ORIGINAL ARTICLE

Integrating research and education into clinical practice:The Multi-Organ Transplant Student Research TrainingProgramOlusegun Famure, dipHSM, MPH, MEd, CHE; Anna Li, HBSc; Heather Ross, MD, MHSc, FRCPC;S. Joseph Kim, MD, PhD, MHS, FRCPC

Abstract—Given the increased student interest in health research and the need to implement health research initiatives, theMulti-Organ Transplant Student Research Training Program provides student trainees with the opportunity to contribute to healthresearch initiatives in transplant care. Program quality initiatives achieved include the development of a clinical research database,knowledge exchange, performance measurement tools, and health research projects. The program promotes collaborationbetween academic and healthcare institutions to integrate research and education into clinical practice.

The need to implement health research initiatives toimprove patient outcomes and foster patient en-gagement is on the rise.1,2 Despite these necessities,

the growth in federal funding for conducting health re-search has declined in the past decade because of budgetcuts. This has led to the challenge of obtaining adequatehuman and financial resources to conduct health researchin a productive and efficient manner.3

Interestingly, there exists a large pool of students intertiary academic institutions with an interest in healthresearch.1,4 Most healthcare-related professional educationprograms often require prospective applicants to possesssome prior exposure to clinical and research practices as apre-requisite for admission.5,6 To address these needs, itwould be necessary to develop a sustainable inter-profes-sional, structured training program that engages studenttrainees, clinicians, and researchers in the developmentand implementation of quality health research initiativeswhile minimizing the need for significant resources.Existing training models that have implemented cost-effec-

tive and quality health research initiatives have integratedboth clinical research and education into one comprehensivecurriculum.2–7 Such models use an inquiry-based learningapproach that encourages active participation in clinical and

From the Divisions of Nephrology (Famure, Li, and Kim) and Cardiol-ogy (Ross) and Multi-Organ Transplant Program (Famure, Li, Ross andKim), Toronto General Hospital, University Health Network, Toronto, On-tario, Canada; Faculty of Arts and Science (Li), Department of Medicine(Ross and Kim), and Institute of Health Policy, Management and Evalu-ation (Kim), University of Toronto, Toronto, Ontario, Canada.

Corresponding author: Olusegun Famure, dipHSM, MPH, MEd, CHE, Multi-Organ Transplant Program, Toronto General Hospital, University HealthNetwork, 585 University Avenue, Toronto, Ontario, Canada M5G 2N2

(e-mail: segun.famure@uhn.ca).Healthcare Management Forum 2012 25:80–850840-4704/$ - see front matter© 2012 Canadian College of Health Leaders. Published by Elsevier Inc. Allrights reserved.

doi:10.1016/j.hcmf.2012.03.001

health research through mentoring and inquiry.4–7 Studieshave shown that this form of learning not only enhances theeducational experience of trainees and increases the researchproductivity of clinicians and researchers but also facilitatesthe development of collaborative relationships betweentrainees and their mentors.7–11 Furthermore, such models usean inter-professional educational curriculum encompassingdifferent biomedical research modules to allow trainees togain exposure to various healthcare disciplines and clinicalresearch areas.2–7 On the basis of past training models, theMulti-Organ Transplant Student Research Training Program(MOTSRTP) was developed to engage student trainees andclinical mentors in contributing to health services initiatives inan inter-professional hospital environment.

THE MOTSRTP

The MOTSRTP is a student training program that was es-tablished in September 2009 at the Toronto General Hos-pital under the direction of Olusegun Famure (a researchassociate in the Multi-Organ Transplant Program) and Dr S.Joseph Kim (a transplant nephrologist in the Kidney Trans-plant Program). This program provides student trainees theopportunity to gain clinical, educational, and research ex-posure to various disciplines in organ transplantation.Trainees come from diverse educational levels (eg, under-graduate, graduate, and professional school) and back-grounds (eg, biologic sciences, allied health sciences, sta-tistics, and medicine). Similarly, the mentors who provideguidance and support to trainees come from diversehealthcare disciplines including medicine, nursing, alliedhealth, bioethics, and clinical research. Currently, there are32 trainees and 17 mentors involved in the program.Trainees within the MOTSRTP partake in educational and

clinical research activities relevant to transplant care man-agement. The program’s inter-professional educationalcurriculum involves (1) educational seminars and activities

covering sub-disciplines that directly or indirectly impact

THE MULTI-ORGAN TRANSPLANT STUDENT RESEARCH TRAINING PROGRAM

transplant care including basic sciences, bioethics, clinicalepidemiology, and applied biostatistics and (2) clinical ob-servations in outpatient and inpatient hospital settings ledby healthcare professionals on the transplant team. Inaddition, trainees have the opportunity to contribute toclinical research activities by (1) assessing the health liter-ature using web-based databases and journals, (2) review-ing patient medical charts for the purpose of data abstrac-tion, (3) performing other relevant data-managementexercises, and (4) preparing project deliverables applicableto transplant care and patient engagement.The objectives of the MOTSRTP are (1) to promote on-

going coalitions between academic and healthcare institu-tions by engaging student trainees, clinicians, and re-searchers in the development of quality health servicesinitiatives using minimal financial resources and (2) to fos-ter the development of collaborative relationships be-tween trainees and their mentors to enable trainees togain clinical research experience while increasing the re-search productivity of their mentors.

METHODS

Development, implementation, and evaluationof the program

Before the inception of the MOTSRTP, a comprehensiveenvironmental scan and a review of existing literature wereperformed to identify the typical components of studenttraining models that integrated both clinical research andeducation into a comprehensive curriculum. Furthermore,the strengths and limitations of such models were assessedbased on evidence from previous studies. Through adopt-ing the strengths and refining the limitations of previoustraining models, the novel MOTSRTP model was devel-oped.Mentors within the program are matched to trainees

interested in performing health research projects in thementor’s discipline. Initial consultations are held betweentrainees and mentors to ensure that proposed projects arerelevant to transplant care, have a feasible timeline forcompletion, and are at an appropriate academic level fortrainees. In carrying out such projects, mentors typicallyprovide guidance to trainees in the following areas: proto-col development, study design, data collection and analy-sis, and manuscript preparation. Regular research meetingsare held between trainees and mentors to report updateson work in progress and address project-related issues. Inaddition to carrying out health research projects, clinicalobservations and educational activities are made availableto trainees through consultation with mentors and hospitaladministration.Evaluations of the MOTSRTP are performed periodically

by both trainees and mentors using quantitative and qual-itative metrics based on the following domains: program

preparation, on-site training, content delivery, facilitator

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performance, quality of facilities, career development, andgeneral satisfaction. These evaluations are used to identifythe strengths and limitations of the program as seenthrough the eyes of trainees and mentors. Through peri-odic assessments, the educational curriculum is revised toaddress existing limitations, and innovative health servicesinitiatives are developed to enhance the training programfor current and future trainees.

Selection and evaluation of trainees

A rigorous approach is used in the selection of trainees toensure that experienced and appropriate personnel arerecruited to complete programmatic deliverables andtasks. The selection process involves the following: (1) areview of the submitted applications, (2) interviews withprospective candidates, and (3) the selection of candidateswith academic and personal qualities and experiencesdeemed most appropriate for success in the program.Successful candidates typically showed an involvementand interest in health research, high academic or scholarlyachievements, and excellent oral and written communica-tion skills.Trainees are admitted into the MOTSRTP through pro-

grams or placements that exist in academic institutions(Table 1). This recruitment method ensures that the aca-demic goals and interests of trainees are fulfilled and fos-ters the development of an inter-professional communityof trainees involved in various health research initiatives.Trainees within the program are evaluated based on the

following criteria: (1) attendance at and participation ineducational seminars, activities, and clinical observations;(2) the quality of independent health research or patientengagement deliverables completed; (3) the presentationof completed deliverables (in the form of a publishablemanuscript) to his/her peers and mentors or the scientificcommunity; (4) the submission of a student journal andperformance report reflecting on tasks and goals achieved;(5) the ranking received on peer evaluations; and (6) overallacademic and work performance. On the basis of thesecriteria, the top-ranked trainees are selected to continuetheir placements in the MOTSRTP in subsequent academicsessions.

RESULTS

Application and admission trends

There are a significantly larger number of applications thanadmissions to the MOTSRTP for all academic sessions (Fig1). This trend indicates a high degree of interest in thisprogram among students coupled with the rigour of theadmission process that is used to admit the most qualified

trainees into the program.

ante – Summer/Été 2012 81

Famure, Li, Ross, and Kim

Program quality initiatives

The collaboration between trainees and mentors withinthe MOTSRTP fostered the development and implementa-tion of various health research initiatives relevant to trans-plant care management (Table 2). Such initiatives have ledto improvements in (1) the management of clinical andpatient-related data; (2) the communication and dissemi-nation of healthcare issues and innovations among health-care providers, patients, and the public; and (3) the assess-ment of patient quality of care and satisfaction.

Table 1. Academic programs or courses providing trainees adm

Name ofprogram/placement

Academic institution(s) that oprogram

Clinical Research GraduateCertificate programinternship

Humber College, Toronto

Research & PolicyPracticum

Dalla Lana School of Public HeUniversity of Toronto

Determinants ofCommunity Health II

University of Toronto

Work-Study program University of Toronto

Service Learning program University of Toronto

Independent studycourses

University of Toronto, YorkUniversitya

Will begin recruiting studentsSeptember 2012

Figure 1. Comparison of the number of applicants who applied to theMOTSRTP and the number of trainees who are admitted into the program

during the 2009–10, 2010–11, and 2011–12 Fall/Winter academic sessions.

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Program evaluation

Since its inception in September 2009, the MOTSRTP hasconsistently been rated favourably among former and cur-rent students in various domains (Fig 2). Commonly citedbenefits reported by trainees included guidance in careerdevelopment goals, an increased interest in clinical andhealth research, exposure to clinical research and educa-tion relevant to various disciplines in transplant care, thedevelopment of research skills (eg, designing research pro-tocols, collecting and analysing data), and the enhance-ment of interpersonal skills (eg, leadership, teamwork, andcommunication skills). Areas of practice in which traineesdesired more exposure included additional opportunitiesfor patient interaction and a greater length of the studentplacement to complete a project from start to finish.

Working hours and cost savings

Student trainees contribute a significant number of workhours weekly. In 2010, trainees worked an average of 297hours weekly, which is the equivalent number of hoursworked by approximately 8.5 full-time employees. In 2011,the number of working hours was increased; traineesworked an average of 329 hours weekly, which is theequivalent number of hours worked by approximately 9.0full-time employees. Based on this trend, trainees on aver-

to the MOTSRTP

Description of program

Graduate students develop the knowledge and skills todesign, administer, and manage clinical researchstudies.

Students in the Master of Public Health in Epidemiologyprogram gain a solid foundation in the application ofepidemiologic methods, research, and policy and anunderstanding of the breadth of community health.

Medical students complete an independent researchproject that analyses the medical, social, andeconomic relationships between determinants ofhealth and various health problems.

Undergraduate students meet financial needs and gainpractical health research experience during theacademic year or summer term.

Undergraduate students develop knowledge exchangeand communication tools aimed at promotinginterest in and knowledge about transplant caremanagement among healthcare providers, patients,and the public.

Undergraduate students work on a research project inthe area of transplant care or clinical management inreturn for a course credit.

ission

ffer

alth,

in

age work 60% over and beyond their contractually agreed

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THE MULTI-ORGAN TRANSPLANT STUDENT RESEARCH TRAINING PROGRAM

number of work hours. Taking into account the wage ofstudent trainees (paid $10.52 per hour) and that of a level1 research analyst (paid an average of $21.98 per hour or$40,000 per annum as per the 2011 University HealthNetwork pay scale), a similar-sized research team em-ployed to undertake the same research activities wouldcost between $300,000 and $350,000 annually. Therefore,the trainees contribute to a significant reduction in healthresearch expenditures for the Multi-Organ Transplant Pro-gram.Trainees in the program voluntarily exhibit the dedica-

Table 2. Summary of program initiatives achieved, objectives of

Program initiative Objective of initiative

Comprehensive renaltransplant researchinformation system(CoReTRIS)

To develop and manage a compreclinical research database that cpatient-related information andperformance measurement toolsclinical research and quality assurelated projects

Knowledge exchange andcommunication tools

To foster engagement among thecommunity and patient populatadvancing knowledge evolvingcurrent healthcare issues and in

Clinical trials projectmanagement

To assist in the management of pbiologic specimens, and humanpersonnel needed to conduct clresearch protocols including tria

Independent researchprojects

To advance knowledge in transplamanagement, improve patient houtcomes, and reduce healthcar

tion to put forth additional hours as necessary to complete

Healthcare Management Forum ● Forum Gestion des soins de s

their tasks at quality standards. This is because trainees notonly enjoy the learning experience but also value thecomradeship with their peers and mentors. Despite theextra time that trainees devote to the program throughouttheir student placements, they continue to perform at thehighest academic level within their respective universityprograms.

DISCUSSION

The MOTSRTP fosters the development of coalitions between

tives, and examples of such initiatives

Examples of initiatives

ivens

d fore

Abstraction, audit, and entry of patient biomedicalinformation (eg, patient demographics, cardiovasculartests, vital patient status, post-transplanthospitalizations and admissions, pathology, and organdonor information)

Implementation of the Research Ethics Boardrequirements for obtaining and managing personaland clinical patient information

Development and implementation of the following:Pre-transplant psychosocial assessment toolPost-transplant quality of life toolQuality of care patient satisfaction questionnaireHealthcare cost and economic evaluative domainsE-learning tools for systematic data managementDatabase operations and user manuals

tific

dtions

Development and implementation of the following:Inaugural Kidney Pulse newsletter (Fall 2011 edition)Kidney transplant living donor patient manual (completerevision)

Kidney transplant recipient patient manual (completerevision)

Clinical research in transplantation educational brochurefor patients

ork,

l

Completion of patient case report forms for therecruitment and follow-up of patients involved inclinical research protocols

Handling, processing, and storage of biologic specimens(blood and urine samples)

Initial screening of patients eligible for participation inclinical research protocols

re

ts

Examples of research projects that trainees have workedon, some of which have been accepted as abstractsat scientific conferences or are in their finalmanuscript preparatory phases:

Development of a mixed methods psychosocialassessment tool to evaluate patient readiness forkidney transplantation

Communicating risk to potential living kidney donors: asystematic review

A comparison of equations to estimate glomerularfiltration rate in Canadian adults without renal disease

initia

hensontai

useranc

scienion inarounnova

aperw

inicals

nt caealthe cos

academic and healthcare institutions that differ from the

ante – Summer/Été 2012 83

11 Fa

Famure, Li, Ross, and Kim

traditional mentor-mentee models of healthcare professionalprograms. Although traditional healthcare training programs(eg, medicine or nursing) require trainees to partake in aclinical preceptorship as a programmatic requirement, theMOTSRTP provides undergraduate and graduate studentswith an early exposure to clinical and health research prac-tices that can be applied to an array of future healthcare-related careers.The mentor-mentee model is broadly applicable to

other healthcare training programs. The collaborativeinquiry-based learning approach focuses on mentorsserving as research advisers and career counsellors. Inturn, this collaborative practice enables trainees to en-hance their academic and professional skills, receiveexposure to different facets of health research, andshape their career goals. Furthermore, the model pro-vides other healthcare or academic institutions with astructured educational-research framework for trainingindividuals with an interest in healthcare initiatives. Thistraining exposure not only significantly enhances train-ees’ learning experiences but also contributes to helpingclinicians and researchers enhance the care of patientswhile reducing healthcare costs. In this sense, theMOTSRTP aims to integrate research and education intoclinical practice.The MOTSRTP is not without its limitations. First, given

the limited period of the student placement (typically 6–8months), trainees generally do not receive in-depth train-ing in clinical research. Second, there are a limited number

Figure 2. Average percentages of students (n�44) who “agreed” or “strMOTSRTP over two academic sessions – 2009–10 Fall/Winter and 2010–

of opportunities for graduate and professional school

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trainees to partake in this program. To address some ofthese shortcomings, the directors of the MOTSRTP plan onpiloting a summer research institute focusing on moreadvanced topics in the areas of clinical epidemiology andapplied biostatistics that will welcome the participation ofundergraduate as well as graduate and professional schooltrainees.

FUTURE DIRECTIONS

Innovative initiatives that may potentially be integratedinto the MOTSRTP include (1) the expansion of the scope oftrainees to include students from other universities withinthe Greater Toronto Area such as Ryerson University andthe University of Ontario Institute of Technology and (2)the implementation of a pilot initiative that offers highschool students completing their grade 12 year the oppor-tunity to partake in this program. It is hoped that suchinitiatives will generate interest in health research bothacross a broader student population and at an earlier stageof student learning.

ACKNOWLEDGMENTS

The authors thank Elizabeth Murakami (Administrative As-sistant, Multi-Organ Transplant Program) for summarizingthe program evaluation results, the students from theMOTSRTP for providing feedback on the manuscript, andthe mentors for making the educational and clinical op-

agreed” with various statements about their training experience in thell/Winter.

ongly

portunities possible for trainees.

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THE MULTI-ORGAN TRANSPLANT STUDENT RESEARCH TRAINING PROGRAM

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