Clinical Research Fellowship

After four years of medical school and the need for specialty training and certification through a residency training program; many, if not most, medical students and emergency medicine residents gravitate further away from the knowledge and skills required to master a career in academia and specifically clinical research.  This trend seems to be enhanced by the increased use of on-line resources (and other quick sources) and the accompanying decrease in the ability to consult the primary literature on which these rapid sources are theoretically based.  Understanding clinical research design, analysis, and utilization of the results has become more complex for us all and is basically a specialty of its own.  Therefore, those interested in an academic career in clinical research will need enhanced and advanced training to insure their success.  This background has defined and fostered the need for our department to offer advanced training in clinical research though a fellowship training program described below.

The ultimate specific goals of a clinical research fellowship will vary based on need, the fellow's area of interest, and the mentor's skills and area of work.  There are, however, a number of general goals for the clinical research fellowship that include:
 

  • Working with the individual fellowship applicant to address their goals and needs – Many graduating residents have specific interests but need assistance in determining how they will meld those interests with a clinical research career.  Our faculty has extensive experience and will help the new fellow define their career goals and focus their area of research interest.   
     
  • Formal training in research methodology – This is accomplished through a variety of mechanisms that includes formal course work and intense individual mentoring in research methodology and project development.
     
  • Research project development, submission to the IRB for approval, and carrying out the project – The fellow will, with the mentor's and other assistance, design and complete a clinical research project.  Our department has many resources that will be available to assist and teach the fellow these mechanisms including, IRB experts, finance and grants management personnel, data base developers and managers, statistics and methodology support, and research assistants.  Nested within this aspect of the program is emphasis and training related to research ethics.
     
  • Abstract, manuscript, and grant writing experience and mentoring – Scientific writing is as much an art as it is science.  The ability to communicate research goals, methods, results, and to help interpret results requires careful thought and a format that allows the reader to easily follow the research trail.  This format is not always intuitive so the fellowship is designed to promote quality writing skills by utilizing published faculty in an authorship mentoring role.
     
  • Manuscript publication and grant submission – At the end of training program it is expected that the fellow will have submitted at least 1 – 2 manuscripts for publication (with the emphasis on quality over quantity) and have a submission ready grant proposal completed reflective of their area of interest.

Overall, the fellow will be prepared for an academic career in clinical research.

So where we now and where are we going with the program?  I, along with others in clinical research, have been tasked to review and, if needed, re-structure the program.  Currently, our fellows are appointed as DMC fellows with a salary that of a PGY4 resident.  They also will work, on average, 6 shifts a month thus providing a decent income.  Funding for DMC salary must come from other sources and likely this will be from grants and contracts and this will continue.  The available areas of research for which we offer a qualified lead mentor include:

  • Hypertension (Levy)
  • Heart failure (Levy)
  • Public health (Levy)
  • Sepsis (Sherwin, Paxton)
  • Neurological disorders (seizures, stroke, TBI) (Welch, O'Neil)
  • Cardiac arrest and global brain ischemia (O'Neil)
  • Circulatory access (Paxton)

In addition, we have young investigators in bedside ultrasound and echocardiography who will be available in the future to mentor a research fellow.  In fact, there is already an ultrasound research component for the ultrasound fellows.

  • Ultrasound (Favot, Ehrman, Galllien)

Another up and coming areas where mentorship is available but currently not at an NIH level:

  • Violence prevention (Sonuyi)

Advanced training and obtaining an advanced degree is critical for developing the skills needed to compete in the research world.  We currently have a number of physicians who have obtained advanced degrees mostly from outside institutions.  We are now looking at tailoring the MPH program at WSU for the Emergency Medicine Clinical Research Fellowship.  Dr. Phil Levy (our department Associate Chairman, now Assistant VP for research at WSU) and Dawn Misra, Ph.D., Associate Chair for Research and Professor, Family Medicine & Public Health Sciences will be advising and assisting in the MPH program development so our fellow will be able to receive needed education and experience solely through WSU.  Alternatively, the University of Michigan on job/on campus (OJOC) programs are potentially available.

Along with formal training there are experts in data base management (Brian Reed), statistical analysis (Scott Millis, Reed, and Welch), and public health (Levy and Brody).  Peter Whittaker, PhD is currently enrolled in the Executive Msc Health Economics, Outcomes, and Management in Cardiovascular Sciences at the London School of Economics and Political Science and will add that area expertise to our fellowship training program.

The program, as designed, will require 2 years to complete with the goals of the trainee 1) submitting competitive federal grant and, 2) having the requisite skills to succeed in an academic research career.  To supplement our program we are exploring certification of the fellowship program.  The Society for Academic Emergency Medicine offers an accreditation process for clinical research fellowships and we plan on perusing that rigorous certification process.

Finally, the experience of a recent fellow, Aaron Brody, is of interest for any potential applicant.  He has related to me his experience that is summarized here:

  • "The degree was challenging, but I felt I had the time, resources, and basic statistical knowledge to succeed"
  • "I worked 6 clinical shifts / month"
  • "The mentoring aspect was probably the most significant element of the fellowship. Phil (Levy) has profound insights, and extensive experience in clinical research, specifically regarding HTN and public health. He helped me set short and long term goals, and gave me numerous writing and publishing opportunities. I probably would have appreciated closer collaboration with a senior mentor from another discipline / institution, to expand my academic contacts".
  • "The fellowship definitely prepared me well for an academic career. I feel that it did jumpstart me."
     

Given our current and bright future in clinical research; a person with interest in an academic and research-based career should strongly consider applying for our clinical research fellowship training program.