Building Successful Clinical Research Careers

1
Building Successful Clinical Research Careers

• Vicky Fraser
• Infectious Disease
• Washington University School of Medicine

2
Why Was I Asked to Give This Talk?

• Humble pedigree (Midwest state schools)
• No formal training in research
• No advanced degrees
• Ended up doing OK.
• Why? / How?
• Great mentor, good clinician, made my clinical
  work / interests my research, wrote a lot of
  grants, developed great collaborations, worked
  really hard

3
My Clinical Research History

• Fellowship here in ID 1989
• Research as a fellow healthcare epidemiology (no
  clinical research in ID then)
• Clinical Instructor, 6 months on ID, 2 mo
  medicine, Medical Director of BJH Infection
  Control and Occupational Health
• Risks to HCWs, nosocomial infections, patient
  safety (adverse events, errors, falls,
  disclosure)
• Healthcare epidemiology risk factors, outcomes,
  costs interventions, health services,

4
Research Grants

• TB (CDC/NIOSH)
• Prevention of blood exposures (CDC/NIOSH)
• Special Care Center for Women with HIV (HRSA)
• Epidemiology of nosocomial infections CDC
  Epicenters, Supplements MRSA, Influenza, C
  difficile
• Antibiotic cycling (CDC)
• Patient Safety Grant (AHRQ)
• Costs of antimicrobial resistance (CDC)
• MFH grants (adherence, access to care)
• NIH K12, K24,
• Pending Breast CA SSI RO1, AHRQ Prevention of
  Hospital Falls RO1

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Start with a Good Research Question

• Keep a running list and prioritize
• Hypothesis
• Develop study design to answer the question
• Identify key partners
• Do it
• Think Significance, approach, innovation,
  investigators, environment

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Building Blocks

• Getting and using mentors /advisors
• Choosing research areas / projects
• Formal coursework / training
• Hands on mentored research practicums
• Research infrastructure
• Writing abstracts, manuscripts, reviews
• Other skills teaching, budgets, management (time
  people), organization, conflict resolution
• Writing and obtaining grants

7
Mentors / Mentoring

• Mentors academic record (research, grants,
  publications)
• Time and interest
• Mentoring track record
• Research area
• Chemistry
• Long term relationship that evolves, matures and
  results in independence of trainee (letting go)

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Mentors Role

• Teach, guide, support from experienced senior to
  junior
• Supervise research, help with study design,
  abstracts papers
• Help you set personal professional goals
• Give feedback
• Recommend you for talks, committees, papers,
  reviews, chapters, study sections
• Teach you to write grants
• Help foster your career

9
Trainees Role

• Pick and interact with mentors and advisors
• Schedule regular meetings
• Ask a lot of questions, discuss your needs,
  goals, plans
• Show your work, ask for feedback on abstracts,
  papers, grants
• Be the driver of your career (may need to chase
  your mentor)
• Work hard, be organized disciplined
• It is ultimately YOU, not your mentor
• You do the research, write abstracts, papers,
  grants

10
Choosing Research Areas

• Numerous approaches
• Study what you have lots of
• Study what the institution needs
• Study what you are passionate about
• Study what there is funding for
• Study what is hot or going to be hot
• Study the area of great mentor, but move on
• Study areas of unmet need
• Brainstorm and ask for advice

11
Formal Training

• Research design, statistics, genetics,
  pharmacology, molecular biology, ethics etc
• Biostatistics Math Dept, GMS, Center for Health
  Behavior, SLU School of Public Health
• Masters Degree (biostatistics, epidemiology,
  clinical investigation, ProTEM, DBBS, MSCI)
• K12, K30, T32 grants here
• K23 expects formal training described in grant
  (career development awards in pt oriented
  research)

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Potential Coursework

• Power calculations, sample size, data management
• Regression
• Survival analysis
• Categorical analysis
• GEE, cluster analysis
• ANOVA
• Advanced Epidemiology, Methods
• Economics
• SPSS, SAS, STATA
• Clinical trials, research ethics, translational
  med

13
Research Practicums

• Clinical research takes a long time (need 2-3
  years to really get going)
• Involve yourself with mentors current research
• Multiple projects, varying stages of development
  to learn different skills
• Start with small do-able projects to learn, then
  get bigger, more complicated
• Develop your own project start to finish
• Study design, forms, definitions, IRB,
  recruitment, data collection, data management,
  analysis, dissemination of results

14
Infrastructure

• GCRC
• Biostatistics Core
• Center for human imaging,
• Genome Sequencing Center
• Research Centers (DD, trauma, transplant etc)
• Center for Clinical Studies (CCS)
• Informatics database
• Siteman Cancer Center
• Disease Registries
• Volunteers for Health
• Office of Research Affairs, Gifts and Grants
• Lots more

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Other Skills

• Time management
• Setting and achieving goals
• Using timelines
• Finishing things
• Building successful teams
• Conflict resolution
• Doing performance evaluations
• Managing budgets

16
Setting Goals

• Short and long term (1 5 year)
• Personal and Professional
• Measureable and specific
• Timelines
• Review with mentors and advisors
• Use this to monitor your progress, identify
  barriers, address them yourself and with mentors

17
Skills Development

• Practice presenting at research seminars, journal
  club, conferences
• Give talks to other divisions, departments
• Seminars, workshops
• Formal coursework
• WUSM, SLU, UMSL, Specialty societies, National
  meetings, Industry
• Ask others what are good courses

18
Becoming a Better Writer

• Read a lot
• Practice, writing, writing, writing
• Get feedback, editing from others
• Block out protected time to write
• Make outlines
• Just write to get going, dont worry about
  grammar, form, perfection (thats easy to fix
  later)
• Expect multiple re-writes

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Funding Streams

• Private foundations, nonprofits, disease based,
  health based, specialty societies
• BJH Foundation
• CDC, NIOSH
• HRSA
• AHRQ
• NIH
• Pilot and feasibility funds
• Electronic Queries, List serves, word of mouth

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Grants

• K awards, KO1, KO2, KO8, K23
• R21, RO3
• RO1s
• Look at other sample grants (good ones!)
• Read RFP and directions carefully
• Block out enough time
• Courses in grant writing available
• Best to learn by doing

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Become a Mentor Yourself

• Multiple sources of trainees in St. Louis
• WUSM mentors in medicine, CSTAR, residents,
  fellows, med students
• WU grad and undergrad students
• SLU grad and undergrad students
• MHA program
• SLU School of Public Health
• Siteman Cancer Center, Deans office
• Keep track of your trainees trainee table

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Making Yourself Known

• Locally, give talks, present your work, train
  others
• Nationally present your work at meetings through
  abstracts and posters
• Disseminate your work through publications
• Join committees
• Serve as an editor to review manuscripts
• Network to develop relationships outside of WUSM
  (you will need letters)

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Keeping Track of Your Activities

• NIH Biosketch
• CV
• Pertinent records of your effort lectures,
  teaching, clinical time, administrative, service
• Community activities
• Research projects
• Abstracts and papers
• Honors and awards
• This is your portfolio

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Summary

• Its a Marathon, not a sprint
• Plan accordingly, need lots of preparation and
  training
• Start is usually slow, but should get better and
  snowball
• Investment in clinical databases, cohorts and
  careful data collection really pays off in long
  run