Celebrating 20 years of the UK Dermatology Clinical Trials Network. Part 2: education, training and capacity building.

In Part 1 of this 2-part review of the 20th anniversary of the UK Dermatology Clinical Trials Network (UK DCTN), we described its role in developing and supporting clinical trial proposals, elaborating on structure, process and clinical trials activity. This review describes the diverse educational and training activities that the UK DCTN supports. Although not primarily set up as an educational organization, an education and training function emerged organically as the network grew. Education and training also embodies the democratization principle that drove the formation of the UK DCTN, allowing participation from a much wider group of individuals than just senior academics. Far from being a sideline, education and training has now become a major component of the UK DCTN that evolves constantly through changing training curricula and trial methodology developments. Formal UK DCTN training opportunities started in 2007 with competitively awarded annual fellowships for dermatology trainees, followed by similar schemes for general practitioners, Staff and Associate Specialist clinicians and dermatology nurses. These were followed in 2013 by larger groups of trainees who work up specific trial proposals with senior mentors. Finally, a virtual journal club emerged during the pandemic in 2020 in order to reach trainees with little access to academic training. Focused activities with dermatological nurses and patients/carers also take place. Such activities require considerable organization and volunteerism from the co-ordinating centre and former fellows. Education and training has become an essential component for capacity building to develop clinical trials and succession planning for the UK DCTN.

Background

Education and training is a critically important facet of the UK Dermatology Clinical Trials Network (UK DCTN) in order to develop critical appraisal and clinical trial designs skills that are needed to sustain the network with the aim of improving patient care. This review describes the evolution of the education and training activities of the UK DCTN.

UK Dermatology Clinical Trials Network fellowships

Specialist registrar (SpR) fellowships for dermatology trainees started in 2007 based on the suggestion of a trainee, Debbie Shipley, following her experience in the PATCH studies. The award structure was co‐developed with our inaugural Fellows (Jonathan Batchelor and John Ingram), providing a formal mechanism to become involved in developing UK DCTN trials. The highest scoring application is designated the Neil Cox award in recognition of the late Dr Neil Cox, who played a key part in developing the UK DCTN PATCH studies. , In 2009, the UK DCTN Nursing Prize was introduced, which later became the Nurse Fellowship. As part of our inclusivity drive, a Fellowship for Staff and Associate Specialist (SAS) clinicians was launched in 2010, followed by a General Practitioner (GP) Fellowship in 2012, owing to growing collaboration with primary care. More recent developments have included broadening the Nurse award into a Nurse/Pharmacist Fellowship and the evolution of the SAS offering to the Certificate of Eligibility for Specialist Registration (CESR) pathway.

The five competitively awarded UK DCTN Fellowships (two SpR, one GP, one CESR and one nurse/pharmacist) are offered annually, with funds covering travel and fellowship meetings. Local training supervisor support is a requirement. Table 1 lists the range of core activities undertaken. The commitment is 1 day/month over 2 years. Year 1 focuses on critical appraisal skills and trial design and Year 2 applies those skills to UK DCTN projects. To date, 65 such Fellowships have been awarded (Appendix 1). Many alumni have since assumed significant leadership roles in network activities and in promoting evidence‐based dermatology.

Table 1

Core activities for UK Dermatology Clinical Trials Network fellowship.

Year	Activities
Year 1	BEES course covering critical appraisal of different study designs, sources of bias in clinical trials, qualitative research, statistics and sample size calculation, systematic reviews and how to practise evidence‐based dermatology
	3‐day visit to the UK DCTN Co‐ordinating Centre in Nottingham to learn more about critical appraisal and diverse clinical research projects
	Join the UK DCTN Steering Committee to hear and vote on outline and full proposals presented that day
	Series of critical appraisal workshops with UK DCTN Chair, which involve submitting written critical appraisals using a framework that are then discussed online
Year 2 a	Maintain membership of the UK DCTN Steering Committee meetings
	Free attendance at the Annual Evidence Based Update Meeting, at which new trial and systematic review evidence for a specific area in dermatology, such as acne or hair disorders are presented in an interactive format
	Undertake a relevant research activity, e.g. get involved in a UK DCTN trial development team, join a systematic review team or participate in a methodological project

BEES, Better Evaluation of Evidence and Statistics; UK DCTN, UK Dermatology Clinical Trials Network.

General Practitioner Fellows and Certificate of Eligibility for Specialist Registration Fellows can choose to undertake their award over 3 years if preferred.

UK Dermatology Clinical Trials Network Trainee Groups

It soon became clear that the limited number of annual Fellowship awards was not sufficient to meet the demand from dermatology trainees for developing skills in clinical trials. Encouraged by the success of a surgical trainee scheme in the West Midlands, the UK DCTN explored how such a scheme could work for dermatology, especially with trials that could be completed in a relatively short time. Initially led by Carsten Flohr and UK DCTN alumni John Ingram, Jonathan Batchelor, Rubeta Matin, Abby Macbeth and Emma Pynn, the inaugural UK DCTN trainee cohort started in 2013 (Fig. 1a) with subsequent cohorts in 2015, 2018 (Appendix 2) and 2021 (Appendix 3).

Figure 1

(a) UK Dermatology Clinical Trials Network Trainee Group members at the research training day in 2013. (b) Taking part in the UK Dermatology Clinical Trials Network Online Journal Club.

The UK DCTN Trainee Group programme has evolved with time, but the fundamental activity has remained the same; trainees work in small groups under the guidance of experienced UK DCTN mentors (SpR Fellowship alumni and committee members) to work up proposals for a clinical trial. Trainee Groups are given hands‐on experience in prioritizing research questions, and they work in small teams with their mentors to develop questions into convincing trial propositions (Table 2). Although there is no expectation on trainees to convert every idea into a funded trial, several groups have generated new study proposals, including the HEALs study of compression to hasten wound healing after surgery for skin cancer on the leg and the COUNT study evaluating nicotinamide for the chemoprevention of keratinocyte skin cancer.

Table 2

UK Dermatology Clinical Trials Network Trainee Groups programme.

Session	Activities
Training Day 1	Introduction to the UK DCTN Trainee Groups Programme (online, half day)
	Sessions on key factors involved including identifying, defining and informing a research question
Small group work	Work for 4–6 months in small groups under the guidance of mentors
	Identify a research question using appropriate sources of evidence (e.g. systematic reviews, PSPs)
	Develop the research question (define, refine and inform, e.g. Critically Appraised Topics, survey work, audits, PPI)
	Complete full UK DCTN vignette form
Training Day 2	UK DCTN Trainee Groups Research Study Day (in person, full day)
	Presentation of study ideas
	Workshops on how to incorporate feedback
	Sessions on moving your study forward in the real world including health economics and the importance of multidisciplinary teams
Further activities	Publications and outputs
	Moving the study forwards into the UK DCTN trial pipeline

UK DCTN, UK Dermatology Clinical Trials Network; PPI, patient and public involvement; PSP, Priority Setting Partnership.

UK Dermatology Clinical Trials Network Online Journal Club

This initiative was developed in 2020 by a UK DCTN SpR fellow (Fiona Tasker) and others (Appendix 4), to plug a national gap on critical appraisal training during the COVID‐19 pandemic. Surveys had indicated that many trainees lacked local opportunities for training in understanding clinical trials and critical appraisal. The online journal club is for and run by dermatology trainees. Senior UK DCTN members are invited as guests to facilitate training in a safe peer‐to‐peer learning setting. Material is selected to highlight new findings that could change clinical care, offering an opportunity to reflect on practice, discuss controversies, share insights and to generate ideas for future research studies (Appendix 4, Fig. 1b).

Educational activities for dermatology nurses

Recognizing the vital role that specialist dermatology nurses play in delivering skin care, a working group (Appendix 5) of UK DCTN and British Dermatology Nursing Group (BDNG) members was established in 2020 to support learning and development opportunities for dermatology nurses. An initial survey to establish need and preference on how such opportunities are provided has since been followed by a series of educational articles in the BDNG journal Dermatological Nursing. , , Online learning sessions covering critical appraisal, demystifying statistics and the use of different research designs to answer different research questions have also been provided.

Capacity building with patients

Patient and public involvement (PPI) in identifying and prioritizing trial questions and commenting on how they should be done was recognized as an essential part of UK DCTN at its inception in 2002. In order to provide a sense of community and continuity to those patients and carers involved in supporting such research, a formal Patient Panel was established in 2009 at the UK DCTN co‐ordinating centre based at the Centre of Evidence Based Dermatology. The panel has grown to a diverse UK‐wide group of over 35 patients and carers, who provide key input into UK DCTN studies emerging from the trial development pipeline. Supporting the patient panel with feedback and updates of research activities and broader PPI developments by regular newsletters is key. Face‐to‐face events with interim online meetings also provide bespoke training and networking opportunities for panel members. PPI colleagues are also involved as full voting members on the UK DCTN Steering Group and as independent members on the Executive Committee.

Wider educational engagement

UK DCTN membership is free, and all members receive monthly email updates that highlight opportunities to take part in activities linked to UK DCTN studies. These include development of core outcome sets, participating in priority setting partnerships, , contributing to clinical surveys about patient numbers and event rates, becoming recruiting centres for funded UK DCTN trials, or joining UK DCTN committees or working groups when vacancies arise. All such opportunities offer valuable informal learning experiences, supplemented by other educational opportunities such as our annual evidence update meetings.

Conclusion

Much of the UK DCTN education and training work has been shaped and developed using a ‘bottom‐up’ approach by trainees, other clinicians and healthcare professionals and changing curriculum needs. Educational opportunities offered by the network are crucial in developing an informed and trained workforce for clinical dermatology research and are critical to its future sustainability and growth. Many of today's UK DCTN trainees will become future leaders in clinical research. The investment of time and effort given freely by senior mentors from across the UK is considerable, but the payback in terms of better research awareness and new trial proposals for the UK DCTN pipeline is clear. The success of the UK DCTN is due to engagement from its membership who share a common vision to deliver better evidence‐based care for dermatology patients.

Group	Medical dermatology	Paediatric dermatology	Skin surgery
Research question	Do patients over 18 with anogenital psoriasis have improved outcomes in health‐related quality of life with an addition of psychological intervention alongside standard medical therapy?	Are teleconsultations as clinically effective and acceptable to patients/clinicians as face‐to‐face consultations for the follow‐up management of paediatric eczema?	Is secondary intention healing equivalent/superior to full thickness skin graft for wounds of keratinocyte skin cancers excisions on the scalp?
Trainees	Dijon Millette	Manrup Hunjan	Iqra Ashraf
	Priya Patel	Aoife Daly	Richard Barlow
	Christiana Stavrou	Anusuya Kawsar	Dushyanth Gnanappiragasam
	Aarthy Uthayakumar	Natalie King	William Hunt
		Sarah McCusker	Jasmine Mann
Mentors	Rosalind Simpson	Lea Solmon	Aaron Wernham
	Alison Sears	Susannah George	Rachel Abbott
	Alia Ahmed	Esther Burden‐Teh	Claudia Degiovanni
Supranumerary mentors a	Lucy Bradshaw
	Rubeta Matin

Advising all groups.