- Top of page
- Design and Implementation of the Course
The advancement of research from basic science discovery to clinical application requires the extensive collaboration of individuals from multiple disciplines, therefore the ability to work as an effective interprofessional team is essential for researchers in clinical and translational science (CTS). Courses that build interprofessional skills are a key component in CTS education, but the development of these courses poses numerous administrative and educational challenges. This paper describes the processes of designing, implementing, and evaluating an innovative graduate-level course that combines online lectures and in-class facilitated group discussions to promote interprofessional interactions. The course offers students the opportunity to interact with and learn from individuals in a variety of disciplines, and it requires students to engage in interprofessional group work to meet the course objectives. During the past 4 years, 96 students from the schools of medicine, pharmacy, nursing, public health, and health and rehabilitation sciences at a large urban university have completed the course. The course has been well-received, with 87% of students rating its overall quality as excellent, good, or satisfactory. The course offers educators a model to teach graduate students the skills that are essential for becoming effective CTS researchers. Clin Trans Sci 2012; Volume #: 1–7
- Top of page
- Design and Implementation of the Course
Clinical and translational science (CTS), an increasingly important focus of health science researchers in the United States, requires investigators to build highly effective interprofessional teams. These teams conduct research that applies both individual skills and group skills to address the complex research issues aimed at improving health. Indeed, interprofessional teams have been recognized as a key component in the efficiency of translating research discoveries into meaningful therapies for patients. For successful “team science,” professionals from multiple backgrounds must be able to communicate effectively, exercise leadership, appreciate the skills and knowledge of investigators from other disciplines, and blend their areas of expertise to reach a common goal. Unfortunately, because academia has traditionally been organized along disciplinary lines to facilitate administration and education, it has been difficult for research trainees to gain the skills and knowledge needed to engage in CTS.[5, 6] To overcome the barriers created by segmented educational offerings, it is crucial for institutions engaged in CTS to foster opportunities for interprofessional interaction.
Larson, Gebbie, and colleagues[8, 9] have recently argued that CTS researchers working in interprofessional teams must develop skills to conduct research, to communicate in a manner that is meaningful to individuals from other disciplines, and to interact with individuals from other disciplines. They divided these three basic skills into 17 core competencies, examples of which include using and integrating theories from multiple disciplines to create a framework for research, publishing manuscripts and writing grant proposals with scholars from other disciplines, engaging and interacting with these scholars, and respecting each individual's perspectives. A willingness to learn and operate within the culture of other disciplines is also critical and may best be practiced in the classroom before students attempt higher stakes research that has a direct bearing on their career success.
To meet the need for interprofessional education for graduate students in the health sciences, the Research Education and Career Development core within the University of Pittsburgh's Clinical and Translational Science Institute designed a course called the Introduction to Translational Research in the Health Sciences. This course provides a foundation of CTS knowledge and develops interprofessional skills through group work to address contemporary research questions aimed at improving human health. In this article, we describe the objectives, design, implementation, and evaluation of this course, which we believe can serve as a model for interprofessional education that aligns with the mission of institutions that have received Clinical and Translational Science Awards from the National Institutes of Health (NIH) and others involved in educating CTS researchers.
Design and Implementation of the Course
- Top of page
- Design and Implementation of the Course
The Introduction to Translational Research in the Health Sciences is a 2-credit, team-taught course that was developed over an 18-month period by an interprofessional group of senior faculty members from the six schools of the health sciences at the University of Pittsburgh: the School of Medicine, Graduate School of Public Health, School of Pharmacy, School of Nursing, School of Health and Rehabilitation Sciences, and School of Dental Medicine. The course planners met on a weekly or biweekly basis to create a cohesive, coherent course with content that would provide the requisite skills for successful interprofessional team-based education in CTS.
The course planners established the following overarching course objectives: (1) educating students about the complex context of health science research by examining critical agenda-setting policy documents about future research; (2) increasing the exposure of students from each discipline to the benefits of multidisciplinary research through case-based examples of successful clinical research teams developed within and outside the university; (3) fostering an understanding of the need for translation of scientific research from the T1 to T3 level (from bench research to human research to application of research to health improvement); and (4) providing students in the class with an experience in multidisciplinary collaboration through completion of a group project.
After defining the objectives, the planners developed a framework (Figure 1) that allowed the group to focus on the specific content for each topic to be covered in the course (Table 1). The planners then worked to overcome two logistic challenges.
Table 1. Course topics and examples of titles of recorded, online lectures
|Topics||Examples of lecture titles|
|Introduction to the National Institutes of Health (NIH) Roadmap and the conceptual framework for multidisciplinary and interdisciplinary research||“Clinical and Translational Research: The NIH Roadmap”|
| ||“The Pathways to Discovery”|
|Objectives at the national level in Healthy People 2010/2020 and at the global level as proposed or designed by organizations such as the World Health Organization||“A Multidisciplinary Approach to a Healthy People 2010/2020 Goal”|
| ||“Healthy Black Families—Pittsburgh: Translate Healthy People 2010/2020 Goals into Culturally Appropriate Community-Based Programs”|
| ||“Nuts and Bolts: Definitions, Terminology, Major Goals, and Objectives of Healthy People 2010/2020”|
|Models of clinical and translational research||“Type 1 Translational Research in Pharmaceutical Sciences”|
| ||“Evidence-Based Approach to the Initial Site of Treatment for Community-Acquired Pneumonia: A Case Study of Type 2 Translational Research”|
| ||“The Conceptual Framework of Type 3 Translational Research”|
|The process of developing drugs and therapeutic devices||“New Drug Discovery: Preclinical to Clinical Drug Development”|
| ||“Postmarketing Surveillance and Individualization of Therapy”|
The first challenge was the busy classroom and clinical service schedules of students to be enrolled in the course. The scheduling problems affected the way in which the primary course content would be delivered and the way in which the student groups would meet to discuss their specific course project. To resolve these problems, the planners decided to offer the course in the evening and to use a “flipped classroom” approach to facilitate provision of instructional content. This approach involves posting the majority of the lecture content online as videos and using classroom time for facilitated discussion of the video content and student group work on course projects. Lectures and slides by University of Pittsburgh faculty were captured using Panopto CourseCast (Panopto International, Pittsburgh, Pennsylvania). The flipped classroom approach was particularly useful because it provided a forum for students to work together on their course project in the presence of the course instructors, who serve as facilitators when needed. It also reduced the number of live in-class sessions from 15 to 9 during the semester. The remaining weeks could be dedicated to watching online lectures and participating in group meetings.
The second logistical challenge was related to the requirement that students be engaged in interprofessional interactions. This requirement made it essential to attract students from multiple health-related disciplines. To promote student enrollment from all six schools of the health sciences, the course planners decided to cross-list the course in each school. Faculty from the planning group and an advisory committee agreed to serve as course advocates in their own schools to attract students with an interest in CTS.
The course was taught the first year (2008) by one faculty member in pharmaceutical sciences. In the subsequent 3 years, the course was team-taught by two instructors, one in pharmaceutical sciences and the other in nursing. The course instructors were purposefully selected because they had different professional and disciplinary backgrounds and because their research is at two different key positions along the translational research continuum, allowing them to provide different perspectives on the students’ project ideas. A teaching assistant, selected from students who took the class in a previous year, was familiar with the course activities and could facilitate the discussions at a level that was close to that of the students.
Team teaching has been critical to the success of the course, as it demonstrates to students the skills necessary to collaborate with and appreciate the perspectives of individuals from diverse professions. Both of the instructors and the teaching assistant have been present at the majority of in-class sessions. Their experiences and perspectives have allowed them to highlight different aspects of the readings or online lectures, and their divergent disciplinary backgrounds have helped them serve as useful resources on which each student group can draw for advice about its group project.
A major objective of the course is to have each student be part of a multidisciplinary group that will develop and complete a 10-page written project to be turned in at the end of the semester. This project requires the definition and justification of a study that involves T1 or T2 translational research and has the potential to make a major impact on health within the next 10 years.
The instructors introduce the goals of the project at the start of the semester and explain how the course content and facilitated group work are designed to accomplish these goals. The instructors emphasize the importance of having the final project incorporate the ideas and expertise of each of the various professions represented in the group. They provide the students with examples of titles of previous group projects to demonstrate how a multidisciplinary group—for example, a group consisting of students from microbiology, pharmacy, behavioral and community health sciences, clinical research, and infectious diseases—can design a project on developing the process for translating a promising vaccine to clinical trials, with full consideration of health policy implications. This translation requires students to consider the larger agenda-setting framework that influences health research.
At the beginning of the course, the students complete a short questionnaire about their professional background and areas of interest. This helps in the formation of groups for class projects. Each group consists of students who are from different professions but share a common interest in a health issue or therapeutic area. Because students range from medical students and early graduate students to faculty members, their differences in theoretical and practical knowledge are often substantial. However, these differences are outweighed by the students’ common interest, which is essential for the group project that forms the main product of the course. Initially, group members spend time becoming acquainted with each other and with the various disciplines and professions that they represent. Only after the group members learn to speak a common language and understand varying interpretations of problems and scenarios can they begin work on the components of their final project.
Instructors are available to work with groups throughout the semester, providing questions for consideration and helping to ensure the projects are appropriate for the course. At the midpoint of the course, each group presents the description and justification portions of its project and receives graded feedback on its progress. This more formative assessment gives the group the opportunity to refocus its project if needed, based on the proposed impact of the work relative to the defined project objectives. At the end of the semester, the group submits its written report, which again receives graded feedback. The assessment methods for the course use a standard rubric (Table 2) that focuses on the extent to which interprofessional teamwork has resulted in a final project that meets the research-related and health-related objectives outlined earlier.
Table 2. Final project rubric
| ||Excellent (4 points)||Very good (3 points)||Good (2 points)||Fair (1 point)|
|(1) Defining and justifying the research|
|Define and justify the line of research selected.||Clear and focused description of the research selected, which is justified from multiple perspectives.||Overall clear description provided. Specific/critical areas of the research are identified but not described completely. Justification is generally provided but primarily from a single perspective.||Generally described but partially unfocused research area with only a partial justification provided.||Unfocused and unclear area of research, which is not well developed or justified.|
|Identify the current barriers that are limiting the field.||The most significant barriers are identified and the ramifications of these barriers in limiting clinical translation are thoroughly discussed.||Some, but not all, significant barriers are identified and discussed. The impact of these barriers on clinical translation is not fully explored.||A few barriers are identified with nonspecific discussion of the impact on clinical translation.||Major barriers are not identified or discussed and the impact on clinical translation is not well developed.|
|(3) Overcoming barriers|
|Describe approach(es) to overcome barriers (detailed methods/study design are not necessary).||A novel approach to overcome the most significant barriers is developed and thoroughly justified.||A novel approach to overcome barriers is developed, but some barriers and/or issues with resolution are not fully developed.||An approach to overcome barriers is discussed, but the most significant issues are not addressed or the approach is not adequate to overcome the barrier.||The approach to overcome the barriers is only discussed in general terms and is not fully developed.|
|Anticipate the outcomes or impact.||A thorough transdisciplinary approach is taken in assessing outcomes and impact.||Outcomes and impact are well addressed in general. However transdisciplinary impact is primarily from a disciplinary perspective.||Outcomes and impact are thoroughly addressed, but from a single disciplinary perspective.||Outcomes and impact are not fully addressed, with few signs of a transdisciplinary perspective.|
|(5) Transdisciplinary aspects|
|Discuss how various disciplines can together create a more effective and novel approach to this research.||Clear delineation of a transdisciplinary approach to enable novel interventions to improve human health in the defined research area.||Adequate delineation of transdisciplinary approach with some new interventions.||General delineation of transdisciplinary approach with very few novel interventions.||Little delineation of transdisciplinary approach with no novel interventions.|
Course changes in response to early feedback from students
In response to student feedback, the methods of forming the project groups have evolved during the 4 years of the course. Students who participated in the first year suggested the need to provide more information on research types along the translational and clinical continuum (T1, T2, and T3) earlier in the course and to focus on this before groups are formed and projects initiated. These suggestions were adopted, and no students provided similar feedback in subsequent years. Now the instructors divide the students into groups a few weeks after the semester begins.
During the first 2 years, some students found the 1-hour online lectures too long to remain engaged. As resources permitted and content changed, lectures were re-recorded and shortened, with the result that no students commented on this problem in subsequent years.
Course enrollment and evaluation
During the first 4 years in which the course was offered (2008 to 2011), a total of 96 students were enrolled. The students were approximately equally split between the sexes, with slightly more women than men. Over half the students were White, with Asian being the next largest group. Almost three quarters of students were under the age of 35, with almost one third in the 25–29 age range (Table 3).The students were from five of the schools of the health sciences plus the School of Education (Figure 2). The students had either completed degree programs or were enrolled in programs to earn a wide array of degrees, including the PhD, MPH, MD, and PharmD. 30% of students had or were earning PhDs, one of which was also earning an MD. The other 70% were pursuing professional doctorates or masters degrees. Although the professional goals of students was not among the data collected, two thirds have published a peer reviewed article indexed by the National Library of Medicine's PubMed database since they entered the class (Table 4). These data suggest that the majority have some interest in conducting research in the course of their careers. The variety of perspectives and research interests, as well as students’ creativity in weaving them all together, is demonstrated by the range of titles of their completed group projects (Table 5).
Table 3. Student demography
|Race|| || |
|Native Hawaiian/Pacific Islander||1||1%|
|Age|| || |
|Sex|| || |
Table 4. Number of publications by students since beginning the class, by class year
| ||Publications per student||Range of publications||Proportion of students with any publications|
Table 5. Examples of topics of the students’ group projects
|• “Lifestyle Modification Improves Fertility and Reduces Pregnancy Complications in Women with Polycystic Ovarian Syndrome”|
|• “The Effect of a Combined Diet and Exercise Intervention on the Efficacy of Tumor Vaccination Therapy in Older Patients with Metastatic Melanoma”|
|• “Suicidality in Depressed Children and Adolescents: Identifying a Biomarker for Risk Recognition”|
|• “Enhancing Medication Adherence to Hydroxyurea among Patients with Sickle Cell Disease”|
|• “The Influence of Stress on Food Reward Processing in the Brain and the Association of Stress with Obesity”|
At the end of each course, the students were asked to complete a survey and indicate their responses on a 5-point Likert-type scale. The survey included items about the topics covered in the course, the group project, the way in which course materials were presented, and the feedback on assignments, and it included one item about the overall quality of the course. The survey also provided students with the opportunity to add comments.
Eighty-one students (84%) provided responses to the majority of the questions. The survey results indicated that the course was well received and was perceived to have achieved its stated objectives (Table 6). Sixty-two respondents (76%) agreed or strongly agreed that the group project provided an authentic experience to understand multidisciplinary teamwork, and 69 (87%) felt that the overall quality of the course was excellent, good, or satisfactory. Of the four students who rated the course as poor, two were enrolled in 2008 (the first year that the course was offered), one in 2009 and one in 2011, suggesting that the course had been improved from its initial year. The interprofessional nature of the course was highly valued. Table 7 presents a representative collection of student comments regarding the interprofessional nature of the course. The most frequently provided comment was an appreciation of working with students from other programs. Constructive criticism was also welcomed by the course directors, and comments of this nature were used in refining the course in subsequent years.
Table 6. Evaluation scores from students who completed the interprofessional course over the 4-year period
|Survey item||Number (%) of responses*|
| ||Strongly agree||Agree||Neutral||Disagree||Strongly disagree|
|Topics were covered in a logical sequence||23 (28.4)||39 (48.1)||14 (17.3)||3 (3.7)||2 (2.5)|
|Group project provided an authentic experience to understand multidisciplinary teamwork||27 (33.3)||35 (43.2)||11 (13.6)||7 (8.6)||1 (1.2)|
|Course material was presented in a way that facilitated understanding||21 (26.9)||39 (50.0)||13 (16.7)||5 (6.4)||0 (0)|
|Feedback on course assignments was helpful and applicable||24 (30.4)||40 (50.6)||7 (8.9)||5 (6.3)||3 (3.8)|
|Overall quality of this course||19 (24.1)||36 (45.6)||14 (17.7)||6 (7.6)||4 (5.1)|
Table 7. Sample comments from students about the interprofessional nature of the course
|• Having an opportunity to work with students from varying backgrounds was the highlight of this course for me.|
|• I thoroughly enjoyed the group project the most out of all class activities. It was a unique opportunity to learn how to work with other subspecialties.|
|• I really enjoyed learning from my group members. Overall, I experienced a transdisciplinary approach to developing a project.|
|• This course gave me a good experience in working within a group effectively.|
|• Working with team members with a variety of different interests and determining how to best design a project was challenging, but will likely be beneficial to my future practice.|
|• The multidisciplinary nature of students fits well with a translational research course.|
|• I appreciated the ability to work in a multidisciplinary group. It allowed us to observe the practicality of research efforts, a perspective I needed earlier last year when my enthusiasm for research was depreciating. The concept of multidisciplinary approaches is current but also forward thinking depending on subject matter. Also, the exposure to the various forms of translational research through the development of our own project was beneficial. I think this course definitely allowed me to apply my current and former knowledge which was rewarding. The group work was stimulating, and it was beneficial to offer a portion of class time for us to work as a team due to our unique schedules.|
|• The term paper did not exactly mimic multidisciplinary teamwork, although the concept was definitely there. Another idea to implement multidisciplinary work is to give group problems, for the multidisciplinary groups to put their heads together and solve them.|
|• The expectations of the group project were difficult to understand at first. We had a lot of difficulty choosing a topic, and eventually, we realized that not fully understanding the expectations contributed to our frequent changes in direction. I think we are all happy with our project now and feel it matches well with the course expectations … it just took us a long time to get there.|
Future offerings of the course will be followed by a survey four months after the end of class, during the same academic year. It will assess whether students feel their behavior within their professional and other course-based teams has benefited from their learning in the course.
- Top of page
- Design and Implementation of the Course
Introduction to Translational Research in the Health Sciences was designed to create a learning environment in which graduate students from multiple disciplines could work together on group projects that address complex health problems. The online lecture material provided students with information about the types of translational research and gave them tangible examples of the research approaches of experts in multiple fields involved in T1, T2, and T3 research. The course focused on enabling students to appreciate the iterative nature of scientific inquiry involved in translational research and to blend different research approaches in their final group projects. The quality of the final projects indicated that the course met its objectives; the project from one group during the first year even received the University of Pittsburgh's Interprofessional Education Award. Student evaluations of the course over a 4-year period indicated that the course met its objectives and has the potential to serve as a template for interprofessional graduate education.
Members of the course planning group were aware of the many logistical and academic challenges to designing and implementing an interprofessional course. As indicated in the literature, these challenges include the following: “turf wars” as departments or schools vie for the rewards and control of teaching,[5, 6, 12] resistance to new organizational or administrative structures that may need to be developed to facilitate interprofessional education,[5, 13] difficulties in matching student abilities and providing the students with a common knowledge base and language to discuss topics,[5, 6] difficulties in ensuring that students are interactively engaged in coursework as a group, rather than merely learning as individuals in the same room, challenges in aligning curriculum requirements and assessment standards based on the practical needs of individual programs and students,[6, 13] difficulties in overcoming stereotypes about colleagues from other professions,[6, 12] and challenges in overcoming differences in the students’ level of familiarity with teaching and learning methods of diverse professions.[12, 13]
The challenges noted in the literature pertain to courses for students who have already received professional degrees. In cases like ours, in which some students are in the early years of becoming professionals, there are also challenges related to course content and how to deal with differences in knowledge about a variety of topics, including methodological approaches. Given our focus on group projects, the faculty also had to ensure that students would not feel that their field of study was unrelated to topics that were being considered for projects. To keep this project-related challenge from becoming a major source of dissatisfaction for students, the instructors grouped the students on the basis of shared interests, while ensuring that each group had representation from at least three different schools of the health sciences. The instructors indicated to students that they believed the students’ different backgrounds would offer the opportunity to exchange knowledge about different approaches to their health-related project, but they emphasized that the project should focus on developing a research idea with the potential to impact human health. It should not focus on methodology and study design or on detailed discipline-specific knowledge. These steps helped students learn from one another through a more general discussion of the broader impact of their project on health.
At our institution, members of all six schools of the health sciences were involved in the course design and served as advocates or ambassadors for the course. Despite this, we found recruitment of students from the various schools to be challenging. To obtain a more even distribution of students from different professions in the course, we need more support and promotion of the course from graduate programs within the different schools. Because the course is not required for any degree, students often take it as an elective later in their studies. Ideally, however, given that the course is an introductory course and that it may have an impact on the research that the students choose to pursue, it would be preferable for advisers to encourage students to take the course earlier in their career.
An additional challenge that we continue to face is the identification of specific core competencies to be addressed by the course. Recently, the School of Pharmacy and School of Medicine at our institution have developed core competencies for clinical research education.[14, 15] The other schools of the health sciences are in the process of developing competencies for some of their programs. After the faculty from the other health science schools have mapped the objectives of the course with the competencies they have developed, we will be able to tailor our student assessments and course evaluations to complete a thorough assessment of competency-based mastery of the course content.
To achieve the goal of competency-based education, we need to address the additional challenge of considering whether it is preferable to use the current set of competencies developed by one specific academic entity (department, school, or institute) or to adopt interprofessional education-specific competencies, such as those developed by Gebbie et al. Additional options—and complications—arise when some of the students in the course must obtain a professional license (such as a PharmD) or meet other certification requirements (such as those of an advanced practice registered nurse, or APRN). The competencies in cases such as this are regulated by the licensing and certifying boards, rather than by academic programs.
The benefit of using internally developed competencies is that doing so allows faculty members to take advantage of existing frameworks, rubrics, and evaluations. However, deciding which academic entity's competencies to use could be problematic in a course that is cross-listed in six different schools. The competencies must be relevant to students from all professions, but they must also be specific enough to be useful in an individual student's professional development, particularly if the student is required to demonstrate specific competencies for completion of a degree or license. The competencies and their relationship to the course objectives therefore remain an important area for future development and refinement of this course.
Although our course has been successful in the organizational context of the University of Pittsburgh, a course like ours may encounter other challenges in universities with different organizational structures and student bodies.
- Top of page
- Design and Implementation of the Course
The success of our course thus far shows the possibilities of interprofessional education for clinicians interested in conducting research, as well as the originality of an approach that is made possible by bringing together researchers from different backgrounds and disciplines. Despite its multiple successes, the course remains a work-in-progress so that student needs are best met and the evolving discipline of CTS is accurately studied.
The success of the course suggests the possibility of offering a broader array of interprofessional courses at academic institutions with strength in the health sciences. Naturally, there is a limit to the range of subjects that can be covered in interprofessional education, but we believe that subjects that deserve consideration include grant writing, biostatistics, and professional skills development. Faculty designing and teaching interprofessional courses will certainly encounter a number of the challenges described above and in the literature. However, our experience has shown that with careful forethought and the intentional solicitation of support from senior faculty members in multiple fields and various schools of the health sciences, many challenging barriers can be overcome.
- Top of page
- Design and Implementation of the Course
This project was supported by the National Institutes of Health through Grant Numbers UL1 RR024153 and UL1 TR000005. For their contributions to the course design, we thank the following representatives from the schools of the health sciences at the University of Pittsburgh: Ellen Cohn, PhD, CCC-SLP (School of Health and Rehabilitation Sciences); Carol Feghali Bostwick, PhD (School of Medicine); Margaret MacDonald, PhD (Graduate School of Public Health and Office of the Senior Vice Chancellor for the Health Sciences); Mary Marazita, PhD, School of Dental Medicine); and Sandra Quinn, PhD (Graduate School of Public Health). For the management of online course material, the collation of student evaluations, and help with student publications data, we are grateful to Lauren S. Talotta.