Segal and colleagues have highlighted the future challenges ahead for gastroenterology and hepatology trainee networks in the UK.1 While there have been numerous local success stories, our community is lacking a collaborative project on a national scale. This may be for multiple reasons including the COVID-19 pandemic.
For a project to enthuse trainees nationwide, there are considerations that need to be addressed. First, is the research question relevant across the breadth of the UK? While niche areas of gastroenterology such as post-liver transplant care are undoubtedly interesting, they are unlikely to engage trainees outside of tertiary referral centres. Secondly, is the answer likely to be important to our day-to-day working lives? As doctors, we are all patient focused and look for ways to improve patient outcomes. Projects that deliver tangible solutions to improve patient care are likely to be more popular among trainees. Finally, are trainees being offered exposure to novel research and audit opportunities which they would not typically have access to, thus empowering them to seek further projects?
Following consultations with trainees across the UK, the Trainee Collaborative for Research and Audit in Hepatology UK (ToRcH-UK) was established to address these questions. It aims to deliver high-quality projects in order to identify and improve outcomes for patients with liver disease. ToRcH-UK is open to all trainees irrespective of seniority, academic background or geography in recognition that the UK requires future hepatologists across the country and spectrum of clinical hepatology. We aim to foster a collaborative research culture for future gastroenterologists and hepatologists and provide the opportunity for all trainees to participate in large-scale projects. We believe that this will engage trainees early in their career and help to secure the future of hepatology in the UK.
The standardised mortality from chronic liver disease has dramatically risen since 1970.2 While there are a number of reasons for this, the 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report demonstrated that only 47% of patients with alcohol-related liver disease received ‘good’ care in hospital and preventable deaths were highlighted.3 In response to this, the British Association for the Study of the Liver (BASL)/ British Society of Gastroenterology(BSG) admission bundle for patients with decompensated chronic liver disease (dCLD) was developed,4 but it is inconsistently utilised across the UK.
In response, ToRcH-UK has launched its first project; a retrospective audit of the BASL/BSG admission bundle for patients with dCLD and its impact on patient outcomes including ICU admission and mortality. This will provide a unique national snapshot of inpatient dCLD care and will be of immediate relevance to the day-to-day working practice of trainees across the UK. However, to achieve this, we require registration of as many sites in the UK as possible. We urge you to contact us on our corresponding email or visit our Twitter page for more information. In keeping with a truly collaborative ethos, all findings will be published and presented under the banner of ToRcH-UK without individuals highlighted as designated authors and we have been endorsed by the Scottish Society of Gastroenterology, Welsh Association for Gastroenterology and Endoscopy, BASL and BSG. Only by working together can we improve outcomes for our patients.
Acknowledgments
We are grateful to the British Society of Gastroenterology, British Association for the Study of the Liver, the Scottish Society of Gastroenterology and the Welsh Association for Gastroenterology and Endoscopy for their endorsement. We are grateful to Dr Stuart McPherson (Consultant Hepatologist, Newcastle Hospitals NHS Foundation Trust) and Dr Brian Hogan (Consultant in Critical Care Medicine and Hepatology, King’s College Hospital) for their advice in the development of the audit.
Footnotes
Collaborators: Project Management Subgroup: Vinay K Balachandrakumar (Mersey Deanery), Paul Brennan (Scotland Deanery), Charlotte Cook (Wessex Deanery), Tim Hardy (North East Deanery), Rebecca Harris (East Midlands Deanery), Janardhan Navaratnam (Wales Deanery), Emma Saunsbury (Severn Deanery), Oliver D Tavabie (South London Deanery). Collaborators: Jane Abbott (North East London Deanery), Kushala WM Abeysekera (Severn Deanery), Kris Bennett (South West Deanery), Ryan Buchanan (Wessex Deanery), Amritpal Dhaliwal (West Midlands Deanery), Vasileios Galanakis (East of England Deanery), Victoria T Kronsten (South London Deanery), Jess Leighton (North East Deanery), Wenhao Li (North East London Deanery), James Liu Yin (Yorkshire and the Humber Deanery), Lucia Macken (KSS Deanery), Thomas Marjot (Thames Valley Deanery), James B Maurice (North West London Deanery), Hannah McDowell (Northern Ireland Deanery), Keith Pohl (South West Deanery), Jeremy S Nayagam (South London Deanery), Jennifer Scott (Scotland Deanery), Abhishek Sheth (East Midlands Deanery), Ricky Sinharay (East of England Deanery), Gio Sheiybani (Severn Deanery), Mohsan Subhani (East Midlands Deanery), Lucy Turner (Yorkshire and the Humber Deanery), Helen White (North West Deanery), Nekisa Zakeri (North East London Deanery).
Contributors: All collaborators, as listed in the online supplemetnal materials, contributed to the conceptualisation of the manuscript. The Project Management Subgroup, as listed in the online supplemetnal materials, drafted the initial manuscript. All collaborators reviewed the manuscript, made critical revisions and approved the final draft.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: Oliver Tavabie and James Maurice are both members of the Editorial Board at Frontline Gastroenterology.
Provenance and peer review: Not commissioned; externally peer reviewed.
Contributor Information
Collaborators: Vinay K Balachandrakumar, Paul Brennan, Charlotte Cook, Tim Hardy, Rebecca Harris, Janardhan Navaratnam, Emma Saunsbury, Oliver D Tavabie, Jane Abbott, Kushala WM Abeysekera, Kris Bennett, Ryan Buchanan, Amritpal Dhaliwal, Vasileios Galanakis, Victoria T Kronsten, Jess Leighton, Wenhao Li, James Liu Yin, Lucia Macken, Thomas Marjot, James B Maurice, Hannah McDowell, Keith Pohl, Jeremy S Nayagam, Jennifer Scott, Abhishek Sheth, Ricky Sinharay, Gio Sheiybani, Mohsan Subhani, Lucy Turner, Helen White, and Nekisa Zakeri
Ethics statements
Patient consent for publication
Not required.
References
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