Vanessa MontanariArticle written by the Pharmaspecific Society, a specialist in clinical research.
I would like to talk to you about a subject that is close to my heart: how can we improve recognition of the CRC profession?
You’ve probably noticed that the CRC trade is not sufficiently recognized, however, this profession is essential to the smooth running of a clinical trial in a Centre and to the dynamism of French clinical research. We may ask ourselves: why is this profession not recognized at its true value?
I have some ideas to bring, to improve the recognition of this profession, and I will share them with you in the presentation below:
Recognition through training
To date, it is rare to find WIPs who have received specific training in the trade. Most have received CRA training only and are trained on the job. CRC training is often similar to CRA training while some differences remain between the two occupations. On the other hand, some CRC training already exists. However, are they comprehensive?
I think there should be a common core for the CRA occupation and the possibility of specializing as a CRC. This would make it possible to professionalize the trade right from the training stage.
Indeed, CRCs are in regular contact with patients. Managing the relationship with patients is not innate. In my opinion, theoretical training would be necessary in order to focus on listening to the person being treated, reacting appropriately, recognizing his or her emotions and concerns and using them with the necessary professional distance.
I think that there should be a « transversal management » section in CRC training courses. A few months ago, I wrote an article on « How will transversal management change your work as a CRC and CRA? CRCs coordinate a large number of players (investigators, pharmacists, radiologist, pathologist, biologist, laboratory technician) and make sure that the ICH/GCP are respected by these players in the clinical study. Couldn’t the CRCs receive training in cross-functional management so that they can manage without hierarchical power?
I think that the content of CRA training courses needs to evolve in order to improve the recognition of the CRC profession.
Recognition of diplomas through attractive salaries
CRCs are generally people with a Bac+3(Bachelor degree) to (PhD degree) Bac+8. The position seems to have little recognition in hospitals. There are few permanent positions. CRCs often move from fixed term to open-ended contracts, although clinical research is still present in hospitals. There is no specific skills leading directly to this job, even though the Ministry of Social Affairs and Health has a job description on its website: http://social-sante.gouv.fr/metiers-et-concours/les-metiers-de-la-sante/les-fiches-metiers/article/technicien-d-etudes-cliniques#Evolutions-passerelles-vers-d-autres-metiers.
So, for me the position is very little recognized in hospitals. There are no specific competitions, there are few open-ended contracts; moreover, the salary grids are unclear
Salary bands are unclear. They range from (gross monthly salary) €1,450 at the start of a career to €2,100 according to the Ministry’s salary scales. Whereas at the APHP (the public hospital system of the city of Paris and its suburbs), they range from €1,887.32 to €3,063.83. There is a discrepancy between what can be found on the ministry’s site and on the APHP site. If any of you can clarify this inconsistency for us, we would be grateful: http://rechercheclinique.aphp.fr/-Les-metiers-de-la-recherche-a-l-AP-HP-.html?rubrique.
Secondly, the single contract has had an impact on the sustainability of jobs. Doctor’s associations had been set up by the investigators themselves in order to maintain and perpetuate these jobs in the form of permanent contracts. Unfortunately, as a result of the single contract, many jobs were stopped because it did not allow the use of the doctors’ associations. Also, the CENGEPS’s Ministerial Order (National Center of Health Product Testing Management) puts a strain on this profession. Some CRCs were integrated into hospitals, but others could not be.
Skills and real permanent contracts should be created among the public hospitals in order to increase the recognition of this profession.
Recognition by title
As we have just seen, the CRCs have a level of Bac+3 to Bac+8 or we use the term clinical research technician. This term does not seem to me to be appropriate since most CRCs have three to eight years of higher education.
The term Site or Clinical study Coordinator would be more appropriate. This same term is just the translation of this profession in other countries such as England or the United States, Clinical research coordinator (CRC), clinical site coordinator (CSC).
We need to give a more rewarding title to this profession.
Recognition by management
Some CRCs are sometimes left to their own devices, i.e. without a manager to help them progress towards the objectives set by the investigators. Investigators must manage both routine care and clinical research. Do they have the time to manage CRC? Wouldn’t it be more interesting to structure and develop certain CRCs for this type of position, as we can see at the Institut Curie or Gustave Roussy.
In addition, knowing that there are opportunities to move on to other positions, including that of manager, is an element of recognition and even an element of motivation for the teams. We therefore need to create many more opportunities for this profession.
Recognition through information
Some hospital staff members are unclear about what CRCs do, even though they have a good understanding of the role of a nurse or radiological manipulator. Could this profession not be promoted so that it is known to everyone through clinical research days organized by the CRCs themselves and their line manager?
In addition, the creation of a French association of CRA with real visibility could help create vocations, better organization and improved clinical research practices in France. At present, there are associations such as SOCRA in the United States, which is an extremely active association of CRA and KTEs that campaigns to improve clinical research. There is also the ACR, which is the association of clinical research professionals.
We have these two entities that are really active at the research level. It would have been interesting to have our own French CRA society so that we could communicate even more about this profession.
After having been in turn CRC, CRA, Project Manager and Manager, I would say that this rewarding profession is struggling to be recognized, but without it, there would be no clinical research in France. After the circular on the single contract, I would like to see this profession revalued among the generations.
I hope that this article will give rise to developments, vocations and even the birth of a French CRA association!
We must continue to boost French clinical research, so… go for it!
See you soon!
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