I found these meetings incredibly fascinating, constructive, and they challenged many of my assumptions about medicine and medical research. So I decided to try to write a manuscript to explore what pediatric research could learn from a complex systems perspective. Fortunately, Federica Russo (IAS affiliate), Olaf Dekkers (epidemiologist and philosopher), and several clinicians (Gorm Greisen, Enrico Lopriore and Willem de Boode) were brave enough to join me in this venture. This experience led me to apply for the fellowship, which was kindly supported by my employer, Sanquin Blood Supply Foundation, who allowed me to ‘disappear’ for almost a year.

IAS is a community and a safe place to explore new and challenging questions. Huub Dijstelbloem and Julia Hoffmann encourage and support fellows to take time and space to think and reflect, which has been incredibly valuable for me. On top of this, the fellow room has the most beautiful and inspiring view of the canals. After having recently moved from Amsterdam to Almere, I could not be happier with this. And most importantly, the IAS staff are the kindest people who make your stay comfortable in every possible way. Thank you!

My favorite lectures were the kick-off lectures, where fellows introduced their research topics. I have learned about mathematical approaches to debris accumulation in outer space, how linguists explore the use of the word ‘pattern,’ economic approaches towards aging, and many other topics wildly different from my own. I literally felt my brain stretch at times. It has been a crash course in interdisciplinarity. The fellowship also opened doors to expand my network, I traveled through the country to have coffee with experts from various disciplines, whose different perspectives have helped me develop my ideas and nuance my views.

The topic of my stay was the use of blood transfusions in preterm infants. This is complex at multiple levels. The biology is complex, infants often have multiple diseases and receive multiple treatments at the same time, while they are also maturing. There is persistent, unexplained variation in practice and rampant lack of high-quality evidence. I wanted to know whether and how a complex systems approach could help. Therefore, the aim of my fellowship was to design new studies in which I apply complex systems approaches in neonatal transfusion research, which could form the basis for follow up grant applications. Ultimately, my underlying question was how complex systems cause uncertainty, how we can recognize and acknowledge the limits to what we can know, and how we can deal with this uncertainty in both science and clinical practice.

One of the most rewarding experiences was a workshop I co-organized with Federica Russo and Marcel Olde Rikkert, on the topic of complexity and uncertainty in medical research and clinical practice. We had a full-day meeting on location with participants from across medical fields, including the Knowledge Institute of the Federation of Medical Specialists, the Rathenau Institute, clinicians, patient-representatives, epidemiologists, and philosophers. The exchange of ideas was inspiring, and the meeting will be continued with a seminar series on specific complex systems methods and how they can be applied in medical research.

Other activities that arose from my fellowship were a a workshop at the IAS Academy Day, and co-authoring a book chapter on the need for asking multiple causal questions (the ‘causal mosaic’), with Federica Russo. I have developed study protocols, established interdisciplinary teams and have submitted two grant proposals. With support of IAS I followed a course on qualitative research methods. I have been invited to speak on the topic of health complexity in unexpected places, such as the European Society for Pediatric Research, the European Hematology Association, and the Dutch Society for Blood Transfusion. 

In short, my fellowship has given me the opportunity to grapple with questions I would not have had time to do otherwise, to rekindle my scientific happiness, to connect with inspiring people, to learn about complex systems, and to shift my own research into new and exciting directions. I am grateful for this opportunity, keen to see what is next, and will definitely be visiting IAS whenever I can.

The fellowship enabled me to develop the following contributions

Suzanne F. Fustolo-Gunnink, Willem P. de Boode, Olaf M. Dekkers, Gorm Greisen, Enrico Lopriore, and Federica Russo. If things were simple, word would have gotten around. - Can complexity theory help us improve pediatric research? Pediatr Res. 2024 Nov 28.  Online ahead of print.

Russo F, Broadbent A, Castellani B, Fustolo-Gunnink SF, et al. A pluralistic (mosaic) approach to causality in health complexity. In: Phyllis Illari and Federica Russo. Routledge Handbook of Causality and Causal Methods. Routledge (2024), Abingdon, Oxfordshire, United Kingdom.