Dr Connor Moore Academic F2 at the Centre for Surgical Research wrote:

Summary of BOSTiC 2021 The 6 th annual Bristol Oxford Surgical Trials Course (BOSTiC) was held in Bristol this year at Engineer’s House, University of Bristol. Excitingly, this was the first in-person conference that many of the attendees and faculty had been to since the advent of the COVID-19 pandemic.

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 multidisciplinary team from the Bristol and Oxford Surgical Trials Units who are supported by the Royal College of Surgeons of England. BOSTiC was attended by surgical trainees from a wide variety of specialities and locations including the lion’s share of England and even Scotland!

The course ran over three days in September. 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” and provide a very supportive environment for learning. The diversity in experiences and levels of training led to rich contributions and discussions.

An exciting background to the three days of intense learning around randomised trials was that each group (with 6 members) was allocated to design a trial, working up to a dragon’s den pitch at the end of the three days. It provided a great opportunity to put in to practice all the key elements candidates learnt about randomised trial design throughout the course, whilst the competition provided the focus that was essential to “making the knowledge stick”. A brief breakdown of the days:

Day 1 Professor Jane Blazeby set the scene for the course and gave expert insight into the role of randomised trials in advancing evidence-based medicine. Candidates learnt the essentials of trial design via a series of presentations that covered research question design (Professor David Beard), trial design (Professor Jonathan Cook), and optimising recruitment (Dr Leila Rooshenas & Dr Marcus Jepson). This was supplemented by expert talks including the experience of being a new PI (Dr Joanna Wills). A particularly notable part of the day was a workshop where Prof Blazeby and Prof Beard delivered mock examples of good and poor trial recruitment methods, providing the course plenty of entertainment! The day finished with group presentations and feedback surrounding their initial trial question and design. This was rounded off with an excellent dinner in the Aqua restaurant Clifton which provided a great networking opportunity for all the candidates.

Day 2 This built on talks from the previous day and featured talks on alternative trial designs, pilot studies, experiences of a CI and selecting, measuring and reporting primary and secondary outcomes by Professor Jonathan Cook, Professor David Beard and Dr Kerry Avery. Miss Deena Harji gave an insightful talk on the experiences of a new CI. 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.

Day 3 This proved to be the most exciting day of the course, with the majority of the time spent prepping presentations before the final dragon’s den pitch. Essential talks that proved to be useful in pitch preparation included talks on designing protocols for trials from Miss Natalie Blencowe and the practicalities of how to run a clinical trial by Dr Lucy Culliford. The course ended with a dragons’ den pitch from each of the 6 groups on their finalised trial design.

The winning group designed a trial called the BURN study, which evaluated “Immediate endoscopic removal versus watch-and-wait for asymptomatic gastric BUtton batteries in childReN: a randomised control trial”.

Feedback

Feedback from the course has once again been excellent with 100% of delegates rating the quality of teaching excellent or very good and 97% rating the course overall as excellent. Below are some of the quotes from the delegates:

“The best money I have spent on a course. Fantastic!”

“Excellent course - very well organised. Lovely staff - learnt heaps!”

For me, an early-stage trainee, the course was a great introduction to randomised trials, which until then had only been briefly covered in medical school. It gave all the essential information that helped me to understand the core elements of optimising trial design, whilst providing a supportive and welcoming environment. Particularly, it was encouraging to hear the stories of career academics and the hurdles they had to overcome along the way to becoming CIs/PIs. After hearing these stories getting involved in trials seems less out of reach. Coupling this with the excitement of working on a trial design makes this course not one to miss!

Next year’s course will be in Oxford – make sure you sign up! 

 

Christin Hoffmann Senior Research Associate in Health Services Research wrote:

The 6th Bristol Oxford Surgical Trials Course (BOSTiC) was held 17th -19th September 2021, following a 1.5-year gap since the previous course due to the Covid19 pandemic. BOSTiC was, once again, delivered by the multi-disciplinary teams of the Bristol and Oxford Trials Units who welcomed course delegates in Bristol at the historic events venue Engineers House.

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 (RCTs). This year, the BOSTiC was attended by a total of 35 delegates from all over the UK, with the majority being surgical trainees from a wide variety of specialities, but invitations were extended to also welcome Academic Foundation trainees and an academic researcher.

The BOSTiC programme covered an array of principles and methods of designing and conducting a surgical trial. The presenters were carefully selected experts in their field, providing unique and diverse perspectives. A wide range of teaching and delivery methods were used throughout the course to promote engagement and participation such as lectures, tutorials and small group forums. A small number of lectures were delivered virtually with a Q&A. The high-calibre speakers and diversity of teaching style was key to maximising learning outcomes for delegates. This also demonstrated the importance the Bristol and Oxford teams are attributing to BOSTiC and is one indicator of the good quality of the course, distinguishing it from many others.

The spectrum of materials and content covered was immense, truly preparing and motivating delegates to put their newly acquired knowledge and skills into practice:

Day 1 laid the foundations of trial design where delegates learned how to define a robust research question (Prof David Beard) and how to minimise bias in RCT design (Prof Jonathan Cook). The importance of recruitment into trials and techniques to achieving recruitment targets was covered in a presentation and workshop (Dr. Leila Rooshenas, Dr. Marcus Jepson, Prof David Beard, Prof Jane Blazeby). The first of two new investigator talks presented learning points and experiences of running the RECOVERY trial as a principal investigator at UHBWT (Dr Joanna Willis). The evening course dinner was a good opportunity to round up the first day with a chance to meet other course delegates.

Day 2 started with two presentations that introduced alternative trial design (Prof Jonathan Cook) and feasibility trials (Dr Kerry Avery) before learning specific details of RCT outcomes and how to select, measure and report them (Prof David Beard). This was followed by a practical exercise to consolidate what delegates had learned in this session. Another insightful and inspiring journey from a new chief investigator was presented before lunch (Miss Deena Harji). The afternoon was concluded by a presentation and workshop that conveyed useful knowledge about statistics in RCTs, such as power and sample size calculations as well as interpretation of trial results (Prof Chris Rogers).

Day 3 was the final day of the course which began with useful practical tips on trial conduct from the perspectives of a member of the Bristol Trials Unit, including processes and governance procedures that need to be considered (Dr Lucy Culliford). Delegates also learned how to assure consistent quality in RCTs (Miss Natalie Blencowe) and what to consider when applying for funding for RCTs (Prof Mike Whitehouse). With a few ‘sweet’ encouragements, recaps on learning points from each day through questions from and for delegates fostered motivation and reinforced knowledge.

The Dragons Den group presentations at the end of Day 3 deserve a special mention. As part of this, delegates were put into groups by the organising team on Day 1. Over the course of the three days, each group had to design and eventually pitch their idea for an RCT to a panel consisting of four independent experts (the “Judges”). A total of five group work sessions were built into the daily course programme which allowed delegates to consider and incorporate newly acquired knowledge throughout the course. Experienced mentors from the organising team helped guide delegates throughout this process. Lasting for approx. 2h, Judges listened to and scrutinised the groups’ presentations to eventually reveal the winning team. The anticipation of prizes gave this exercise a competitive edge, however, everyone benefitted from this experience which provided an insight into the challenges and complexities of designing and justifying an RCT.

During the many sociable lunch and coffee breaks, I had the opportunity to ask other delegates what they thought of the course and received overwhelmingly positive responses, such as the ones below:

“I think it’s really good. I was recommended this course by another surgical trainee who attended a few years ago. I think it’s absolutely brilliant.”

“I have so many ideas [for trial design]. I now have the skills to implement them, but just need to find the time to put it all into practice.”

Personally, I felt that the course structure and organisation created an extremely conducive learning environment which was further supported by the diversity and expert knowledge of speakers, topics and tasks. For many, this was the first face-to-face course attended since the start of the pandemic and it was certainly a safe but also intimate learning atmosphere. I particularly appreciated the enriching opportunity to speak to medical/surgical trainees from a variety of backgrounds. For me, BOSTiC had a really positive impact, evident by the fact that there was a sustained reflection on the contents conveyed. I am in a fortunate position to be able to discuss and put into practice elements of the course with colleagues and projects at the Centre for Surgical Research. Ultimately, I believe that knowledge “really did stick”.

I am looking forward to the opportunities to mentor at the next BOSTiC courses.