Episode 06: Interview - Lorraine Dishman
Our guest today is Lorraine Dishman. Lorraine is a diligent and detail-oriented clinical research professional who is passionate about supporting the advancement of scientific discovery. She oversees the clinical trial process from start-up to closeout and has held roles from clinical research coordinator to clinical research project manager. She’s worked in academic institutions, third-party sites and the Department of Health and Human Services.
In this episode we discuss being furloughed due to COVID19, creating relationships within clinics, academic vs independent research sites, and the importance of using this downtime to improve your skills and knowledge.
Show Notes/Transcript:
+ Full Episode Transcript
Note: Transcript is auto-generated so there may be some inaccuracies or typographic errors.
Brad Hightower: Hello, and welcome to episode six of the Note to File Podcast - a collection of interviews, best practices and candid conversations for clinical research sites. I'm Brad Hightower. And today on the show we have Lorraine Dishman Lorraine's worked throughout her career across a variety of different positions from clinical research coordinator to clinical research project manager. She's worked in a number of different environments, including three different research universities or local department of health and human services, as well as a third party clinical research site. We had a great conversation. We talked a lot about creating relationships within clinics, academic versus independent research sites and the importance of using this downtime to improve your skills and knowledge without further ado, Lorraine Dishman All right. Thank you so much, Lorraine, for coming on the show today. How are you how are you holding up with the COVID-19 world?
Lorraine Dishman: I'm pretty good. Just hanging out focusing on developing some professional skills, spending time with family and just making the best of the situation.
Brad Hightower: Sure. Yeah. I mean, it's a, it seems like it's certainly affected a lot of us in different ways. Were you, were you able to stay in clinic where you furloughed, what was your kind of outcome of the situation so far?
Lorraine Dishman: I was laid off pretty early on, so right about second, third week of March on the trials we were working on were pulmonary related COPD. So we were a very high risk patient patient population. So they cut enrollment. We didn't have anybody active on the trial, so furloughed laid off, however you want to call it. So right now I've been home for months.
Brad Hightower: Yeah. And I mean, that makes it really tough depending on what therapeutic area you're in. We work a lot with IBD patients. So they've got, you know, a little built in risk as well. And we sort of had, we were able to still see patients, but we couldn't do colonoscopies in the hospital. Our hospital was seeing these COVID patients. Things are slowly now starting to pick back up here in Oklahoma, I believe. Are you in San Antonio? Is that right?
Lorraine Dishman: Yes. San Antonio, our city shut down pretty quickly. We were very aggressive long before our state did. So I think we followed that trend and then the state followed the trend and then the other cities. So we're opening back up, but our mayor doesn't agree with our governor. So we're still unfortunate, official lockdown, even though our state's open, if that makes sense.
Brad Hightower: Yeah. Yeah, no, I imagine there's a, quite a bit of that going on around the country and it's affecting sites in different ways. It's a, but even that no two sites in the same area, I've got groups here down the street from me who were all furloughed while we were able to stay open and see patients. So it's a real hit and miss out there. And I'm curious to see how the next month or so progresses or things get worse. Things get better. It's just so, so much uncertainty right now.
Lorraine Dishman: Yeah. I'm wondering if sponsors that, you know, put a halt to these studies that had maybe very few enrolled at the beginning, we'll just decide not to move forward with that trial just depending on, you know, now when we renegotiate budgets and stuff moving forward, it'll be really interesting. Yeah. And we did see, we saw some studies that weren't really doing very well. I feel like they sort of used this opportunity to just go ahead and shut their studies down and pull the plug on them because they weren't doing that well to begin with. And then they weren't able to enroll anyone at all, but we're still waiting on some studies that had not started yet that we should hopefully be getting in to the study startup process anytime. But again, it's, it's crazy. Some are being super aggressive. Some are, you know, you get no word from, I guess that's par for the course in what we do. All right. So I'm curious to hear a little bit, as I looked through your experience, it looks like you've kind of a span to the spectrum in clinical research. You kind of worked a few different places across a few different job titles. So I'm just curious to know a little bit about how you first got into clinical research. That's always a particular interest of mine. I feel like a lot of people sort of fall into you know, the industry. So tell me a little bit about how you got your start.
Lorraine Dishman: You know, I fell into it just like how you were saying I was an undergrad and I took a couple of elective courses that were research assistant courses in the social psychology department. I fell in love with being a research assistant, you know, just being an errand person for all the graduate students. I just loved the process. And when I went off to graduate school, I started applying for research jobs, walked in, had a fantastic interview, the lady and I clicked. She's like, you may have this job before I walked out and I've never looked back. It was really random and almost meant to be so, yeah, I love it. I love what I do. I actually miss what I do. So
Brad Hightower: That's what I tell people all the time. Like I'm, I love working in clinical trials because really there's no end to the different aspects of what you can do. You know, if you like a science and, you know, research design, then obviously there's immediate attraction there. If you like, you know, relationship building, interpersonal communications, you get to talk to patients and deal with people. If you like clinic work, you can, you know, work in the clinic. You can take, take blood, you can take vital signs, you can do that sort of thing. There's a business aspect. Obviously there's a lot of tech involved, there's administrative work. There's almost an endless amount of things you can do within clinical research. So that's, that's what immediately appealed to me.
Lorraine Dishman: I agree. I think there's a lot of flexibility. I think the flip side to that is when you have the basic fundamentals down of being a coordinator, there are so many different therapeutic areas you can work in. And I liked that too. You can do neurology cardiology, you know, if someone can see past that experience and say, okay, here's a certified coordinator. Here's what this person's doing. So there, it also gives you that flexibility for a different variety in your career.
Brad Hightower: Yeah. And that's, again, that's an awesome point, you know, I've, I feel like, yeah, once you have the fundamentals down, you can take those with you to any therapeutic area. So I went from neurology to cardiology and I know that the people I interviewed with, you know, they had concerns that I didn't know cardiology, but you kinda, you pick that stuff up as you go. As long as, you know, the, the fundamentals that are involved in clinical research, it doesn't change. GCP is GCP. You know, the, the consent process is the consent process. We're not treating patients. So we're not necessarily always experts on, you know, the mechanisms of action of these drugs. You don't have to be, you know, you can sort of, you can sort of span the spectrum there between relying on your physician or another great thing is it gives you the opportunity to become an expert in those, there, you can read the 200 page protocol, you can go read all of the previous work that's been done in the field, and it gives you an opportunity to learn as deeply as you want about medicine and the mechanism of action of these medications and so on and so forth.
Brad Hightower: But yeah, I think that's a, an underrated point. And I think that maybe sometimes people get too hung up on the therapeutic area experience versus the clinical research experience.
Lorraine Dishman: Yes. And then as I had an experience, I came from neurology as well. So we were doing stroke epilepsy studies. And as a coordinator in that particular position, I was really lacking the understanding of the regulatory process and the IRB process. Cause we had a research manager at that time and there was an opportunity within the university to work in compliance. And so I wanted to learn it from that perspective. And I applied for that job and I ended up taking that job for a year just to understand it, to make me a better coordinator and, you know, research manager to predict progress in my career, moving forward. So that flexibility is very important.
Brad Hightower: Yeah. Well, and again, that's something that I've already stressed. I know other people stress is the more you can learn about the whole cycle, the better off you're going to be, the more well rounded you're going to be the better understanding you're going to have of the processes. And I know, especially I'm guessing that was maybe in a larger institution you had worked in academic centers tend to be so siloed. You know, in my, in my past, I never even saw a finalized budget as a coordinator. I saw, I had no idea sometimes what we were being paid for these study visits. It was handled by somebody else who didn't know about clinical research. As a result, there's surely money left on the table. There's a separate, separate regulatory group there who, you know, you don't know, you don't know what's involved in an IRB submission. It's really contradictory to giving your people the resources. They need to be better research coordinators.
Lorraine Dishman: I agree. I felt that way. And it can be frustrating when you're in those large, larger academic research centers.
Brad Hightower: Sure. And you know, I think that gets, it creates a little bit of a dichotomy because I think if you're, if you work with a company where everybody does know their stuff, it kinda, it can make sense to have different specialized groups, but not if they don't communicate. And I guess that's the key is for them being really the same page with each other. So, you know, what we do now is we have centralized regulatory and centralized budgets and contracts, but those are conversations that are had and processes that are done with the coordinators involved. So at least everybody knows, you know, what's going on. So like, you know, if there's something in a budget that needs to be invoiced as it occurs, well, you need, you want the coordinator to know that you need them to know that if your budget person is not communicating to your coordinator, then that may never be captured.
Lorraine Dishman: Right. That's a good point. True.
Brad Hightower: So, yeah, that's what always kind of interests me again about the different setups in some of these places. And you know, not surprisingly the more of the small independent research groups tend to have a better understanding of that. So I would guess that as you, it looks like you've worked obviously in some, some more independent places, they, they were probably a little more transparent and less siloed than your larger academic institutions.
Lorraine Dishman: Yes. And that's why I left the academic institution. I was at to take a job with a smaller research site because I wanted that more holistic perspective and that hands on. And then I felt like, you know, it was a small mom and pop organization. There were four of us working together and it was all hands on deck. If something needed to be done, it wasn't because, Oh, you're a coordinator. You can't touch the budget. No help, help. It's slow. We don't have, we had a no show patient today. I need your help, you know, working on this feasibility, et cetera. So I really valued that experience. And so there is a stark contrast.
Brad Hightower: That's a beautiful thing. I think that just like that, I mean, I've worked in places where it's, it's almost taboo for the coordinator to know what the budget is.
Lorraine Dishman: Oh, yes, it was though. But why? Well, I was told that we weren't allowed to know what our PIs had in their research fund for the academic department, because one doctor might be more upset that somebody had more money in their fund, which they have time to really be upset by that. I don't know. I just,
Brad Hightower: Probably not. And, you know, if, if anything, that's that maybe that's a indication of, you know, who's doing more work or who's being more successful in their trials and that's not a, you should necessarily have to hide that information, you know?
Lorraine Dishman: Right. I agree. And the other difference that for me, from coming from a large academic site to a smaller research site was just the enthusiasm of the PIs. I feel like when I was out in the real world is what I call it. And working with private physician groups, those doctors wanted to be there. They were interested in research. It was, you know, a part of their clinic. Whereas when I was at a larger academic institution, some of the doctors I was assigned to work with didn't really want to do research, but it was part of their,
Brad Hightower: Yeah, no, that's again, that's a perfect point. So again, I had the same experience, so that's the reason that I left you know, a couple of years ago to do my own thing. It was, so these guys were not incentivized in any way. They didn't they didn't even make any additional revenue from it. It was sort of just expected of them to participate in trial. So as a result, unless it was just something that they were super interested in, they weren't interested in doing trials. So it became the burden of the coordinator. Because, you know, you've, if you're going to have a research department, or if you're a research company, you got to keep the doors open, you got to keep the lights on. So you can't just sit and wait for the perfect study every time. So, yeah, I found the same thing once I left these first academia and then a hospital setting the physicians you work with are way more motivated. It gives them in their practice, a higher level of credibility that they're offering research to their patients. And it's a good revenue stream for them as well. I mean, it's a win, win for everyone and for their patients,
Lorraine Dishman: Right. We've had plenty of patients that are interested in participating in research just because they love the doctor and they believe in what the doctor you know, is doing. And they have a lot of respects. They have that longterm relationship.
Brad Hightower: Yes, yes. Again, a super underrated point that if your doctor is engaged and supportive, then you're just, you're going to be exponentially more successful in rolling these trials and helping patients who need help. And that's, you know, really, that's what it's about at the end of the day. So I'm glad to see more people are recognizing that and sort of breaking free from the constraints of these large institutions. Who've made it a bureaucratic process rather than helping people
Lorraine Dishman: So many layers.
Brad Hightower: It is it's, it's insane. Yeah. So tell me a little bit about your last position here then at element research group.
Lorraine Dishman: I worked ...
Brad Hightower: So said that wasn't, that's an independent group. Do you guys have a standalone site or are you a, was it more of an integrated network?
Lorraine Dishman: Oh, it was integrated network. We had four physicians doing four different trials. So we were working on podiatry, pulmonary, and then we had a private excuse me, a family physician working on a device trial for diabetes. And we had a phase four phase four trials, phase three trials. So it was a nice mix of everything. So we didn't have an office per se. We roamed around per offices depending on patient visits and what needed to get done again. So I liked that.
Brad Hightower: Yep. And I think that's awesome. I say we do the same exact thing. So we negotiate a small amount of space within these physician offices. It's a great way to keep your overhead down or, you know, nonexistent really, if you can, if you can swing the space and also puts you there with the physician. I think that's also a super important point that no standalone research sites I understand, and obviously they're, they're successful, but the closer you can be to the action, again, the better off, more likely you're going to be able to get patients in the studies.
Lorraine Dishman: Right. Cause being in a separate building with all the coordinators on a certain part of campus, and yet you have your docs at the hospital, your, your docs in clinic, it's really hard to develop that relationship. You're a high rolling PI because you're really, really motivated.
Brad Hightower: Yeah, no, we are my last job. We were about a quarter of a mile away, you know, connected through a tunnel with the hospital we made as well. We may as well not have existed, you know, unless you're, unless you're standing in front of their face, there's zero chance. They're going to pick up the phone and refer a patient to you.
Lorraine Dishman: Right. So being in there every day, and I think part of it, it's not just the PI in my experience at element, even though my experience was short lived because of, you know, COVID-19, it's also about integrating yourself in with that office staff, that nurse, the, you know respiratory therapist that was there, the nursing AIDS, cause they all also keep an eye out for patients like, Oh, Hey, I saw somebody today. Do you want to run up and talk to them because the PI might be busy or the PI might not be there. So it's a holistic perspective of you, we're all in this together. And I really appreciated that perspective.
Brad Hightower: Yeah. And that's almost sometimes more useful than the relationship with the physician. I mean, not more useful, but you, yeah. You're able to get more buy in and referrals from office staff. That's again, another amazing point. And I think a lot of that goes back to when you're in the clinic. So like for us, we're almost like a white label service for these physician groups. Like, you know, my company is high tower clinical, but if I'm here working with the doctor, they don't know that I'm a part of the practice as far as everyone's concerned. I think that also gives some accountability to the group because what you're doing is representing them, not necessarily some third party company that's down the block.
Lorraine Dishman: Right. I think element research group did a great job with that. I mean, we were part of, I felt like our doctors staff, when, where I was at that particular doctor's office, so that was something that they did and they did it really well.
Brad Hightower: Yeah. That's huge. It goes back to a podcast I did previously it's about that relationship. If you can build those relationships, they become ridiculously important to your, your success as a, as a research group.
Lorraine Dishman: Yes. I think so as well. I agree. And I like that experience. I'm glad to have had that. So
Brad Hightower: Yeah. No, that's, that's good. I'm, I'm always encouraged to see people kind of make that jump from, you know, large academic institution where, you know, I know when I worked there, I thought this, I was like, this is insane. How does anyone get anything done? I don't understand how this industry works until I really started to break out and see like, Oh, there's a whole different way to do this. That makes way more sense. We don't have to be beholden to the large siloed institutions. So that's always very encouraging for me to see.
Lorraine Dishman: But you know, though, just a one side note is I feel in my experience that, you know, element took a risk on me and it worked out again, it was perfect timing. That's a hard transition to make, because I think sometimes there's a stigma between academic research coordinators and small private practice group research coordinators. And I think sometimes it's without understanding that, Hey, we both have the same skill set. We're just in a different environment.
Brad Hightower: Well, yeah. And I mean, obviously I feel academia lends itself to just a different view. So, you know, it might, it might experience in academia. It was more important to have a lot of letters after your name then to be a good research coordinator. And those two things are not mutually exclusive. You know, some of the best coordinators I've seen have high school educations and some of the worst coordinators I've seen are foreign MDs or, you know, have masters in public health. Now, obviously that's not a blanket statement. It's just the point is that it's, it's more valued in academia to have more education, even though that doesn't necessarily translate to being a good coordinator. That's a perfect way to say it. Absolutely. So again, it looks like I'm, I'm very impressed as, you know, see how you've progressed throughout your career. What's what's the best practice that you've sort of picked up along the way or something you'd share with the greater clinical research community.
Lorraine Dishman: For me, I think the best practice is just attention to detail - quality over quantity. If we just slow down and do it correctly, the first time we're going to have so much less hassle on the back end, moving forward. And by that, I mean, making sure your source stocks are right, taking that time with that patient, making sure your data entry isn't rushed. So you don't have to, you know, answer all these queries, you know, three days from now, when you're slammed with patient visits, I'm just slowing down and having that attention to detail and organizing your day to be able to do that. That's my best practice.
Brad Hightower: Yeah. That's a, that's something that I, I need to, I need to hear and I need to do, I'm a you know, I'm a, I'm a bigger picture thinker generally. So I struggle with sometimes the, the details that go into to some of these things. That's not to say that, you know, I can't coordinate a trial. I do, of course still coordinate trials even now, but that's something I have to constantly remind myself of just because I'm not naturally detail oriented. So I, I love that. Obviously that's a, that's a huge skill you look for when you do hire or work with clinical research.
Lorraine Dishman: I think. So you just don't want your monitor to find all these things in your source docs that you then have to fix and notes to file. And it's just so much more work on the backend. That's just my opinion in my experience though.
Brad Hightower: Yeah, no, there's, there's no question. There's nothing worse than enrolling 10 patients and having your monitor come and having to make the same 10 changes or this name 10 mistakes that you've made over and over again.
Lorraine Dishman: Right. And look like a competent site. You don't look like you're doing well. And it's like, well, no, I'm just trying to get all these patients in to meet quota. And you're like, ah, we'll slow down. I'd rather bring in one or two at a time than like five on one day.
Brad Hightower: Right, right. Yep. Nope. That's a fair point. So what are some resources that you use in your job to, to make it easier? Is there anything specifically you lean on, whether it's, you know, software or you know, a process a book any kind of resource?
Lorraine Dishman: Actually I'm a member of the association of clinical research professionals is the ACRP. And I think that is a great resource for continuing education. Anytime I have a question or need clarification, they have a beautiful dashboard for helping understand different aspects of the trials. If you're confused or something doesn't make sense. I have always relied on that and will continue to do so. I mean, I'm still attending webinars now in quarantine. So that's my go to there are some other sites out there. I know Dan Sephora does have a book. I think that's a good little handbook to have, especially if somebody is new into clinical research, I wish I would have had a book like that when I started. Yeah. But definitely.
Brad Hightower: Yeah. So yeah. Yeah. ACRP, I've, I've spent a little bit of time in their community forums. It looks like there's a lot of good conversation there, which is a huge, a huge benefit for people because, again, where do you go to ask questions that are so specific? I think there's, there's a lot of stuff on there. That's great for people who are looking for help with specific issues. Obviously there's all the webinars and other resources from the ACRP site. And yeah, I recently bought a copy of Dan's book and I'm going to start having my new coordinators. Read it again. I think the quicker you can get somebody sort of the big picture, the easier it is to understand how all these things fit together. Because I mean, we live in a world, that's got, you know, a million ridiculous acronyms and just you learn very piecemeal. So it takes a long time for people to really get confident. So whatever you can do to sort of give people that bigger picture, I think is a big, big value.
Lorraine Dishman: And I think another resource for me or definitely for me is our monitors for any trial. I think a lot of times in my experience, people are like, Oh, the monitors coming. And I'm like, no, the monitors coming, I get to ask a lot of questions. And I think that relationship of, Hey, we're still on a team you're coming to monitor me. I'm the coordinator, your site let's work on this together. I am not too shy to reach out to my monitor if I have any questions. Cause that is an invaluable resource, in my opinion, that's my team
Brad Hightower: Again. Yeah. That goes back to just building those relationships. They can be, I mean, it can be your enemy or they can be your friend. It's really a matter of how you, how you approach that.
Lorraine Dishman: They want your site to be successful. So I've had great water. I can only think of one that was little touch and go. I'm definitely, it was an NIH trial that I worked on at an academic center. So it was a very different experience with that monitor, but I feel like I've been very blessed with monitors and they represent a variety of the CRMs that are out there. So.
Brad Hightower: Sure, sure. Yeah. I mean you know, we've certainly had our share of bad monitors. There's nothing worse than having eight monitors throughout the course of your study because there's so much turnover from the CRO side. So that can be challenging and just, I mean, annoying, it's just, it can be annoying to have to deal with the way that eight different people want things done when they all don't jive with each other.
Lorraine Dishman: Right. Just recently at the very end, before, you know, we were furloughed, we had a monitor come in and caught things that previous monitor that had been on the trial for two years never caught. So it was interesting at different why's and I was like, Oh, okay, great. You know, and you did that. And it was like, Oh, I can't believe two years later we're fixing this, but we're all human.
Brad Hightower: Yeah. It's true. It happens. Well, I really want to thank you so much for coming on. Where can, where can people find you online on LinkedIn? Okay. I'm gonna, I'm gonna put a link to your LinkedIn in the show notes. I'll also, I'll go ahead and include a LinkedIn or a LinkedIn. I'll include a link to the ACRP website. I'll go ahead and plug Dan's book for him just, just cause, all right. And I'll put all that information in the show notes, be developing your skills as much as you can, if you're, if you're stuck at home or furloughed or otherwise not able to get out there and see patients.
Lorraine Dishman: Yes. Well, thank you for that. I think this is a great concept and I look forward to following you and learning more as you bring more people on for interviewing and watching you get successful with this. This is great.
Brad Hightower: Well, I appreciate it again. Thank you so much. And I'm sure we'd love to have you back here before too long. We'll talk and thank you very much, Lorraine. You have a great day. Thank you so much for listening to the note to file podcast for guest contact information, as well as any resources mentioned throughout this episode, please check out the show notes at www.notetofilepodcast.com. If you have any questions, comments, or interview requests, please feel free to reach out to me and brad@notetofilepodcast.com. And once again, thank you for listening.