BOSTiC is a three day residential course that aims to engage and educate surgeons-in-training in the design and conduct of randomised controlled trials (RCTs) in surgery. It is run by members of the Bristol and Oxford Royal College Surgical Trials centres in collaboration with members of the MRC ConDuCT-II Hub. The May 2016 course was held in Bristol and attended by 40 surgical trainees of various specialities.

We use a variety of teaching methods are used to maintain engagement. Didactic lectures are kept to a minimum. Instead, we favour interactive teaching with electronic voting and small group work. For example, Professor David Beard talked about how to develop a research question using the PICO (population, intervention, comparator and outcome) approach. Professor Jonathan Cook covered different trial designs and Professor Chris Rogers provided delegates with the opportunity to practise sample size calculations (pitched at a surgical audience). Professor Jane Blazeby described how critical pilot and feasibility work is for surgical trials and explained what this involves. One highlight (led by Drs Leila Rooshenas and Paul Whybrow) was a session on how to communicate key trial concepts in consultations with patients to optimise recruitment and informed consent. They covered the ‘how and why’ of randomisation, explaining clinical equipoise and balancing information about trial treatments so patients can appreciate the pros and cons of each intervention and the uncertainty surrounding their comparative effects. This was illustrated with patient-surgeon scenarios enacted by Jane and Paul – see photos. Another session led by Dr Jelena Savovic taught trainees about internal and external validity, and ways of minimising bias in RCTs, with the opportunity to refine their critical appraisal skills using examples from published papers. Each day started with a short ‘what have we learnt so far’ session to consolidate delegates’ learning led by academic trainees Natalie Blencowe and Sean Strong. Throughout the course, groups of trainees worked together to develop their own trial ideas, with bite-sized tasks to reflect each day’s learning objectives.

Guest speakers included Professors Gianni Angelini and Ashley Blom. Both described first hand experiences of being a chief investigator of a surgical trial in cardiac and orthopaedic surgery, respectively. All trainee groups developed their trial proposals with expert guidance from team mentors and course tutors. The event culminated in an interactive Dragons’ Den session, during which each team presented their trial idea. Prizes were awarded for the best trial as well as to trainees asking the most probing and challenging methodological questions.  

Feedback from the course participants rated the overall quality of teaching as excellent with a score of 90%. A score of 100% was achieved in terms of providing research training for trainees.  Here are some quotes from the participants;

“The best thing was the process of designing an RCT in our group & learning the importance of each component/phase & how to minimise bias”.  

“Very approachable faculty. Research can be very intimidating for a complete novice & I felt it was made easy to ask questions & accessible teaching”.

“…very informative, fun & fantastic to meet other trainees keen to carry out RCTs in the future”.

We thank the Royal College of Surgeons for funding our centres (http://www.bristol.ac.uk/social-community-medicine/centres/surgical-research/education/ & https://www.situ.ox.ac.uk/) and acknowledge support from the MRC ConDuCT-II Hub and Universities of Bristol and Oxford.