Professional Documents
Culture Documents
key influencer, promoting knowledge and understanding by engaging the healthcare community
and the general public.
The Institute of Clinical Research
Thames House, Mere Park, Dedmere Road, Marlow, Buckinghamshire SL7 1PB
info@instituteofclinicalresearch.org
www.instituteofclinicalresearch.org
Telephone: 01628 899755
Facsimile: 01628 899766
Disclaimer: The opinions expressed in this publication are those of the subcommittee, and not
necessarily those of The Institute of Clinical Research
All rights reserved.
No parts of this book may be reproduced by any means or transmitted, or translated into
machine language without written permission of the publisher.
ISBN 0-9549345-4-7
Designed by Stretton Graphics 01628 828222
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raising standards
sharing knowledge
developing professionals
Raising standards
The Institutes professional standards encourage our members to work to the highest standards,
enhancing the standards of clinical research and maintaining the professional identity of members
The Institute recognises the academic achievement and clinical research experience by awarding
designatory letters e.g. MICR to our members.
Sharing knowledge
The Institute offers a comprehensive range of Information Services and publications, including our journal
Clinical Research focus, our publications, online resources, a resource centre and membership helpline.
Developing professionals
The Institute provides educational courses and training workshops, continuing professional
development, academic qualifications and accreditation of training courses. All of these enhance the
professional competence of our members.
Acknowledgement
Grateful thanks are extended to members of the CRA Subcommittee past and present for
their input.
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Contents
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Is this you or could this be you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
The Clinical Research Associate (CRA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Role and Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Education and Training Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Qualifications, Experience and Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Qualifications: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Experience: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Essential Skills of a CRA include: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Career Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CRA Level I: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CRA Level II: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CRA Level III or Senior CRA: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
How do I find a CRA Position? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
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Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Organisations and Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
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Introduction
An important objective of clinical research is to ensure that marketed drugs are as safe
and effective as possible. When a promising drug is discovered, a pharmaceutical company
will plan a clinical development programme involving several phases of clinical research.
Each phase will involve at least one clinical trial or trial, sponsored by the pharmaceutical
company responsible for the drug to be tested.
CRAs are involved in all phases of clinical research and at all stages of a particular trial.
Therefore, possible CRA duties include most of the activities required to set up, monitor
and complete a clinical trial. A new CRA is most likely to be involved in the initiation,
monitoring and close-out of a selected group of investigational sites.
Recruitment of CRAs may be directly into a pharmaceutical company or into a Contract
Research Organisation (CRO) which can plan, organise and/or conduct clinical trials on
behalf of pharmaceutical companies.
This booklet aims to provide ideas, information and guidance to those who might be
interested in becoming a CRA, either within the Pharmaceutical Industry or within the
Pharmaceutical Service Industry. Existing CRAs and colleagues may wish to give this booklet
to those who express an interest in the CRA role. Careers Advisors, recruitment and Human
Resources may wish to use this booklet to provide information, in a concise and relevant
form, to those actively seeking a CRA position.
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Table 1
Initiation:
Monitoring
visit:
Close-out
visit:
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This is the visit to the investigational site at the very beginning of the trial that
is carried out once all the appropriate approvals and paperwork are in place.
This involves meeting with all the appropriate departments/site staff within the
investigational site (e.g. pharmacy, laboratories, radiology etc) This is to ensure
that they are aware of the trial protocol, procedures, ICH GCP and the logistical
aspects of running the trial, to name a few. This can involve speaking one to
one, or speaking in front of a group about the trial.
These usually take place over one to two days at the investigational site
approximately every four to six weeks depending on the trial, therapeutic area
and the number of subjects taking part. Regular monitoring visits are made by a
CRA to verify (SDV) and collect data recorded on CRFs, ensure prompt reporting
of adverse events, maintain drug accountability, ensure adherence to the trial
protocol, Good Clinical Practice (GCP) and Standard Operating Procedures
(SOPs), encourage further subject recruitment, identify and resolve problems.
This is the very last visit that is made to an investigational site at the end of the
trial once all subjects have finished the trial and the database has been cleaned
by data management. This will involve ensuring that 100% Investigational
Medicinal Product (IMP) accountability, checking all the paperwork is in place
and that any remaining trial supplies have been removed/destroyed. This
meeting will always involve a final discussion with the investigator at the
investigational site to remind them of their responsibilities for archiving and
retaining the trial documents according to ICH GCP.
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Experience:
To get your first job it is essential to do your homework and have knowledge of:
The pharmaceutical and services industry.
The job role itself and what it might entail.
The industry regulations that must be followed (e.g. International Conference on
Harmonisation for Good Clinical Practice (ICH GCP), EU Clinical Trials Directive (2001/20/EC),
EU Directive on GCP (2005/28/EC).
Demonstrate an understanding of the travelling that can be involved in a CRA role.
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Career Development
The CRA role is varied and the career development can vary from company to company.
Some CRAs begin their career in data management or as Clinical Trial Administrators (CTAs)
before gaining a Junior CRA position. Others may have gained a background in areas
involving pre-clinical research.
The Institute of Clinical Research offers members an active continuous professional
development (CPD) scheme, which is strongly encouraged when you are looking for a
career as a CRA and during your career to improve your skills and expertise.
A guidance of the career path as a CRA is given below.
CRA Level I:
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Supervision and/or distribution of trial supplies, including the trial drug (investigational
medicinal product).
Organisation, attendance and/or presentations at investigator meetings.
This more senior role may cover any of the above tasks but may also include supervising,
training and mentoring junior members of staff, and project management of whole trials
within a country/internationally. You may also get involved in protocol and Case Report
Form (CRF) development and other medical writing projects.
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strict and limited so as to ensure a well-defined trial population. Here the aims are to
demonstrate a proof of concept.
Phase III (Therapeutic Confirmatory) trials assess short- and long-term safety and
efficacy in larger numbers of subjects. Entry criteria are well defined but may be less
limiting than in Phase II. Trials usually involve a placebo and/or a competitor drug for
comparison, with blinded randomisation of treatment allocation. These trials usually
provide the pivotal data needed for a Marketing Authorisation Application.
Phase IV (Therapeutic Use) trials are conducted after the Marketing Authorisation
Application has been granted and often coincide with the launch of the new drug onto the
market. Trials involve large number of subjects; the entry criteria are less limiting so as to
encompass a broad selection of subjects. Trials are usually comparative with a competitor
drug or occasionally placebo control. The aim is to provide more safety and efficacy
information and sometimes to change or expand the indication for use so as to increase
market share.
Post Marketing Surveillance (PMS) trials involve very large number of subjects from a
diverse general population. Important information is collected on subjects to whom the
drug is administered. The aim is to continue the monitoring of drug safety and to highlight
any rare side-effects which might only come to light after large scale use.
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to provide the necessary information. The trial design may be single-blind or double-blind,
with a placebo or active control and parallel or cross-over treatment.
The content of the final protocol will be mirrored in the design of the Case Report Forms
(CRFs), used by investigators to record the subject data collected during the trial. The
protocol and CRF and any later amendments are put through rigorous internal and external
approval processes.
Investigator sites are carefully chosen and briefed to ensure that each has adequate
facilities and enough staff, time and enthusiasm to carry out the trial procedures correctly.
The surgery list or hospital population must be such that suitable subjects can be recruited
at an acceptable rate. Each site must be provided with adequate trial supplies, including the
trial drug and any comparators with correct labeling and procedures for maintaining any
blinding and ensuring accurate accountability.
The clinical research industry is controlled by strict ethical restrictions. Since 1st May 2004,
the ethics process has undergone major structural and operational changes, to bring the
processes into line with the EU Directive 2001/20/EC. All potential clinical trials must be
approved by a research ethics committee (REC) before participants can be recruited into
the trial. Audits are often performed by Quality Assurance personnel from the sponsor and/
or contract organisation. Trials can also be inspected by the Regulatory Authority at any
time before or after a Marketing Authorisation Application has been made. A Regulatory
Authority inspection can also take place after the trial has finished and all documents have
been archived.
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Conclusions
If you are enthusiastic, logical, methodical and looking for career variety then the CRA role
may offer you a career opportunity within the clinical research industry.
It is hoped that this booklet has helped clarifying the role and responsibilities of the CRA. If
this could be you and you would like to find more information than what is provided in this
booklet, or you wish to become a member of The Institute of Clinical Research, please visit
the website of The Institute of Clinical Research: http://www.instituteofclinicalresearch.org.
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References
Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 on
the approximation of the laws, regulations and administrative provisions of the Member
States relating to the implementation of good clinical practice in the conduct of clinical
trials on medicinal products for human use. Official Journal of the European Communities
L121/34-44
Commission Directive 2005/28/EC on the laying down principles and detailed guidelines
for good clinical practice as regards investigational medicinal products for human use, as
well as the requirements for authorisation of the manufacturing or importation of such
products. European Commission, 2005. Official Journal of the European Communities
L91/13-19
ICH Harmonised Tripartite Guideline for Good Clinical Practice, ICH Secretariat, 1996
World Medical Association Declaration of Helsinki Ethical Principles for Medical Research
Involving Human Subjects, South Africa, 1996.
World Medical Association Declaration of Helsinki Ethical Principles for Medical Research
Involving Human Subjects, Edinburgh, 2000.
World Health Organisation, No. 850, Annex 3, WHO Technical Report Series: Guidelines for
Good Clinical Practice (GCP) for Trials on Pharmaceutical Products, WHO, 1993
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Glossary
Active control
Adverse event
Archiving
Audit
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A printed or electronic document designed to record all of the information required by the
protocol to be reported to the sponsor on each trial subject.
The location(s) where the trial-related activities are actually conducted. Trials may be at one
site or multisite.
Comparator trial
A trial in which subjects are allocated to more than one alternative active treatment and
the alternatives are then compared.
Competitor drug
An alternate treatment, which is used for the same indication as that proposed for the trial
drug and would therefore, compete for market share.
The application form for applying for regulatory approval, required prior to the start of any
trial, in line with the EU Directive
Someone who administers, maintains and co-ordinates the logistical aspects of clinical
trials according to Good Clinical Practice and relevant SOPs and acts as a pivotal point of
contact for the clinical trial team
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Clinical Research
Clinical Research Associates are research professionals carrying out activities that may
include investigational site selection, set up, initiation, monitoring and close-out, and can
be involved in all operational aspects of the clinical phases of drug development
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Clinical Trial
A type of research trial that tests an investigational new drug or method to see how well it
works on people.
The planned acquisition of knowledge, experience and skills and the development of
personal qualities for the execution of professional duties and for career management
throughout working life.
Cross-over trial
A trial in which subjects receive one treatment followed by another, the treatments often
being separated by a washout period when the subjects receive no treatment or placebo.
Data management
All procedures for handling and processing data collected during a trial.
Double-blind
A system to ensure that the treatment allocated is unknown to both theinvestigator and
the subject.
Entry criteria
Rules to ensure that suitable subjects are selected for entry into a trial. Inclusion criteria
describe subjects who are suitable in terms of age, sex, disease. Exclusion criteria describe
subjects who should not be selected, so as to avoid various health risks and to maximise
the validity of the trial results.
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Generic
Genetic engineering
The science, which, includes the mass production of useful biological substances by
modification and transplant of genetic material.
A standard for the design, conduct performance, monitoring auditing recording analyses
and reporting of clinical trials that provides assurance that the data and reported results
are credible and accurate and that the rights, integrity and confidentiality of trial subjects
are protected.
The ICH GCP guideline was developed to provide a unified standard for the European Union,
Japan and United States, as well as those of Australia, Canada, the Nordic countries and the
World Health Organisation (WHO).
Indication
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Informed consent
Investigator
A person responsible for the conduct of the clinical trial at a trial site. If a trial is conducted
by a team of individuals at a trial site, the investigator is the responsible leader of the team
and may be called the principal investigator.
Monitoring
The act of overseeing the progress of a clinical trial, and of ensuring that it is conducted,
recorded, and reported in accordance with the protocol, Standard Operating Procedures
(SOPs), Good Clinical Practice (GCP), and the applicable regulatory requirement(s).
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Parallel trial
A trial in which two or more separate groups of subjects are used to compare two or more
treatments; each group receives a different, single treatment, usually allocated randomly.
Patent protection
The exclusive right to produce a particular compound or formulation, such that no other
company can produce a copy.
Pharmacology
Pharmacodynamics
Pharmacokinetics
The trial of Absorption, Distribution, Metabolism and Excretion (ADME) of drugs when
administered to humans or animals.
Pivotal trial
A trial conducted to GCP Guidelines and providing crucial efficacy and safety data to
Regulatory Authorities.
Placebo
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Product License
Regulatory approval needed to market, advertise, sell and supply medicinal products.
Protocol
Randomisation
Receptors
Safety/Tolerability
Shelf life
The period for which a product is confirmed as being fit for its purpose.
Side-effects
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Single-blind
A system to ensure that the treatment allocated is unknown to the subject. In this case the
investigator does know which treatment the subject is taking.
Verifying that all information in original records and certified copies of original records of
clinical findings, observations, or other activities in a clinical trial are accurately reported in
the Case Report Form (CRF).
Sponsor
Steering committee
A group of medical and research experts, who review, discuss and advise on the
development of the trial protocol and/or aspects of the ongoing trial.
Subject
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Toxicology
The file (s) containing all the essential documentation for a trial.
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