From "Doctoring" to Discovering

As physicians, Stephanie Carlson and Jon Ebbert like to provide their patients with the latest treatments and therapies. As researchers, they're on the front lines helping make breakthroughs to provide those treatments. Both are graduates of a special Mayo Clinic program that gives young researchers the skills they need to find novel ways to solve old problems.

Now in its sixth year, the Clinical Research Training Program provides a formal education in all aspects of clinical research, including grant-writing, legal and ethical issues, statistics, epidemiology and study design and protocols. It's designed for health professionals who have a doctoral degree or are enrolled in a doctoral program and includes physicians, nurses, dentists, psychologists and basic science researchers. To date, 50 people have completed the program, earning a certificate or a master's degree. Participants say it also offers a boost to their careers.

Cancer Prevention

Dr. Ebbert, an internist, focuses on tobacco. The reason, he says, is simple: tobacco use is the number one preventable cause of death and disability in this country. His research -- at Mayo's Nicotine Research Center seeks to identify new treatments and therapies for smokeless tobacco users, which he describes as an underserved population. There are few proven therapies to help people quit smokeless tobacco, Dr. Ebbert says, but he is testing some tools that he believes have strong potential. In particular, he is conducting clinical trials on a smoking-cessation drug (bupropion) as well as on nicotine lozenges and nicotine patches. Dr. Ebbert's study of high-dose nicotine patch therapy (up to 63 milligrams per day) is funded by the National Institutes of Health (NIH), an outstanding achievement for a young investigator. He expects to have preliminary findings this summer.

He says both Mayo and the CRTP enhance collaboration.

"The clinical expertise and the close contact between researchers and the clinical environment provides a rich source for investigative questions," he says. "People know who we are, people respect our clinical enterprise, and people respect that we're a big research institution as well. We have a reputation that opens doors for us in terns in collaboration. The Nicotine Dependence Center is a nice opportunity for the results of our investigations to be translated very quickly into clinical practice."

Dr. Ebbert is studying the effectiveness of telephone counseling in tobacco cessation; stepped care for cigarette smokers in a clinical treatment setting; and the effect of smoking cessation on weight gain and hypertension. He also is involved in studies with colleagues from other disciplines investigating the genetics of smoking and lung cancer and the role of genes in nicotine dependence.

Advancing the Science

Dr. Ebbert first became interested in research as a chief resident.
"I realized how exciting research can be," he says, "and how exciting it is to advance the science." At the relatively young age of 35, Dr. Ebbert has published an impressive amount of work. He says the CRTP has helped him to compete successfully for the grants that fund his research. Currently, he spends 75 percent of his time on research and 25 percent in clinical practice.

"It's nice to have a mix of clinical practice and research," he says. "If you lose touch with the clinical practice, I think that you lose sight of what's important to patients, what patients need. It has been an enormous advantage for me to have obtained the skill set provided by the CRTP for trying to get to that point. It may provide some individuals with a greater understanding of what goes into research, rather than having to go through some of the painful experiences of doing it wrong. It certainly has made my time in research a lot more exciting and a lot more rewarding with fewer frustrations than I might have had trying to learn everything on the back end of writing a grant."

The CRTP emphasizes multidisciplinary collaboration, and Ebbert considers it crucial to his work to team up with researchers from other fields. His participates in joint research efforts with colleagues from Laboratory Medicine and Pathology, Epidemiology, Psychology, Anesthesiology and Dental Specialties.

Research in Radiation

Dr. Carlson, a radiologist, focuses her research on interventional computerized tomography (CT) and molecular imaging. She is working in the lab of Stephen Russell, M.D., on a project dealing with molecular imaging and image-guided gene and virotherapy for pancreatic cancer. Molecular imaging enables researchers to see the results of therapies much more quickly than traditional methods.

It was during her residency and fellowship that Dr. Carlson realized she needed more training in research to achieve her goals.
"I decided I'm either going to do research well or I'm not going to do it at all."
After she joined the staff at Mayo Clinic, she was awarded a major grant for junior investigators, which allowed her to both conduct research and enroll in the CRTP. She credits the training program with helping her secure the grant. The research project began as a pilot study and eventually grew into a full, randomized clinical trial. Best of all, Dr. Carlson says, it resulted in an improvement to clinical practice.

The project involved breath-hold monitoring and feedback for patients undergoing CT-guided lung biopsies. Because tumors in the lung and upper abdomen move around significantly during respiration, it can be difficult for radiologists to extract a tissue sample. Dr. Carlson's project studied the use of a new system created by Radiology colleague Joel Felmlee, Ph.D., that was designed to make it easier for patients to hold their breath at the proper time.

"Patients look at a monitor and are able to adjust their breath-hold level so that we can accurately localize and access their nodule throughout the procedure," Dr. Carlson said. "We found that the system decreases procedure time, radiation dose and complication rate. Previously, we had difficulty accessing small tumors for biopsy. Now we're able to consistently biopsy tumors less than one centimeter in size. This can save people from going to surgery for a diagnosis. This study was exciting because I could immediately see the results of our research making a clinical impact. That's what keeps me going -- how it will apply toward patient care."

Bolstered by that success, Dr. Carlson turned much of her attention to functional imaging, which goes beyond traditional anatomical imaging and reveals the physiology of how a tumor functions. Using a combination micro-SPECT/CT scanner, Dr. Carlson is studying the ability to accurately deliver and monitor intratumoral gene therapy in a pancreatic cancer model.

"This type of fusion imaging allows us to noninvasively determine if the therapeutic gene is being expressed and if it is having an antitumoral effect within hours or days instead of waiting weeks to months to see if a tumor shrinks," she noted.

Dr. Carlson believes her CRTP experience, as well as the general environment at Mayo Clinic, have been invaluable in helping her achieve her goals. "I can't imagine now doing research without having that training," she says. "It was just huge. I wouldn't be doing research if it weren't for that, which would be a shame because I absolutely love what I'm doing now. It's so hard as a junior investigator to get started and get funding and get training. That was all available to me here. Every opportunity that Mayo has is so incredible. That sounds sappy, but it's true."

Both Dr. Carlson and Dr. Ebbert stress that even with the training offered through the CRTP, young investigators need to have a strong mentor. Each has found one at Mayo Clinic. Dr. Carlson credits Claire Bender, M.D., with guiding and inspiring her. Dr. Ebbert says he has benefited greatly from the tutelage of Richard Hurt, M.D., director of the Nicotine Dependence Center. For more on clinical research training programs at Mayo Clinic, visit: http://www.mayo.edu/msgme/crtp.html