Training Providers Posted on January 20, 2009 Dr. José Szapocznik finds the perfect metaphor to explain why a protocol might need adaptation to a site.

We do a lot of work over the Web, telephone conferences. We have training on the phone. We have weekly call with all the sites, and so we are able to talk about the study.

Actually we have weekly calls with all the sites that are doing a single study, so that as questions come up, they all learn from the experience. We then have one or more national trainings as needed. Typically it's one, but occasionally we've had to bring a second group or a part of the group back in.

And then we'll do site visits, and the site visits involve understanding what they're doing and providing training to move them from what they're doing to what they need to be doing. And it always needs to be adjusted to the real context.

So if you think about if you wanted to build a three bedroom, two bath home, you can build it on a flat piece of land or on the side of a mountain. And so it may be the same protocol, but you really have to adjust it to the terrain in which you're laying the protocol.

And then that you can only do on site. You have to do it with their organizational practices, with their specific patient population they have, and with the personnel they have. You have to adjust to all of that, and sometimes also to their local and state regulations.