We all have to balance competing demands on our time. But as an academic oncologist, I have to keep a foot in 2 worlds, research and clinical, while still keeping my balance.

	Working as a medical oncologist in an academic setting challenges doctors to have a foot in 2 worlds: the first world revolves around scientific advancement, and the second around patient care. Each realm has inherent opportunities, rewards, and difficulties that we encounter every day. In this brief snapshot of my experiences, I will try to describe a day that illustrates the balance between these worlds, which is essential to achieve a balanced career in academic oncology.

	Of course, each academic medical center has its own culture, demands, and spectrum of job types. Some academic physicians have a much more lab-based research practice; others focus on a strictly clinical research practice. My description reflects my own experiences in what might be a typical workday for a clinical trial researcher in gastrointestinal oncology.

	Each week, I spend 2 days with an entirely clinical schedule. On these days, I see patients in the clinic and administer chemotherapy. I also have at least 1 day each week for entirely academic work. On this academic day, I dedicate my time to research protocols; student, resident, and fellow mentorship; and administrative duties. On other days, I have a mixed schedule with both clinical and research responsibilities. In this article, I will describe a typical Tuesday, which is the best example of a mixed clinical and academic day on my schedule.

	Our GI oncology group works closely with a variety of other disciplines, and we are lucky to have collaborators in surgery, radiation oncology, gastroenterology, and radiology who share a common vision for patient care and research. We meet weekly to review challenging cases at a colorectal surgical conference. Since this conference is run by our surgical colleagues, we have an early start (but coffee is readily available)! The surgeons review new patient consults and challenging cases. Representatives from each of the participating disciplines have an opportunity to weigh in with their expertise and feedback. This conference is not only a place to collect fascinating cases, it is also a chance to learn the styles and personalities of the other physicians from other departments. Outside of this in-person conference, I may only interact with them over the phone. During conference, we also discuss open research trials, update the group on how shared patients are doing, or vet ideas about possible proposals for new research studies. Getting a “buy-in” for study participation from the providers who have the first contact with patients (in GI, that is usually the gastroenterologists and surgeons) will lead to more fruitful studies and faster subject accrual.

	After meeting with the colorectal surgeons, we share clinic space and time with our hepatobiliary surgical colleagues. Like the colorectal conference, this multidisciplinary clinic provides us with an opportunity to see patients as close to the time of diagnosis as possible. In this half-day clinic, we see up to 7 patients. Pancreaticobiliary malignancies often need neoadjuvant/adjuvant therapy, which requires delicate timing and effective collaboration between medical oncologists, radiation oncologists, and surgeons. This collaboration is both clinically and academically rewarding. Patients like to be able to have a “one-stop shop” to see multiple health care providers, and the close collaboration across specialties maximizes our patients’ potential for the best clinical outcome. In addition to the clinical benefits, this multispecialty coordination allows for direct research collaboration among 3 different sets of research disciplines, since each subspecialty has its own multi-institution research group. We are an Eastern Cooperative Oncology Group (ECOG), Radiation Therapy Oncology Group (RTOG), and American College of Surgeons Oncology Group (ACOSOG) site. Furthermore, having other clinical and research experts from other departments working closely together and reviewing common literature helps keep all of us at the top of our games. At the conclusion of clinic, the most complicated cases are often also reviewed with our colleagues from radiology and pathology, which allows them to offer their insights as well.

	In this meeting, the GI oncologists gather with the research program manager, our mid-level providers, and clinical research assistants to review the status of our study patients for the last week. We review all open study protocols in our disease group. In a systematic way, we also discuss the status of each patient in terms of duration of treatment, toxicity, response to treatment, and survival. Protocol deviations and serious adverse events are reviewed for attribution, and we brainstorm ways to avoid future problems. We review the progress of proposed future studies and evaluate where they are in the regulatory process and how we can speed these ideas through the necessary regulatory bodies. At this meeting, the 4 GI oncologists bring up clinical trial ideas, and we review one another’s proposals, protocols, and grants and provide constructive feedback.

	After a busy first part of the day working with my partners and seeing patients, it is nice to have some time to catch up on clinical administrative work: dictating notes, following up on the results of lab work, scans, and biopsies, and making phone calls to patients. All of these tasks are vital for good patient care. It really takes a dedicated block of time to stay on top of clinical information, and, ideally, some time with the all-too-rare space of peace and quiet. Sometimes it feels as though there is no way to ever be caught up with the administrative work, but it is really essential to make a regular effort to stay on top of clinical documentation. I’m very thankful that I work with very good nurses and administrative assistants, who help to keep me organized and also do as much of the administrative work as possible. But as the doctor, there are some things that I have to do myself.

	If I have patients in the hospital, I check in on them during my inpatient time. I’ll also coordinate with the inpatient team to see if guidance is needed.

	For my research work, I use some of my administrative time, in addition to my dedicated research hours scattered throughout the week, to review protocols, make study-related conference calls, and meet with study monitors and basic science collaborators. It is especially challenging to find time when more than 2 busy schedules can coordinate, but it is imperative that an academic investigator have regular meetings with mentors and collaborators to keep research heading in the right direction. This is true for both clinical or basic science research. My colleagues who perform basic science research use their administrative time to meet with students and techs in their lab, ensure that their experiments are progressing to the next step, and troubleshoot ahead of time.

	My workday really ends whenever the rest of those tasks in my administrative time are done. Before I head home, I stop by my department mailbox to see if there are any journals I can pick up and read at home. It is vitally important for any research or clinical physician to make time every day, whether at work or at home, to try to stay current with the literature. I must confess that I have not been able to carve out that reading time at work, so I do my reading after I put my little guy to sleep.

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We all have to balance competing demands on our time. But as an academic oncologist, I have to keep a foot in 2 worlds, research and clinical, while still keeping my balance.


Finding Time: A Day in the Life of an Academic Oncologist

Clinical investigation is a vital part of an academic career in medical oncology. Gaining experience in clinical investigation, however, requires enthusiasm, opportunism, and a little bit of luck. Residency and fellowship can teach you about the clinical care of patients, but it takes an extra bit of eff ort and opportunity to learn how to be a clinical investigator.

The annual Methods in Clinical Cancer Research Workshop, sponsored by the American Association for Cancer Research/American Society of Clinical Oncology (AACR/ASCO) in Vail, Colorado, provides a unique opportunity to meet and work with expert investigators and to network with other fellows or new faculty who are interested in developing a career that includes clinical research. The workshop helps you to hone your research skills, understand trial design, and read and comprehend the literature.

This article will outline some of the steps required in the process of getting accepted to the workshop and developing an excellent protocol. It begins with mentorship, continues through the application/preparation stages, and even extends to after the meeting.

Coming up with an original idea that merits further studyis intellectually the most difficult part of the process. Having good mentorship is critical to getting an idea started, whether it is a mentor from prior research experience in medical school, your residency, or your fellowship. Having a point person—such as your program director, a research mentor, or someone with whom you have already collaborated&mdash;review your idea is absolutely essential in the early stages of developing a protocol.

Before applying to the workshop, ask your mentor to review your idea and determine whether it can be developed into a viable protocol. A good idea is simple, has a measurable end point, and asks a question that can be answered by a relatively straightforward design. Broad questions such as “Does agent X work in breast cancer?” are much too general. A focused way of formulating the question would be more like, “Does agent X, when given with standard neoadjuvant therapy in breast cancer, phosphorylate target Y in the tumor when the excised tissue is examined?”

Once you have developed an idea, start looking for funding mechanisms, whether it is an institutional grant, National Cancer Institute (NCI) grant, ASCO fellowship grant, or some other resource. In your application, you will need to demonstrate that the trial you are planning has a chance of reaching completion.

The application itself will test your ability to distill your idea into a concise application, and closely mirrors the structure of an NCI-sponsored grant application. Applications are due in March and can be downloaded from www.vailworkshop.org. (Check the site for the actual deadline date.) The requirements are fairly straightforward. You will need to submit an online application form, a brief description of your trial, your CV, a statement explaining why you wish to participate in the workshop, and a letter of recommendation from your program supervisor or department head. If individuals from your institution have attended in the past, soliciting their feedback during this process would be very helpful. If they still have their proposal, it is worth a read to get an idea for the structure of the application.

As you write your application, ask yourself, “If this concept gets approved, could I accomplish this in the next couple of years?” You will be judged on your trial design, so keep it simple and straightforward and be sure your objectives are achievable. If you design a multi-institution trial that enrolls 3000 left-handed patients with atypical carcinoid, your application will probably be turned down because it is simply not feasible. A small, biomarker-driven, proof-of-principle, early-phase study is much more likely to be accepted.

The review of your application takes a couple of months. If you get accepted to the workshop, congratulations! If not, use the experience to make next year’s application better. (And do not lose heart: applicants are encouraged to reapply.)

						You will have about 3 months to prepare for the workshop. Do not use the time to write the protocol; the whole point of the week in Vail is supposed to be for crafting the protocol itself. If you have a prewritten protocol, you will end up being disappointed, because what you thought was a perfectly elaborated idea will likely be radically changed. Instead, use the time to solidify your thinking and to learn everything you can about the disease you are studying, the treatment you are proposing, or the experiment you are conducting.

If you planned on doing a lot of hiking, biking, canoeing, or sightseeing while in Colorado, you will be disappointed. Most of your time at the workshop will be spent indoors. Remember, Vail is at 8000 feet, so if you feel dyspneic, you are not alone. You will also be reminded to drink a lot of water.

The lectures are broad and not too in-depth, so they will be applicable to most attendees. Most of the lecture slides are available on a flash drive that you will receive when you arrive, so you will not have to scribble notes the whole time. Bring your own laptop. Although there is a computer lab, having your own hardware is helpful.

The essence of the workshop is in the small-group sessions. You will be asked to defend your idea to about 8 or 9 other workshop attendees, a statistician, 2 faculty members, and a patient advocate. Many times, the trial concept will be radically altered by the group or the faculty. Be willing to be flexible. This is the time where you will be sorely disappointed if you had a randomized phase II design already written and it gets critiqued into a single-arm phase I study.

If you need extra assistance, every faculty member has “office hours” for one-on-one time. Take advantage of the opportunity to meet opinion leaders and key members of the research community. Not only can they improve your protocol, they can help provide you with career advice or some direction on future trial concepts.

When you are not in lectures, small-group sessions, or office hours meetings, you will be writing. You will need to turn in a protocol development sheet (ie, a brief summary of the trial after its initial revision), a statistical design, rough draft, informed consent, and final copy. In total, it will end up being more than 50 pages of text. It seems like a lot, but the templates are incredibly helpful for keeping your protocol in proper order. By the time you complete the workshop, the document you produce will be nearly ready for a review committee back home.

While the workshop cannot teach every nuance of clinical research in the span of a week, it will certainly illuminate some of the critical steps required for turning a hypothesis into a study with maximal potential for achieving its objectives. Applying the tools learned in terms of statistical methods, correlative end points, or useful biomarkers will help you in any future research endeavor. Spread the lessons around to your co-fellows and be a helpful reviewer of your colleagues’ ideas. Stay in touch. Your faculty members from Vail will want to hear how your protocol went and how your career is going. Their feedback can be helpful well beyond the week you spend in the mountains.

My time at the Methods in Clinical Cancer Research Workshop was one of the most challenging—but fun&mdash;experiences of my fellowship in oncology. I hope these refl ections will encourage you to submit your own application!

Sam J. Lubner, MD, is assistant professor at the University of Wisconsin Carbone Cancer Center in Madison.

The annual Methods in Clinical Cancer Research Workshop, sponsored by AACR/ASCO and held in Vail, Colorado, offers an ideal opportunity to gain experience in clinical investigation. This article tells you how to apply to the workshop and lets you know what to expect once you are there.

Sam J. Lubner, MD

Articles

Finding Time: A Day in the Life of an Academic Oncologist

All Roads Lead to Vail: Preparing for a Career in Clinical Research