Foundations of a translational health sciences doctoral program

Community member post by Gaetano R. Lotrecchiano and Paige L. McDonald

gaetano-lotrecchiano
Gaetano R. Lotrecchiano (biography)

How can doctoral studies be developed to include innovation in practice and research, as well as systems and complexity thinking, along with transdisciplinarity? This blog post is based on our work introducing a PhD in Translational Health Sciences at George Washington University in the USA.

Innovation in Practice and Research

We suggest that innovation in practice and research is achieved by the integration of knowledge in three key foundational disciplines:

  • translational research
  • collaboration sciences
  • implementation science (Lotrecchiano et al., 2016).

We define these as follows:

Translational research is a crosscutting approach that informs associations across a continuum of knowledge generation from basic biomedical discovery to rehabilitation interventions to global population health impact.

paige-mcdonald
Paige L. McDonald (biography)

Collaboration sciences form the foundation by which translational research is conducted and when implemented along with practice and policy efforts ensure that translational science can occur with strong representation of multi-stakeholders invested in health outcomes.

Implementation science is the investigation of processes and strategies influencing the movement of evidence-based healthcare and prevention strategies or programs from the clinical or public health knowledge base into routine use.

When considered together, these provide a recipe for high impact in innovations research and practice (see figure below from Lotrecchiano et al., 2016).

These three disciplines support innovations in health practices and research necessary to promote changes at the organizational, team and individual levels. All three are reflected in the overall program goals and were used to inform curriculum competencies. The aim is to prepare students to move from more basic approaches to research to those that are more systems based, as shown in the following figure (from Lotrecchiano et al., 2016).

 

 

Pairing complexity principles with transdisciplinary characteristics

Moving to a more systems-based approach requires the pairing of complexity principles with transdisciplinary characteristics to develop scientists equipped to operate beyond the confines of traditional or unidisciplinary training. These are illustrated in the table below, with complexity principles in the left hand column and transdisciplinary characteristics in the right hand column. We feel that introducing doctoral students to these principles allows them to participate in translational trandisciplinary research activities.

Complexity principles (left hand column) and transdisciplinary characteristics (right hand column) –  full references are available in Lotrecchiano (2012)

Conclusion

Readers may be interested in our doctoral student handbook (PDF 1.1MB). Our work to establish and maintain our approach to doctoral studies in this vein continues and we have enjoyed both successes and setbacks, but mostly successes, as we transform the way we approach this particular type of doctoral training amidst the healthcare and research climate in the United States.

We invite your comments and questions and hope to hear from you about your experiences.

To find out more:
Lotrecchiano, G. R., McDonald, P. L., Corcoran, H. K. and Ekmekci, O. (2016). Learning Theory, Operative Model, and Challenges in Developing a Framework for Collaborative Translational and Implementable Doctoral Research. Conference proceedings, 9th Annual International Conference of Education, Research and Innovation, 14-16 November, 2016, Seville: Spain. Online via Researchgate – 311363970

Reference:
Lotrecchiano, G. R . (2012). Social Mechanisms of Team Science: A Descriptive Case Study Using a Multilevel Systems Perspective Employing Reciprocating Structuration Theory. Doctoral dissertation, George Washington University: Washington DC United States of America. Online: https://pqdtopen.proquest.com/pqdtopen/doc/992950947.html?FMT=ABS

Biography: Gaetano R. Lotrecchiano, EdD PhD is an Associate Professor at the George Washington University (GWU) School of Medicine and Health Sciences, Washington DC USA, where he is the Director of Doctoral Candidacy in the PhD in Translational Health Sciences Program. He is the vice-president of the International Society for Systems and Complexity Sciences for Health and of the International Society of the Science of Team Science. He is the convener of the GWU program entitled Creating a Culture of Collaboration at GWU. He is also the Team Science Lead of the Clinical and Translational Science Institute (CTSI-CN), a partnership between Children’s National Health System and George Washington University.

Biography: Paige L. McDonald, EdD is an Assistant Professor at the George Washington (GW) University School of Medicine and Health Sciences, Washington DC USA, where she is the Director of Curriculum in the PhD in Translational Health Sciences Program. She is the Managing Director for the GW IMPACT Initiative and GW Collaboratory for Health Research and Education. She is also the Secretary of the International Society for Systems and Complexity Sciences for Health.

6 thoughts on “Foundations of a translational health sciences doctoral program

  1. Dear Guy,

    Thank you so much for the response and congratulations on the successes. As you and Linda both noted it can be hard to build action/intervention/translation efforts within our prevailing academic reward structures. Thus, it is really exciting to hear that the program is flourishing alongside of the more traditional basic science Ph.D. programs. I would also like to thank you for emphasizing the T3-T4 end of the translational science spectrum. This does seem important, and if I understand correctly, the broad curriculum exposes learners to other perspectives that don’t fit neatly on the research-to-practice spectrum. Thank you also to Linda for raising that point, and for providing the excellent references and information on the Berkeley and ETH Zurich programs.

    I’m relatively new to this forum so it is great to learn from these impressive training models. Because I’m somewhat new, I’m not sure that I have much to add to the conversation, but I guess I should try. I have had some thoughts about encouraging traditional (intradisciplinary) researchers to be more open to broad endeavors. In short, I was lucky enough to work on a team project which sought to demonstrate the utility of cross-disciplinary communication in health research settings by providing tangible examples of success (https://www.ncbi.nlm.nih.gov/pubmed/27893987). This approach doesn’t really attempt to explain “how” to communicate but it hopes to clarify “why” it might be worthwhile. In other words, these examples might increase the “openness to engagement” among traditional researchers. You, and Linda, and the ETH Zurich team have clearly had great success in explaining the “why” to a wide variety of people, but maybe some of these examples would still be of interest. Thank you again for the excellent posts!

    Best,
    Tim

  2. Dear Gaetano and Paige (and I2S colleagues),

    Thanks for your excellent post! Your description of your doctoral program in Translational Health Sciences is a valuable addition to understanding how the science and practice of integration and implementation can be incorporated into a doctoral program. As a faculty member involved with the Doctor of Public Health program at the School of Public Health at the University of California, Berkeley (USA), I can see key similarities and also some additions that we could learn from your program. A few comments and questions:

    • Like our program, yours is located within the health sciences. This no doubt reflects the inherent interdisciplinarity of health sciences, as well as the significant funding that has been allocated to transdisciplinary and translational efforts in the US (especially from the US National Institutes of Health) and in Europe, Australia, South Ameria and now elsewhere around the world. Importantly, although health sciences are obvious for this kind of work, it can be applied to any area of efforts to understand complex problems and make change.

    The environmental sciences (also naturally interdisciplinary) are another area of focus on I2S approaches to pedagogy, research and action (see a reference chapter (#1) below that I co-authored with Christian Pohl at ETH Zurich that describes transdisciplinary training in environmental sciences (ETH) and in public health (Berkeley)). It would be interesting to hear whether students from not-specifically-health areas (although we know that everything that affects the planet affects health) are participating in courses in your program and whether there’s interest in building out your program or its offerings to doctoral students getting other degrees at GWU.

    • I like how you drilled down into I2S areas including translational research, collaboration sciences, and implementation sciences. Historically, it’s been intriguing to see the emergence of these “sciences” and the different ways in which people use or conflate these areas. I remember that in the initial period when the “science of team science” was emerging (late 90’s, early 2000s) that there was emphasis on linking disciplines (collaboration science), but less so on translational research. This was because the “science of team science” work was mostly coming from a biomedical perspective and funded by the National Institutes of Health with the intent of getting scientists from different disciplines to work together. At that time, the translational and implementation aspects of the work were not yet a strong focus. The Clinical and Translational Science programs funded by NIH are now putting a stronger focus on the translation and implementation aspects. For example, there is one at our sister school at the University of California, San Francisco which specifically added a community-facing committee to help strengthen translation. However, I think, as you describe with your program, it’s important to start these efforts with a solid conceptual and practice foundation from the beginning.

    • I was interested in how you explicitly identify translation, collaboration and implementation sciences as the conceptual foundation of your program. There is a strong trend in “transdisciplinary” training, research and practice, to have the term “transdisciplinarity” subsume these others areas. Even if that remains the trend, it is useful for students to understand exactly what is covered under a large umbrella term. This brings up the question of the name of your program being “Translational Research Sciences.” Do you find this a limiting factor given that you are not only about learning how to translate research to practice, but also about how to think about issues and conduct research from many disciplinary perspectives (with the help of many societal stakeholders)?

    • I like the “Translational Science” conceptual image. It is a good way to contrast the traditional vs. your newer way of approaching complex issues.

    • I also like your complexity/systems principles as shown in the table. That is something I think will enhance our doctoral public health program and other public health offerings focused on intervention research and practice, and certainly could be useful to higher education outside of health, too. It’s so valuable to incorporate the complexity/systems sciences in your foundational work (that could be part of the first image you showed with the 3 sciences, although complexity and systems sciences are part of the 3 sciences you identified).

    • Regarding the “interpenetration of epistemologies” principle, I don’t know which ones you include, but I have found it very helpful to put a strong emphasis on the “design sciences”—the “3rd branch of epistemology” pioneered by engineers, architects, computer scientists and other socio-technologists in the mid-20th century (see references below). This branch of scientific inquiry focuses on “working in the future” and “building solutions that are effective” rather than testing theories, as has been a main goal of the other 2 main epistemologies (natural and human sciences). As such, its theory and methods focus on complex, “wicked” problems (what we face in health and most other human endeavors), the need to intensely involve “end users” and all relevant stakeholders in defining problems and generating and iteratively testing solutions, until they are successful. Some of those techniques include design thinking and usability testing—among many others. We emphasize this in our program and find that students (from medicine, public health, social welfare, business, etc.) have typically not been exposed to this useful paradigm.

    • As we know, it’s hard to establish a transdisciplinary and action-based program on most campuses that have followed a trend of greater disciplinary sub-specialization and still prize “new knowledge discovery” more than getting knowledge converted to practice. It would be helpful to hear how you got your program approved, how it is viewed by the administration and students, and whether you get good faculty support from faculty who work In specific disciplines and may view cross-disciplinary and translational work as something removed from their disciplinary focus and their career motivations (and rewards). We are all struggling with this issue!

    • To other I2S colleagues: this blog site is one of the best ways for all of us to share our innovative pedagogical work. I recommend this site to my students who want to hear voices from around the world. We’d like to hear from you.

    • I’ve included a few references below. Reference #1 gives more information about our the Berkeley Doctor of Public Health program and the ETH Zurich transdisciplinary programs in environmental sciences. Reference #2 is about a new book coming out this summer that has good information on transdisciplinary research, teaching and practice, including examples of teaching and case studies of action from different parts of the world:

    1. Neuhauser, L., Pohl, C. Integrating Transdisciplinary and Translational Concepts and Methods into Graduate Education. In: In P.T. Gibbs (Ed.) (2014). A transdisciplinary study of higher education and professional identity. New York: Springer.

    2. D. Fam, L. Neuhauser and P. Gibbs. (Eds.) Collaborative Research and Collective Learning: Transdisciplinary research and practice. Springer Press.

    3. Bammer, G. Disciplining Interdisciplinarity: Integration and Implementation Sciences for Researching Complex Real-World Problems (pp. 461-472). Canberra Australia: Australian National University Press. Available at: http://epress.anu.edu.au/titles/disciplining-interdisciplinarity/pdf-download

    4. Neuhauser, L. Integrating participatory design and health literacy to improve research and interventions. Information Services & Use. 2017;37:153-176. Available at: http://content.iospress.com/download/information-services-and-use/isu829?id=information-services-and-use%2Fisu829

    • Linda,

      Thanks so much for your wonderful and thoughtful insights and resources. We are very happy to be accepting our third cohort of students into this program starting this summer. To your question about why collaborative, translational, and implementation sciences, I must turn to the core nature of our program embedded in the health sciences. We wanted to create an environment that would attract health scientists and emphasize what we felt are truly the benefits of looking at translational research through lenses that include those used by professionals that make up the breadth of health scientists and providers beyond medicine (exclusively). We also wanted to capitalize on our strengths within our clinical research and leadership department that includes expertise in collaboration and team science, education, and implementation science. We tend to stress the importance of the T3-4 end of the spectrum where many other programs (especially those part of CTSAs) tend to live more in the T0-2 space. We feel it is a unique contribution. Thanks for your comments!

      Best
      GUY

  3. Thank you very much for this great post, and for including a paired list of principles/characteristics, as well as references, and a link to your training program handbook. There is a lot to think about (and I have not yet gone through the entire handbook), but it appears that your approach exposes graduate students to several relevant disciplines in this space. You mentioned that there have been a number of successes and a few setbacks. Certainly no pressure either way, but are there any successes, setbacks, or fixes that you might like to describe in this forum? Thank you again for the post and for developing this impressive training program.

    • Tim,

      Thanks for your post. We continue to learn from our students about what works and what does not. As a blended lock-step program, we continually tweak our methods and our approaches to meet the needs of our emerging population of students. This stated, many of our accomplishments are with the university where we work and implementing a program of this kind within a medical school where the other PhD programs are basic science in nature. This applied program draws on our expertise in organizational sciences paired with our health science culture. Not an easy sell to a Council of Deans. What has been truly amazing to me is that on top of what we have been able to design, our students are full paying clients as we do not provide much outright support for our students. With cohorts averaging about 15 per year, we are able to have a fully sustainable program.

      Guy

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