Mentoring produces better investigators and trials
Mentoring produces better investigators and trials
Eliminate barriers to their success
Most clinical trial administrators would agree that investigator recruitment and retention over the long-term can be a problem at times.
But how do you find good clinician researchers and help them improve their research skills?
"One thing I’ve noticed is that people try to push research on clinicians sometimes, trying to teach them how to do statistics and all of that," says Cathy Carroll, PhD, director of patient care services research at Children’s Mercy Hospital in Kansas City, MO. "I’m not sure the educational push strategy works very well, so here we’ve tried to make research exciting," she says. "It’s something that garners recognition with the organization, and we try to get people involved in the research process by pulling them toward the positive aspects of it, instead of just pushing research on them."
The hospital also has identified the barriers to clinical research success, Carroll adds.
"The first is that some people don’t see research as a part of their real job because they are clinicians," she says. "They think research is something people do with mice or in a lab."
Another barrier is that the clinical staff sometimes don’t think they can do research, and this is related to an organization’s lack of efficient and effective support for investigators, Carroll adds.
"Their time is so limited that when you’re working with them, you have to use their time efficiently," she says. "So we rely on technologies for doing literature searches and preparing IRB applications."
A third barrier involves technical writing, as many clinicians are not required to learn how to use words most effectively, Carroll notes.
"Sometimes, I work with investigators who have great ideas and know how to improve care, but they don’t have an understanding of technical writing or even know how to use words," she says.
And a final barrier is that the incentives for doing research are not well aligned with respect to the incentives for productivity in clinical work, Carroll says. "If you’re a clinical person, you need to bring in revenue and so you need to be in the clinic all the time; and if that’s what people want, there are not a lot of incentives for allocating your time to research."
Transitioning clinicians
However, there are ways hospitals and other research institutions can improve the process of turning good clinicians into good researchers, and Carroll offers these suggestions:
• Develop and communicate a plan.
"Our plan was focused on assembling teams who have similar interests," she says. "If you look at the work we do here, it can be five to eight people on any one team; but they keep each other motivated, and they don’t have to be experts on everything."
The idea is to bring expertise to the table and rely on each person to do his or her own part. After assembling the team, participants review the body of evidence on any particular research interest to make certain that whatever study they elect to do is new, Carroll says.
Once it’s decided that a particular research idea is unique, the team will talk about the data they want to collect, how to define the data, and begin the research process, she explains.
• Set realistic expectations.
"We set realistic expectations two ways. One is in respect to the time frame, because we realize it’s an ongoing process and will take a while," Carroll says. Secondly, new clinical researchers are coached on what to expect from the IRB process, including how to handle questions from IRB members, she continues. "We tell them that the IRB is not designed to challenge them, so they should view it in a positive light."
• Build a culture of research.
For new staff, the hospital has an orientation brochure that discusses research and how it’s a critical part of meeting the hospital’s mission, Carroll says. "It describes the support we have, and we continue to build the culture of research within departments. We show how to do research well and efficiently, using electronic tools to reduce the time spent in research."
The hospital provides support for staff who conduct research, she says. "We mentor our staff in a way that shows how, at a certain level of organizational research, it is a key part of their job description."
• Make the research process transparent.
With an on-line mentor system, the research process is as transparent as possible, Carroll adds. "There’s a step-by-step guide on how to build a research question after you have your question. Then staff can talk with colleagues and fill in the next step in the guide."
The guide tells them where to find information and what to do with it. "In that process, we’ve built in a lot of face time where other members of the team and I sit and talk with the investigator about research ideas," she says.
"We don’t have the philosophy that It’s on the web, so go do it. So for our junior investigators, that hands-on face time is very important." As investigators gain experience, they need less attention, Carroll adds.
• Recognize excellence.
"We recognize excellence every step of the way," she notes. One way the hospital does this is by providing a research "kudos" via e-mail and the Internet every two months, and the staff listed are those who have submitted IRB applications, clinicians who have submitted abstracts, and staff who have submitted publications, Carroll says.
"Some purists would say you should only get recognition when you’re published in a peer-reviewed journal, but we think if you are doing the work, every step of the process is important, so we recognize all of the work that goes on and not just the results," she explains.
Another recognition program is the hot topics forum in which clinical investigators can present their research information to colleagues within the hospital, Carroll adds.
• Remove the barriers.
Once a health care system removes the barriers to staff conducting research, there are intangible benefits, including morale improvement, she says. "They feel good about the quality of care they’re providing and knowing they’re trying to be the best they can be," Carroll explains. "There’s a benefit in how they can talk to colleagues about their research, and the research program grows."
For instance, the hospital had 12 research projects under way a year ago, shortly after the mentoring program started, and now there are more than 60, she notes.
"So that includes people who have been sitting on really great ideas for a long period of time," Carroll adds. She often hears people comment, "I’ve had this idea for three years and have never had the help to get it going."
Most clinical trial administrators would agree that investigator recruitment and retention over the long-term can be a problem at times.Subscribe Now for Access
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