Joseph Mikhael, MD, MEd
Consultant Hematologist, Mayo Clinic Arizona, Associate Professor, Mayo College of Medicine
Editor’s Note: 2012 marks the 10-year anniversary of the Clinical Research Training Institute (CRTI). In the September/October issue of The Hematologist, articles that focused on the history, productivity, and direction of the program were published in recognition of this milestone in the history of ASH’s flagship training program. The current article is a continuation of the 10-year anniversary celebration and spotlights a successful mentoring relationship that came out of the Institute.
When Dr. Tanya Wildes was selected as a member of the CRTI class of 2011, she had no idea of the profound impact the program would have on her career path. Following completion of fellowship training in hematology/oncology and geriatrics, Tanya knew she wanted to devote her career to studying older adults with multiple myeloma, but she was struggling to formulate a plan to achieve that aim. After completing the CRTI training week in La Jolla, CA, she returned to her home institution with a clear vision of how to proceed both with her research project and her career development. The CRTI experience provided Tanya with the academic tools and the confidence to seek extramural funding for her project, and this past summer, she received an NIH R03 award through the Grant for Early Medical and Surgical Subspecialists’ Transition to Aging Research (GEMSSTAR) Program to support her project titled “Pilot Study of Geriatric Assessments in Senior Adults with Multiple Myeloma.”
Tanya identified the CRTI small-group sessions and the yearlong mentoring program as pivotal to her success. Small-group sessions take place daily for three to five hours during the intense one-week summer session and consist of three to four attendees, two to three CRTI faculty members, and a biostatistician. The intent is to individualize feedback to the attendees focusing on both their research projects and their career development. In Tanya’s case, the small-group mentoring sessions made her think through her research question in a way that led directly to the idea for the R03 project. Her initial CRTI project was designed as a retrospective study aimed at comparing outcomes between older adults with multiple myeloma who underwent high-dose therapy and autologous stem cell rescue with those who did not. Her small-group mentors, Dr. John Leonard, Dr. Scott Gitlin, Dr. Sarah Vesely, and I, helped illuminate the limitations of this approach, identifying confounding elements that would limit interpretation of the data. We provided guidance in the restructuring of the research question that allowed for data evaluation using the statistical technique of comparative effectiveness analysis. In this case, the focus was on identifying the characteristics of older adults with multiple myeloma who underwent treatment with induction chemotherapy followed by autologous stem cell rescue. These data would then provide the basis for properly matching the control group.
The small-group discussions, coupled with didactic seminars dealing with research design, provided Tanya with the background necessary to develop a model that would yield valid, interpretable results. Drawing from her training as a geriatrician, Tanya recognized that common geriatric problems, such as functional impairment, fall history, cognitive decline, comorbid conditions, and polypharmacy, likely impacted a clinician’s decision to offer aggressive therapy. Using her CRTI experience, Tanya developed a pilot project in which she proposed a prospective cohort study to examine comprehensive geriatric assessment as a predictor of treatment strategy for older adults with multiple myeloma. This pilot project served as the basis for her successful R03 application.
Another pivotal moment during her CRTI week was the day her small-group mentors asked each trainee to review their career-development plans. With an objective view of her career goals, her mentors focused on areas that needed additional attention. In particular, it was clear that her clinical work and her research program were not well aligned. She was not formally part of the myeloma clinic, although her research involved patients with myeloma. With her small-group mentors’ support and with the assistance of her institutional mentors and her department chair, significant changes were made in her clinical activities allowing her to match those duties with her research interests.
CRTI has been critical in launching Tanya’s career and moving her along the path toward her goal of studying older adults with multiple myeloma. Taking the next step on her path, she has applied for an ASH Scholar Award based on a project looking at peripheral neuropathy as a risk factor for falls and functional decline in older adults with multiple myeloma. She is grateful to ASH for supporting CRTI and credits it with her early funding success. Tanya said, “I am not overstating it to say that CRTI changed my life and will continue to impact my career as I move forward." She credits the yearlong mentoring component of CRTI with helping her maintain momentum. “Dr. Mikhael continued to keep tabs on my progress through phone calls and emails, and he pushed
me to take steps that were out of my comfort zone. He took the time to read my specific aims for my ASH Scholar Award submission, and he made suggestions for improvement. During fellowship, a senior fellow told me that ‘Nobody cares about your career but you.’ CRTI has shown me over and over again how untrue that is.”
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