How are clinical trial leaders picked? No one can or will hand you a principal investigator role on a platter. You have to work for it. Some things you can do if you are interested in leading a clinical trial. 1) Become a disease expert. Really understand the disease well. When you speak or write colleagues should recognize your talent and depth. The more you speak and write the more you will be noticed and sought out. Social media helps raise your visibility but it has no value if others think you are superficial. You must be credible. This is the most important step. There are no short cuts except to really understand the disease, what is known, and what remains to be known. It’s hard work. 2) Volunteer to be co-investigators on trials and help with trial design, development, and accrual. 3) Network. Most senior investigators will be more than happy to help you succeed. 4) Study trial protocols in depth to understand the elements and how it’s formatted. Better still write out protocol concepts and protocols. Clinical trial workshops help. There is an awful lot of detail. 5) Identify important questions that others are not thinking of. The question should be original, authentic, and important. If you have a great question, and you are credible, you are on your way to leading a trial. (The process from that point on is still very long and arduous — see second tweet in thread. But you have made it to being the PI). Clinical trial leadership is not transferable. When you are asked to be a lead investigator it’s not in your power to hand it over. If you don’t want it, that spot will go to the next most credible person not the one you anoint. As it should be.