In this episode, we sit down with Brian Gryzlak, program director in the department of epidemiology, to talk about what it really takes to coordinate large multi-site epidemiological research. Brian directs Iowa’s participation in PCORnet, a national patient-centered clinical research network that standardizes healthcare data across institutions to support large-scale comparative effectiveness research.

The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin:

Hello everybody, and welcome back to Plugged in to Public Health. Today’s episode takes us behind the scenes of a large multi-site epidemiological research study. We often hear about study findings and policy implications, but rarely do we talk about the people coordinating dozens of institutions, managing data quality across 80 sites and keeping projects moving when timelines are tight and questions are still evolving. I’m Lauren Lavin and today I’m joined by Brian Gryzlak, Program Director at the University of Iowa College of Public Health. Brian directs Iowa’s participation in PCORnet, a national patient-centered clinical research network that standardizes healthcare data to support large scale comparative effectiveness research. Over more than 20 years at Iowa, he has worked his way from research assistant to program director, coordinating complex multi-site studies like the NET-PRO Neuroendocrine Tumor Project. In this conversation, we talk about what it really takes to sustain high quality data across institutions, how trust and clarity drives successful collaboration, and why institutional knowledge matters more than you think, and what early stage researchers can do now to position themselves for roles like this.

If it’s your first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and outside the field. So let’s get plugged into public health. Plugged Into Public Health is produced and edited by the students at the University of Iowa College of Public Health. The views and opinions expressed in this podcast are solely those that the student hosts, guests, and contributors, and do not necessarily reflect that these are opinions of the University of Iowa or the College of Public Health.

Well, Brian, thank you so much for being on the podcast today. To begin, could you introduce who you are and what your job is here at the University of Iowa College of Public Health?

Sure.

Brian Gryzlak:

Thanks for having me. My name’s Brian Gryzlak. I’m formally, what do they call me now? They call me a program director.

Lauren Lavin:

They do.

Brian Gryzlak:

So I direct primarily Iowa’s participation in PCORnet, which is a national network to standardize patient healthcare data and facilitate comparative effectiveness research and other kinds of research. Yeah. So that’s the short of it.

Lauren Lavin:

Yeah. And you were originally a research assistant a little bit ago.

Brian Gryzlak:

A few years ago, yeah.

Lauren Lavin:

And now you’re a program director. So what motivated you to take that path? What skills turned out to be important along the way?

Brian Gryzlak:

Yeah. So some of it was happenstance, I think. There’s a lot of luck. And for staff, so not faculty. So I’m not faculty, I’m staff, just staff.

Lauren Lavin:

Don’t say just.

Brian Gryzlak:

I think a lot of it is luck and timing of when proposals are submitted and get funded. So I started back in the day, 2004.

Lauren Lavin:

So you’ve been here for 20 years.

Brian Gryzlak:

Oh yeah, 21 years. Oh yeah.

Lauren Lavin:

Oh my gosh.

Brian Gryzlak:

Believe that. I started with Bob Wallace up in Department of Epidemiology. So do you want me to give like the background on it?

Lauren Lavin:

Yeah.

Brian Gryzlak:

Okay. So I come from, so I got my master’s in social work and then I went on to get my master’s in sociology just for fun.

Lauren Lavin:

Just a double master’s casually.

Brian Gryzlak:

Because there were books I wanted to read and I was like, “Well, hell. Heck, I could get a degree out of doing it.” And I didn’t like, I don’t know. I was like mid-20s. I didn’t know what I want to do with my life.

Lauren Lavin:

That’s so fair. I also don’t know.

Brian Gryzlak:

Yeah.

Lauren Lavin:

More school.

Brian Gryzlak:

Do I know now? No. Who does? But I was living in Moline at the time working at an agency to help keep older adults out of nursing homes by providing them with like community supports and whatnot and other services. And applied for an RA 1 position with Bob Wallace. And it was a subcontract to ISU on, It was a center grant on looking at the epidemiology of dietary and botanical supplements.

Lauren Lavin:

Oh.

Brian Gryzlak:

So before I actually applied, I had to look up what that meant and also what epidemiology meant. And so I did the interview, I got the gig and I commuted actually for nine months from Moline to ISU.

Lauren Lavin:

That’s like an hour plus.

Brian Gryzlak:

Yeah, 67 and a half miles each way.

Lauren Lavin:

Specifically.

Brian Gryzlak:

But, and this speaks to the unfortunate state, but I get it, of like nonprofits and folks that are doing the good work, that it was still way worth it financially for me to do that. So yeah, I wasn’t happy about burning all that fuel every day.

Lauren Lavin:

You win some, you lose some.

Brian Gryzlak:

Yeah, yeah.

Lauren Lavin:

That was also before podcasts. So did you have to listen to the radio?

Brian Gryzlak:

Oh, NPR, Democracy Now! Yeah. They played on the local affiliates, but then you have to change when you approach the Quad Cities.

Lauren Lavin:

Right.

Brian Gryzlak:

Yeah.

Lauren Lavin:

That’s a whole thing.

Brian Gryzlak:

So yeah, then that was ending. And he suggested I talked to Betsy Chrischilles and she was looking for a project coordinator for a grant. And when I talked to her, she’s like, “Oh, there’s a project on living.” And I thought I heard living will. And I was like, “Oh, okay. Sure it’s a job and I need a job at whatever.” And then later in the email exchange, she’s like, “Yeah, I’m happy to interview you or whatever, talk about the Living Well project, which is totally different kind of topic.” She gave me the opportunity and coordinating that project, which was the first kind of step up to the first multi-site study that I coordinated, kind of cut my teeth on it. And then I’ve worked for her since that time, since 2006, I think.

Lauren Lavin:

So is all of your funding from grants?

Brian Gryzlak:

Yes. Can I say that knowing for sure? Grants. Sometimes there’s like a internal grant through like maybe the provost office or whatever, like the P3 mechanism, but yeah, it’s all self money.

Lauren Lavin:

Does that stress you out?

Brian Gryzlak:

I rely heavily on the HR rule or policy that says you get, I think it used to be 12 months, but now it’s six months furlough notice. And so I expect that if something were to go down.

Lauren Lavin:

Okay. So you get a little bit of a safety net.

Brian Gryzlak:

But I haven’t received a furlough notice ever, which I’ll knock on something for that, whatever that is, laminate and hope that I don’t. Yeah.

Lauren Lavin:

Yeah. You just keep moving forward.

Brian Gryzlak:

Yeah.

Lauren Lavin:

So what skills did you have prior to doing this that you think were really beneficial or did you just learn everything along the way?

Brian Gryzlak:

Oh boy. Okay. So I have somewhat of a, in a sense it was a good fit for me, like the RA position because halfway through my junior year of undergrad, so I did community college for two years, went to Western Illinois University for junior and senior year. Halfway through my junior year, I got an RA position as an undergrad, which is not-

Lauren Lavin:

That’s pretty uncommon.

Brian Gryzlak:

Not that common.

Lauren Lavin:

Yeah.

Brian Gryzlak:

And so and I also got some shout out to like the WIU sociology, it used to be called Sociology Anthropology Department in terms of like social research methods and whatnot. So as an RA there, I actually wrote questions for the state of Illinois master’s level folks for DHS who are taking their qualifying exams. So they gave me the policy or like the law or whatever, and I created question banks.

Lauren Lavin:

Interesting.

Brian Gryzlak:

Maybe they’re still being used, I don’t know. I know they were right, but like it was like very dense and they said, “Be very dense and specific because these folks have to know how to cite policy.” So I was like, “Okay.”

Lauren Lavin:

Wow.

Brian Gryzlak:

Yeah. And then when I was at University of Illinois where I got my master’s in social work, I was lucky to get a GRA there. And then I went back to Western and got a GRA there too. So the research assistant position and like working with faculty, supporting faculty, knowing how to act, that kind of stuff, I think that came more naturally at the point where I applied for this job. And I was raised Catholic. I’m former Catholic, but I mean, there’s something to be said for like how to deal with, how to keep quiet for two hours-

Lauren Lavin:

Yeah, that’s a skill.

Brian Gryzlak:

How to suck it up and that kind of thing.

Lauren Lavin:

Perseverance.

Brian Gryzlak:

Yeah, there’s a little bit of that.

Lauren Lavin:

So now that kind of brings us to where you’re at in your current role, which is coordinating multi-site epidemiological studies like, and is NET-PRO another one that you do?

Brian Gryzlak:

PCORnet actually.

Lauren Lavin:

PCORnet.

Brian Gryzlak:

It’s a common. No, I can’t blame you. It’s a common miss, but so PCORI is a Patient Centered Outcomes Research Institute that Congress authorized, I think, in 2009 under Obama and is now like a separate entity, gets reauthorized every X number of years by Congress. They fund PCORnet, which is the National Patient Center Outcomes Research Network, whereby I think we’re about 80 sites now in the US, standardize their data to a common data model or CDM that, your epidemiology folks will probably know what that is based off the mini Sentinel model, I believe.

Lauren Lavin:

Yes. So what are the biggest challenges if you’re trying to coordinate 80 sites with different resources, cultures, protocols?

Brian Gryzlak:

Yeah. So luckily, excuse me, so luckily Iowa is part of, so PCORnet’s built as a network of networks, it’s kind of cutesy. And so we are part of the GPC or the Greater Plains Collaborative Network, which is one of eight networks in PCORnet. My role… So let’s see, there’s a couple ways to answer that. And there’s a little nuance. There’s a few nuances that I’ll throw in here. So for my role in the GPC, one of my hats, I was appointed as the research readiness coordinator, which is a new position in the network as of phase four. So we’re like four iterations into the matrix. My job there is to help ensure that all 14 sites in the GPC, for example, submit their results from data queries on time, that their data meet certain quality thresholds, that they’re actively engaged in the network otherwise, meaning they’re raising their hand to participate in study opportunities for PCORnet studies, which are studies that leverage the network resources, and that they’re also hopefully cultivating investigators at their sites and proposing their own PCORnet studies, which benefits everyone.

Lauren Lavin:

Just a few things.

Brian Gryzlak:

Yeah, just a few things. And keeping tabs on other initiatives like expanding the CDM to include, what are we doing now? Patient reported meds and medications from external institutions, timelines for that. And just like I’ve been around since its inception, serving as the project manager, which is another hat I wear for the network. So there are things that you pick up that a newbie wouldn’t know or wouldn’t think to ask. And so I actually made a note for later based on some of the questions you were asking about like, what helps support effective epi research on an ongoing, What helps sustain it? And that historical institutional knowledge, I think that plays a big role.

Lauren Lavin:

Yeah.

Brian Gryzlak:

It’s harder to… Yeah.

Lauren Lavin:

Do you think someone like you with 20 plus years of experience is rare to come by in these types of roles or do you think that that’s the norm?

Brian Gryzlak:

I have to think about that.

Lauren Lavin:

Yeah. I’m asking you that on the spot.

Brian Gryzlak:

Yeah. No, no. So I can answer that in a few ways. Well, one, for like the research readiness role, like that’s a new thing for the network and there’s eight of us in the network. But in my experience, what I’ve observed is a lot of staff turnover and investigator turnover, there’s just turnover in general. And yeah, I think there’s a core group of us that have been in PCORnet, involved in the network since its inception, but probably less than half of the site staff are in that position, probably a third. So it’s, yeah, my kind of position is rare.

And I’m very engaged, like even before this phase, just working under, I mean, I have to get Betsy props. Dr. Chrischilles’ leadership, just being on top of things, anticipating issues that are coming up instead of just waiting to be told, “Do this or do that.” Or whatever. That’s actually a big… There’s more that we could talk about later maybe. But yeah, in terms of my role in NET-PRO, I think it can be a high stress situation. And I want to say things that are generalizable for your audience, but I think some of the answer is that it really depends on the folks you’re working with and the institution you’re at and I think that’s just how it is.

Lauren Lavin:

Yeah, I think that’s a totally valid answer. What do you have to do to ensure consistency and high data quality when each site has different staff, settings, or constraints? And is that something you deal with?

Brian Gryzlak:

Yeah. So for data quality, there’s a, let’s see, if we’re talking about PCORnet, then we’re talking about quarterly refreshes of the data. So, and I don’t think there are more… There’s a sub study for which we refresh the data every week.

Lauren Lavin:

Oh, wow.

Brian Gryzlak:

And that stemmed from COVID and the need to have real time surveillance for CDC and the RECOVER initiative, which we’re still part of, I believe, but we’ve kept that going here at Iowa and I believe we use it as a source for other data sets because we work very closely with ICTS. When I say we, in terms of the PCORnet common data model here at Iowa, I mean the bioinformatics folks at ICTS. The data are actually stored behind the UHC firewall and whatever. So they do the lifting. We have a very, I would say, very good working relationship. In terms of helping ensure that the sites in the network are submitting data of high quality, that coordinating center, which is kind of a trio of sites, but the main folks I think are at Duke, they produce curation scripts that tell you, “Hey,” There are all these quality metrics and indicators and thresholds, “You’re below the mean for, I don’t know, number of meds per patient or you’re above for encounters or more than 80% of your lab records don’t have a standard reference range.”

Lauren Lavin:

Oh, interesting.

Brian Gryzlak:

And so like that kind of stuff versus if you did this, trying to do that kind of research without a standard, it is as limited, perhaps some could argue as the CDM for PCORnet it may be, like how would you know? You wouldn’t know as a researcher until you got the data and looked at it and maybe a year down the road, you’re like, “Oh wait, this site’s an outlier and these metrics and this site’s an outlier for these other data elements.” And the network is serious about that. But I mean, so back to your question, each site will get a report, spit out after they do the refresh, run these programs against their data and then they have, we have two or three weeks to refresh the data, run the script and remedy issues and then rerun it.

And maybe you do that a few times until you get like a quote, “clean” report and then submit that, the results of that package to the coordinating center who then gives the seal of approval or says, “Uh-uh, you have to fix this and that.” And sometimes it gets sites in trouble and like I said, they take it seriously and you can be cut from the network if you have like persistent or excessive issues with data quality.

Lauren Lavin:

So is that something that then you’re doing on a weekly and quarterly basis?

Brian Gryzlak:

There’s a team of us. I don’t get into the details of each site’s quality metrics in terms of looking, drilling down into that. That had already been done at University of Missouri, who’s the prime for our GPC network. I focus mostly on the participation in studies, time to submitting query results, were you late? Which is a big no-no in our network. Because a lot, if I may, just like, it’s a quasi-tangent, but researchers approach what’s called the front door at PCORnet and they say, “Oh yeah, okay, our network is viable for your research question. Hey, do you want, you may benefit from having counts for your proposal of this cohort at each of our sites. Does that sound good to you?” “Oh, heck yeah, but I only have… It’s due in three months and I have to route it in two and a half months or whatever.”

And so they work with the researchers to develop a feasibility query that’s sent out through our software to all the sites, all the sites respond and as soon as the [inaudible 00:17:53], there’s a due date of five business days after it’s sent out and so the coordinating center wants to move on getting that report back to the researcher so they could… Because it behooves everyone. So it’s like, it is really a team effort like at the network level to get your results in on time because you’ll be included in the proposal possibly depending on what the researcher wants to do and if you are and it gets funded, you might be asked to be a site. So like, get it in on time.

And everyone knows this and just things come up like we had a site that their SAS license expired and so they, SAS is like the main platform and so they got dinged for being a few days late, but you know, that happens. But in terms of like the data quality for like the NET-PRO study, which I don’t think I said is an acronym for neuroendocrine tumors, hyphen, patient reported outcomes. So it’s looking at lung and gastrointestinal neuroendocrine tumors in terms of healthcare quality of life, disease progression and treatment sequencing. And there are 14 sites in that study. So we’re actively working on the interim data pull for that study. And like today, for example, right before I came down, we had a site that had some missingness that we didn’t expect. And so I worked with the status or the data manager who communicated with me and then I kind of wrote up a communication to them to that site and hopefully it’ll all work out.

Lauren Lavin:

So you’re the problem solver in that situation?

Brian Gryzlak:

Yeah. So here’s an analogy that I use and I think it’s true or I think it’s accurate. There was a game called, your older listeners will remember it was called Smash TV. It was an arcade game and one joystick, you move the, it’s always a guy, it was the ’90s or ’80s, the guy or the person and things and robots are attacking you. With the other joystick, it’s your ray gun or whatever. So you’re shooting in directions. So it’s, you have two 360 degree joysticks, one’s for movement and one’s for warding things off. So I view my role as like that guy because you get hit from all angle and not in a bad way, it’s just the job. When you have X number of projects at once, because these are just two of several that I’m actively working on now, then you have to prioritize, you have to know how to keep a cool head, how to get out in front of the curve.

Lauren Lavin:

I think that’s where that institutional knowledge is probably really important.

Brian Gryzlak:

Yeah, It’s hard to write like a manual of, “Here’s what to do. Here’s the SOP.” Like, “Oh boy.”

Lauren Lavin:

Yeah. And if you’re trying to like get ahead of the curve, how would someone new know? They don’t even know what the curve is.

Brian Gryzlak:

Yeah, yeah. That there is a curve.

Lauren Lavin:

So obviously teams are pretty important in the work that you do. What role does trust play in coordinating all of these teams across sites and different communities and how do you go about building a team?

Brian Gryzlak:

Good question. So there’s trust at different levels. There’s kind of the highest level, like institutional trust of can your legal department work with the prime’s legal department? That kind of thing. There’s the IRB or human subjects protections issues, but I think you’re maybe getting at more of the like on the ground day to day stuff. Part of it comes from longevity and it’s so cliche, but leading by example. So I was a lead site in the NET-PRO study. So maybe I’ll just, if that’s okay, I’ll just take it from that perspective.

Lauren Lavin:

Yeah, absolutely.

Brian Gryzlak:

So there’s a few things like, you have to be helpful. You have to minimize your assumptions of where the staff at the other sites are. And when I say staff at other sites, I mostly mean the project coordinators, project managers, but also informatics staff, investigators, and then the site PIs. You can’t assume that they know what you’re talking about. Even if you said it a thousand times before-

Lauren Lavin:

They might not have been listening.

Brian Gryzlak:

They might not have been listening and you have to hold their hands through the process and don’t, I don’t know if you’ve seen that shirt, it’s like, “Per my last email.” Like the quote, don’t send a per my last email, email.

Lauren Lavin:

So you’re just being nice about it.

Brian Gryzlak:

You have to be nice about it, but you have to be willing and able to assist. So here’s just like a somewhat trite example. Like on the calls that I run, we used to have them every two weeks. It’s a little less now because we’re done with enrollment for the NET-PRO study, but I’ll say, “All right, we’re about to adjourn. If you have issues you want to consult on that you don’t want to talk about in front of 30 or 40 people, hang out and we can discuss.” And that almost always gets one or two sites.

Lauren Lavin:

Really?

Brian Gryzlak:

Yeah. “I don’t want to like talk about, because I feel stupid or I should have known that. I’m sorry for asking you. I know you said this before.” I’m like, “I don’t care.”

Lauren Lavin:

Better to ask than the people who logged off without knowing.

Brian Gryzlak:

Or there’s some studies that I think I’ve been on where the, careful what I say here, but there’s some groups that I’ve worked with where it’s a very kind of sterile relationship and that’s off-putting and it results in, “Okay, I’m going to do technically what I need to.” And people will push back on the, “Well, what technically do I need to do?” And they won’t go the extra mile for you if there’s that kind of, “I’m the lead side and you all need to do it and why haven’t you?” There’s always going to be expectations that you have to follow. We’re not just doing research and just kicking back and like, “Oh, whatever, submit it next year. You can enroll however many people you want.” No, you have to set, I mean, that’s another thing back to trust, setting as clear as expectations as you can upfront, because then there’s no ambiguity about, “Well, you didn’t say that.” Or, “We didn’t know that.”

Lauren Lavin:

I always say to be clear is to be kind, because it makes it a lot easier.

Brian Gryzlak:

True. And it’s very difficult to do for, like for the NET-PRO study, we’re collecting there’s enrollment and consent for those of you, and then four surveys over 18 months. Sounds pretty straightforward. The main platform is a custom-built website that we’ve used for other studies. There’s also a paper option. So now you have two modes of implementation, you have to make sure they’re synced. Some things don’t sync from electronic to paper. You select yes and then the items just aren’t there on paper, that’s not possible. And then what you’re tracking for all of the events, like when they started it, when they finished it, how many contacts, knowing all that in advance is probably one of the bigger challenges. But also related to your question about trust, if you could establish that upfront and not move the goalposts throughout this study, which, again, is hard not to do because things come up that you would never think would come up.

Lauren Lavin:

So it’s just a lot of communication and setting some expectations that everyone is aware of.

Brian Gryzlak:

Yeah. It’s a little cliche, but it is helping out. I’ve done one off reorientations with sites that, “Could you just walk me through this?” Okay, like REDCap was a biggie. There’s a few sites that, we use REDCap extensively for all of our, or I do at least, but for NET-PRO it’s indispensable. And a few sites, the staff that were onboarded never used REDCap and in a few cases, this is their first research gig. And so, okay, instead of, “Oh, you have training.” I could have said that and I did. Like, “You probably have resources, I’m also happy to walk you through it. Sometimes it’s easier.” And it was totally successful because the site I’m thinking of was one of the best enrolling sites in the study.

Lauren Lavin:

So it’s worth it.

Brian Gryzlak:

Yeah. I think it’s always worth… I mean, and sometimes you take that time and then they take another position like, “Oh, well.” But what do you… It’s out of my control.

Lauren Lavin:

But being available.

Brian Gryzlak:

Yeah.

Lauren Lavin:

So another cornerstone besides teamwork is the participants themselves. Can you walk us through how you recruit, retention, ethical oversight when studies span so many different locations and populations? And what do participants get for being in these? Money?

Brian Gryzlak:

So there are some studies in PCORnet and outside, for sure outside PCORN that the retrospective observational studies, so data on 50,000 people who are in this cohort or that cohort, those usually are not paid studies. It’s usually a partial HIPAA or HIPAA or waiver of consent that’s granted and you don’t have to tell them about the study and you get to use the data and there’s very specific HIPAA rules for-

Lauren Lavin:

Yeah, don’t worry. You’re here in the guidelines.

Brian Gryzlak:

Yeah, yeah. And for the NET-PRO study, the first survey is like 40 minutes long, 45 minutes long. And so we decided, and a lot of it’s based on our prior experience, front loading it so they get $40 for doing the first one and then 20 for each one after that, which is decent.

Lauren Lavin:

Yeah.

Brian Gryzlak:

I mean, I would do it.

Lauren Lavin:

That’s a couple of diet Cokes for me.

Brian Gryzlak:

Yeah, yeah. That’s a pony keg of diet Coke. And then ultimately, I mean, the thing that should always be done, especially now, is spitting back results to people. Some people for sure join because of the monetary incentive and I don’t think there’s getting around that.

Lauren Lavin:

No.

Brian Gryzlak:

You going too exclude them like, “No, you really need this, so ethically we can’t.”

Lauren Lavin:

Yeah, it’s always a concern.

Brian Gryzlak:

I know bioethicists think about that and that’s just the reality. But then some folks are genuinely seriously interested in the question. They all have the condition and so they most probably want to see, “Well, so what happened with this? I spent all this time, I spent two hours, three hours doing these surveys, what’d you do with it? Where’s the results?” For PCORI funded work, for sure for PCORI funded work, there’s always like dissemination plans, data sharing plans built into the proposal. So there’s things that you just have to do.

And so we’re not at that phase yet, but one thing is making the data available for other researchers to use at a repository at the University of Michigan, but in terms of, yeah, what are the patients kind of, how we engage with them? I mean, we do have several patient organizations or representatives from organizations that are advising us on the study conduct and have kind of throughout the several years of the study. But I think we don’t have results and so we haven’t opened that can yet of how to really disseminate in a way that like folks could digest, not just some technical abstract.

Lauren Lavin:

And then stepping back from your vantage point of more than 20 years working in this field, what kinds of infrastructure or leadership or policy really help make these large scale studies feasible, but also impactful once the results do come about?

Brian Gryzlak:

Like I said earlier, the historical institutional knowledge is, for example, we’ve, despite the promise of email, like, “Oh, email will make recruitment so pragmatic and let’s use the process tool and look at how great it is.” It goes to junk, they don’t know who it’s coming from.

Lauren Lavin:

Everyone just ignores it.

Brian Gryzlak:

Yeah. And like, so we’ve found success with the old school paper mailings and we’ve done surveys of 30,000 people for a screening survey back in the day, but collectively on the fourth floor here, we have the institutional knowledge of who to contact? What are the pitfalls? What’s the timeline? How to make that work. If you came into it, you wouldn’t know where to start.

Lauren Lavin:

I wouldn’t even think of paper mail. I’d be like, “No, we’re not doing that. We don’t do that anymore.”

Brian Gryzlak:

You have to make it very easy for subjects or prospective subjects to participate. So we always put a prepaid business reply envelope so that they don’t have to, they could literally put it in their mailbox, hang it from their mailbox when they’re done, no postage or anything. So here, ICTS, the Institute for Clinical and Translational Science, it’s one of the CTSA’s programs. It’s the name of the shop for our, it’s our CTSA shop. They’re indispensable because they stand up and support things like REDCap. They have access to data. The data request mechanism now here that we use house-wide is run through them. And so I joined those meetings twice a week to review the requests and then talk to the folks who are fulfilling them to make sure they don’t have any questions.

So we’re getting there here at Iowa. I mean, obviously things like IT support, you have to have computers that are not running XP or Windows 95 and that are relatively quick because the time it takes to load, I mean, not websites anymore, hopefully, but I don’t know, if you’re running SQL server or using Access or even REDCap sometimes, if you wait 10 minutes a day, that adds up and you can afford a new workstation. So it’s just thinking like that.

Lauren Lavin:

That’s very pragmatic.

Brian Gryzlak:

Yeah, yeah. Another duh, but like IRB, having a relationship with the Human Subjects Office that’s not contentious. They’re here to help. I think they do a good job. And they’ve, especially the last, I could say like 10 years. Well, a lot has changed in the last 10 years, but they’re much more responsive and supportive, I think. Same with, if you’re here long enough and you kind of move up in the ranks, the Division of Sponsored Programs, DSP does data sharing agreements, contracts. Having someone on the inside that you have worked with is never a bad thing.

Lauren Lavin:

Yeah. Relationships and that institutional knowledge. How do you keep people in these jobs longer, if that’s such a key part? How do we keep people like you around?

Brian Gryzlak:

Yeah. So I’m glad you said that because I’ve been wanting to ask for a raise. No, I mean, boy, good question. So part of it is my position here is a bit unique. I think I have counterparts at other PCORnet that do, They serve as a coordinator for PCORnet stuff at their site, and then they also have a few other projects, but there aren’t multiple of me here. There almost by definition can’t be, unless we scale up enough where everyone’s using the network. The benefits are good. The compensation is on. But I don’t think that’s true across… I mean, I suspect just from turnover of folks that I interact with on campus, I think there has to be constant support and probably constantly increased support for just basic stuff. We rely heavily on our research support staff in the department. And I know it’s not the college’s sole responsibility. It ultimately, well, it comes from the legislature, from the general funds. So increasing that, I mean, money talks and it’s no different here. Yeah, I mean, I’m not going anywhere. As long as I don’t get that furlough.

Lauren Lavin:

Okay. So to close this out, what advice would you give to students or early career researchers who hope to work in these types of multi-site clinical or epidemiological studies?

Brian Gryzlak:

I think I’ll focus on students going into maybe I’m graduating with my MPH, looking for an entry level RA position, that kind of thing, or PhD looking for research scientists. One thing to the students specifically, whether you know it or not, people take note of how you’re performing and especially if you have a GRA, make the best of that opportunity because it can and in a lot of cases will open, it sounds so cliche, but like will open doors for you.

Lauren Lavin:

No, it’s a good reminder for students to not take those experiences for granted, because that is how you get a job.

Brian Gryzlak:

A GRA is a big thing. And my students, I’m not saying anything about anyone in particular, the folks I work with now are great. But yeah, just even if you’re like an hourly employee, you never know what faculty is going to land, what grant, at what time, and just like… Yeah, never take up a chance if someone’s asking you, “Hey, do you want to help with…” I mean, not on a volunteer basis necessarily. Don’t make assumptions. Like I said this earlier, but don’t assume that someone’s, if you’re coordinating a project, you can’t assume that this work is done or that that work is done or that, “Oh, I just assumed the statistician was going to take care of it.” No, if you’re really a coordinator or PM, or I kind of use those terms interchangeably because I don’t really know the difference.

At the onset of a project, I will list out like several dozen questions and go to the leads, the PI or sometimes there’s a team of like the PI and then co-investigators and say, “Here are my questions.” And a lot of times, “Well, we’re not sure. We’ll talk about that in six months.” They just got the proposal in on, barely usually, on time and they haven’t thought through those details, but do it early and often. Ask questions. Don’t be afraid to ask clarifying questions of your investigator team because it will likely result in them or can result in them thinking of something that wasn’t on their radar that really needs to be.

And then both at the study level and your team level, but also institution wide, like DSP or IRB even, or if you’re working with ICTS, if you see something like, “Oh, it’d be really good if this could happen.” Suggest that to them. And half the time, yeah, they’ll roll their eyes or like, “We’re not going to do that.” But I’ve done it and I’ve actually seen things change and it takes time. And sometimes it needs, you’ve said it three times and then the investigator says, “Oh yeah, I agree.” And they say it and then it happens, but whatever, if you didn’t say it the first time, you wouldn’t have been there.

Lauren Lavin:

So don’t be afraid to share your ideas.

Brian Gryzlak:

Yeah. Oh, one other thing. You’re usually missing something and that’s okay and that’s expected, but when you think you have everything covered, that’s when you’ll realize that you don’t. So pilot the heck out of materials, consent forms, surveys, workflows, tracking databases. Even if it’s a coworker who’s on the study, ideally it’s someone that’s not as close, but a student that you’re working with, just have them walk through it and tell, “Do the sniff test. Is anything off here?” And like almost always someone finds something because you don’t want to go to production and print out something or go live and then be like, “Oh, crap, that question is on the form three times.” Or whatever.

Lauren Lavin:

Especially when you’re trying to get something done, you miss things because you’re just excited to get going.

Brian Gryzlak:

Yeah, yeah, yeah, yeah. And you always have everything going on all at once.

Lauren Lavin:

Always.

Brian Gryzlak:

Yeah.

Lauren Lavin:

Well, Brian, thank you so much for being on the podcast today.

Brian Gryzlak:

My pleasure.

Lauren Lavin:

That was great.

That’s it for our episode this week. A big thank you to Brian for joining us today and for giving us a candid look at the infrastructure behind large scale public health research. One of the biggest takeaways from this conversation is that impactful research does not happen by accident. It requires strong systems, clear expectations, constant communication, and people who are willing to ask hard questions early. From maintaining quarterly data refreshes across dozens of institutions, to front loading participant incentives and piloting materials before launch, Brian reminds us that good research is built on preparation, relationships, and follow through. For students and early career professionals, his advice is practical. Take your research role seriously, ask clarifying questions. Do not assume someone else handled it and never underestimate the value of institutional knowledge. This episode was hosted and written by Lauren Lavin, and edited and produced by Lauren Lavin.

You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cph-brandambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy and stay curious and take care.