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EASD Robert Turner Clinical Research Course 2018

Oxford, UK, 1 - 5 April 2019

Day-1  Sunday & Monday:

SUNDAY

Arriving at Corpus Christi College on a beautiful Sunday afternoon we were met by Mary Hata.  This course would not have been possible without the tireless efforts of Mary who organised and facilitated 20 travellers from all around the world to be able to come to Oxford and be taught by such a faculty of clinical and research experts. We met and toured the colleges of Oxford before retiring for the evening.

MONDAY

This course began with a warm welcome from Prof. David Matthews, Dr. Anne Clark and Dr. Jonathan Levy when we stepped into the Robert Turner Lecture Theatre at OCDEM (The Robert Turner: pioneer of the UK PDS). As Anne said, “Please let here become your home”, so definitely she became our mother at home who carefully looked after us all during the following five days. 

After a brief introduction about the course, Prof.  Matthews began to shake our brain. It is not the way we normally think about the numbers; what is  a ‘number’ and how numbers can be interpreted. "What is the probability that the next person to walk through the door will have more than the average number of arms?" Silence. Most people wrote down the answer "0" without hesitation. This seemingly simple question sparked an intellectually stimulating discussion around what is probability.

After that Jonathan Levy delivered a vivid lecture about physiological experiments and then showed us many useful tips for dealing with raw data, like a magic Excel tool to compare the difference between two sheets after data cleaning, which were all helpful for us to work more effectively in the future work.

Next on the agenda, an experiment to help illustrate some of the difficulties encountered in real world research. Figure 1 below speaks for itself.  Using PVC pipe, marbles and Weibull paper we calculated what angle of elevation our pipe needed to be for 50% of our marbles to fall out the end of our pipe, with the remaining falling out of a hole further along the pipe (analogous to particles in the blood and receptor activation).  Exercises also highlighted how there can be high inaccuracy (variation) in estimating outcomes (i.e. the area of our lecture theatre in square feet) and what tools we could use to improve our estimation.  

During these experiments, we also understood some precious points: 1. There are a lot of confounders in the real world when conducting a real trial and maybe a pre-trial study will help you to find out these confounders and then control for them later; 2. There did exist laboratory error when conducting a multi-center trial; one way to control this is to standardized method between centers and recalibrated it when necessary.

Our day consisted of three more lectures from experts including: Brian Shine, Jeremy Tomlinson and Jonathan Levy.  Lectures included an interactive discussion about statistics and modelling of data, vital for designing and conducting research projects; discussing Translational Medical Research and how to get a drug from the lab to market and hypothesis testing.

Figure 1. From the left: Jonathan Levy, David Matthews and Brian Shine demonstrating how the experiment should be performed.

Our day was not yet through! After finishing at OCDEM we were off to Corpus Christi College for dinner during which David Matthews entertained us with anecdotes from his time at Corpus.  The beautiful halls of Corpus Christi and the opportunity to sleep there during the week will be an experience I’m sure that we will all cherish. Our international evening afterwards consisted of each of us bringing something from our home country to share with our fellow travellers; food (biscuits, chocolate, cakes), pictures, traditional items decorated eggs, bookmarks and clothes. 

Day-2 Tuesday:

09.00-10.00 What is the role of a clinician in research

Tuesday was dedicated to the adequate preparation of research both in short term and in the long term. The day was kicked off by Alistair Lumb who challenged us to put ourselves in the shoes of the researcher, clinician, and the research-clinician. The group was split into three and all were asked to debate on the advantages and difficulties of one of the three positions. All viewpoints were then written on a flip-over which we presented to the other members of the groups.

10.00-11.00 Clinical trials in Diabetes

The next hour was dedicated to clinical outcome trials in the field of diabetes. Prof. Rory Holman gave us an elaborate and interesting oversight of global cardiovascular outcome trials. Being young diabetes researchers, we were captivated by the overview and insights Prof. Holman presented to us. We discussed the start of UK PDS and the impact of the CVOTs since. A particular point of interest was the development of SGLT2-inhibitors and the striking outcomes they showed on cardiovascular endpoints. We considered potential underlying mechanisms and future studies, and the hour turned out to be almost too short to discuss all. 

11.30 Using the Literature

During the last part of the morning, we were taught how to appreciate existing literature and how to write a decent paper by Dr. Anne Clark. She gave us very concrete advice on how to manage our result section, how to inform our audience properly in the introduction, and how to complete our paper by a concise yet complete conclusion.

In addition, we were put in the shoes of an editor-in-chief to judge existing abstracts on their publish-ability. The group was appropriately critical and we decided that none of the abstracts were ready to be published in our prominent journals.

14.00 Presentation skills

After lunch, one of the great speakers of the Robert Turner Course, Prof. David Matthews himself, gave us some of his best advice in how to capture our audience’s attention with a good presentation. The most useful trick, we thought, was the use of hyperlinks throughout our presentations. In this way, you can quickly jump to a slide with additional information about the subject, or to your finishing powerpoint slide whenever you are short in time. Furthermore, we experienced the effect of lowering your voice when speaking in front of a group.

15.00-18.00 Working in the CRU / planning and preparing tomorrow’s experiment

At the end of the day, we were ready to design and prepare for our own experiment. We first got an explanation about the logistics of the clinical research lab and of its possibilities, and were then split into groups of 5.  For the design of our research, we had access to measuring equipment needed for, amongst others, length, weight, and blood pressure. In addition, we were given the opportunity to draw blood samples and determine a certain set of variables. Each group formulated a research question and designed their experiment appropriately. In many groups, this involved an intervention with caffeine, and several groups made use of the home trainer in order to study exercise. In every group, one or two participants stepped forward to volunteer as test subjects. These were the people who generally did not get to eat breakfast the following morning, for which we owe them our thanks.

Day-3 Wednesday:

Wednesday was perhaps the most interactive day. The objective of the day was to conduct our own clinical experiment with analysis, interpretation and presentation of the data.

We were divided into four groups the previous day. We discussed various ideas and planned our experiment which we could do with the available facilities and in limited time.

We also decided within our teams about various roles. Some of us had to fast for the experiment while others enjoyed a typical English breakfast in Corpus Christi College.

In OCDEM, we separated into our respective groups and started our experiment. The Green group worked on the role of caffeine in preventing exercise-induced rise in lactate. While other groups worked on their respective ideas. Subjects who were fasting got their breakfast after the experiment.

After lunch, Prof. Dylan Thompson gave us a very exciting talk on exercise and metabolism. Dr. Eleanor Kennedy then gave a talk on how to apply for research grants. This talk was rated highly useful by the participants.

After these two talks, we got the results of our experiment back. We again divided the tasks amongst the group members and started preparing abstracts and powerpoint presentation of our experiment. We only had a short time for this.

After that, we presented the results and findings of our experiment in the form of oral presentation where David Mathews, Anne Clark and Jonathan Levy gave us very useful feedback.

We thoroughly enjoyed the teamwork and proved how effectively we could perform the experiment, the analyses, interpretation and presentation of our own data. It really was an unforgettable experience and brought a lot of laughter and fun to the week as a whole!

It was a wonderful day in which we learnt how to work as team and how to conduct a scientific experiment.

Day-4 Thursday:

After the all-exciting Wednesday, expectations for Thursday were not high.  After all, everyone had attended fascinating research ethics lectures at medical school.

But Thursday was nothing as expected. On that day, the sun had not decided to make an appearance and it had been drizzling all day. The famous Oxford greenery appeared misty as we took the short walk from our hostel to Corpus Christi College.

After introductions, Dr. Paul Chester and Dr. Catherine Carrington started the best interactive activity on Good Clinical Practice, with timely Pub quizzes and a lot of sweets and fruits.

Following lunch in the College Dining Hall, our group conducted a small tour of Corpus Christi College - famous in Oxford and a proud beauty. The chapel with its painted glass was a sight to behold while the library was the perfect blend of old and modern. After the tour, the afternoon session of the Good Clinical Practice was resumed, followed by just enough time to do some wandering around Oxford peeking into its historical sights.

 

After a day full of lectures we gained our prize: in the evening we had the honour to meet the widow of Robert Turner – Dr. Jennie Turner. Dr. Turner found time to get to know each of our group. We were totally spellbound with how nice, open and charming she was.

During the whole course we were introduced to Robert Turner’s work but we had also the unique opportunity to get to know him as a person – still alive in memories of his co-workers and friends. Thursday evening was also full of memories of Robert Turner. The friends of the famous scientist entertained us with some anecdotes from their life and work together.

That was really an unforgettable evening.

Day-5 Friday:

Robert Turner Course 2019- the last day had arrived. We were all very sad that we soon had to leave Oxford and to separate from this great group that we had so enjoyed working together with over the last four days. We definitely grew together during this week.

Like the previous days, also the last one started early. After four days of tough work we were even more tired this morning but still enthusiastic and motivated by the last dinner within the college and this beautiful speech of David Matthews.

In this mood, we were again driven to OCDEM. Here, the last day started with an interactive lecture on ethics by Hugh Davies. We appreciated it a lot seen that, in science, this topic is as highly important as it is often underestimated. Discussions on specific cases showed us in an impressive way how difficult ethical questions sometimes can be found answers to. There is never only right or wrong and even if it seems to oneself that an issue is univocal, it appears that it’s not. Thus, it was a very thought-provoking lecture.

The last session was the debating club or ‘clinical conundrums: sorting the wheat from the chaff’. With this, we didn’t only have to deal with pros and cons of GLP-1 receptor agonists (do they increase the risk for pancreatic cancer?), we also had great fun and were introduced in this wonderful English tradition of debating- that has always been an important custom especially in Oxford. So, we were split into two groups, one being pro use of incretin mimetics, the other one being against. In order to prepare our respective debate, we were supplied with the same scientific papers on this topic. Each group was supported by one specialist from OCDEM, helping to sort out the most important up- and downsides of each study. After an intense preparation phase, two persons of each group were sent to the front: one to present and defend the respective group’s point of view, the other to criticize the opponent’s position. We learned how to interpret studies and put them into context. Additionally, we directly experienced how publicity and success of a scientific “story” is not only depending on its content but also often on how it is presented.

Today again, we were lucky to get such an excellent lunch at OCDEM, last refreshment before our journeys home. Also, it was the last chance to say goodbye and thank you to David Matthews and Anne Clark.

After this, we got a tour through the research center. Having learned a lot about it already during the week, we were all very keen on getting some insight. Again, we were split into groups and each group was guided by a lab member, each of them being very friendly. The tour was very informative and interesting- getting to see the different lab rooms, various machines and instruments, Anne Clark’s bench… One of the most exciting parts was the islet transplantation lab where we didn’t only get an insight into this highly sterile room but also learned something about how islet transplantation actually works. Of course, already the building as such and its story as well as the staff working there are really remarkable and left a strong impression.

After the tour, we finally had to break up as a group: some of us stayed at OCDEM, some took a bus already outside the building and some went back with the bus to Corpus Christi where most of us definitely said goodbye to each other.

We all left Oxford with a huge treasure, including memories, knowledge, skills and of course contacts of many interesting, motivated and lovely people from all over the world.

Thanks again, EASD for this great opportunity to take part in the RCT. Thanks also to Lilly Diabetes for their sponsorship making the whole course possible.