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Petrie S, Cheng I, McMahon M, Lavis JN. Future leaders in a learning health system: Exploring the Health System Impact Fellowship. Healthc Manage Forum 2024; 37:151-155. [PMID: 38016119 PMCID: PMC11044521 DOI: 10.1177/08404704231216951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The Canadian health system is reeling following the COVID-19 pandemic. Strains have become growing cracks, with long emergency department wait times, shortage of human health resources, and growing dissatisfaction from both clinicians and patients. To address long-needed health system reform in Canada, a modernization of training is required for the next generation health leaders. The Canadian Institutes of Health Research Health System Impact Fellowship (HSIF) is an example of a well-funded and connected training program which prioritizes embedded research and embedding technically trained scholars with health system partners. The program has been successful in the scope and impact of its training outcomes as well as providing health system partners with a pool of connected and capable scholars. Looking forward, integrating aspects of evidence synthesis from both domestic and international sources and adapting a general contractor approach to implementation within the HSIF could help catalyze learning health system reform in Canada.
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Affiliation(s)
- Samuel Petrie
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Meghan McMahon
- University of Toronto, Toronto, Ontario, Canada
- CIHR Institute of Health Services and Policy Research, Ottawa, Ontario, Canada
| | - John N. Lavis
- McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, Hamilton, Ontario, Canada
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Kasaai B, Thompson E, Glazier RH, McMahon M. Enrichment of core competencies to maximize health system impact: An analysis of an embedded research training program. Learn Health Syst 2024; 8:e10399. [PMID: 38633024 PMCID: PMC11019376 DOI: 10.1002/lrh2.10399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction The Health System Impact (HSI) Fellowship is an embedded research training program that aims to prepare doctoral trainees and postdoctoral fellows for stronger career readiness and greater impact as emerging leaders within and beyond the academy, including in learning health systems (LHS). The program supports fellows to develop 10 leadership and research competencies that comprise the Enriched Core Competency Framework in Health Services and Policy Research through a combination of experiential learning, mentorship, and professional development training. This study tracks competency development of HSI fellows over time and examines fellows' perspectives on which program design elements support their competency development. Methods A competency assessment tool developed for the program was independently completed by 95 postdoctoral and 36 doctoral fellows (self-assessments) and their respective 203 dyad (academic and health system) supervisors in the 2017 to 2019 program cohorts, who independently rated the strength of fellows' 10 competencies at baseline and several points thereafter. Competency strength ratings were analyzed to understand change over time and differences in ratings across groups (between fellows' sex, supervisor type, and supervisor vs. fellow). Program design element ratings were examined to understand perspectives on their contribution toward fellows' competency development. Results Fellows' competency strength significantly improved in all 10 domains over time, based on independent assessments by the fellows and their dyad supervisors. Supervisors tended to rate the fellows' competency strength higher than the fellows did. Differences in competency ratings between male and female fellows (self-assessments) and between academic and health system supervisors were either negligble or not significant. Fellows identified all nine program design elements as enriching their competency development. Conclusion The HSI Fellowship provides an opportunity for fellows to develop the full suite of enriched core competencies and to prepare a cadre of emerging leaders with the skills and experience to contribute to the advancement of LHS.
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Affiliation(s)
- Bahar Kasaai
- CIHR Institute of Health Services and Policy Research (IHSPR)TorontoOntarioCanada
| | - Erin Thompson
- CIHR Institute of Health Services and Policy Research (IHSPR)TorontoOntarioCanada
| | - Richard H Glazier
- CIHR Institute of Health Services and Policy Research (IHSPR)TorontoOntarioCanada
- Institute for Clinical Evaluative Sciences (ICES)TorontoOntarioCanada
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
- Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Meghan McMahon
- CIHR Institute of Health Services and Policy Research (IHSPR)TorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
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Gallant SM, Cassidy C, Al-Rassi J, Moody E, Shin HD, Best S, Steenbeek A. Integrated knowledge translation guidelines for trainees in health research: an environmental scan. Health Res Policy Syst 2023; 21:74. [PMID: 37452332 PMCID: PMC10349463 DOI: 10.1186/s12961-023-01024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Collaborative health research, such as integrated knowledge translation (IKT), requires researchers to have specific knowledge and skills in working in partnership with knowledge users. Graduate students are often not provided with the opportunity to learn skills in how to establish collaborative relationships with knowledge users in the health system or communities, despite its importance in research. The objective of this environmental scan is to identify available guidelines for graduate trainees to use an IKT approach in their research. METHODS We conducted an environmental scan with three separate systematic searches to identify guidelines available to support graduate students in engaging in an IKT approach to research: (i) a customized Google search; (ii) a targeted Canadian university website search; and (iii) emails to administrators of graduate studies programmes asking for available guidelines and documents designed for graduate students. Data were extracted using a standardized data extraction tool and analysed using a directed content analysis approach. Due to the minimal results included based on the a priori eligibility criteria, we returned to the excluded records to further review the current state of the environment on trainee support for IKT research. RESULTS Our search strategy yielded 22 900 items, and after a two-step screening process with strict inclusion criteria three documents met the eligibility criteria. All three documents highlighted the need for an IKT plan for knowledge user involvement throughout the research process. Furthermore, documents emphasized the need for tangible steps to guide graduate students to engage in effective communication with knowledge users. Due to the lack of documents retrieved, we conducted a post hoc content analysis of relevant IKT documents excluded and identified five themes demonstrating increased education and engagement in an IKT approach at an interpersonal and organizational level. CONCLUSION We identified three documents providing guidance to trainees using a collaborative approach in their health research. This scan highlighted two key findings including the importance of supporting trainees to engage knowledge users in research and preparing an IKT plan alongside a research plan. Further research is needed to co-design guidelines to support graduate students and trainees in engaging in an IKT approach.
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Affiliation(s)
- Sarah Madeline Gallant
- School of Nursing, Dalhousie University, Halifax, NS, Canada.
- The Strengthening Transitions in Care Lab, IWK Health, Halifax, NS, Canada.
| | - Christine Cassidy
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- The Strengthening Transitions in Care Lab, IWK Health, Halifax, NS, Canada
| | - Joyce Al-Rassi
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Management, and Evaluation, Institute of Health Policy, University of Toronto, Toronto, ON, Canada
- Centre for Complex Care Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Kasaai B, Thompson E, Glazier RH, McMahon M. Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program. Int J Health Policy Manag 2023; 12:7333. [PMID: 37579439 PMCID: PMC10125101 DOI: 10.34172/ijhpm.2023.7333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This descriptive study reports the early career outcomes of postdoctoral fellows who completed a novel embedded fellowship training program, the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship. The program was designed to support impact-oriented career paths of doctoral graduates, build research capacity within health system organizations, and help to advance learning health systems in Canada. METHODS Employment of fellowship alumni upon completion of the program were tracked using internet searches of publicly accessible online sources and complemented with program survey data. RESULTS Descriptive analyses show that all 87 eligible alumni included in the study are currently employed (100% of 87), with 92% employed in Canada. Their employment spans several sectors, including in academic (37%), public (29%), healthcare delivery (17%), and private (14%) sectors. Altogether, 32% of alumni held hybrid roles with an affiliation in academia and another sector. The most common position types were senior scientist (42%), professorships (18%), and director, manager or administrator roles (12%). Program reporting data indicate that these employment outcomes are generally consistent with the group's career aspirations reported at the start of the fellowship program, and that the program receives high ratings from fellows in the extent it is believed to support their career preparedness and readiness (4.49 out of 5). CONCLUSION We find that HSI Fellow alumni are employed mostly in research-related roles in a range of sectors including, but not limited to academia, that they positively perceive the program's success in elevating their career readiness and potential to make an impact - suggesting that the program may help equip fellows with the skills, readiness and networks for a broad array of employment sectors and roles. The findings are a promising signal of the demand for research talent and the growing capacity for learning health systems in Canada.
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Affiliation(s)
- Bahar Kasaai
- CIHR Institute of Health Services and Policy Research, Toronto, ON, Canada
| | - Erin Thompson
- CIHR Institute of Health Services and Policy Research, Toronto, ON, Canada
| | - Richard H. Glazier
- CIHR Institute of Health Services and Policy Research, Toronto, ON, Canada
- ICES (Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Meghan McMahon
- CIHR Institute of Health Services and Policy Research, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Terry AL, Stewart M, Ashcroft R, Brown JB, Burge F, Haggerty J, McWilliam C, Meredith L, Reid GJ, Thomas R, Wong ST. Complex skills are required for new primary health care researchers: a training program responds. BMC MEDICAL EDUCATION 2022; 22:565. [PMID: 35869518 PMCID: PMC9306239 DOI: 10.1186/s12909-022-03620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Affiliation(s)
- Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec Canada
| | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Leslie Meredith
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Graham J. Reid
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Psychology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sabrina T. Wong
- School of Nursing, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia Canada
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Cassidy CE, Shin HD, Ramage E, Conway A, Mrklas K, Laur C, Beck A, Varin MD, Steinwender S, Nguyen T, Langley J, Dorey R, Donnelly L, Ormel I. Trainee-led research using an integrated knowledge translation or other research partnership approaches: a scoping reviews. Health Res Policy Syst 2021; 19:135. [PMID: 34727926 PMCID: PMC8561363 DOI: 10.1186/s12961-021-00784-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work. METHODS We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research. CONCLUSION Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.
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Affiliation(s)
| | | | - Emily Ramage
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Aislinn Conway
- Better Outcomes and Registry Network (BORN), Ottawa, ON Canada
| | - Kelly Mrklas
- Alberta Health Services Foothills Medical Centre, Calgary, AB Canada
| | - Celia Laur
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Canada
| | - Amy Beck
- Faculty of Nursing, University of Calgary, Calgary, AB Canada
| | | | | | - Tram Nguyen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Jodi Langley
- School of Health and Human Performance, Dalhousie University, Halifax, NS Canada
| | | | | | - Ilja Ormel
- Department of Family Medicine, McGill University, Montreal, QC Canada
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Cassidy CE, Beck AJ, Conway A, Demery Varin M, Laur C, Lewis KB, Ramage ER, Nguyen T, Steinwender S, Ormel I, Stratton L, Shin HD. Using an integrated knowledge translation or other research partnership approach in trainee-led research: a scoping review protocol. BMJ Open 2021; 11:e043756. [PMID: 34035094 PMCID: PMC8154946 DOI: 10.1136/bmjopen-2020-043756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Collaborative research approaches, such as co-production, co-design, engaged scholarship and integrated knowledge translation (IKT), aim to bridge the evidence to practice and policy gap. There are multiple benefits of collaborative research approaches, but studies report many challenges with establishing and maintaining research partnerships. Researchers often do not have the opportunity to learn how to build collaborative relationships, and most graduate students do not receive formal training in research partnerships. We are unlikely to make meaningful progress in strengthening graduate and postgraduate training on working collaboratively with the health system until we have a better understanding of how students are currently engaging in research partnership approaches. In response, this scoping review aims to map and characterise the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees. METHODS AND ANALYSIS We will employ methods described by the Joanna Briggs Institute and Arksey and O'Malley's framework for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. We will include both published and unpublished grey literature and search the following databases: MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global databases, Google Scholar and websites from professional bodies and other organisations. Two reviewers will independently screen the articles and extract data using a standardised data collection form. We will narratively describe quantitative data and conduct a thematic analysis of qualitative data. We will map the IKT and other research partnership activities onto the Knowledge to Action cycle and IAP2 Levels of Engagement Framework. ETHICS AND DISSEMINATION No ethical approval is required for this study. We will share the results in a peer-reviewed, open access publication, conference presentation and stakeholder communications.
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Affiliation(s)
| | - Amy Jane Beck
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Melissa Demery Varin
- School of Nursing, University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - Celia Laur
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily R Ramage
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tram Nguyen
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Steinwender
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ilja Ormel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lillian Stratton
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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McMahon M, Creatore MI, Thompson E, Lay AM, Hoffman SJ, Finegood DT, Glazier RH. The Promise of Science, Knowledge Mobilization, and Rapid Learning Systems for COVID-19 Recovery. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:242-246. [PMID: 33736515 DOI: 10.1177/0020731421997089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The health, economic, and social crises created by the coronavirus disease 2019 (COVID-19) pandemic have been global in scope and inequitable in impact. The global road to recovery can be enhanced with robust, relevant, and timely scientific evidence. This commentary seeks to illustrate the power of science, scientific collaboration, and innovative research funding programs to inform pandemic recovery and inspire transformational changes for a more equitable, resilient, and sustainable future. Specifically, this commentary provides an introduction to the United Nations (UN) Research Roadmap for the COVID-19 Recovery that was published in November 2020. It introduces 5 scoping reviews that helped inform the UN Research Roadmap and that are now available open access within this series of special papers, and it provides an overview of an innovative research funding program that facilitated rapid mobilization and collaboration to produce the scoping reviews. The publication of the scoping reviews in this journal series will help complement and amplify the UN Research Roadmap by furthering knowledge mobilization efforts and informing COVID-19 recovery around the world, to ensure a more equitable, resilient, and sustainable postpandemic future.
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Affiliation(s)
- Meghan McMahon
- Institute of Health Services and Policy Research, 27349Canadian Institutes of Health Research, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Marisa I Creatore
- 280092Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erin Thompson
- Institute of Health Services and Policy Research, 27349Canadian Institutes of Health Research, Toronto, ON, Canada
| | - Andrea Morgan Lay
- 280092Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, ON, Canada
| | - Steven J Hoffman
- 280092Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, ON, Canada.,Global Strategy Lab, Toronto, ON, Canada.,York University, Toronto, ON, Canada
| | - Diane T Finegood
- 27349Canadian Health Services and Policy Research Alliance, Vancouver, BC, Canada.,Morris J. Wosk Centre for Dialogue, 1763Simon Fraser University, Vancouver, BC, Canada.,1763Simon Fraser University, Vancouver, BC, Canada
| | - Richard H Glazier
- Institute of Health Services and Policy Research, 27349Canadian Institutes of Health Research, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES (Institute for Clinical and Evaluative Sciences) central, Toronto, ON, Canada.,MAP Centre of Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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McMahon M, Habib B, Tamblyn R. The Career Outcomes of Health Services and Policy Research Doctoral Graduates. ACTA ACUST UNITED AC 2020; 15:16-33. [PMID: 31755857 PMCID: PMC7017755 DOI: 10.12927/hcpol.2019.25982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine the career outcomes of 20 years of PhD graduates from Canadian health services and policy research (HSPR) doctoral training programs. METHODS The deans of the doctoral training programs were invited to participate in this national cohort study. A standardized career-tracking template was developed. Internet searches of publicly accessible sources were used to track graduates' employment. Descriptive analyses summarized PhD program characteristics and current employment. RESULTS Of the 1,208 trainees who graduated during our study period, 884 (73.2% of 1,208, or 90.3% of the 979 with complete data) could be successfully tracked. HSPR PhD graduates are highly employable, but employment trends have changed over time. Today's graduates are more likely to enter careers in a wider variety of sectors and roles and are less likely to be employed in academia than previous graduates. However, over 50% of graduates are currently employed in professorial positions within the academic sector or in research roles or departments within healthcare delivery organizations. CONCLUSIONS This article provides an initial descriptive profile of the career outcomes of HSPR PhD graduates in Canada from 10 university-based doctoral training programs. To ensure that PhD graduates are prepared to contribute fully within diverse sectors and roles, doctoral training must evolve to keep pace with employment trends and encompass, in addition to research skills, the professional skills demanded in the public, private, not-for-profit and healthcare delivery sectors.
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Affiliation(s)
- Meghan McMahon
- Associate Director, CIHR Institute of Health Services and Policy Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Bettina Habib
- Research Assistant, Clinical and Health Informatics Research Group, McGill University, Montreal, QC
| | - Robyn Tamblyn
- Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC
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McMahon M, Bornstein S, Brown A, Simpson LA, Savitz L, Tamblyn R. Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships. ACTA ACUST UNITED AC 2020; 15:34-48. [PMID: 31755858 PMCID: PMC7017757 DOI: 10.12927/hcpol.2019.25981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The benefits of supporting experiential learning for improved health and societal outcomes have been recognized in many countries. A number of funding organizations have developed competitive funding opportunities to support experiential learning in health system organizations outside of the traditional university setting. AcademyHealth in the US is an early innovator that pioneered the Delivery System Science Fellowship (DSSF) and inspired Canada's creation of the Health System Impact (HSI) Fellowship program. The DSSF and HSI Fellowship have similar objectives: to improve the career readiness of doctorally prepared graduates and to build research capacity within health system organizations. However, the programs have taken different approaches to achieve these objectives and operate in different healthcare systems. This paper outlines the two models of embedded fellowships, analyzes their commonalities and differences, discusses lessons learned and suggests future directions for health services and policy research training.
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Affiliation(s)
- Meghan McMahon
- Associate Director, CIHR Institute of Health Services and Policy Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Stephen Bornstein
- Professor, Division of Community Health and Humanities, Faculty of Medicine, Department of Political Science, Faculty of Arts, Memorial University; Director, Newfoundland and Labrador Centre for Applied Health Research; Co-Director, SafetyNet Centre for Occupational Health and Safety Research, St. John's, NL
| | - Adalsteinn Brown
- Dean, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Lucy Savitz
- Vice President, Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Robyn Tamblyn
- Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC
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McMahon M, Bornstein S, Brown A, Tamblyn R. Training for Impact: PhD Modernization as a Key Resource for Learning Health Systems. ACTA ACUST UNITED AC 2020; 15:10-15. [PMID: 31755856 PMCID: PMC7017756 DOI: 10.12927/hcpol.2019.25983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Meghan McMahon
- Associate Director, CIHR Institute of Health Services and Policy Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Stephen Bornstein
- Professor, Division of Community Health and Humanities, Faculty of Medicine, Department of Political Science, Faculty of Arts, Memorial University; Director, Newfoundland and Labrador Centre for Applied Health Research; Co-Director, SafetyNet Centre for Occupational Health and Safety Research, St. John's, NL
| | - Adalsteinn Brown
- Dean, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Robyn Tamblyn
- Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC
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Blanchette MA, Saari M, Aubrecht K, Bailey C, Cheng I, Embrett M, Ghandour EK, Haw J, Koval A, Liu RH, Manhas KP, Mawani FN, Mcconnell-Nzunga J, Petricca K, Sim M, Singal D, Syrowatka A, Lai J. Making Contributions and Defining Success: An eDelphi Study of the Inaugural Cohort of CIHR Health System Impact Fellows, Host Supervisors and Academic Supervisors. ACTA ACUST UNITED AC 2020; 15:49-60. [PMID: 31755859 PMCID: PMC7017753 DOI: 10.12927/hcpol.2019.25980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context: The Health System Impact (HSI) Fellowship, an innovative training program developed by the Canadian Institutes of Health Research's Institute of Health Services and Policy Research, provides PhD-trained health researchers with an embedded, experiential learning opportunity within a health system organization. Methods/Design: An electronic Delphi (eDelphi) study was conducted to: (1) identify the criteria used to define success in the program and (2) elucidate the main contributions fellows made to their organizations. Through an iterative, two-round eDelphi process, perspectives were elicited from three stakeholder groups in the inaugural cohort of the HSI Fellowship: HSI fellows, host supervisors and academic supervisors. Discussion: A consensus was reached on many criteria of success for an embedded research fellowship and on several perceived contributions of the fellows to their host organization and academic institutions. This work begins to identify specific criteria for success in the fellowship that can be used to improve future iterations of the program.
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Affiliation(s)
- Marc-André Blanchette
- Département de chiropratique, Université du Québec à Trois-Rivières; Epidemiology, Biostatistics and Occupational Health, McGill University; Institut national d'excellence en santé et services sociaux, Trois-Rivières, QC
| | - Margaret Saari
- SE Research Centre, SE Health and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Katie Aubrecht
- Nova Scotia Health Authority Continuing Care-Research, Mount Saint Vincent University, Halifax, NS
| | - Chantelle Bailey
- Canadian Nurses Association and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Mark Embrett
- Canada Health Infoway, McMaster University, Toronto, ON
| | | | - Jennie Haw
- Canadian Blood Services, Western University, Ottawa, ON
| | - Andriy Koval
- Observatory for Population and Public Health, University of British Columbia, Vancouver, BC
| | - Rebecca H Liu
- University of Ottawa, Region of Peel Public Health, Toronto, ON
| | | | - Farah N Mawani
- MAP Centre for Urban Health Solutions St. Michael's Hospital; Faculty of Environmental Studies, York University, Toronto, ON
| | | | - Kadia Petricca
- North York General Hospital, Department of Research and Innovation, University of Toronto, IHPME, Toronto, ON
| | - Meaghan Sim
- Nova Scotia Health Authority; Healthy Populations Institute, Dalhousie University, Halifax, NS
| | - Deepa Singal
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Ania Syrowatka
- Canadian Foundation for Healthcare Improvement, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON
| | - Jonathan Lai
- Centre for Innovation in Autism and Intellectual Disabilities, Miriam Foundation, co-funded by Mitacs, School of Physical and Occupational Therapy, McGill University, Montreal, QC
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13
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McMahon M, Brown A, Bornstein S, Tamblyn R. Developing Competencies for Health System Impact: Early Lessons Learned from the Health System Impact Fellows. ACTA ACUST UNITED AC 2020; 15:61-72. [PMID: 31755860 PMCID: PMC7017754 DOI: 10.12927/hcpol.2019.25979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The Health System Impact (HSI) Fellowship program provides highly qualified post-doctoral fellows studying health services and policy research (HSPR) with opportunities for experiential learning, enriched core competency development and mentorship from senior-level leaders within health system organizations. Its overall aim is to prepare post-doctoral fellows with the research and professional skills, experiences and networks to make meaningful and impactful contributions in careers in academic and applied health system settings. Objective: This study examined whether this HSI Fellowship program has contributed to the development of enriched core competencies in HSPR. Methods: A competency assessment tool was developed and administered to the 46 fellows and their health system and academic supervisors from the inaugural HSI Fellowship cohort. Fellows' self-assessments at baseline, three months and 12 months were analyzed, along with supervisors' assessments at three and 12 months. Descriptive analyses were used to examine competency development over time. Differences by gender and between supervisor and fellow ratings were analyzed. Results: HSI fellows' self-assessments indicate that they strengthened their skills in all 10 enriched core competencies. Supervisors' assessments of the fellows' competencies also improved from baseline to 12 months. Gender differences at baseline disappeared by the 12-month assessment. Conclusion: The HSI Fellowship provides an opportunity to develop the full suite of enriched core competencies, particularly in competency domains that are not currently emphasized in HSPR doctoral curriculum.
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Affiliation(s)
- Meghan McMahon
- Associate Director, CIHR Institute of Health Services and Policy Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Adalsteinn Brown
- Dean, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Stephen Bornstein
- Professor, Division of Community Health and Humanities, Faculty of Medicine, Department of Political Science, Faculty of Arts, Memorial University; Director, Newfoundland and Labrador Centre for Applied Health Research; Co-Director, SafetyNet Centre for Occupational Health and Safety Research, St. John's, NL
| | - Robyn Tamblyn
- Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC
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Fattahi H, Abolghasem Gorji H, Bayat M. Core competencies for health headquarters: a systematic review and meta-synthesis. BMC Public Health 2020; 20:891. [PMID: 32517665 PMCID: PMC7285561 DOI: 10.1186/s12889-020-08884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background The availability of human resources for the health sector is not enough requirement for addressing health needs. Instead, it is necessary to take effective steps to meet the requirements of the health care system in case the system has the necessary competencies. This study was performed to identify the competencies of health headquarters in meeting the needs of the health system. Methods This thematic synthesis was performed to develop a set of central themes that summarize all the topics raised in the articles reviewed in this study. The quality of the articles was assessed by the Standards for Reporting Qualitative Research. Results We included 12 articles from seven countries. Seven central themes were inductively developed from the analysis: (1) Leadership and management, (2) Analyzing, interpreting, and reporting, (3) Public health knowledge, (4) Interpersonal relationship, (5) Personality competencies, (6) Cultural and community competencies, and (7) International/Global health competencies. Conclusion The findings of this review may help to address how to recruit and retain health headquarters, optimize the headquarters ability and expertise, and develop some approaches to promote their scientific, practical, and professional levels. These issues can drive the organization toward their visions, strategies, and great objectives.
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Affiliation(s)
- Hamed Fattahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. .,Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahboubeh Bayat
- Gerash University of Medical Sciences, Gerash, Iran.,Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
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Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care. Prim Health Care Res Dev 2020; 21:e3. [PMID: 32026798 PMCID: PMC7056390 DOI: 10.1017/s1463423619000938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. BACKGROUND In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group. METHODS After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature. FINDINGS Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.
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16
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Development of core competencies and a recognition program for gerontological nursing educators. J Prof Nurs 2019; 35:452-460. [DOI: 10.1016/j.profnurs.2019.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 11/18/2022]
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17
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Capacity development among academic trainees in community-based primary health care research: The Aging, Community and Health Research Unit Experience. Prim Health Care Res Dev 2019; 20:e139. [PMID: 31662127 PMCID: PMC6842651 DOI: 10.1017/s1463423619000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Health care system capacity and sustainability to address the needs of an aging population are a challenge worldwide. An aging population has brought attention to the limitations associated with existing health systems, specifically the heavy emphasis on costly acute care and insufficient investments in comprehensive primary health care (PHC). Health system reform demands capacity building of academic trainees in PHC research to meet this challenge. The Aging, Community and Health Research Unit at McMaster University has purposefully employed a capacity building model for interdisciplinary trainee development. This paper will describe the processes and outcomes of the model, outlining how the provision of funding, mentorship, and a unique learning environment enables capacity building in networking, collaboration, leadership development, and knowledge mobilization among its trainees. The reciprocal advancement of the research unit through the knowledge and productivity of trainees will also be detailed.
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McMahon M, Tamblyn R. The Health System Impact Fellowship: Perspectives From the Program Leads Comment on "CIHR Health System Impact Fellows: Reflections on 'Driving Change' Within the Health System". Int J Health Policy Manag 2019; 8:623-626. [PMID: 31657192 PMCID: PMC6819624 DOI: 10.15171/ijhpm.2019.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
As the Canadian Institutes of Health Research (CIHR) leads in designing and implementing the new Health System Impact (HSI) Fellowship program, we congratulate Sim et al for their thoughtful contribution to the nascent literature on embedded research, and for advancing our own learning about the HSI Fellowship experience. In our commentary, we describe the HSI Fellowship and its key components, discuss the factors that motivated and inspired the creation of the program, and highlight successes thus far.
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Affiliation(s)
- Meghan McMahon
- Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Montreal, QC, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Robyn Tamblyn
- Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Montreal, QC, Canada
- Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Sim SM, Lai J, Aubrecht K, Cheng I, Embrett M, Ghandour EK, Highet M, Liu R, Casteli CP, Saari M, Ouédraogo S, Williams-Roberts H. CIHR Health System Impact Fellows: Reflections on "Driving Change" Within the Health System. Int J Health Policy Manag 2019; 8:325-328. [PMID: 31256564 PMCID: PMC6600016 DOI: 10.15171/ijhpm.2018.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022] Open
Abstract
Learning health systems necessitate interdependence between health and academic sectors and are critical to address the present and future needs of our health systems. This concept is being supported through the new Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship, through which postdoctoral fellows are situated within a health system-related organization to help propel evidence-informed organizational transformation and change. A voluntary working group of fellows from the inaugural cohort representing diversity in geography, host setting and personal background, collectively organized a panel at the 2018 Canadian Association for Health Services and Policy Research Conference with the purpose of describing this shared scholarship experience. Here, we present a summary of this panel reflecting on our experiential learning in a practice environment and its ability for impact.
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Affiliation(s)
- S Meaghan Sim
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Jonathan Lai
- McGill University, Montreal, QC, Canada.,Centre for Innovation in Autism and Intellectual Disabilities, Montreal, QC, Canada
| | - Katie Aubrecht
- Mount Saint Vincent University, Halifax, NS, Canada.,Continuing-Care Research, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ivy Cheng
- Institute of Health Policy and Management, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark Embrett
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada.,Nova Scotia Health Research Foundation, Halifax, NS, Canada
| | - El Kebir Ghandour
- Institut National D'excellence en Santé et en Services Sociaux (INESSS), Québec City, QC, Canada.,Centre Intégré en Santé et Services Sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada.,Département de Médecine Familiale et Médecine D'urgence, Université Laval, Quebec City, QC, Canada
| | - Megan Highet
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Primary and Community Health, Health Service Delivery, Alberta Health, Edmonton, AB, Canada
| | - Rebecca Liu
- Department of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Christiane Pm Casteli
- University Health and Social Services Centre (IUHSSC) of Capitale-Nationale (CN), Faculty of Nursing Sciences, Université Laval, Québec City, QC, Canada
| | - Margaret Saari
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,SE Health, Markham, ON, Canada
| | - Samiratou Ouédraogo
- Department of Epidemiology Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada.,Institut National de Santé Publique du Québec (INSPQ), Montréal, QC, Canada
| | - Hazel Williams-Roberts
- Saskatchewan Health Authority, Saskatoon, SK, Canada.,University of Saskatchewan, Saskatoon, SK, Canada
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Wolfe MJ, Simpson LA, Menachemi N. Understanding the Current Health Services Research Workforce and Maximizing its Future. Health Serv Res 2019; 53 Suppl 2:3921-3926. [PMID: 30240008 PMCID: PMC6149364 DOI: 10.1111/1475-6773.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In 2016, AcademyHealth continued its longstanding efforts to understand the health services research (HSR) workforce, to inform its changing needs through the commissioning of several papers and an invitational conference. This paper serves to summarize the commissioned studies that appear in the current issue of this journal.
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Affiliation(s)
- Meghan J Wolfe
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - Nir Menachemi
- Richard M. Fairbanks School of Public Health, Department of Health Policy and Management, Indiana University, Indianapolis, IN
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