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

5. 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”

6. 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 • Mentor’s 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”)

8. Mentor’s 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. Trainee’s 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)

12. 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 mentor’s 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

15. 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, don’t worry about grammar, form, perfection (that’s easy to fix later) • Expect multiple re-writes

19. 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

20. 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

21. 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

22. 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)

23. 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”

24. Summary • It’s 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