Three Considerations Before Getting Involved in Clinical Research

Jill Steiner, MD, FACC

Many feel the pressure to do – and enjoy – research at every step of their medical training. Some feel that spark and run with it, and they go on to have successful research careers. But others are still trying to figure out how to be meaningfully involved in clinical research.

The traditional way to build a research career is to pursue mentored, grant-funded research in an academic setting. This often begins prior to or during fellowship and is comprised of a series of steps toward independence. A faculty appointment in a research or physician-scientist track means substantial time is protected for research, as stipulated by percent effort toward one or multiple grants. This time allocation may fluctuate depending on the project status, but on this track, promotion is often based on research and funding productivity. Because of its rigidity, the minority of cardiologists find themselves pursuing research in this manner.

More cardiologists become involved in research by other means, the simplest being to analyze existing medical records data. Conducting prospective and clinical trials research, however, requires much more time, infrastructure and effort. Time, or lack thereof, has been described as the main barrier to cardiologists' involvement in research. Still, it is never too late to do so, though the type and extent of involvement may vary across practice models.

Here are three factors for early career cardiologists to consider before participating in research:  

Protected Time And Funding

Research activities are not revenue-generating in the same way as clinical care, and therefore are compensated differently – and usually less. Successful grant applications or larger studies require more than the occasional nights and weekends, which is not sustainable if a substantial portion of professional effort cannot be protected for this purpose. In most settings, this is only possible if funding is achieved. Cardiologists operating in more clinical or private practice roles may succeed in securing institutional, industry, or foundation grants to protect the time necessary to work toward more substantial funding.

For cardiologists who do not wish to lead their own studies, serving as a site primary investigator may be an excellent option. In this scenario, one may be involved in large, multisite trials with minimal protected time of their own.

Mentorship And Infrastructure

Mentorship and infrastructure are key requirements for successful research, even if you are not leading your own studies. Mentors with experience and connections can help with planning studies and efficiently running site protocols. They are crucial to learning how to write grants – including the principles of "grantsmanship" – without constantly reinventing the wheel.

Research infrastructure can take many forms and vary depending on the study. A grants/financial officer is needed to handle paperwork and reporting for grants and site documents. An institutional review board and, sometimes, a data and safety monitoring board are important for overseeing study ethics and processes. For some types of research, a core lab is required. Statistics consultants could also be beneficial. While most common in an academic setting, some private institutions have these built into their research infrastructure.

Additional Training

Regardless of the research environment, any cardiologist who wishes to conduct rigorous primary research will require additional research training. Since practical research skills are not guaranteed in fellowship training, cardiologists must often learn these skills in an intentional manner. A formal degree, like a Master of Science or a Master of Public Health, is not required but recommended to gain firsthand experience with different types of research methods and statistical software – especially if statistical support is not available or you are working with trainees. Shorter certificate programs, workshops or seminars (like ACC's Clinical Trials Research program) are occasionally available for focused skills building, but they are rarely comprehensive.

Similar to choosing a subspecialty or designing one's clinical practice, the decision to participate in significant clinical research as an early career cardiologist will require intentional decision-making and a supportive environment. Hopefully, awareness of some of the key considerations mentioned here will start you off on the right foot.

Acknowledgement: I would like to recognize Catherine Benziger, MD, MPH for sharing her experiences regarding this topic.

Jill Steiner, MD, FACC

This article was authored by Jill Steiner, MD, FACC.

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