Dr Antoni Gardener is currently completing a two-year Foundation Programme at St Mary's Hospital, part of the Isle of Wight NHS Trust. Despite having no previous experience of leading a clinical trial when he arrived, the COVID-19 pandemic prompted Antoni to join the Associate Principal Investigator (PI) Scheme to assist the hospital’s involvement in the RECOVERY Trial. He talks about how being involved in clinical research has benefitted his medical training and impacted his career ambitions.
When did you start working on the Isle of Wight?
I moved to the Isle of Wight in August 2020 to start my Foundation training. Before then, I was completing medical school at the John Radcliffe Hospital in Oxford, a large facility with many specialist care units. Coming straight from there to St Mary’s, one of the smallest hospitals in the UK, was a real contrast. Here, we have fewer resources and critically unwell patients often have to be airlifted by helicopter to the mainland. But ultimately this has probably benefitted my training, as it forced me to become independent more quickly.
How did you become involved in the RECOVERY trial?
When I first arrived at St Mary’s, the COVID-19 pandemic was a very challenging situation, as we don’t have the resources and expert staff for managing infectious diseases that larger hospitals have. In September 2020, I heard that Dr Aliraza Naqvi, the principal investigator who was leading the RECOVERY trial at St Mary’s, was struggling to manage the study, so I approached him and offered to help. At that point, it was literally just him and two research nurses, which wasn’t sustainable. They asked if I could assist on the study through the Associate Principal Investigator scheme, a course that develops skills and understanding of clinical trial research, and leads to a recognised qualification.
At that point, the only experience I had of clinical research was data collection roles during medical school. These hadn’t been very fulfilling, as I felt like a small cog in a big machine, disconnected from the bigger picture of what the study was trying to achieve. But I was excited by the opportunity to be involved in an active clinical trial, and by joining the Associate PI Scheme, I would be gaining experience of delivering clinical research whilst having the reassurance of a mentor to guide me. So I agreed.
What sort of things did you learn?
The Associate PI training modules cover topics such as the structure of a clinical trial, ethical considerations, how to document any safety issues, and so on. Because my focus was the RECOVERY trial, I also completed specific training modules on the study’s website, for instance, the process to randomly allocate participants to a treatment.
Thankfully, all of the training was delivered online, which helps a great deal when there is a large body of water between you and the rest of the UK!
How did you feel when you started working on the trial?
It was fantastic to be able to apply my new skills and knowledge straight away. I was involved in the whole process from recruiting participants and randomisation, to collecting follow-up information and outcomes. It also felt a real privilege to work on the RECOVERY trial because the study had already achieved a worldwide impact through the dexamethasone result in June 2020. A really high proportion of the patients being admitted with COVID-19 already knew about RECOVERY from the news coverage, and some even asked upfront if they could take part.
How did your skills develop over time?
Once I got into the swing of things, I became confident enough to suggest areas where we could make improvements, in particular how we recruited participants. I realised that potential participants being admitted onto the acute care wards were often not told about the study in time before they were transferred elsewhere, which meant the ‘recruitment window’ was missed. So I made sure that patients with suspected or confirmed COVID-19 were given the information about the RECOVERY trial as soon as possible, so they had time to decide whether to take part or not.
One of my strategies was to recruit a huge base of doctors and nurses across the hospital to a WhatsApp group, so they could immediately alert the acute medical team about any potential new participants. We got the junior doctors involved in recruitment, and they were incredibly motivated, even staying behind after their shift finished.
I also introduced a separate database for all the COVID-19 patients who had consented to take part in the trial, so we could manage the process more efficiently. This meant we could easily keep track of every participants’ status, for instance, whether they had been randomised, if they had actually received the study treatment, and so on.
These systems really came into their own in May 2021, when the UK Government launched a new traffic light scheme for international travel. Because the Isle of Wight was listed as a ‘green’ destination, we suddenly had an influx of holiday makers that literally doubled the population of the island. We became a COVID-hotspot and our hospital was full to the brim. But we managed to recruit around a tenth of all potential participants which, for a small hospital, is an incredible achievement.
Were there any other key lessons?
Perhaps the single most important lesson for me was the difference that giving patients good information can make to recruitment.
I believe one of the reasons we recruited so many participants was that we really took the time to explain what the study was investigating, the results so far, and that even if they didn’t benefit directly, they could be helping someone else. Even if it was one o'clock in the morning, we made sure to have that conversation.
What were the highlights?
One of the real highlights for me was the sense of teamwork, and how everyone across the hospital united behind the study. RECOVERY became the single most important thing because it gave us a way to practically help the patients in front of us, besides the global COVID-19 effort. Everyone was so motivated and we all put a lot of blood, sweat, and tears into it. I think we all wanted to show that even though we are just a small island, we could do something great.
In particular, Dr Aliraza Naqvi and the two research nurses Sarah Knight and Alison Brown were brilliant. No matter what the time of day or night, if we had a question or concern about a RECOVERY trial participant, we could ping them a message and get an answer almost straightaway. Over time, I began to step up to that role myself, helping to mentor the junior doctors involved in the study.
It was also a very rewarding feeling each time we had the news that RECOVERY had discovered another effective treatment for COVID-19. At that point, you really appreciate that your role is part of a much bigger project that is having an immensely positive impact everywhere.
Has the RECOVERY trial impacted your own career ambitions?
Definitely. Before being involved in the RECOVERY trial, I felt that the entry barrier for an academic career might be too high for me, but now I’m aiming to have a long-term career in evidence-based surgery. I know I’m not the only one: many of the junior doctors who became involved in RECOVERY are now interested in a career in clinical research.
This October, I will be moving to New Zealand for the next stage in my journey, hopefully as a plastic surgery registrar in Waikato. Wherever I go, I will always look to continue developing the skills and knowledge I learnt through the RECOVERY trial. Although I’d rather the pandemic hadn’t happened, it gave junior doctors like myself an unprecedented opportunity to get involved in research that would help patients facing one of the greatest challenges the NHS has had to face in recent years.