Ethics & Engagement across the Wellcome Trust Major Overseas Programmes
The seventh annual Global Health Bioethics Network (GHBN) Summer School was hosted by the Ethox Centre. We were back in Oxford again, having come full circle, six years after the very first GHBN Summer School in 2012. The Summer School took place at St Anne’s College from 2-6th July 2018.
Attendance was open to ethics and engagement staff from the Africa and Asia Programmes in Kenya, Malawi, South Africa, Thailand-Laos, and Viet Nam and their partner sites, members of the Ethox Centre team in Oxford, members of the new Wellcome Trust Centre for Ethics and Humanities in Oxford, members of the Wellcome Trust Brighton and Sussex Centre for Global Health Research (WTBSCGHR), members of the Wellcome Trust, and other invited experts. These experts were:
• Robin Vincent, Independent Consultant
• Jim Lavery, Emory University
We were also lucky to have three representatives from the Wellcome Trust attend various parts of the Summer School –Paul Woodgate, Joao Rangel de Almeida, and Katherine Littler.
Finally, for the first time, we also hosted two staff members from the MRC in Uganda.
Purpose and Aim of the Summer School
The aims of the Global Bioethics Network (GHBN) are: to promote and support ethical reflection; to build ethics capacity; and to carry out ethics research across the Africa and Asia Programmes and beyond. Annual Summer Schools are a key activity of the GHBN in all three of these respects. Summer Schools aim to develop capacity in ethics across the MOPs through educational activities, and to facilitate research collaboration between the MOPs ethics and community engagement teams by supporting the work of the Global Health Bioethics Network Bursary Fellows and by providing a space in which members of the five MOPs, Ethox, and other relevant partners, can discuss and plan research activities in person. In both these respects, the summer schools also aim to promote and support ethical reflection.
53 participants in total attended the Summer School – making this one of the largest Summer Schools we’ve ever hosted.
Delegates came from the following 13 countries: Ethiopia, Kenya, Malaysia, Malawi, Myanmar, New Zealand, South Africa, Sudan, Thailand, Uganda, the United Kingdom, the USA, and Vietnam.
Based on the interests of participants, and the areas proposed by the MOPs the Summer School agenda was organized around six key themes:
1. Ethics in Challenge Studies (a continuation of the discussion that we started at the Spring School in 2017)
2. Research in Emergencies
3. Ethics in community engagement
4. Ancillary care/duties of care
5. Big Data and/or Data Sharing
6. Vulnerability and agency
In addition to these six themes, other topics of discussion at the spring school included a debate on whether to pay research participants, a panel session on what global health bioethics can achieve, short talks by Bursary Fellows, PhD students and the new GHBN post-doctoral researchers. We also had an ethics clinic, and talked a bit about future directions for the GHBN.
Also, for the first time at the Summer School, we held a one day ‘Training Day’ for Bursary Fellows and early career MOP staff just before the Summer School. At this Training Day, we covered the following topics:
-What is ethics?
-Research with children and young people
Activities at the Summer School
The activities at the summer school fell into the following categories:
• Sessions on the six themes listed above - that included short, introductory talks, followed by group work on case studies or role-plays (more details below)
• An ‘ethics debate’ session - on the topic of whether research participants should be paid (not just reimbursed) for their participation
• Poster presentations by both junior and senior researchers, showcasing their recent work
• A session on WT funding led by the WT
• ‘Free’ meet-up sessions, which allowed participants to set up individual or group meetings
• A site visit to the BDI building on the Old Road Campus and an ethics ‘clinic’ where Oxford researchers gave short presentations on specific ethical problems that have come up in their practical work
• Short talks by Bursary Fellows, post-doctoral researchers, or PhD students that showcased their work
A summary of what was presented on the six themes
These sessions focused on highlighting emerging or important topics in ethics, bringing all participants up to speed on these topics and getting them (through case studies or role plays) to delve deeply into some of the complex problems that arise in these areas.
A brief history of challenge studies was provided, followed by an overview of current initiatives formed to provide guidance (ethical and regulatory) in this area. This was followed by a discussion of the numerous ethical issues that arise in CHIM studies – including issues such as deliberately infecting healthy volunteers, keeping volunteers in-house in a controlled environment, the right to withdraw, the risks of challenge studies, inadequate guidance on compensation mechanisms, whether paediatric challenge studies are ever acceptable, and so forth.
Ethics in Community Engagement
In this session, the presenters used a ‘game show’ format to get participants to think about the different ethical dilemmas that can arise when carrying out community engagement work. Participants were given a list of scenarios that gave rise to different ethical dilemmas– and asked to think about different ways they would address these dilemmas. A sample scenario included:
- While carrying out a photo story project and encouraging people to talk about their food practices, you find out that one of the participants in your project might have sold contaminated meat to his neighbours. What do you do?
Panelists presented their ‘solutions’ to these various ethical dilemmas, and participants had great fun in voting on which solution was the best one.
AHRI presented their recent plans on work in this area. Ancillary care has been defined as ‘medical care that research subjects need but that is not required to make a study scientifically valid, to ensure a study’s safety or to redress research injuries’. However, the big question is how this care is to be provided? Janet Seeley and Nothando Ngwenya talked about the four ‘P’s’ of ancillary care: positive duty, planning, partnership and practical provision.
Big data & data sharing
This session was led by Susan Bull and Phaik Yeong Cheah. First, Susan Bull presented on the collaborative award application on the equitable sharing of health research data. The proposed study asks a key question: what is equitable data sharing? And looks at theoretical and conceptual approaches, stakeholder views and experiences, and engagement with stakeholders.
Phaik Yeong Cheah focused on data sharing in the MORU experience. She asked the question – what is data sharing, and looked at the pros and cons of data sharing. The ethical questions around consent were also raised.
Vulnerabilities and Agency
Maureen Kelley, Jennifer Roest and Busi Nkosi led this presentation. They asked the group to think about the definitions of vulnerability, resilience and empowerment. They talked about why it’s important to understand these terms for practical ethics. They also highlighted why it is important to be precise about vulnerability in context. Who is vulnerable? Vulnerable to what? How vulnerable? How long? What are the mitigating factors? And so on.
A summary of the short talks given by Network Bursary holders and PhD students
Deborah Nyirenda of MLW talked about ‘Social interactions among research stakeholders and ethical issues in community engagement’. Her study seeks to contribute to the theoretical understanding of CE in health research and strengthen CE practice.
Alex Hinga of KEMRI-WT talked about his work on verbal autopsy ethics. His objective was to explore key ethical issues for HDSS sites in sub-Saharan Africa and make recommendations on how these issues should be addressed, looking specifically at the empirical-normative interaction.
Rwamahe Rutakumwa of the MRC in Uganda spoke about ‘research participants perspectives on genomic research’. He talked about a recent study he had carried out. Generally, participants struggled to explain genomic research concepts – things like sample and data sharing and broad consent. His study participants in Uganda had an overwhelming preference for broad consent.
Tom Peto and Nou Sanann of MORU presented on their work on ‘ethics and engagement for malaria elimination in Cambodia: research to understand and address malaria in forest workers’. They talked about the emergence and spread of multi drug-resistant parasites, and the challenges of reaching remote populations around forests and the sustainability of the Village Malaria Worker programme.
Betty Kalama of KEMRI-WT talked about the bursary project she and Salim Mwalukore carried out on ‘strengthening the processes for informed consent translation’. The challenge in Kilifi was the difficult terminologies and concepts in health research with no equivalent in the local language. They carried out a literature review, a KWTRP protocol review, qualitative interviews, and a translation workshop. The outcome of the workshop was that they translated 104 words to Giriama or Swahili, and they had input on the translation process.
The two new GHBN Senior Researchers - Jennifer Van Nuil (OUCRU) and Primus Che Chi (KEMRI-WT) also gave short presentations about their future plans and upcoming work.
Jennifer talked about the research she’ll be doing in the context of clinical trials – this includes a HCV study and acceptability studies in ICU. She also has several manuscripts under development, and will mentor PhD students and bursary fellows as well as carry out qualitative methods training.
Primus explained that his main focus will be developing and conducting social science research on the ethics of Controlled Human Infection Models (CHIM) in Kenya, and exploring the practical, social, and ethical implications of such studies with the goal of contributing to policy and practice.
Site visit and ethics clinic
We spent one afternoon of the summer school at the BDI building with participants. There, we had three Univ of Oxford researchers present to us on various ethical dilemmas that they face, including ethical issues that arise when using digital images, as well as ethical issues in the field –e.g. what do you do when you know that a research participant is a rape victim?
For the fourth time, the Summer School hosted a poster competition. There were 9 posters submitted in total (1 from Sudan; 2 from Uganda; 1 from AHRI; 1 from MOCRU; 1 from MLW; 2 from OUCRU; and 1 from KEMRI). The posters were displayed in the meeting room next to the Summer School for the duration of the week. Individual feedback was privately provided to each poster author on their poster, and the Summer School participants were also asked to vote for their favourite poster. For the first time, we also had two judges carry out a careful analysis of each poster and choose the poster they thought was best. There were therefore two prizes – one chosen by the judges (this one was won by Mackwellings Phiri of MLW) and one chosen by the participants (this was won by Htet Htet Aung of MORU).
The 9 posters submitted were:
1. Ethics committee and scientists’ experiences of the ethics review process: a study in Uganda - by Agnes Ssali
2. Building Mobile-phone connected diagnostics and online pathways for HIV care: early findings from the m-Africa formative study – by Femi Adeagbo
3. Mycetoma clinical trial and recruitment ethics – by Hana E. Alhaj
4. Ethical challenges related to short-course Tenofovir to prevent mother-to-child transmission of Hepatitis B in Myanmar – by Htet Htet Aung
5. Sharing identifiable data on research participants: benefits, risks and acceptable approaches – by Mackwellings Phiri
6. Developing a robust and supportive ethical and governance framework for genomic research in Africa – an exploratory study in Ghana, Uganda and Zambia – by Rwamahe Rutakumwa
7. A case study to assess the feasibility of implementing ethnographic methods in the Intensive Care Unit in Vietnam – by Chi Le Phuong
8. ‘10/10 for sensitivity’: ethics of verbal autopsy in HDSS sites within sub-Saharan Africa – by Alex Hinga
9. Pathways to HCV “cure”: experiences and perceptions of health and illness during clinical trials for HCV treatment with DAAs at Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam – by Jennifer Van Nuil
At the end of the session on Friday, participants were asked to fill out an evaluation form.
This is a summary of some main highlights.
Do you have any comments you’d like to make about the sessions? Anything in particular that inspired or engaged you?
Answers to this question were generally positive. Many participants wrote that they enjoyed all the sessions and found the content very inspiring.
At least six participants said that the sessions overall were very engaging and included diverse activities. Respondents also said that enough time was given, and they appreciated the more active & more productive group discussions this year. They praised the great facilitation & use of methods this year – sessions were well prepared, engaging, & pitched at the right level.
Other positive comments included:
- the panel was really helpful in terms of broader career advice and a nice mix of people; all the sessions were insightful but the panel on global health bioethics was particularly inspiring – it asked me to think beyond just doing ethical research, asking the question whether the research is impactful. The advice from the panel was great.
- I appreciated the WT presentation on funding and also them being present is important for them to see the impact of their funding and how these funds are being used.
- This was a good mix of practical & theoretical sessions. The panel discussion & debate were very useful to highlight key issues/opportunities; the discussion set up was very useful. You get to hear other peoples’ perspectives. Even when you completely don’t agree with them, you still see their argument.
- I was inspired by the fact that there are GHBN PhD and Post-doc opportunities within the Network and also WT funding – that there’s effort towards capacity building in the GHBN
There were also some comments on where improvements can be made:
- It would have been interesting to hear more on how researchers work with governments to build capacity
- I would like more on issues in global health bioethics and our role in those as a Network; more debates & games; more discussion of contemporary/current ethical questions.
- I think we could go deeper into some of the topics that have been covered before
What are your thoughts on the poster presentations? Was the content of the posters interesting or relevant to you? Is there anything we can do to improve the poster competition?
The majority of respondents (65%) said that the poster session was interesting and relevant and that this is a good way to summarize the research going on. Comments from these respondents included:
- The presentations were clear. Good to see a range of work. Good to have it at the beginning. Good to have a balanced representation across partners and no more than 15 posters.
- Most respondents highlighted that the best part was the variety of work presented: “I loved the breadth of the types of research projects – it widens the scope of thinking in terms of ethical issues involved.”
- “The quality of posters and presentations is really impressive and has improved over the years.”
Room for improvement:
Several respondents (40%) suggested ways in which the poster session can be improved. These suggestions included:
- It would have been better to have shorter presentations (max 5 min) and then more time to mill around & discuss with presenters; some presentations weren’t very focused & were too long; I lost energy & interest after a few posters.
- Presenters should present more briefly and work on their clarity of presentation skills of main ideas; or have fewer presenters (9 people made a similar comment)
- Posters were at different levels of outcomes – some were for proposed work, others for completed work, others on-going. It would be good to separate these clearly.
This year once again we emphasised group work in each session in order to encourage participation and stimulate the sharing of information and ideas. What did you think about the group exercises?
The vast majority of respondents (81%) praised the group work enormously. They said this was an excellent way to share experiences between people; they liked the variability in the way information was shared. It was very participatory; everyone contributed; and group discussions were very useful for hearing different perspectives on the issues; it helped generate ideas in a very broad scope. Additional comments included:
- I loved group work and tried to sit at a table with different people and especially those not from my institute in order to learn different approaches.
- Exercises were well run. Very strong group work & discussions;
- Led to insights that were useful.
- Worked much better this year. Cases were well defined & guiding questions helped to structure discussions better and I learned a lot as a result.
- Very engaging way of teaching.
What, for you, is the most important output of the Summer School?
The answers for this section of the evaluation fell into several categories.
1) Networking: 17 respondents (55%) highlighted networking as a key output of the Summer School. Networking & discussing collaborations; exchanging ideas; getting to interact with various colleagues involved in similar work and to know what they are doing - were all mentioned by several respondents. One said, for example: “I have 5 papers to review/comment on and have relinked with various participants where I might be able to contribute to their on-going work & had updates (which I see as part of my role and not always possible/easy to follow up remotely).” People also highlighted the idea of building partnerships; having opportunities to catch up and plan inter-group work; and the idea that the Summer School “makes me feel like I am part of something bigger than my site.”
2) Gaining new knowledge: 11 respondents highlighted new knowledge as the output that is key to them. They talked about the “chance to hear other perspectives/experiences” and gain awareness of issues. They also highlighted the importance of capacity building across teams; learning about new topics, e.g. challenge studies; expanding my knowledge about other areas of ethics – CHIM, data sharing, etc; being up to date with the challenges of ethics in the field & taking that knowledge back home & oversight of it in practice.
3) Being inspired: 5 respondents emphasised the output of being inspired – “being challenged by like-minded academics working in similar settings, on similar issues and through these discussions advancing my own thinking and work in this area.” Some said the Summer School is a safe place to share ideas or get feedback; and they make decisions & goals to reflect on at the end of the summer school and share upon return to research units. One person said the Summer School “challenges my practice and ideas.” Another person talked about “the ability to appreciate varied thinking and being able to identify ethical issues and take a step back to actually analyse. Within the one week you get to pick brains on any issues you have.”
4) Mentorship: 3 respondents mentioned that mentorship was a key highlight of the Summer School for them. Not just receiving advice, but giving advice too. “Helping individuals to think about ethics in their work and build relationships with others interested in ethics & CE “; “having time to meet with senior people to discuss draft proposals content & get feedback/input.”
Has the summer school made an impact on the way you think about ethics, or changed your perceptions about ethics? Has it made you think differently about your work? If yes, how?
Almost everyone answered ‘yes’ to this question. Only one person replied to this question with “not sure”.
Positive responses fell into several categories:
- Made me more ‘aware’ of ethics/the importance of ethics (6 people):
o The Summer School made me want to learn more about ethics;
o Made me aware of its complexity and the value of inter-disciplinary research;
- Has helped to shape my work/improve my study (12 people):
o Through my discussion with some of the experts in attendance, I think I have been made aware of the need to more critically reflect on the concept that I am currently developing.
o Chance to reflect on some current areas of work; gain new insights into approaches; helped me a lot in preparing for ethical problems in the planning process of a study;
- Improved my understanding of what ethics is:
o Has made me think about the higher level ethical issues and impact of local research at the international level – e.g. climate change as an ethical issue;
o I’m not a researcher but I gained great insight & learned a lot about the challenges involved;
- Made me realise our influence/the importance of our Network (7 people)
o It’s amazing how the inclusion of non-AAPs members allow us to see how much we’ve grown in terms of ethics practice in our various MOPs and its time we shared this knowledge outside. Science & ethics don’t conflict – valid science is an ethical requirement.
o The Summer School makes me feel like I am in the right Network. I feel like my ideas are relevant to the group and I was able to discuss easily with others.
In what ways do you think the network is helping you and your scientific colleagues address the key issues you are facing in your work at present? (Please give one example)
The answers from respondents generally fell into three categories:
- Network provides knowledge/ideas/opportunities to discuss & seek advice (16 people):
o I have more ideas to build and complement my study;
o it addresses my questions of ethical obligations of the researcher towards participants, especially in ancillary care;
o gives me access to other researchers working in similar regions & on issues & thus being able to benefit from discussions with them on how to deal with ethical challenges that arise in my current research.
o Platform to get input into planned work;
o Support to address complex issues relevant in multiple settings;
o Really helpful when through presenting people realise their work crosses over with mine & then come & make suggestions;
- Network provides support and training (3 people):
o It helps us through guidance, support, training courses & scholarships – because we lack that training;
o I am the only one with more extensive ethics knowledge (by attending the Summer Schools) so this helps me train others at work.
o Offering additional support in research work beyond our supervisors at work.
o Giving opportunity for capacity building. The network members have stated repeatedly that they are open to offer support to everyone.
- Network provides collaboration opportunities (4 people):
o Making me aware of potential future research collaborations and funding opportunities; developing collaborative proposals for future work;
o Through REACH – awareness of issues, support, links to other sites; fostering appreciation of the work of different welcome units. For example, the blogs have been useful to learn about work across the network.
o The exposure to other research/researchers/practitioners and different contexts stimulates creative thinking. Very important for capacity strengthening & confidence building.
o Having regional meetings and time to plan them is useful in bringing issues from a global level to a local/contextual setting.
- Specific outputs (1 person):
o Contributing to development of guidelines on data sharing.
What more should the GHBN be doing to help you with your career or your work?
Several people answered this question to say that there are lots of ways the Network is already helping – and “continue with the fantastic work”.
One person answered this question by saying “I’m not a researcher – therefore this is not relevant to me.” This shows perhaps that we need to be more specific about the GHBN not just being of value to researchers.
Other respondents asked for:
- more organized linking/collaboration between people working on similar issues (8 people)
- more training (3 people)
- more organized mentorship (3 people)
- reading group (2 people)
- more support with PhD or other applications (1 person)
Some sample positive comments include:
- I really benefitted from this summer school and really appreciate being able to take part. It was a real joy to see all these friendly faces again & meet some new ones.
- Overall, I felt the discussions took place at a very high level given we all have a similar starting point and shared understanding of the basics of GH ethics.
- This is very valuable for critical reflection on the topics discussed and really helped me advance my own understanding on the topics discussed & how they link to my own research.
- Thank you so much for this wonderful experience!
- Thought it was absolutely brilliant!
- Fantastic work by Dina & Mike in stewarding the Network. Oxford menu really enjoyable. Timetable well balanced.
- I would like to acknowledge Dina for the amazing work she does ensuring everyone is taken care of. I think we are paid to do our jobs but no one can really pay you to be nice, so a big thank you. She ensured we had information on time, we knew where to go, what to do.
- Everything was excellent in all manners. What a fabulous meeting, logistics, venue, and above all – people. Wonderful!
- Logistics was amazing – I felt very well prepared beforehand – very clear information. Really found this SS useful and enjoyable, particularly as newer members seem more confident.
- It was made very clear that there is all the support one can need within the network. All the senior network members are willing to help others grow and this really stands out for me. I will be looking forward to more support and growth in the coming days. Looking forward to getting the slides.
- And yes, the whole team was very warm and friendly and it made the stay really enjoyable. The porters at the porters lodge were also kind and helpful, they made our stay comfortable. We appreciate them too.
- I really enjoyed the discussions and presentations and the wonderful mix of people.
- I want to thank you and your team for giving me an opportunity to attend this year summer school and a nice reception, which makes my stay in UK throughout the summer school wonderful with full of memories to cherish. You are a great and wonderful people with amazing team work.
- I arrived home safely, fully imparted with knowledge and great ideas about ethics ready to roll.
Room for improvement:
There were a few suggestions about improvement in future:
- Differentiate some way between the new members and the old members. I am new and it was a challenge to keep my focus, to follow most topics.
- Would be good to receive agenda earlier, or the free meeting slots so that meetings can be organized earlier
- Seminar room a bit small (3 people commented on this)
- Coffee in the morning, please.
- For the food, it was a culture shock for some of us, but nothing catastrophic. We learn to appreciate the contextual differences.
Lessons learned from the evaluation
Having had seven Summer Schools and learning from the experience, we can confidently say that the 2018 Summer School was a big success. We instilled many of the changes and improvements participants had suggested in earlier years, and continue to expand the group of participants beyond the MOPs.
Last year, the improvements we considered making included:
1. Make sure the debate topic is clear.
I believe we succeeded here. The debate was highly praised by many participants. The topic was interesting, and the debaters were well prepared and engaging.
2. Try to find the perfect balance between presentations and group work – try to include:
a. At least one (or maybe two) plenary sessions on new, cutting-edge, or theoretical issues. Consider inviting an external expert to take part.
We succeeded here, sort of. Jim Lavery was a great addition as an external expert. The plenary session on ‘what is global health bioethics’ was well received. The session on ‘research in emergencies’ can be seen as a cutting edge issue.
b. Allow MOPs to present on the latest research from their regions – but maybe do this in the form of a poster, instead of a regular PowerPoint presentation (as in previous Summer Schools the ‘MOP update’ presentations were too long and participants complained about them). Maybe ask MOPs to specifically talk about ethical challenges they face in their daily research?
MOPs presented briefly on their work on the very first day. This was well received.
c. Ensure that group work activities contain a mix of participatory methods – consider asking SS participants to submit case studies or suggest group work activities for certain themes.
The group work this year was incredibly varied and got enormous praise.
3. For the poster presentations, have them earlier in the week. Also, consider splitting them up to have a few each day instead of one very long session. Consider increasing the prize given to the poster winner.
The poster session was held on the first day. Unfortunately, it was still criticised for being too long and the seating was inadequate. We did give nice prizes though, and having official judges went down well.
4. Consider organizing an interesting site visit – although not yet sure where to go in Oxford.
We took everyone to the BDI – unfortunately there was no time for a proper tour of the building though.
5. Networking is a key output of the SS, so try to ensure that there is enough time for this in the agenda. Arrange at least two social events.
We got great feedback on the social events – so having two social events worked well.
6. Allocate time in the agenda for individual meetings, but also for group meetings/satellite sessions on certain issues – e.g. field workers, CHIM, etc. People can bid on certain free slots in the agenda.
Meeting time slots were a huge success. Must do this again in future.
7. Arrange a bursary fellow’s lunch, or another such type of activity for bursary fellows to get to know their peers.
We had a training day prior to the Summer School which brought bursary fellows together. Can do something similar in future, but can also arrange a social event just for them if need be.
8. Arrange an ethics clinic – but also encourage members of the MOPs to come forward with their issues and take part in the clinic.
This worked well this year – although it was external people who presented their ethical dilemmas, not members of the MOPs.
9. Consider continuing with having a couple of hands-on ‘training’ type sessions – perhaps focusing on publishing & writing; and an actual grant writing workshop (where people bring their grant proposals for feedback)?
We did not do this – but given there is a demand for more training, perhaps we should do this in 2019?
10. Reinstate the Critical Friends program – but this time maybe focus on pairing people up with general long-term mentors, and not just someone who will only give feedback on their presentation?
We did not do this - but there is a call for more organized mentorship, so perhaps redouble our efforts in this area for 2019.
This year, the lessons learned from the evaluation are as follows:
1. Meeting time slots in the agenda were very popular – do again next year!
2. The balance worked well – 2 social events, 2 half days-off, and time for meetings. See if we can recreate this in future.
3. The enormous variety in group work received great praise – we should continue this!
4. There seems to be a need for more training, or ‘hands-on’ practical sessions for a small group of people. For example, a workshop on writing, or grant applications. Perhaps we can consider this in future?
5. There is a call for more organized mentoring – consider setting up people with an official mentor prior to the Summer School.
6. The poster session can be handled differently – either be more strict with timing, or allow people to mix and mingle with presenters more. Perhaps do a maximum of 8 poster presentations in one session, as more than that becomes tiring.
7. Have a training day again, or some ‘starter’ session for those more junior, just so they don’t feel lost during the sessions.
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