CTSA Profile: On Camera with Steve Grambow, PhD

Director of the Clinical Research Training Program is comfortable in front of the camera. Usually.

May 23, 2016

Steve Grambow has been at Duke since 1999, working as a collaborative statistical scientist and teaching statistics within the Clinical Research Training Program (CRTP). His collaborative research projects have spanned a broad range of topics, including examination of the occurrence of amyotrophic lateral sclerosis (ALS) among Gulf War Veterans, weight loss, quality of colorectal cancer care, cardiovascular disease risk reduction through hypertension control, smoking cessation, and substance abuse. His recent collaborative trials have focused on the utilization of web, mobile, and telemedicine-based behavioral interventions for management of chronic health conditions. He has seen lots of change in the world of biostatistics at Duke – from the names of departments to the increasing impact of ideas such as data provenance, reproducibility, and the rise of fields that did not exist when he first came. “Now I’m working more in mobile health interventions that we could not have dreamed about in the early 2000s,” he says.

Here, in his own words, are some reflections on what has – and has not – changed in his career.

 

What jobs do you have at Duke?

I am the Director of the Clinical Research Training Program (CRTP), Vice-Chair of Education and an Assistant Professor in the Department of Biostatistics and Bioinformatics.

What brought you to Duke?

I came in 1999 as a joint appointment with the Durham VA Medical Center and the forerunner of our current department, the Division of Biometry in the Department of Community and Family Medicine. As I was completing my PhD in Statistics, I attended the annual Joint Statistical Meetings (JSM) – the largest annual gathering of statisticians in the U.S. They offer a career placement service during the conference, and I interviewed with 15 different employers in a wide variety of fields in three days. It included Pillsbury (who employs statisticians to design experiments that identify the optimal combination of ingredients and factors to develop the best tasting food products – think crescent dinner rolls), the CIA, the Census Bureau, industrial corporations, pharmaceutical companies, and several academic institutions. I was intrigued by the opportunity at the VA and Duke of contributing to research that enhances the delivery and quality of healthcare among veterans and also allowed me to collaborate with and teach statistics to physicians in an academic medical center environment.

What ideas or trends have had the biggest impact on statistics during your time at Duke?

In the last decade, the notions of data provenance, appropriate expertise, and reproducibility have had a huge impact on how we teach physicians about statistics in clinical research. We also have an increased emphasis on interdisciplinary collaboration. In the CRTP course, we don’t expect students to become statisticians – we want them to understand the fundamental concepts in statistics and their use in clinical research so they can effectively collaborate with statisticians and other quantitative scientists.

The other major impact has come from all of the activity in the online education space, which has interestingly spurred innovation in how we teach in the traditional classroom. We now teach a partially flipped classroom – we use online materials to supplement the classroom experience. For example, students might watch videos on their own time and then do homework in teams in the classroom. We have also created some specialized online certificate programs, such as our certificate targeted at fellows in reproductive medicine, which was designed to prepare physicians to participate as site investigators in clinical trials networks.

You’ve recently produced your own video series - PCATS - about giving scientific presentations. What was it like being in front of the camera?

Actually, most of my teaching is done on camera. In addition to our classroom in Hock Plaza, CRTP has two remote classroom sites, one at the NIH Clinical Center in Bethesda, Maryland and the other at the Brazilian Clinical Research Institute in Sao Paulo, Brazil. All of our courses are streamed live to the remote sites and recorded so students can review them later. Having said that, the camera work for our PCATS video series on giving presentations was quite a bit different. Most of the video was shot with a cell phone camera mounted on a tripod in front of a green screen either in my Hock office or in my workshop at home. All of our scripts were written out in advance. It’s amazing how quickly you can forget your lines when that little red recording light starts blinking.  Some of the scenes ended up taking quite a few takes to get right. For fun, we included some of the outtakes at the end of each part of the series.

What is an average day like for you?

Very collaborative. I meet with many PhD and MD clinical researchers in a collaboration or education role. I teach formal courses and serve as a statistical mentor to CRTP students, fellows in the KL2 or other career development programs at Duke. When I am not in meetings or teaching, I spend a lot of time on the computer working on grants, developing teaching materials, collaborating on manuscripts, and of course, performing statistical analyses on research data. Over the years I have become more involved in collaborations around mobile health interventions in chronic diseases such as obesity and hypertension.

When did you decide to become a statistician?

When I was an undergraduate math major at California State University at Chico pursuing a math education degree I took an elective course on probability and statistics. I was fascinated by the probability and combinatorics associated with poker hands. When I asked some of my statistics professors about what opportunities beyond teaching were available for statisticians, they really opened my eyes – there was financial support to attend graduate school and incredible career opportunities across multiple sectors of the economy.

Did you go straight on from college to graduate work?

No. After college I had a strong desire to do some kind of service work and decided to join the Peace Corps. I taught high school math and science in Ndaragwa, Kenya for two years. It was a British-style boarding school, with tea served at 10 a.m. and 2 p.m. each day. We taught the British syllabus, which was, at times, rather disconcerting. I remember thinking it odd to be teaching Cathode Ray Tube theory in physics in a place with limited access to electricity. After finishing the Peace Corps, I attended graduate school at the University of Kentucky in Lexington, Kentucky where I received my MS and PhD in Statistics.

When did your involvement in CRTP start?

Bill Wilkinson, who developed and was the first director of CRTP, approached me in 2001 about teaching the introduction to statistics course. I enthusiastically said yes, and I am still teaching that same class. The basics haven’t changed, but we now touch on new ideas – data provenance, data reproducibility, and applications to translational research – that we didn’t cover back when I started teaching the class.

How do you spend your time when you are not at Duke?

I spend most of my time outside of work with my wife who is a family medicine physician at Lincoln Community Health Center, and our two sons, age 7 and 10. This past winter we read the entire Harry Potter series together as a family and celebrated finishing the series with a trip to Harry Potter World, which was incredible.

How do you take care of yourself?

I walk a lot and I track my steps. Part of the reason I collaborate in mobile health interventions is because of my interest in wearable technologies. I can tell you exactly when, where, and how much I have exercised on any given day in the last year. I like to take ‘think’ walks around campus to explore and mull over whatever problem I am working on. Twinnies is always a great destination for a little exercise and a cup of coffee. It’s also a great place to meet with colleagues or work on problems. I also walk my two dogs every day when I get home from work.

Where is your office?

My current office is on the 11th floor of the Hock Plaza, and there’s a story there. When I first came to Duke, my office was located on the VA campus. When Hock Plaza opened, the VA moved our research center over to Hock. After a number of years, we moved again, this time to the NC Mutual Building downtown. When I resigned from the VA in 2013 and moved my office back over to Duke, our department was moving into the same Hock space the VA center had previously occupied and I got my old office back.