Further discussion of these topics through the day was interesting and useful. A well-recognised problem was the competing interests that exist for trainees’ time, and thus the number of trainees getting involved with TRNs. It was noted that there may be some national guidance coming on trainees being able to use SBA time in a more personalised manner, particularly outside of key exam years. I personally think that a discussion about the ability to use training time in this manner could be a big draw for trainee involvement, especially as such training/ARCP requirements are often being completed in trainees spare time. This does still seem to be a significant challenge but hopefully the increasing recognition of the quality of the work that is being done, such as the size and scope of the DALES project, will continue to be a draw for trainees. With trainees already working so hard, it is difficult to ask for additional free time to be sacrificed, no matter how interesting the projects are.
This topic of engagement was touched upon again later in the day. Charlotte Small delivered a presentation on some of the work of the West Midlands TRN (WMTRAIN) on promoting trainee engagement in their region. They had created a number of videos introducing their network, giving a brief introduction to what they were about. They felt that this was a useful and helpful approach to advertising and promoting the network over a large region, especially compared to ‘in person’ promotion at the different hospital sites. This was a particularly nice way of distilling the concept of trainee-led research and audit into a clear message.
Tim Cook then gave an overview of the processes behind the NAP projects in particular looking at the challenges in getting them completed. A key point was the size of the studies - for example, NAP5 essentially doubled the case numbers on anaesthetic awareness in the medical literature. It is partly this size that makes them so valuable but requires a significant effort. A major part of this has been the engagement of clinicians throughout the country who have allowed it to work, a similar factor in the success of the RAFT projects. The primary goal of NAP is to produce a better knowledge of harm and thus improved information for patient. This study approach is well suited to answering the question that is being posed, where the events are so rare that and RCT approach is impossible. Despite their rarity the seriousness of the events is a big factor of interest for anaesthetists. Indeed, the design of the NAPs is that they are chosen, funded and performed by anaesthetists, which is perhaps why the topics that have been picked feel so relevant. Whilst wrapping up he used the term ‘citizen science’ to describe this widespread engagement of clinicians who aren't 'researchers'. I really like this term to highlight the ability for non-research clinicians, especially trainees, to participate in meaningful, large scale projects that can make a positive impact for patient care.
There are a couple of other major national projects ongoing that are of particular interest to RAFT groups. The FLO-ELA (Fluid optimisation in emergency laparotomy) project is currently ongoing and really benefiting from trainee involvement. The concept behind this project is that currently we don’t have a good idea what to do for fluid management in this cohort of patients. These patients are probably different from both the elective laparotomy patient and the patient with sepsis which have both been studied. Given the number of emergency laparotomies that happen out of hours, the involvement of trainees in recruitment is really helpful. More information is available from their website here: https://www.floela.org/
A final project that was presented was the Perioperative Quality Improvement Programme (PQIP). This is a national programme that aims to look at the perioperative care that is being provided and then providing local data back to participating sites to aid local QI work. Data is collected locally from certain patient groups, submitted to the PQIP database and a lot of this is then collated and returned by the PQIP team to aid this process of QI locally. Measures include parameters such as the number of patients receiving the different ERAS components, and the number of patients meeting targets such as drinking, eating and mobilising on the first day after surgery. I continue find this project very interesting because of the QI focus of it, giving it some very immediate utility for the vast majority of hospitals. As has been done at some sites, the PQIP work can be used as a foundation for more specific local project of interest e.g. looking at perioperative anaemia. This seems like such a good starting point for many different sorts of QI work that it is something I am quite interesting in finding more about. More information is available here: https://pqip.org.uk/content/home#
The TRI-STAR team also provided an update on the work of their developing trainee network. They are another geographically spread-out trainee network of military trainees. They have started with a few smaller studies, including exploring the role of peripheral nerve blockade, and are looking at developing future projects.
Next the Paediatric Anaesthesia Trainee Research Network (PATRN) team talked about their special interest network (https://www.apagbi.org.uk/professionals/trainee-section/research-network-patrn). They are part of the Association of Paediatric Anaesthetists (APA) and have undertaken a few projects since their 2015 inception. The biggest has been the PAPAYA study which looked at unplanned admissions of paediatric patients after day case surgery, recruiting nearly 24,000 patients. They are currently preparing to deliver the PEACHY project looking at the impact of obesity on adverse perioperative respiratory events.
Finally, James from the STARSurg team talked about the work of their surgical network. Developed as a more student focused research group, he talked about how they were set-up to promote medical student involvement whilst still ensuring the support of senior clinicians. They have done some pretty impressive collaborate work, including on an international scale, as well as other work promoting research skills (HACK days). They have just started their next study, RECON, looking at postoperative pulmonary complications following abdominal surgery. More information can be found at: https://starsurg.org/