Lead CRA Q&A:Challenges to a New CRA

One of my connections is taking a CRA Development course and her homework assignment was to ask a tenured CRA “What did you feel were the biggest challenges of the position when you first started?” I am providing my answer and would love to hear if other seasoned CRAs agree or if there are other hurdles that I didn’t even mention.

My answer:

CRA med ctr
When visiting a major medical center it can
be a major challenge just to figure out the
parking or navigating the campus (pictured: UCLA).

I am not a nurse and I have never worked with patients in a clinical care setting so it was a challenge to learn how office and hospital charts were organized. You have to know what is supposed to be in there in order to recognize what is missing. On the flip side, there is a lot of stuff there and you need to be able to figure out what is noise and what is actually important in your role as a monitor and the context of the study. Charts are sometimes hundreds of pages long and I have worked on studies where it took 2 days just to perform chart review on a single patient. Again, developing that skill to filter what is important and needs to be in the database versus what is just extra information is really critical to your success. Once I started on in-patient studies I also needed to learn how to read surgery reports and hospital medication administration records and the slew of acronyms and institution specific items that accompany both. I’m still learning, every time I go to a new hospital or study center. Charts are organized similarly but there are always institution specific nuances and learning how to read the charts is one of my main objectives at my first monitoring visit to each new site.

When reviewing AEs, labs, and Con Meds, you frequently come across things you are unfamiliar with. It was important when I first started to be industrious and know where to find answers. You can’t possibly know everything but you have to be able to use your resources like Wikipedia, Epocrates, Merck, study staff, extension courses, and other training databases/materials provided by your employer or the sponsor to fill in those deficiencies as you come across them. You can also better prepare for a new study by doing internet research on the therapeutic area. On a recent study, I downloaded medically relevant podcasts to help me prepare and learn some of the common issues and medications with my patient population. When you are learning about a new therapeutic area, start with patient advocacy or education websites because they are nonscientific and then work your way up to journal articles, sponsor slidedecks, the IB and more intense material.

Finally, it is important to find the right balance when writing your monitoring reports. You want to give enough information and specifics to show you were there and followed all relevant SOPs and guidelines but you want to keep it succinct and avoid a novella. You also want to cover yourself in an audit later but different sponsors want different levels of detail. Your Lead CRA and Project Manager will help you land on the right amount of detail through their reviews but the first couple reports on a study are always a challenge because of this issue. You can read more on my blog about efficiency tips, timesheet tips, MV report tips, and Career Advice.

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About The Author

The Lead CRA

Nadia started The Lead CRA blog in 2007. She is now lead author for ClinOps Toolkit. Nadia is currently working as a Clinical Program Manager at a small specialty pharmaceutical company in the San Francisco Bay Area. You can reach Nadia via email at [email protected] anytime.


  • Sherry

    August 19, 2016

    Good post. I absolutely appreciate this site.

    Stick with it!

  • CRA Q&A

    March 10, 2011

    WOW, just the information I was looking for, thanks for the great post!

  • The Lead CRA

    Hi Valina, Thank you for your question. I want to direct you to a relevant post I did a few years ago called “How to break in to the industry” (link) I think this advice is still relevant and the only thing I would add is that when changing careers it helps to be currently employed. I’ve always been a more attractive candidate when I had a job and I think that rings true for all job seekers – even if your current job isn’t perfect being employed really makes you more marketable.

  • Valina

    May 27, 2010

    how am i to start my career as a CRA? Currently i m doin a course in clinical research

  • The Lead CRA

    Thanks everyone for commenting. I’ve had the opportunity lately to do some co-monitoring on my current study in preparation for a big data-sweep. I’m enjoying both working so closely with my CRA peers and banking the frequent flier miles. 😉 I’m thinking up some new blog topics and I’ll try to stick to the schedule of writing a post once or twice a month. Julia, I worked as a Data Manager for several years so I used to build eCRFs and I have worked in a variety of EDC systems as a monitor. Feel free to email me at [email protected] if I can be of more assistance.

  • Julia

    June 1, 2009

    Thanks for your blog Nadia. I am the only CRA in my company and I read your articles because I don’t have the chance to learn from someone directly at my workplace.

    The toughest thing at the start was to deal with all the different aspects of monitoring at once. There are so many gaps about diverse subjects.

    Do you have experience working with eCRFs? I am having issues with one at the moment – it has added an extra layer of complexity to one of my studies that I have to say I didn’t need right now!

  • That was a real good article Nadia..
    And nice to see u post after such a long time..

  • Fran

    May 18, 2009

    hey, happened to stumble on your blog.. fellow CRA too.. thanks for sharing your thoughts 🙂

  • Iche

    May 17, 2009

    Great article Nadia!

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