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Building a research career on ancillary studies Kirsten Bibbins-Domingo, PhD, MD Associate Professor of Medicine and of Epidemiology and Biostatistics Outline Intro - goals of junior faculty researchers My experience and lessons learned

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building a research career on ancillary studies

Building a research career on ancillary studies

Kirsten Bibbins-Domingo, PhD, MD

Associate Professor of Medicine and of Epidemiology and Biostatistics

outline
Outline
  • Intro - goals of junior faculty researchers
  • My experience and lessons learned
  • Pros and cons of ancillary studies and additional thoughts on building your career
goals of junior faculty researchers
Goals of junior faculty researchers
  • Acquire skills in clinical research
  • Publish papers (lots of them!)
  • Gain recognition as an “expert” in a content area
  • Get grants funded (hopefully big ones!)
  • Accomplish all of this in a defined period of time

Ancillary studies can be an efficient way to accomplish these goals

my experience
My experience

Goal:

  • to identify individuals at risk for heart failure in order to modify this risk
  • to improve heart failure care in the outpatient general medicine practice
  • Heart failure in HERS
  • BNP in Heart and Soul
  • Heart failure, cystatin C, BNP and more in CARDIA
heart failure in hers
Heart failure in HERS
  • My question as a resident: which women are at risk for heart failure?
  • In HERS:
    • What clinical factors are associated with incident heart failure in women with coronary disease and no heart failure?
    • What other clinical factors increase the risk of death among women with heart failure and coronary disease?
    • Does estrogen increase the risk of death among women with heart failure and coronary disease?
  • Learned analyses through biostats courses
  • 3 publications - Circulation, others
heart failure in hers6
Heart failure in HERS

What worked?

  • Studying an outcome that others are not studying

What was gained?

  • Achieved some goals (skills, papers, reputation?)
  • Collaborate with senior clinical researchers at UCSF

Pitfalls?

potential pitfalls
Potential pitfalls
  • Data not collected for this research question
  • Some secondary questions work, some don’t
    • Self-report of heart failure
  • Don’t force it just because data available to you.
bnp in heart and soul
BNP in Heart and Soul
  • My question as a fellow: can BNP be used in the outpatient setting to manage heart failure more effectively? An RCT
  • In Heart and Soul:
    • Is BNP as a useful screening test to detect LV dysfunction? X-sectional study
  • Analyses in biostatistics course
  • 2 papers (Circulation, Am J Med)
  • Received intramural grant for more assays (REAC)
  • 5 papers (JAMA, others)
bnp in heart and soul9
BNP in Heart and Soul

What worked?

  • Switch from a project not feasible to a related project that was feasible
bnp in heart and soul10
BNP in Heart and Soul

What was gained?

  • More goals accomplished
  • Continue to expand collaborators at UCSF
  • Adding new measures– a gift that keeps on giving!
potential pitfalls11
Potential pitfalls?
  • Who’s the boss?
  • Service to the parent study
  • Gaining independence
heart failure in cardia
Heart failure in CARDIA
  • My question as a junior faculty: Why are my heart failure patients so young?
cardia
CARDIA
  • NHLBI-funded cohort study designed to examine how heart disease develops in young adults
  • 5115 young adults age 18-30 yrs in 1985
    • Men and women
    • Black and white
    • Low and high SES
  • Followed nearly 25 years (exams at years 0, 2, 5, 7, 10 15, 20, new 25)
  • Medical history, psychosocial variables, blood tests, diet and exercise, subclinical CHD, clinical cardiovascular endpoints
heart failure in cardia14
Heart failure in CARDIA
  • My question as a junior faculty: Why are my heart failure patients so young?
  • In CARDIA
    • Incidence of heart failure in young and middle aged black and white adults
    • Clinical antecedents of premature heart failure
    • Chronic kidney disease and cardiovascular risk
    • Cumulative exposure to cardiovascular risk factors (blood pressure, lipids) and subclinical cardiovascular disease
    • Biochemical (BNP) and genetic precursors
    • Social factors and heart failure risk
  • Several paper (NEJM, Annals, Archives, others in progress)
  • R01 from NIDDK (other grants planned).
heart failure in cardia15
Heart failure in CARDIA
  • What worked?
    • Exactly the right dataset to answer research question
  • What has been gained?
    • Continue to work on goals
    • Local and national collaborators
    • NIH interest
    • Broad base from which to explore multiple questions
other examples of ancillary studies
Other examples of ancillary studies
  • Using publicly available data
    • NHANES/NHIS/NHDS/NAMCS/ Vital Statistics
  • Adding a new measure
    • Incarceration in CARDIA
    • ABI in CARDIA
  • Analyzing data in new ways
    • Interactions in genetic studies
    • Decision and cost-effectiveness analyses
potential pitfalls17
Potential pitfalls
  • So many research questions, so little time….
  • Big family
  • Bureaucracy
  • Service
  • Independence
but i m interested in collecting my own data
But I’m interested in collecting my own data…

Ancillary studies may

  • Lay the foundation (papers, reputation) for more competitive grant application
    • Submitted RO1 for RCT
  • Keep publications, reputation going during start-up phase of primary data collection
slide19
But are ancillary studies really fundable?

PA-08-167NIAAA R01 Secondary Analysis of Existing Alcohol Epidemiology Data (R01)

RFA-HL-09-001NHLBI Ancillary Studies in Clinical Trials (R01)

PAR-09-252NEI Research Grant for Secondary Data Analysis (R21)

PA-09-131 NIDDK Secondary Analyses in Obesity, Diabetes and Digestive and Kidney Diseases (R21)

PAR-09-247R01 Ancillary Studies to Major Ongoing Clinical Research Studies to Advance Areas of Scientific Interest within the Mission of the NIDDK (R01)

thoughts on building your career
Thoughts on building your career
  • Be true to your interests
  • Be flexible and recognize opportunities
  • Re-evaluate your career development plan frequently and seek out ways to enhance
thoughts on building your career22
Thoughts on building your career
  • Concentrate on a few big ideas and the other stuff will follow
  • Develop, nurture, and expand your circle of collaborators
mission statement templates
Mission Statement templates
  • "To ... [what you want to achieve, do or become] ... so that ... [reasons why it is important]. I will do this by ... [specific behaviors or actions you can use to get there].“
  • "To be known by ...[an important person/group]... as someone who is ...[qualities you want to have]...; by ...[some other person/group]... as someone who is ...[other qualities]...; ...“
  • "I value ...[choose a value]... because ...[reasons why these values are important to you]. Accordingly, I will ...[what you can do to live by these values]."
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