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Five Questions for Our Departing Research Assistants

Emma Williams (EW), Kaetlyn Arant (KA), Mike Zarra (MZ), Val Leifer (VL) and Peter Bensen (PB) joined OrACORe as research assistants during the summer of 2019 and are now in the final days of their second year with us. We are extremely grateful for their hard work, dedication, and good spirits and will miss their presence in the office (virtual or not!). Here are some of their responses to our questions about their time here.

1. How have your roles and responsibilities changed in going from a first-year research assistant (RA) to a second-year RA?

EW: My second year at OrACORe has been much more focused on OAPol analyses and regulatory and coordination work for our clinical studies. I’ve been able to oversee the IRB approval and start-up of our MeTeOR 12-year follow-up study, coordinate all regulatory activities for the TeMPO trial, and focus on a cost-effectiveness analysis of arthroscopic partial meniscectomy (APM) using the OAPol model.

While I certainly miss the level of clinical exposure and participant interaction that I had during my first year, my second-year has pushed me to grow a lot as a leader, a critical thinker, and a problem solver. The transition from first to second year feels a lot like a transition from research assistant to researcher!

KA: I think now, in my second year, I spend much more time overseeing and teaching than I did in my first year. For example, last year my primary responsibilities for the TeMPO study were to recruit participants in clinic, perform MSK exams, and call participants to collect their questionnaires. This year, while I still spend time in clinic and carry out study-related activities, my primary role is to oversee the TeMPO study and to coordinate with our partner sites around the US. I lead all project meetings and ensure that the study is running smoothly. Additionally, I’ve been given a greater variety of responsibilities in my second year, as I now have my hand in many different projects, grants, and manuscripts. My favorite part about second year is having the opportunity to teach the in-coming RAs. It has been so much fun to pass along the skills that I was taught last year, although quite honestly, I have learned more from the new RAs than I’ve taught them! In my first year, I was so appreciative of the help and advice offered to me by the second-year RAs, and so it’s been exciting to have the opportunity to reciprocate this year.

MZ: The most significant way that my responsibilities have changed relates to the shift from mentee to mentor. In my first year, I was more focused on the details of the day-to-day work, mainly regarding ORBIT and TeMPO visits. Now, I work on improving the larger processes that allow daily operations to run smoothly. What IRB amendment can I suggest that would make reaching participants easier? Which avenue of communication with our imaging team will allow study visits to integrate into hospital workflow? How can I support current first-year RAs so that they are prepared to lead our studies this summer? Of course, I have been figuring it out as I go and thus the second-year position is still one of learning and personal growth.

VL: Being promoted to Project Coordinator of OAPol was one of the most rewarding experiences I’ve ever had. It came with so many new responsibilities, from training multiple cycles of RAs in how to use OAPol and conduct OAPol analyses, to helping RAs with their own projects once they were fully trained. Being Project Coordinator during the COVID-19 pandemic challenged me not only to be the best teacher and team leader I could be, but also to be creative in unexpected ways. For example, I designed a new OAPol training program, complete with remote lectures and Khan academy style videos, to ensure that training went as smoothly as possible during the pandemic. Even as we return to in-person work, it’s really rewarding to know that the training schedule and videos I designed will be helpful for future generations of RAs.

I’ve also loved the ongoing opportunity to find new, creative ways to use OAPol. In my first year, I developed a new method that allowed us to model multiple treatment tracks in a single model run, which increased the efficiency of our model runs, and allowed us to model more complicated clinical scenarios and intervention sequences. As Project Coordinator this year, I developed a method that allows us to model interventions in parts (e.g. months 0-6, months 6+), which allows us to replicate clinical data more accurately over time. I’ve also really enjoyed helping my fellow RAs develop modeling strategies for their own projects.

PB: We talk about this transition from first to second year, but I think it happens more organically than that. The training structure is so well done that you naturally fill your new roles. Having more responsibility on the projects that you’re working on often includes both greater organizational and managerial tasks. You are tasked with giving more presentations, and have more ownership over your assigned modeling projects, which I like a lot. You train the new first-year RAs and this is an opportunity to reflect on how much you’ve learned over the years. My workload increased a fair amount from first to second year, and it wasn’t that my work was more challenging, but I had to learn to be more efficient because I am constantly bouncing from one project to the next and I always need to know what is going on.

[left to right] Kaetlyn, Val, and Emma on their way to observe a total knee replacement in the operating room (photo courtesy of Williams)

2. What’s a typical week on the job for you?

EW: Every week is different, but I usually spend about two to three days working on OAPol. Some of this work is general model maintenance, such as writing requests for model updates, corresponding with our model programmer, and overseeing debugging efforts. But most of my OAPol time has been devoted to the cost-effectiveness of APM analysis, which has ranged from deriving input values to drafting the manuscript.

Another two to three days each week is spent preparing for the MeTeOR 12-year follow-up. Last summer and fall, I was focused on obtaining IRB approval for this study and creating all of our study documents. During the winter and spring, the focus shifted to creating our data management system, training off-site personnel, and ensuring that all sites (and my wonderful replacement Claire!) are ready to start recruitment in June.

The remainder of my time is filled with TeMPO recruitment and regulatory tasks and the occasional social media check-in!

KA: My job varies a lot week to week, but in general, I spend one day in clinic alongside some of our orthopedic surgeons trying to recruit participants for the TeMPO study and I often  host and lead one to two meetings for TeMPO either with just the Boston team, or with some combination of physicians, physical therapists, and research coordinators at our other sites. I also spend a chunk of time each week scheduling participants for exams, enrolling them into the study, checking in with participants who are halfway through the intervention, and coordinating with other sites. Recently, I’ve been working on two different NIH grants, so those tasks had been added to my weekly task list. Finally, I am also often working on some form of a writing project, and I work on those documents in my spare time.

MZ: In the COVID-aware world, processes are continuing to evolve and as such every week looks a bit different in terms of how and where I do my work. Most tasks that I can complete remotely, I work on from my apartment – tasks like IRB submissions, phone-screening clinicians, and medical record reviews. A typical week, finds me in the office about two days when I need to conduct an ORBIT visit, randomize subjects, or work l with physical equipment. My goal each week is to keep the ongoing studies running efficiently while completing all the miscellaneous tasks that arise. Right now, I am also working on drafting a manuscript, which occupies any spare time I might find myself with.

VL: One of my favorite things about life at OrACORe, and being Project Coordinator of OAPol, is that no two weeks are ever the same! It keeps things exciting and engaging. For example, last summer, I was fortunate to have the opportunity to be part of a COVID-19 modeling project with the Medical Practice Evaluation Center at MGH, in addition to working on OAPol and RA training. Then, over the fall and winter, I transitioned more towards helping the first- and second-year RAs with their own OAPol projects, and in the spring trained a new RA who joined our team.

I’ve also found it fascinating to have the opportunity to study knee osteoarthritis and its treatment from so many different perspectives. For example, I’ve been working on a project examining surgical and non-surgical weight loss, along with helping other RAs with projects examining gabapentinoids, arthroscopic partial meniscectomy, a walking program, and more!

PB: I think what everyone will say that there isn’t necessarily a typical week, I have been fortunate enough to work on a lot of modeling-based projects and primarily spend my time doing those. I also perform study visits for ORBIT, which provides variation in my weekly structure. Usually I work on 4-7 projects at a time, and all of those projects have their check-in meetings with the full OrACORe team and then we have smaller group meetings. My typical week ends up being structured around what I need to prepare for my project meetings and I prepare my figures, tables, agendas, or discussion points based on what is needed for each meeting.

3. What are you going to miss most about OrACORe?

EW: The people! Drs. Katz, Losina, and Selzer have been fabulous mentors throughout my two years here. They’ve pushed me in all the right ways while also providing me with the support I needed to feel confident and inspired in the work I’m doing and in the medical school application process.

I’ve also found friends for life among my fellow research assistants. I can’t wait to see where we all end up in 10 years!

KA: The people!! I realize that sounds like a cheesy answer, but it’s true! My coworkers are some of my closest friends here in Boston, and I will miss them dearly next year. The biggest disappointment about working from home this year is missing out on daily conversations with some of the most interesting people I know. We have a lot of fun in and out of the office, so I’m really lucky I had the chance to experience such a fun and welcoming work environment.

MZ: The people. What makes OrACORe such a great place is the synergy of uniting the talents of diverse and interesting people to work towards common goals in osteoarthritis research. I have found, as I think most of us RAs have, that our coworkers become our close friends. Having the shared experience of applying to medical or graduate school facilitates camaraderie as well that I hope will persist as we become colleagues in the healthcare field. I will also miss the mentorship of Jeff, Elena, Faith, Lindsey, Jamie, Zoey, Heidi, and more, which has undoubtedly played a significant role in shaping the physician I will become. Working directly with the people participating in our studies has kept me grounded in remembering the reasons why I chose this path and each of them also deserve credit in helping me to get there.

VL: Without a doubt, I will miss the people most. My colleagues at OrACORe are some of the most wonderful, dedicated, and thoughtful people I’ve ever worked with. I learn something new from them every day, whether from hearing about the work that they are doing, talking about life in general, or from the volunteer work that we do together as an office. That’s one of the things I’ve found so inspiring about working here – how committed everyone is, not only to research, but also to using our roles as healthcare workers to improve the world and local community. Before the pandemic, several members of the office and I volunteered once a week at FINEX House, a shelter for battered women in Boston. Many of us also participate in Read to a Child, a national mentoring and literacy non-profit program, which continues to be a high point of each week for me. I also have been incredibly inspired by the Anti-Racist Task Force our office formed last summer, led by Emma Williams, another OrACORe RA, through which we’ve had so many productive discussions and I have learned so much.

[left to right] Chloe Schulze, Jamie Huizinga, Kaetlyn Arant, and Emma Williams at the orthopedic department holiday party in 2019 (photo courtesy of Williams)

PB: I think the biggest thing is the mentorship and support you get from Jeff, Faith, Elena, and the other RAs. Whether it’s going through the medical school application process, studying for the MCAT, and taking a project start to finish, you are given a lot of responsibility, but you also get a lot of help and coaching. You know that you have people who will be reviewing your work and giving you feedback, which is a reassuring thing that helps you to grow. The work we do is primarily thought-provoking, and with that comes a lot of learning and growth. Having check-ins with Elena where we run through calculations together is something that’s been really valuable.

4. What’s one lesson you’ve learned during your time here that has changed the way you understand health care and/or clinical and policy research?

EW: I’ve gained a deeper appreciation for the volume of research that informs physicians’ treatment recommendations and the importance of being able to communicate that research to patients. For example, much of my focus for the past year has been on surgical vs. non-surgical treatment options for degenerative meniscal tears. The differences in outcomes between these treatments can be modest and may depend on the patient. There have been numerous large randomized controlled trials comparing APM to physical therapy (including MeTeOR!), yet we still don’t have an entirely clear picture of how these treatments affect pain, function, or progression of joint disease. Treatment discussions between physicians and patients can easily become nuanced and may ultimately come down to the weighing of two uncertainties. Physicians need to be able to understand and communicate these nuances and uncertainties to patients, which can be a challenge, especially if the patient has little experience with medical research.

KA: One of the most important lessons I’ve learned from observing the physicians at the Brigham is that healthcare is holistic. It is not a matter of simply addressing the one issue at hand, but rather, considering all aspects of a patient’s well-being. I first noticed this when shadowing Dr. Jeff Katz in my first month at OrACORe. One woman came in with knee pain, which Dr. Katz immediately addressed. But then he continued to ask about her family, her mental well-being, her occupation, and addressed several other health problems— I think a majority of the clinic visit was spent addressing things other than her knee! It was clear what a difference this listening ear made for the patient, and it’s something I’ve since observed while shadowing several other physicians.   I hope to keep this lesson in mind when I become a physician.

MZ: One of the many lessons I have learned while at OrACORe is that patients feel the pervasive effect of racism in medicine, which ultimately affects their health care and health in a negative way. Moreover, that as a physician, it is not only prudent but necessary to become an agent against racism. I feel extremely fortunate to have been working at OrACORe this past year as society grapples with the effects of racism. Our RAs found support from our leadership in forming an Anti-Racism Task Force that served as a safe place to learn about racism and act as a conduit for change. I know that effort has led me down a road that will make me better as an individual and as a physician operating within a systemically flawed system.

VL: Perhaps one of the most important lessons I have learned is the importance of seeing each patient as an individual, and understanding the full picture of a patient’s health – not just the disease or illness for which the patient has come into the office – when considering different treatment options and making recommendations. For instance, I’ve had the opportunity to work on a study examining the cost-effectiveness of surgical and non-surgical weight loss interventions for patients with knee OA and BMI > 35kg/m2. This research has shown me that, while weight loss treatments might not seem like an obvious, direct treatment choice for people with knee OA, weight loss surgery can actually reduce patients’ knee OA pain substantially, sometimes so much so that they may not need total knee replacement surgery, a treatment for end-stage knee OA that is often pursued after other, non-operative pain-management strategies have been exhausted. 

PB: I’ve come away from this with a greater appreciation for the collaboration and teamwork that is required in medicine and research. Before this job I had done some summer research but coming here I realized how much collaboration is involved in research, policy, and medicine. I’ve worked on projects with surgeons, nurse practitioners, epidemiologists, etc. and they are all needed to provide their expertise to make sure we are asking the right questions and including the necessary perspectives. Getting to participate in these collaborations has been one of the highlights of my experience here.

The OrACORe team at the annual cookie competition in 2019 (photo courtesy of Williams)

5. What are your career plans post-OrACORe and how has your time here influenced them?

EW: I’ll be heading west for medical school at UC San Diego! From convincing me that I want a career spanning research and clinical practice to showing me what it means to be a great mentor, my time at OrACORe has been one inspiration after another. I am immensely grateful for all that I have learned about medicine and myself over the past two years.

KA: My time at OrACORe had a huge influence on my career plans—I entered this job unsure of what I wanted to do next. I hoped that this job would provide an in-depth look into the field of medicine and it did not disappoint! I spent 2-3 days a week working alongside physicians, had numerous opportunities to shadow them in clinic and to observe in the OR and received mentorship from some of the finest doctors and human beings I’ve ever known. Ultimately, this job is what inspired me to apply to medical school. I will be headed to Brown for medical school next year and my time spent at OrACORe played a significant role in that.

MZ: After a long hectic application cycle, I will happily be attending Tufts medical school. OrACORe granted me a window into the life of physician scientists, which has reinforced my desire to pursue a career as a physician and medical researcher. It has also offered my insight into outcomes research and how such work stands to impact the health of populations as well as individuals. My time at OrACORe has inspired me to strive to treat people both on the personal, community, and global level.

VL: After OrACORe, I am excited to be starting medical school at Columbia University’s Vagelos College of Physicians and Surgeons. The opportunity I have had at OrACORe to experience the incredible research going on at Brigham and Women’s Hospital has made me even more excited about pursuing a career in medicine and medical research. My work at OrACORe has shown me, in particular, how much I enjoy applying computational and statistical approaches to research. In medical school and beyond, I am looking forward to continuing to use cutting edge computational techniques to tackle challenging problems in medicine and develop new therapies for patients, to improve their health and their lives.

PB: I’ll be attending Harvard Medical School, so I’ll be in Boston for a while. That plan hasn’t necessarily changed, but I think the piece that has changed is that I want to keep research as a part of my career. I hope to be involved in academic medicine and work at an academic center. I really like teaching, and I aspire  to be involved in teaching residents and students as well as performing research and having a clinical practice. I had not been exposed to public health policy before this job, and I want to continue contributing to this field because I’ve become more interested in population and community health through my work at OrACORe. I’m considering pursuing an MPH degree as well to expand on my real-world experiences.

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