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In late 2015 INTEGRATE, the UK ENT Trainee Research Network, was formed. Since then, two national projects have been completed and INTEGRATE has grown into a larger, more structured organisation, with otology, head and neck and rhinology subcommittees working alongside a research fellow. Chair Matthew Smith outlines INTEGRATE’s past, present and future.

 

What’s been achieved so far?

INTEGRATE’s first project was to establish evidence-based recommendations for epistaxis management, and audit current UK practice. The delivery of 15 systematic reviews screening nearly 50,000 papers, and the INTEGRATE-led British Rhinological Society multidisciplinary consensus event provided early proof of the benefits of collaboration. The following national prospective epistaxis audit involved 113 UK sites, with 1826 cases uploaded to the online database. Participating trainees have now been rewarded with three published papers based on the epistaxis national data set, with a fourth currently under peer review. We are delighted to have received the ‘Best Original Paper’ award for both 2017 and 2018 by the Journal of Laryngology and Otology for this work.

“Participating trainees have now been rewarded with three published papers based on the epistaxis national data set, with a fourth currently under peer review”

Our second project was the 2018 Head and Neck Cancer Follow-up Audit, based on BAHNO guidelines. For this project, trainees at 89 sites submitted data from 5,700 patients. The work was presented at the BAHNO conference in May 2019, winning ‘Best Oral Presentation’. The publication containing the results of this work is under peer review, and we hope that the interesting findings will provide impetus to explore alternative regimens of patient-driven follow-up, with improved patient education and risk stratification.

Our third endeavour, which is currently underway, is the DECODE project: DEveloping a Core Outcome set and Diagnostic criteria for acute otitis Externa. This project aims to pave the way for future studies of acute otitis externa, including a multisite interventional trial run by INTEGRATE.

As well as delivering national projects, a further aim of INTEGRATE has been to provide ENT trainees with the skills to participate in research, and to lead their own projects regionally and locally. To this end, INTEGRATE has run two-day Research Competencies and Development courses, in January 2018 and 2019, providing ENT trainees with Good Clinical Practice (GCP) training and an overview of critical appraisal and research skills. The course imparts basic skills for participation in systematic reviews and research studies, and will run again in April 2020.

With generous funding from ENTUK and the Royal College of Surgeons of England, INTEGRATE has been the first trainee collaborative (to our knowledge) to support the salary of a research fellow to help with the running of the group and drive the delivery of our projects.

 

 

What’s in it for trainees?

Participation in collaborative research has been recognised as a valuable part of surgical training [1], and in the future we hope to increase trainee exposure to high-quality clinical research activity, continuing to create opportunities for junior surgeons to interact with experienced researchers and multidisciplinary teams.

Other benefits to trainees have been easier to quantify, such as the multiple published papers for which all those submitting data to INTEGRATE projects are named authors. INTEGRATE now has a formal authorship policy, in line with National Research Collaborative and Association of Surgeons in Training guidance [2]. This ensures that trainees gain appropriate credit for their work, with complete transparency regarding the level of contribution, which is particularly important at the Annual Review of Competence Progression. The INTEGRATE Research Competencies and Development course has also helped ENT trainees by providing a complete package to ensure they meet CCT research training requirements and are prepared for other roles, such as those within the excellent new NIHR Associate Principle Investigator scheme [3].

 

John Hardman and Thea Tikka give the prize-winning INTEGRATE talk at the BAHNO Annual Conference, 17 May 2019.

 

A workshop at the INTEGRATE Research Competencies and Development course at the Royal College of Surgeons of Edinburgh Birmingham centre. 

 

What does the specialty gain?

Trainee collaboratives and networks are recognised by the Royal College of Surgeons of England as a key part of the research infrastructure being developed to expand the UK surgical clinical trials portfolio [4]. Groups such as INTEGRATE help to engage a new cadre of surgeons in research, providing not just surgical research skills training, but hands-on experience in study design, site set-up and patient recruitment. This helps to create a research-ready clinical workforce, building long-term research capacity in ENT.

Collaboratives also provide a highly cost-effective means to deliver large projects, as demonstrated by the epistaxis project, where total expenditure for the audit and the associated consensus process was under £6000, less than one tenth of the cost of previously delivered national audits in the specialty [5,6]. This comes from online working, innovative methodology, and importantly, using the highly-motivated, patient-facing pre-formed network that the trainee body provides. These benefits can also apply to some research studies, with two impressive examples from other trainee-led collaboratives completing large randomised controlled trials, each involving over 750 patients, for only around £250,000 funding.

What’s next for INTEGRATE?

While large national audits have proved that the trainee-led collaborative model is effective in ENT, in the future we are looking to deliver large research studies. The specialty subcommittees are currently working on plans for national prospective studies, assessing quality of life outcomes following tonsillectomy, and the efficacy of intranasal haemostatic agents for epistaxis.

As well as our own national projects, one of our more recent aims has been to develop a varied portfolio of projects which are supported by INTEGRATE but remain externally led and funded. These will benefit from access to a national network of trainees, and our experience coordinating national projects. Once the scheme is established, it is hoped that trainees will be able to browse a list of studies, and pick and choose which they become involved with according to their interests. Our first portfolio project, the SeaSHeL study investigating sudden onset sensorineural hearing loss, is currently recruiting site leads across the UK. We are pleased to have had further approaches from teams with studies at various stages of development and hope to add to the INTEGRATE portfolio soon. If you have a project you think may benefit from more widespread trainee involvement, please get in touch to discuss how INTEGRATE might be able to help.

It is an exciting time for trainees interested in research, and we hope INTEGRATE continues to grow and develop, helping trainees to participate in meaningful audit and research studies, and continuing to build the research capacity of ENT as a specialty in the UK.

 

References

1. Lee MJ, Bhangu A, Blencowe NS, et al. Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group. International journal of surgery 2016;36(Suppl1):S24-S30.
2. National Research C, Association of Surgeons in Training Collaborative Consensus G. Recognising contributions to work in research collaboratives: Guidelines for standardising reporting of authorship in collaborative research. International journal of surgery 2018;52:355-60.
3. National Institute for Health Research. Associate Principal Investigator (PI) Scheme.
www.nihr.ac.uk/documents/
associate-principal-investigator
-pi-scheme/11694

Last accessed October 2019.
4. Morton D. RCS to Expand Surgical Research Infrastructure. Ann R Coll Surg Engl (Suppl) 2012;94:131–2.
5. The Royal College of Surgeons of England. National Prospective Tonsillectomy Audit Final Report. RCS England. London, UK; 2005.
6. The Royal College of Surgeons of England. National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis. RCS England. London, UK; 2003.

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CONTRIBUTOR
Matthew E Smith

MA, PhD, FRCS (ORL-HNS), Addenbrooke’s Hospital, Cambridge Biomedical Campus, UK.

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