The 7th annual Bristol Oxford Aberdeen Surgical Trials Course (BOSTiC) was held in Oxford this year at Worcester  College, University of Oxford. Indeed, it could have been considered the 1st ever with the addition of the Aberdeen  Surgical Trials Unit to the core team, adding a certain sense of self-confidence to the new acronym. The three day  course took place over the 7th, 8th and 9th of September 2022. The lecture theatre was nestled deep in the beautiful  setting of Worcester College gardens, surrounded by weeping willows, adjacent to a serene lake and within the well tended lawns of the ancient college. Accompanied by the surrounding transition from Summer to early Autumn, thiswas the perfect setting for the deep contemplation of surgical trials methodology. Expert trialists from Bristol,  Oxford, and Aberdeen descended on Worcester College, each group bringing their own nuanced views and expertise  on surgical trials, but most importantly bringing a sense of good vibes and collaboration. 

We were warmly met on Day 1 by Professor Beard, showcasing a delicious array of breakfast items, including fresh  pastries and bacon sandwiches, coffee, tea, and orange juice. Once we had enjoyed these refreshments, we were  seated in the lecture theatre and the course began in earnest. From the off, we were informed that it would be an  intense ‘crash course’ in trials methodology by Prof. Beard, and in retrospect, he couldn’t have been closer to the mark. What was striking from the off was the extraordinarily low ratio of delegates to faculty. Two sides of the  lecture theatre were reserved for surgical trialists who were there to facilitate our learning. We sat in groups of 4-5,  with ample space and comfort. The first day focused on the broader aspects of clinical research in surgery. Dr. Sheraz  Markar explained why we need evidence-based surgery – something that although we may all inherently feel, is  occasionally difficult to articulate. Having established this, we moved on to preparing the foundation for good clinical  research. This session was delivered by Prof. David Beard and led directly into the ‘anatomy’ of a good research  question, covering the essentials of research question design: the PICO framework. Having designed our clinical trial  question with Prof. Beard, Prof. Jonathan Cook then took to the lectern and explained to us how to boost the  internal and external validity of our trial through minimising bias and maximising generalisability. By lunch on Day 1,  we had learned to develop our question and design a robust trial that might answer it. 

Following lunch, we heard from Prof. Marion Campbell from the Aberdeen Unit, who deftly and comprehensively  covered outcome measurement in 60 minutes. A key lesson here was that although the ‘O’ comes at the end of the  PICO, getting it wrong at the start will jeopardise the entire study. We then split into small groups and began working  up our own trials. We were grouped broadly by surgical specialty interest, which worked excellently as we were able  to all work towards something with genuine clinical academic interest. The afternoon of Day 1 was spent hearing  from Dr. Natalie Blencowe and Dr. Sheraz Markar about the logistics and realities of conducting surgical trials in the  NHS. Building on the theory of the morning, this session really hammered home some of the highs and lows of doing  this kind of research. We finished the day by presenting our initial ideas for our group projects to the wider group.  There was time for a swift pint before heading for the course dinner at Mamma Mia Pizzeria, an Oxford landmark  restaurant, just down the road from Worcester College. 

Day 2 began with a similarly sumptuous breakfast. We then heard from Professor Jane Blazeby of the Bristol Surgical  Trials Unit who delivered a session on pilot and feasibility studies. She explained clearly the indications for such  studies, the differences and similarities, and the consequences that can occur when they are not undertaken. Before  tea, Prof. Cook gave us an overview of alternative trial designs: stepped wedge, cluster, cross-over, etc. which addedfurther breadth to the knowledge gained the day before. After coffee, we had two talks that covered recruitment  and retention. Dr. Marcus Jepson covered strategies and tools we can use to optimise recruitment into trials, the  Quintet Recruitment Intervention in particular. This talk was augmented with theatrical performances from Prof.  Beard and Prof. Blazeby who demonstrated the dos and don’ts of recruitment. Dr. Katie Gillies from Aberdeen then  gave a hugely insightful lecture on retention – a sometimes overlooked but absolutely critical aspect of trial design. 

The afternoon of Day 2 was spent in our groups, putting what we had learned into practice, punctuated by two  excellent lectures with practical exercises on statistics by Dr. Beth Conroy. Dr. Conroy made stats fun. We covered  the pertinent aspects of trial statistics, which for me, finally made a lot of sense. Day 2 came to a close and more  social activities were undertaken by delegates and faculty alike, although off our own steam this time. 

The morning of Day 3 arrived. Again, a nutritious breakfast was laid out. There was a palpable feeling of excitement  as we would be up against each other in the afternoon for the Dragon’s Den. The group with the best and most well thought-out trial idea would win the coveted BOSTiC Dragon’s Den (first ever? See above) prize. We had some  fantastic practical talks in the morning from Prof. Beard and Dr. Lottie Davies from Oxford who shared their personal  lessons learned from running surgical trials at the Oxford Unit. Ms. Deena Harji then gave a hugely inspiring talk  about her career as a surgical academic, again offering up her own personal experiences and insights. After coffee,  Professor Matt Costa delivered an astounding overview of the WHITE platform, demonstrating the power and  efficiency that is possible through platform trials. A great talk to finish the lecture series. We then had the afternoon  in our groups to formalise, refine and perfect our trial pitch for the Dragons’ Den. We were up against Prof. Blazeby,  Prof. Costa, Prof. Campbell, and Ms. Harji. All groups did a sterling job against the Dragons and the competition was  extremely tough. Ultimately, our group was announced as the winner, with our trial ‘FITENITE’ taking the top spot.  We were showered in high praise, certificates, congratulations, and chocolate. This brought BOSTiC 2022 to a close.  A three day, intensive, comprehensive, and stimulating crash course in surgical trials. We learned everything from  asking the right question to delivering a multi-arm multi-intervention platform RCT of surgical interventions and  more. What struck me was the extraordinary breadth of clinical trial methodology that was covered, yet each talk  was delivered in a manner that was bespoke to surgical trials and furthermore, appropriately tailored for surgical  trainee audience. That is what makes BOSTiC stand apart from other trials courses for me and that is why I would  recommend it to any trainee who is interested in surgery, clinical trials, or indeed, both.  

Justin Wormald 

Plastic Surgeon, NIHR Doctoral Research Fellow