Transforming Ideas into Research Reality

Participants come to the ASH Clinical Research Training Institute with ideas and enthusiasm, and leave with new skills to conduct patient-oriented research.

Just 20 years ago, it seemed as though the academic hematologist was at risk of becoming an endangered species. In a 2003 survey of directors of adult and pediatric hematology/oncology subspecialty training programs in the United States and Canada, the American Society of Hematology (ASH) found that research training accounted for less than 50% of the total training experience in the majority (65%) of the training programs surveyed.1 This gap left fewer hematologists and oncologists pursuing academic medicine. Moreover, a lack of effective clinical research training and mentorship was identified.

To help fill that gap, ASH launched its Clinical Research Training Institute (CRTI), a unique yearlong education and mentoring program for hematology fellows and junior faculty at academic medical centers. The program provides clinical research–specific training and support for rising hematologists, with a goal of producing “leaders armed with ideas for clinical hematology research and the tools and resources to make their ideas a reality.”2

“Patient-oriented research is important because, functionally, it is how we identify the best approaches to improve patient outcomes, whether that be survival, quality of life, costs, whatever,” said Lillian Sung, MD, PhD, who serves as an appointed member of the CRTI steering subcommittee of ASH’s Committee on Training. “To do that, we need to provide training and support to make sure people know how to develop studies, how to execute them, and how to disseminate their results in the most effective ways possible.”

Nearly two decades after it began, the program continues to inspire. It has produced a collection of past graduates from all subspeciality areas, backgrounds, and research interests who have used what they’ve learned to move their careers – and the profession as a whole – forward.

“I believe that CRTI ended up playing a central role in my career and shaping what it has become,” said Alex Herrera, MD, assistant professor in the Division of Lymphoma at City of Hope in Duarte, California, and a 2014 CRTI graduate.

ASH Clinical News spoke with Drs. Herrera and Sung, and other CRTI graduates and faculty, about the state of clinical research training and how the program is shaping young researchers’ careers.

The Why of CRTI

Traditionally, hematology training programs have focused on basic and translational sciences. What makes the CRTI program unique is its focus on navigating the increasing complexities of clinical research.

“I’ve always felt like clinical research comes with experience, and there are few times when people are able to give you a ‘crash course’ or critical insight into how to conduct clinical research and to understand what is expected of you,” said Foluso “Joy” Ogunsile, MD, an assistant professor of hematology and oncology at the University of Alabama-Birmingham. Dr. Ogunsile graduated from the program in 2019. “I felt like CRTI opened my eyes and gave me new insight into sound clinical research,” she said.

Dr. Sung, of the Hospital for Sick Children (SickKids) and the University of Toronto, explained that CRTI was initially developed to address a “lack of training in patient-oriented research in hematology and to bridge the gap between adult and pediatric medicine.”

Participants receive education on methods of clinical research, research collaborations, and statistical analysis, and discuss strategies to juggle the demands of a career and home life.

The program is also achieving success in its goal of retaining clinical researchers in hematology. A 2016 cross-sectional study of previous CRTI participants found that more than 90% of graduates remained in academic hematology and were still a part of hematology research after the program’s completion.3 Allison A. King, MD, MPH, PhD, chair of the CRTI steering subcommittee and a professor of pediatrics in hematology/oncology at the Washington University School of Medicine in St. Louis, was lead author on the study.

Researchers also found that 63% of respondents surveyed between 2005 and 2012 “strongly agreed” that the program had facilitated their careers as independent researchers. Participants surveyed reported being more confident in their skills as researchers, presenters, and team leaders after completing CRTI.

A central component of CRTI – which became a formalized aspect of the program in 2011 – is mentorship. Each participant is paired with a skilled mentor to serve as a resource throughout the year as participants refine and work on their chosen research project.

“It’s a multi-layered community of people who are all focused on hematology research. Those connections become so valuable with every study,” Dr. Sung said. According to a mentorship survey included in Dr. King’s study, nearly three-quarters of respondents felt that “the CRTI mentor played a role in increasing their knowledge or skills in conduct of research.” (See the SIDEBAR for more survey results.)

Who Is Selected?

The program is intended for faculty in their early careers in hematology-related programs at academic medical centers. Its four components are:

  • a weeklong workshop in La Jolla, California, focusing on foundation, methodologies, and the application of patient-oriented clinical research, as well as individual project development
  • a follow-up meeting at the ASH annual meeting in December
  • a one-day meeting in May to present a final update on the projects
  • ongoing networking and mentorship throughout the year

The application and selection processes are rigorous. Each year about 20 participants are chosen after submitting a career development plan, research proposal, mentor letter of support, institutional commitment letter, and National Institutes of Health (NIH) biographical sketch.4

Faculty members are also carefully selected based on their mentorship experience, communication skills, and clinical research. Dr. Sung said the CRTI steering subcommittee prioritizes finding faculty members from diverse backgrounds in terms of race and ethnicity, gender, home institution, and specialty area.

CRTI faculty work with the selected participants on their own research project they have brought to CRTI. Each CRTI participant brings their own enthusiasm and research focus but leaves with a story of how the program influenced their career development in the years that followed. Here, six past graduates share their stories.

Finding Career-Long Collaborators

Dr. King, who tracks the success of CRTI through past graduates’ survey data, was also one of the program’s first graduates.

She went through the program in 2005 and focused on a cognitive training intervention for children with sickle cell disease (SCD) who had cognitive deficits. At the time, she had submitted a career development grant application to the National Heart, Lung, and Blood Institute, but it was not funded at first. That changed after she was able to gather feedback from others in the program.

“All the advice I got at CRTI was helpful in refining my application and so then when I resubmitted, I was awarded the grant,” she said.

She continued to draw on connections made during the program when she later expanded the intervention. “All of those contacts were great about establishing collaborations,” Dr. King added. “I’ve gone on to get funding with some of my colleagues who were at the same stage, as well as [to work] with people who are more senior that I met there.”

Dr. King now serves as a principal investigator for the ASH Research Collaborative (ASH RC) SCD Clinical Trials Network and has published papers evaluating the CRTI program. Investigators assess the program every three years on outcomes such as grant awards, publications, promotions, work-life balance, and other factors contributing to overall success.

In the latest paper, published in Blood Advances, Dr. King said participants overwhelmingly reported what she felt all along: Participation creates a true sense of community.

“The program itself lasts for one year, but the contacts and the relationships that were built were not just for one year,” she said. “I am still in touch with all of these people.”

Forming Key Connections

When Alison Walker, MD, participated in 2007’s CRTI, she had no way of knowing how much it would shape the future of her career.

During the program she met John C. Byrd, MD, who offered Dr. Walker her first faculty job at The Ohio State University Comprehensive Cancer Center – where she remains to this day, enjoying “a fantastic career.”

“For me, the most significant part of CRTI – besides, of course, the clinical trials and getting excited about research – was the networking,” she said.

Dr. Walker spent the yearlong program working on a clinical trial with decitabine and the mTOR inhibitor rapamycin in patients with relapsed or refractory acute myeloid leukemia (AML).

When she obtained the faculty position at Ohio State, the clinical trial continued at the University of Rochester without her, but she said the experience of fine-tuning the project and seeing the clinical research process unfold gave her valuable skills that she continues to use in her research today.

Dr. Walker also called the experience of working closely with her CRTI mentor, Jane Larae Liesveld, MD, “incredibly valuable.”

“In retrospect, when I think about how she interacted with me and how she taught me, that has influenced how I’ve worked with trainees as a faculty member,” she said.

Today, Dr. Walker is a full professor at the university, serves as the director of the acute leukemia program, and continues to conduct clinical research in the field of acute leukemia. As of July 2021, Dr. Walker will serve as chief of staff for the cancer hospital.

She also continues to play an active role as a volunteer with ASH – something she said was kickstarted by her own experience in CRTI.

Paying It Forward

Within a year of graduating from CRTI, Dr. Herrera was already finding ways to give back.

He first served in the recent graduate role on the CRTI steering subcommittee and is now in his fourth year as a member of the CRTI faculty. He has mentored six graduates, publishing papers with them and assisting with research projects and clinical trials.

For the past two years, he has also served on the steering committee as a faculty advisor, helping to craft the curriculum, improve the course, and even find ways to keep CRTI going during a global pandemic.

“CRTI brought me into the ASH family and created an avenue for me to contribute through volunteerism, which has been an important part of my career,” he said.

Dr. Herrera also continues to study minimal residual disease assessment in lymphoma – the focus of his project at CRTI years ago – and runs clinical trials in Hodgkin and non-Hodgkin lymphoma, primarily on immunotherapy.

“A lot of what I do is trying to find biomarkers of outcomes in patients who are undergoing immunotherapy or stem cell transplant as part of their lymphoma therapy, with the goal of tailoring their therapy a little more,” he said.

Today, he is the primary investigator for approximately 30 clinical trials and is leading a phase III randomized trial with more than 1,000 patients, hoping to define a new standard of care in patients with newly diagnosed Hodgkin lymphoma.

Informing Career Decisions

When emergency room physician Jeffrey Glassberg, MD, of Mount Sinai School of Medicine, learned that he’d been accepted into CRTI, the timing wasn’t ideal. After talking with his mentor, who urged him to participate, Dr. Glassberg rearranged his schedule and soon found himself immersed in what he referred to as “a research boot camp.”

“It’s an all-day, all-night initiation into how to do NIH-quality research in hematology and how to get funded to do it,” Dr. Glassberg said of the week-long component in La Jolla.

In addition to learning the nuts and bolts of clinical research, Dr. Glassberg spent the week interacting with top medical research statisticians, leaders from the NIH, and successful clinical researchers in hematology.

At the time, he had just received an NIH Career Development Award to study an asthma-like syndrome in patients with SCD. He also planned to begin his foray into qualitative research by studying the promotors and barriers to taking asthma medicine for those with SCD.

“We need to provide training and support to make sure people know how to develop studies, how to execute them, and how to disseminate their results in the most effective ways possible.”

—Lillian Sung, MD, PhD

Dr. Glassberg said being around NIH faculty and hematologists who were conducting mixed methods and qualitative research showed him “that there are rigorous ways to do it and that you can get funded for it.”

Two to three years later, he was one of a select few to receive an NIH grant in implementation science for SCD and later secured an NIH Research Project Grant on the first submission to continue his research.

“I think a lot of the decisions that I’ve made since leaving have been informed by CRTI,” Dr. Glassberg said. “Or, if I wasn’t sure about something or there was a fork in the road, I would call someone from CRTI and chat with them to help me decide.”

Today, Dr. Glassberg runs a 400-patient SCD clinic at Mount Sinai, sees patients in the clinic, and still does three emergency room shifts each month.

Adopting a Mixed Methods Approach

Dr. Ogunsile, a 2019 CRTI graduate, came into the program with a specific project in mind. She wanted to evaluate the effects of exercise for patients with SCD and cardiovascular disease, but after receiving feedback from the program faculty, she realized that she needed to expand her approach to fully understand the issue.

“At CRTI, people told me that if I was going to develop a behavioral intervention, I had to think about getting patients’ input,” she said. “So, since my CRTI graduation, I have been working on ways to include a mixed methods assessment to get patients’ input and taking a more comprehensive approach with my project.”

Dr. Ogunsile said this was an avenue that she would not have considered without CRTI.
Now, in addition to assessing the efficacy of the intervention, she plans to identify the barriers to and facilitators of exercise to determine the practicality of recommending exercise to this patient population.

Participating in CRTI allowed her to take advantage of the mentorship incorporated directly into the program and consider various perspectives when modifying the project.

“I felt like it was a good dive into clinical research,” she added. “It was very good to have the hands-on instruction from leading hematologists.”

Currently, Dr. Ogunsile is an assistant professor of hematology and oncology at the University of Alabama-Birmingham, where she has continued developing her project.

Prospering During a Pandemic

Hope Wilson, MD, of University of Alabama-Birmingham/Children’s of Alabama, graduated from CRTI in 2021. It was a unique time: The global COVID-19 pandemic was raging and the program itself looked a bit different than previous years.

COVID-19 regulations forced the program’s week-long intensive course to move online, where participants spent several days in virtual classes and discussions, but it also forced program organizers to get creative about how to stay connected.

Dr. Wilson believes one benefit to the virtual program was the monthly check-ins with participants’ small groups that were built into the program. “In some ways, this format that we were forced to do actually worked better,” she said of the regular small group meetings. These check-ins kept participants on task and allowed them to develop deeper relationships throughout the year.

“It’s definitely one of the best experiences I’ve ever had in my development as a junior faculty,” Dr. Wilson said.

As a pediatric hematologist/oncologist, Dr. Wilson selected long-term anticoagulation in children with a history of thrombosis as her project, with an eventual goal of helping develop effective guidelines for treatment.

The crux of the project remained the same from its origination throughout the year, but she noted that the project was fine-tuned thanks to input from CRTI faculty, her peers, and her improved research skills.

“It forced me to think critically about the design of the study,” she said. “It made me think about things I hadn’t previously considered that could strengthen the study. More than anything, it helped develop my skill set as a clinical researcher.”

The critical feedback and career development advice, together with the connections forged with leaders in hematology, made CRTI participation a “well-rounded” experience, she added.

“It was invaluable to have all these experts in all these different fields under one roof and at your fingertips. Their sole intent is to help you, from a personal standpoint, from a project standpoint, and from a professional standpoint,” she said.

Dr. Wilson is already planning to give back to CRTI by serving on the organization’s steering subcommittee this year, providing the perspective of a recent graduate.

Each class of CRTI participants is composed of hematologists who bring distinct perspectives and distinct goals to accomplish. The six graduates who spoke with ASH Clinical News believe their time at CRTI has helped foster their careers, connected them with the greater hematology community, and allowed them to develop the necessary skills to evaluate and execute their own research in the field. —By Jill Sederstrom

References

  1. Todd RF, Gitlin SD, Burns LJ, et al. Subspeciality training in hematology and oncology, 2003: results of a survey of training program directors conducted by the American Society of Hematology. Blood. 2004;103(12):4383-4388.
  2. American Society of Hematology. Clinical Research Training Institute. Accessed June 20, 2021. https://www.hematology.org/awards/career-enhancement-and-training/clinical-research-training-institute.
  3. King AA, Vesely SK, Elwood J, et al. The American Society of Hematology Clinical Research Training Institute is associated with high retention in academic hematology. Blood. 2016;128:2881-2885.
  4. American Society of Hematology. Apply for the Clinical Research Training Institute. Accessed June 20, 2021. https://www.hematology.org/awards/career-enhancement-and-training/clinical-research-training-institute/apply#Process.

In the 2016 survey of CRTI participants, graduates described the mentoring experience as beneficial, resulting in posters, presentations, or manuscripts. The relationships also fostered knowledge development and future career opportunities.

For example, survey respondents reported the following benefits of mentor interaction:

  • resulted in publication: 16%
  • resulted in presentation: 18%
  • resulted in poster: 11%
  • led to learning new teaching method or approach: 11%
  • resulted in increased knowledge or skills in conduct of research: 74%
  • resulted in increasing new clinical knowledge: 24%
  • facilitated job change or promotion: 16%
  • facilitated involvement in a clinical trials cooperative group: 16%

Source: King AA, Vesely SK, Elwood J, et al. The American Society of Hematology Clinical Research Training Institute is associated with high retention in academic hematology. Blood. 2016;128:2881-2885.