Young GI angle: What are the steps for a successful clinical research career? The voyage to Ithaca

Introduction

The Egyptian-Greek genial poet C.P. Cavafy wrote a beautiful poem, entitled Ithaca, which was inspired by the journey of Ulysses from Troy to his hometown, the small Greek island of Ithaca. The journey took many years and provided Ulysses with many adventures, over the course of which he became wiser and stronger. Medicine is a scientific discipline, with research as the cornerstone to advancing our understanding of the normal and diseased human body. The final aim (Ithaca) must be to help the patients, who are the centre of the health-care effort, but beyond that, clinical research (the voyage) will help you be a better professional, to acquire new skills, to have a deep understanding of certain fields of knowledge (i.e. to become an expert) and to interact with other people from different professions, from other countries and cultures and with other points of view. As in Cavafy’s poem, clinical research should be a long road ‘full of adventure, full of discovery’. ¹ Don't be afraid to embark on the galley and start the journey.

This article aims to highlight that a successful clinical research career is a gradual process, a step-by-step, long and wonderful trip that will enlighten you.

We have divided clinical research careers into five levels, from Beginner to Legend. We will share with you our personal point of view regarding what to learn, what to look for, what studies to perform, which skills should be developed and the end points for each level. This is not a road map to becoming a Legend. You should achieve the level at which you feel personally and professionally comfortable.

First, in our experience, the following advice is important for advancing in your journey. (1) Try to spend a fixed time each day on clinical research. Choose a feasible moment of the day and be constant. (2) Make a list of objectives each month, including not only nearing deadlines, but also time for developing current and future projects. Don’t work without a clear direction and timing, or you will be enslaved by deadlines. (3) Balance your personal life and clinical duties, as success in clinical research is not everything. (4) Be humble, promote collaborative research and share your success. Your team and collaborators are the pillars of the endeavour.

Beginner: the data hunter

What to learn

To start, you need the basic tools for clinical research and to be able to communicate your findings. The first steps are to take a basic statistics course and to start learning English if it is not your native language. In addition, a Good Clinical Practice course will teach you ethics in research, which is an important part and helps you to understand how an Institutional Review Board works. Remember, the patient is the final aim, not an instrument for your success.

What to look for

Finding a good mentor is the key step for the beginner, as he or she will help you develop your skills and guide you in your first studies.

Research activity

A retrospective study based on patients from your centre is the simplest way to start conducting research. These kinds of studies are only useful for generating hypotheses, but will help you understand the basis of clinical research.

Skills to develop

The Beginner is a ‘field agent’ who should be good at obtaining data and managing databases. Learn to create databases with Access, Excel, RedCAP and other software. Start playing with statistical software, such as STATA, SPSS, SAS and R. Choose one or two and learn them step by step. Clinical research involves not only obtaining and analysing data, but also communicating your findings. Start working on your communication skills by learning how to do a poster and oral presentation. Start using social media to share articles, cases or professional experiences. Twitter is a very good platform for this. In fact, this article is based on a Tweet and the discussion it subsequently generated. ²

End points

This stage should generate your first posters and oral communications at national meetings, and your first retrospective papers as a collaborator.

Competent: training your leadership

What to learn

Learn to talk fluently about technical aspects in English. It is also time for an advanced statistics course – there is a world beyond chi-square!

What to look for

Find clinical questions that are interesting to you. Start putting together a team, with a statistical adviser as the first step. Create a group of national collaborators (your friends and colleagues with shared interests) for simple collaborative studies and surveys.

Research activity

Start a prospective observational study at your centre and a multi-centre retrospective study. Again, these studies will only be useful for generating hypotheses, but they are more robust. Meta-analyses are also interesting at this stage.

Skills to develop

Communication skills: time to start engaging the audience. Your aim is not only to share your research; you want the audience to like your work. During this phase, you must start to develop your leadership skills. Start to collaborate with your national scientific association, make national contacts, learn what studies are feasible. This is more important than it seems, as investing time in an unfeasible study is to waste it. Collaborate in randomized controlled trials (RCTs) by other groups as a way to learn how RCTs work. Keep using your social media. If you post good scientific stuff, you will gain interesting followers, some of whom may be your future collaborators.

End points

Publish your first observational studies as first author. The two main markers of a good researcher are publications and grants. Try to get your first grants, mainly from your national scientific associations. Grants for young researchers are a good opportunity for this purpose. Make your first communications at international meetings, and increase your proportion of oral communications in national meetings.

Expert: starting to make robust science

What to learn

Train yourself to speak fluently in English about any topic, not only medicine. Learn advanced methodology in research.

What to look for

Look for important, not just interesting, clinical questions to answer. Start putting together your own team, look for mentees, help them advance from Beginner to Competent. Now you need an expert in statistics.

Research activity

Start your own multi-centre prospective studies, as this will help you become a strong leader. Design your first single-centre RCT. Lead the design and development of national guidelines addressing your main field of expertise.

Skills to develop

Progress in your communication skills – try to fascinate the audience. Make international contacts to be part of more ambitious projects. Start to collaborate with international associations. Share your success with your team and increase their visibility. Use social media to share your work, to gain collaborators and for educational purposes.

End points

Publish your first papers as a senior last/corresponding author. This will give visibility to other members of your team as first authors, and being the last senior author is good for future grants and awards (e.g. the UEG Rising Star Award) because it means you are leading the team. Obtain your first large national public grants. Work hard for your national scientific association and apply for positions there. Start your first RCT at your centre.

Champion: changing the way we manage patients

What to learn

Progress in your English grammar and fluency. You should be able to write manuscripts in English without requiring translators. Develop strategies to deal with a lack of time and maintain balance, as you will be very busy.

What to look for

Look for key questions to answer. Find clever, constructive, imaginative and judicious people to join your team.

Research activity

Design and perform pivotal multi-centre RCTs that will change clinical practice. Promote and develop international guidelines addressing your area of expertise.

Skills to develop

You have developed great skills for research, but at this point, you need a strong team; it is a phase of advanced team building. You will have to spend a lot of time and develop strategies to obtain resources for your team and your projects. Learn to delegate to your team, which is sometimes difficult, and help the members of your team advance – help them to become, step by step, Champions like you.

End points

Apply for large multinational grants (e.g. Horizon 2020 grants from the European Union). Collaborate very closely with international scientific associations and apply for positions there. The main end point for a champion is the publication of pivotal RCTs that change clinical practice.

Legend: inspiring new generations

What to learn

The most important and difficult challenge of a Legend is to learn to deal with your own success.

What to look for

Promote and lead national and international projects involving public health and wider strategies to improve the treatment of patients (e.g. a European programme for early diagnosis of pancreatic cancer).

Research activity

Your priority is to promote studies leading to revolutions in medicine, to integrate different groups and to reach complex end points. Your team (not you) is in charge of international multi-centre RCTs.

Skills to develop

As a Legend, the most important step is not to fall into dogmatism, stubbornness and egocentrism. You should let the best members of your team become independent and create their own teams. At this point, you are more involved with politics, making contacts with national and multinational (i.e. European Union) governments to be involved in large projects. You are capable of leading an international scientific association.

End points

Your team, and other teams under your guidance, are producing good science, and they consider you a mentor, not a boss. You are promoting actions with the aim to improve the health of the general population or wider improvement in the management or early detection of certain diseases in your field.

Conclusion

Learn from your successes and mistakes, improve step by step, interact with and engage other people, fascinate your audience, think big, share your success with your team and balance your career and personal life, but do not forget that helping the patient is your final aim. Most importantly, enjoy the journey:

Hope your road is a long one.

May there be many summer mornings when,

with what pleasure, what joy,

you enter harbors you’re seeing for the first time.¹