She has experience in both clinical trials and observational research. Some of her achievements include; membership on multiple committees for the American Statistical Association, membership as a voting member of multiple data and safety monitoring committees, and past Associate Director of Biostatistical Clinical Operations at the Duke Clinical Research Institute (DCRI). Karen has given talks around the world on statistical methods. She has developed educational series for non-statisticians and was the first recipient of the DCRI fellows' Best Teaching and Support Award. This award has been since named the Karen Pieper Fellowship Teaching or Support Award.