The 4^th annual Bristol Oxford Surgical Trials Course (BOSTiC) was held in Bristol in 2018, at Canynge Hall, University of Bristol. The course is primarily aimed at surgical trainees who are interested in clinical research, with an emphasis on design and conduct of randomised control trials. The course is delivered by a multi-disciplinary team from the Bristol and Oxford Surgical Trials Units who are supported by the Royal College of Surgeons of England. This year the course was attended by surgical trainees from a wide variety of specialities across the UK and even one participant from the USA!

The course ran over three days in June. A variety of teaching methods were utilised to maintain audience engagement and participation such as lectures tutorials and small group forums. The faculty maintain the view that “no question is a bad question”. There is great diversity in terms of the surgical specialities of the participants, which also helps in sharing of ideas and experiences.

Day one started with a series of presentations from Professor Jane Blazeby, Professor David Beard and Professor Jonathan Cook around the need for evidence-based medicine, how to formulate a research question and the key elements required for randomised trial design. Following this, there were a series of talks on optimising trial recruitment. Ms Shelley Potter also shared her experiences as a new Chief Investigator (CI) in designing the iBRA study. During the day, the groups met with their mentors and initial trial ideas were discussed. The day finished with a course dinner at Aqua restaurant.

The morning sessions on Day two built on from the previous day and featured talks on alternative trial designs, experiences of a CI and selecting, measuring and reporting primary and secondary outcomes by Professor Jonathan Cook, Professor Andrew Carr and Dr Kerry Avery. Mr Veeru Kasivisvanathan also gave a fascinating talk on being a CI as a trainee. Professor Chris Rogers summarised key statistical concepts and provided the opportunity for delegates to calculate power and sample sizes for a study. The delegates also continued to work in groups to design their RCTs for presentation on the final day.

BOSTiC aims to enlighten delegates with regards to research methodology, but also give them real world insights regarding trial design. Day three started with Professor Rob Hinchcliffe providing insights into being a Chief Investigator and Dr Lucy Culliford then spoke around some of the practicalities in running clinical trials. This was followed by an insightful talk by Professor Julian Higgins on how evidence synthesis can help in trial design. Professor Jonathan Cook then spoke to the delegates about structured reporting of clinical trials and the CONSORT statement. The course ended with a Dragons’ Den style presentation with each of the delegate groups presenting their designed RCT which they had worked upon throughout the course. Experienced mentors from both Bristol and Oxford Universities helped guide delegates throughout this process. The winning group designed a trial looking at different surgical techniques for managing the distal ureter during a radical nephrectomy.

Feedback from the course has once again been excellent with 100% of delegates rating the quality of teaching and the course overall as excellent or very good. Below are some of the quotes from the delegates:

 "Absolutely brilliant course. Extremely good value for money considering how much I have learnt. Very enjoyable but also really educational. Thank you!"

 "This has been my most valuable course, I would happily attend other courses you organise."

 From a personal point of view, I found listening to the experience of various Chief Investigator’s at different stages of their career to be fascinating. The practicalities of running trials and methods used to optimise recruitment were also very interesting. The take home message for me though was the importance of framing the research question correctly in the first place–and how long that process can take!

Next year's course will be in Oxford–see you there!

Samir Pathak

Academic Clinical Lecturer in HPB/General Surgery

University of Bristol