrangements of researchers and their easy access to one another, the Board of Directors’ support for SHARE’s research is also important. The Board has made major investments in several research groups in the form of new staff or in appointing people to a tenured position (particularly striking in PHR, EBM-P and ICPE). Thus, we have funding for quite a large tenured staff, and given the research lines already realized, we look to the future with great confidence, also given the fact that a lot of the senior staff are of a young age.


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S WO T a n a l y s i sStrengths • An increase in principal investigators with a very good track record • The appointment of a lot of relatively young staff as full professor, what – as is expected -

will contribute to continuity of research lines over an extended period of time • The tighter criteria for full membership of SHARE and its monitoring system. This contrib-

utes to an explicit focus on quality and high performance• The focus of the entire UMCG research community on Health Aging and the amount of

available resources• Excellent opportunities to carry out multi- / inter-disciplinary research between pre-clinical

and clinical departments and the availability of a Rehab clinic to carry out research• Setting up of the very ambitious LifeLines program in which longitudinally data (expected

duration 35 years) of 165,000 people will be collected. This program has excellent possibili-ties for health research

• The joint efforts of the UMCG Graduate Schools to set up a PhD training and monitoring program

Weaknesses • The institute as a whole still needs a stronger international position, although some groups

do have a strong or even very strong position internationally

Opportunities • The LifeLines program• The implementation of a new system to compensate tenured staff for their educational

activities. Given the fact that education for Research Masters and PhD training will also be awarded adequately will give a better balance of education, research, clinical work and management. Moreover educating Research Master and PhD students will become more rewarding which also certainly will be of influence on the quality of the training

• The start up of the Graduate School of Medical Sciences which will result in joined forces to train and educate PhD students

• The start of the Research Master Clinical and Psychosocial Epidemiology will enable us to further develop good education in this area. PhD students also can profit from courses in the Research Master’s program. Thus, we are able to train a next generation of highly quali-fied researchers, of which a part will certainly get a PhD position within SHARE research programs

• The large number of cohort studies, the different programs carry out themselves or are involved in, which forms a rich source for high-quality output

• The integration of a number of new and promising groups within SHARE

Threats • The financial position of scientific research in the Netherlands. The amount of fundings

spent on research lies low in terms of OECD comparisons. Given the economic difficul-ties, it might be that budgets will have to be cut. This may affect biomedical research in the Netherlands disproportionately given the high efficiency which is already in place


LifeLines long-term research project set to monitor

165,000 Dutch citizens

Professor of Clinical Epidemiology, Ronald Stolk, does not beat around the bush: ‘It’s a mega-project’. Stolk is one of the researchers in charge of LifeLines, an ambi-tious scientific research project being carried out at the UMCG over the next few years, in which some 165,000 people from the north of the country will be partici-pating.The researchers want to get a better idea of the factors that play a role in the development of chronic illnesses such as asthma, diabetes, respiratory disease and psychiatric disorders.The development of age-related diseases like these depends on a complex combination of factors. Alongside hereditary tendencies, environmental factors like upbringing, smoking, exercise and social life are also significant.

Knowledge of the individualMany of these contributory factors do not come as a surprise: we have known for many years that being overweight can cause diabetes, for example. But why do some overweight people develop the disease while others get away with it? ‘Our knowledge in this area is lacking,’ admits Stolk. ‘We need a lot more information on individual cases.’And this is where LifeLines comes in. The UMCG launched LifeLines as the first ever large-scale Dutch study looking into a multitude of different life factors, from heredity right through to social and psychological aspects. Participants not only have their blood pressure taken as a matter of routine, but are also asked to fill in a personality questionnaire and take cognitive tests.Psychologist and diabetes researcher Joost Keers is closely involved in the implementation of this enor-mous project. ‘We are aiming for 165,000 participants, spread over three generations.’ The first group is aged between 25 and 50 years old, and we started to recruit their parents as well. Early 2010 we will invite their chil-dren as well to participate. LifeLines aims to monitor the participants for thirty years. People in Friesland, Groningen and Drenthe are being approached via their GP. Keers: ‘We saw the very first participants in Sneek two years ago.’ Now, full-time research is also being conducted in research centres in Oude Pekela, Drachten, Bedum, Emmen, and Leeuwarden. Before the end of 2010 centers in Groningen, Oosterwolde,

I m a g i n e : t wo b r o t h e r s e a c h s m o ke a p a c k o f c i g a r e t t e s p e r d ay. W hy d o e s o n e o f t h e m d i e a t f i f t y f r o m a h e a r t a t t a c k w h i l e t h e o t h e r o n e l i ve s t o a r i p e o l d a g e ? T h e Li f e Li n e s r e s e a r c h p r o j e c t i s t r y i n g t o f i n d a n s we r s t o t h i s a n d o t h e r s i m i l a r q u e s t i o n s .

Box 5


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Hoogeveen and Assen will be open as well. Then were are operating at full strenght ‘Things are speeding up. We already have more than 17500 people taking part.’

BiobankThe result of all this research is a mountain of informa-tion. For example, LifeLines takes about ten phials of blood from each participant. This means that a total of a million-and-a-half blood samples need to be stored while awaiting the attentions of enthusiastic scientists. Keers: ‘We are a biobank, collecting data for other people to research and examine in more detail at a later date.’To Stolk’s mind, this should not be left too long. ‘LifeLines should be seen as an infrastructure. It’s time that UMCG researchers started thinking: hey, this is an interesting project and I can use it to answer my ques-tions!’ Stolk and Keers cannot resist the temptations of the LifeLines pond themselves. ‘Of course we’ll be fishing too,’ laughs Keers. They are mainly interested in intro-ductory research and requests from partners that work together with LifeLines. ‘We have looked into obesity and compared our location in Oude Pekela with other locations, for example. You see quite clearly that Oude Pekela shows a higher incidence of obesity and a higher incidence of illness, measured in terms of visits to the doctor and absenteeism. It also demonstrates other health problems. These general findings can serve as a starting point for further research into the underlying mechanisms.’ The researchers sometimes make unexpected discov-eries among the participants. Serious kidney failure was found in a 56-year-old man from Sneek. The man had been under the illusion that he was perfectly healthy. His kidney dysfunction was discovered through the LifeLines project and he was able to be treated in time.

Healthy AgeingParticipants must agree to the condition that some of the information is sent to their GP. ‘Certain data, like information from DNA tests, is not passed on. But medical information like blood pressure is reported back.’So on the whole, the project is running smoothly. But have there been any setbacks? Stolk: ‘Well, we’re

behind schedule of course, but that’s only to be expected with a project of this size. It’s unique, so we come across unexpected things. This can set you back a bit, but things always seem to resolve themselves in the end. And no, I can’t say we’ve met with any insurmount-able problems.’The UMCG is hoping that LifeLines will become a successful component of the Healthy Ageing theme that is at the top of the hospital’s list of priorities. In the future, research based on data from LifeLines will be useful in identifying ‘predictors’ for disease. In turn, this will help improve prevention and treatment.The hospital departments involved were given a voice in the way the research was set up. Only logical, according to Stolk. ‘We concentrated on disorders for which the UMCG has in-house expertise; psychiatric disorders such as anxiety and depression, respiratory disease, kidney dysfunction and endocrinological prob-lems such as obesity and diabetes. This doesn’t include rare diseases.’Much painstaking consideration eventually generated a research instrument of gigantic proportions. Over the next thirty years, LifeLines will monitor some 165,000 Dutch citizens. And then? Stolk sighs: ‘We haven’t got that far yet. Our first concern is to keep the current target group in the research programme for thirty years. We’d eventually like to test the children of this group too, but that’s still a long way off.’