Case study: Taking on new challenges- The junior doctors making a difference to COVID-19 research
We spoke to two junior doctors, Bilal Ahmed Mohamud and Antoni Gardener, who have been supporting the RECOVERY trial.
Across the UK, acute NHS trusts have been supporting the delivery of the world’s largest trial into treatments for patients hospitalised with COVID-19. The randomised control trial, known as RECOVERY, has already changed clinical practice, identifying the commonly used steroid dexamethasone as the first drug to improve survival rates in certain coronavirus patients.
On the Isle of Wight, collaboration between research and clinical teams at St Mary's Hospital has resulted in more than 100 patients joining the study, helping to provide the data which has saved lives.
Antoni: I became involved with the RECOVERY trial shortly after joining the Isle of Wight NHS Trust. I had a bit of experience in research through my training at medical school but I’d never been involved in an active clinical trial before. The opportunity to work on the RECOVERY trial was one that I felt was important to take.
At the time, we only had one Principal Investigator (PI) on the Isle of Wight to manage this clinical trial. I was approached by the team at the hospital about training to become an associate PI in addition to my usual role and helping on the RECOVERY trial.
It seemed like a good choice for me; I could already see areas where we could establish improved processes and how I could help improve recruitment to the trial so I said yes to the training. Not all of it was unfamiliar to me, but it required a couple of days of working through the online modules and training resources.
Once I’d completed the training, I became the Associate PI on the RECOVERY trial which I felt privileged to be. To learn new skills and then apply them straight away, was a fantastic opportunity. I also hadn’t appreciated the fact that undertaking a medicine-based clinical trial involves a lot of behind the scenes work that you don’t normally face as a doctor.
Consenting patients into the trial, which is a key part of my role, is so important to get right. I have to ensure that the process is formalised and explicit, everything has to be ethical and nothing can be assumed – I have to come up with solutions for problems to help these processes.
We worked on several ways to help us streamline how we were consenting patients into the trial, including giving information to patients and relatives early so that they had time to absorb it all and ask questions – an important part of the role is being on hand to answer those questions in detail.
Once patients were consented into the trial, we created a separate database for all our COVID-19 patients to manage the process more effectively.
Working as a Principal Investigator has broadened my interactions with research departments, a multi-disciplinary approach is new to me and has really enriched my experience of working in the NHS.
Applying my associate PI training to a trial like this has been an excellent remedy to tunnel vision. We have a reliable framework to troubleshoot issues regarding patient recruitment, randomisation and treatment allocation, which gives us a holistic approach to looking at improvements we can make. It’s also broadened my interactions with research departments, a multi-disciplinary approach is new to me and has really enriched my experience of working in the NHS.
Being involved in the trial as an Associate PI has been a unique opportunity because the pandemic has expanded impactful research all over the world. It’s been a fantastic way to get involved in research and such a large scale too. Qualifying as an associate PI has given me the confidence to take on more senior leadership roles and get involved in more research projects further down the line.
Bilal: I’ve been working on the Isle of Wight, at St. Mary’s Hospital, for the past 15 months as a locum in acute medicine. As such I’m usually the first port of call for a lot of COVID patients that come into the hospital.
In December 2020 we had a lot of COVID-19 patients coming into the hospital, which is when the RECOVERY trial was first mentioned to me. I was keen to get involved as in my normal role I prescribe the required medication for patients which involves me explaining to them in detail about the medicines. I felt that it was a natural fit for me to help consent patients into the trial.
Explaining important information and simplifying relevant medical jargon for patients is a key part of what I do and consenting patients into trials is very similar; the process of answering any questions they may have about the trial, gaining informed consent by being clear about what is involved, completing relevant documentation and randomising them into the trial.
This is my first experience of being a member of a clinical trial research team so it has been a real learning curve. There is some online training in the form of videos that have to be completed before someone can start recruiting, I found them really helpful and it made my work in the trial a lot easier. Putting those new skills into practice was really rewarding and I could revisit the training at any point to refresh my memory which made a big difference.
The study moves at such a fast pace that the research nurses have been essential and amazing at keeping us up-to-date with trial changes and new approaches. I’ve never worked with research nurses before but it’s been a great experience – they’re always on hand to answer any questions I have. Learning from this different clinical experience has been an exciting and interesting part of being involved with the trial.
There’s a real diversity to my day and it’s certainly inspired me to get involved in more research opportunities in the future."
At the beginning the consenting process for this trial was unchartered territory for me, but I grew more comfortable with experience and was able to anticipate the questions and needs the patients might have which helped them to have confidence in participating in the trial and to put them at ease, making the process much smoother for everyone.
Being involved in such a large trial and seeing the difference it has already made to patients, for example dexamethasone becoming a recommended treatment for patients with COVID-19, gives me hope that every time we trial a new treatment option it could be the one that we’re looking for.
I can see the hope that we’re giving patients through the trial and with the restrictions on visitors and staff all in face masks and protective equipment, that hope has become so much more important for patients, their friends and their relatives.
I’ve been able to learn a lot during this time by working across so many different departments and making connections with people in the hospital that I normally wouldn’t have met. There’s a real diversity to my day and it’s certainly inspired me to get involved in more research opportunities in the future.