A research journey in the time of corona virus disease (COVID-19)

ABSTRACT

BackgroundCOVID-19 has seen a global research effort to address the pandemic and U.K has been at its forefront with flagship trials such as RECOVERY trial which have transformed COVID-19 management. RECOVERY trial involved hospitals and healthcare professionals in research in an unprecedented scale and provided opportunities for trainees to engage in research.While children have been relatively spared from acute COVID-19, emergence of the novel hyperinflammatory condition Paediatric Inflammatory Multisystem Syndrome Temporally associated with Severe Acute Respiratory Syndrome Coronavirus 2 (PIMS-TS) was a diagnostic and treatment dilemma. Commencement of treatment trials for PIMS-TS in the paediatric arm of RECOVERY trial coincided with the roll out of NIHR Associate PI scheme, which is an opportunity for trainees to gain experience in research.ObjectivesWe aim to describe the trainee experience of research during COVID-19, as part of the RECOVERY trial team at a specialist children’s hospital.MethodsInterviews were undertaken with non-consultant grade paediatricians involved with the RECOVERY trial as Associate PIs, regarding their research journey.ResultsUndertaking the Associate PI scheme was a structured introduction to research, requiring completion of the training and familiarity with trial protocol. As a specialist children’s hospital with a regional paediatric intensive care unit, the number of patients eligible to participate in the trial increased rapidly during the peaks of the pandemic. The increment in numbers meant that Associate PIs had to be skilled up quickly in all the aspects of this ‘platform trial’ which evaluates several drugs at the same time. However, the pragmatic trial methods which aim to ease research recruitment for the busy clinician with minimal burden to families and the excellent training resources instilled confidence in embarking on the research journey.Informed consent process was an iterative learning journey where the theoretical understanding of consent and assent in paediatric trials was followed by a very different learning curve of real-life consent process. Understanding consent as an information cycle rather than a single process and balancing the needs of the carers of a sick child empathetically was a skill developed by observing the consent process before independently recruiting. Valuable communication skills were gained as COVID-19 visiting restrictions meant discussions with non-visiting parents and occasionally obtaining remote consent. Team working in collaboration with research nurses and pharmacists was another benefit of the research journey. Attending the regional PIMS/COVID MDT discussions where standardised treatment and research decisions were undertaken, enhanced the knowledge and experience in clinical management of these patients.ConclusionsOverall it has been rewarding to have contributed to one of the largest recruiting COVID-19 research trials, thus making a difference to children’s outcomes. Furthermore, the RECOVERY trial and Associate PI scheme have provided unique research opportunities hitherto unavailable for trainees in general paediatrics and embarking on this journey has cemented our intention to continue research engagement as part of day-to-day clinical practice.