At the 2010 National Research Service Award (NRSA) meeting, directors
of T32 training programs funded by the Agency for Healthcare Research and
Quality (AHRQ) discussed the importance of sharing knowledge and working more
closely together. Following this rich discussion, AHRQ issued a request for
proposals for the formation of a study group to explore the feasibility of
establishing a mechanism for collective knowledge production, specifically the
formation of a learning collaborative. Collaborations are formed when two or
more stakeholders invest their resources (e.g., talent, information, money), to
solve problems that they could not solve by themselves. Central to this concept
of collaboration is knowledge translation and knowledge transfer.
Collaborations have become necessary for organizations
performing complex work, with emerging technologies and rapidly changing
environments. The rapidly changing field of health services research
necessitates knowledge transfer and translation among health services
researchers spanning multiple disciplines and housed in a number of
organizations representing the public and private sectors in academic, medical,
public health, and numerous other settings.
Recognizing the rapidly increasing complexity of the field
of health services research, all T32 program directors, assisted by Brenda
Harding and external staff from Team PSA (Professional and Scientific
Associates), were invited to participate in an initial conference call that
provided an overview of the concept of an AHRQ Learning Collaborative. This
initial conference call helped establish the broad goals of the AHRQ Learning Collaborative,
which are to: foster partnerships across institutions; facilitate the exchange
of information, networking, and mentoring opportunities; and improve the
training of health services researchers by sharing best practices, curricula,
and innovative training efforts across institutions.
To gain a better understanding of the unique needs,
preferences, and challenges of AHRQ training programs with respect to achieving
these goals, a brief initial survey involving 10 of the 18 training programs
was conducted. Responses were received from 8 program directors, 14 predoctoral
trainees, and 2 post-doctoral trainees. Respondents recommended three key
functions for an AHRQ Learning Collaborative: sharing, collaborating, and
networking. In particular, some of the specific areas for sharing included: curricula,
training opportunities, methods, best practices, ideas and information, career
resources, data sources, and presentation opportunities. Collaboration on
research projects and publications was often noted as a potential function of
the collaborative. Lastly, the prospect of developing relationships among
students, alumni, and fellow researchers was seen as a way to network, seek
mentorship, enhance communication about the exchange of ideas and future
opportunities, and perhaps acquire publications.
To explore these themes in more detail, 15 semi-structured
interviews were conducted (five each with program directors and pre- and
postdoctoral trainees). Additionally, interviews were conducted with
individuals with expertise in establishing and working with collaboratives.
These experts represented: AcademyHealth, AHRQ, The Institute for Healthcare
Improvement, the NEWMEDS Project, and the PCMH/MU (Patient-Centered Medical
Home/Meaningful Use) Collaborative. Applying a conceptual framework developed
from a literature review of collective learning, themes were identified and
consolidated as they emerged. Through the in-depth interviews, it became clear
that both program directors and trainees view the collaborative as a tremendous
opportunity for augmenting the learning process at their home institutions,
specifically through sharing, building relationships, and developing an
With regard to sharing, the AHRQ Learning Collaborative
could shed light on program characteristics with respect to research methods
training, knowledge of techniques for secondary data collection and analysis,
and overall competence in health services research. With regard to building
relationships, trainees expressed a strong belief that mentoring from senior
health services researchers was a critical element of their training and
professional development and that faculty at their home institutions could
leverage their networks of expertise for these purposes. Related to building
relationships is the development of a health services research identity.
Specifically, trainees agreed that, within the field of health services research,
there is a substantial but untapped opportunity to develop a well-solidified
community of health services researchers and indicated that the AHRQ Learning Collaborative
could be a valuable mechanism for creating this community among fledgling
health services researchers, specifically through T32 training programs.
In order to organize and manage the collaborative, AHRQ
could play a critical role in institutionalizing the collaborative, and program
directors could be co-champions of the collaborative alongside trainees. Both
program directors and trainees agreed that, although a variety of communication
strategies could be effective, strong networks require periodic face-to-face
meetings, at least initially. Additionally, an effective learning collaborative
must operate within the information-rich environment in which we exist, and it
must be sensitive to time and money constraints.
In order to assess the impact of the collaborative, measures
of success should be directly linked to the stated goals and activities of the
collaborative, which may change over time and/or with changes related to
different issues the collaborative wishes to address. Additionally, these
measures would have to be clearly linked with changes in individual training
programs that are expected to result as a direct consequence of the efforts of
Based on a synthesis of the current literature as well as
the essential insight from current trainees, program directors, and experts in
the field, recommendations for an AHRQ Learning Collaborative are as follows:
Structure: Explore establishing two mechanisms for
mutual helping among T32 programs: one, an informal, voluntary network of AHRQ
T32 programs, and two, several ongoing learning collaboratives that would be supported
by formal communication mechanisms, such as in-person meetings and virtual
forms of communication.
Following the T32 program directors meeting, program directors,
trainees, and faculty were invited to join a LinkedIn AHRQ Training Program
Group, which included three sub-groups: one for training directors and one each
for pre- and postdoctoral trainees. The network could be informal and Internet-based,
with portals and other electronic media.
In the startup phase, one or more learning collaboratives could
be created based on new issues generated at the T32 annual meetings and/or
organized around specific research interests. Each collaborative would be
championed by several people and could cover a wide range of technical or
problem-driven areas. The work led by Chris Forrest and Diane Martin on health
services research core competencies, as well as their affiliations (at the time
of that work) can be found at http://www.biomedcentral.com/1472-6963/9/107 .
key activities of an AHRQ T32 Network would include:
mentoring relationships between trainees and senior researchers within and
across T32 programs.
through social media and in-person events.
each other with requests for information.
based on complementary skills and experience.
resources, including data, expertise among faculty and trainees, and other
critical training issues.
Roles and Responsibilities: The AHRQ Learning
Collaborative would be a joint effort by trainees and program directors with
support from AHRQ. Representatives from AHRQ, program directors, and trainees
will play an important role in investing in and building social relationships
AHRQ T32 program directors meet once a year at the annual NRSA meeting,
which offers an opportunity for productive helping and collaborating.
Trainees could be invited to participate with program directors
during T32 meetings to brainstorm about how to build capacity and enhance
innovation across programs. Trainees, with the support of program directors,
could co-lead and be engaged in these discussions.
AHRQ could support the learning collaborative by setting aside
time during the annual T32 meeting to engage in collaborative activities (for
example, sharing what we are learning about tough problems and identifying
candidate issues for ongoing learning collaboratives).
Funding: Trainees and directors could apply for
AHRQ's Small Conference Grant Program to fund and establish one-year learning
collaboratives that result in workshops and sessions at the annual NRSA
conference. This program is intended to encourage members to share learning,
connect with stakeholders and programs, develop new thinking, and build
capacity in health services research.
Launching the Collaborative: Begin preliminary
conversations on issues relating to engagement and evaluation, which may
do we create a national identity?
do we cultivate and leverage an open network of training programs whose members
have promising ideas and want to help each other?
do we create opportunities for faculty and student exchanges or linkages across
programs among faculty and students with common interests (e.g., student
rotations at AHRQ and/or collaboration with AHRQ researchers)?
do we engage the more than 1,500 past and present trainees in new and
do we find better ways to connect and develop existing AHRQ research and dissemination
do we connect with AcademyHealth and other stakeholders around the work they
communication media will help to rally the people interested in collaborating?
addition to the Annual AHRQ T32 Program Directors Meeting, what other forms of
collaboration could be conducted (e.g., webinars, in-person local or regional
meetings, discussion forums, and wikis)?
we establish a set of common performance measures with common definitions for the
purpose of comparative benchmarking across programs?
would the network and future collaborations help to establish a national
identity for AHRQ trainees that transcends fellowship appointments and funding?
one criterion for AHRQ training grant renewal be the amount of mutual helping,
networking, and collaborating with other training programs the grantee has done?
Would AHRQ want to establish "proof of collaboration" as part of
renewal? How would this be measured?
each core competency, can we create a knowledge map (K-Map) that identifies the
experts, practitioners, locations, and sources of knowledge? The model for this
is the work that Jonathan Weiner, Diane Martin, Tim Carey, and other programs
have been doing to map courses, resources, and other capabilities to health
services research core competencies.
can we highlight achievements of former and current trainees to demonstrate the
value of this investment and solidify a national identity?
do we work to sustain this effort and maintain buy-in over the long term?
During the 2011 NRSA conference, feedback on a draft white
paper was solicited from attendees of the director's meeting. Comments have
been integrated into this final white paper, which will guide the next steps
for establishing an AHRQ Learning Collaborative.
We offer the following
concrete suggestions for moving forward with the AHRQ Learning Collaborative:
Brand the AHRQ Learning Collaborative with a name and a
catchphrase that is memorable or appealing. For example: "SpAHRQ: Training the
Next Generation of Health Services Researchers." Individual T32 programs could
be referred to as "SpAHRQ Plugs" because they are individually necessary but
only collectively sufficient for powering the health services research engine.
- Solicit trainees' thoughts on a name and catchphrase. The
thinking behind the name and catchphrase would have to be explained briefly and
be immediately clear to others.
Develop an explicit mission or charter.
Develop clear objectives and/or goals. These could be selected
from those suggested in this White Paper, and they could be field tested for
relevance among AHRQ program directors and trainees.
Develop routine activities. For example, a periodic check-in call
or webinar on training program issues where trainees are the prime
participants. Program directors, alongside AHRQ personnel, could take turns
hosting the call/webinar. Another potential activity would be to publish a
brief periodic letter about the AHRQ T32 programs to share program highlights and
opportunities for collaboration. Finally, trainees could be "invited" into
other programs' classrooms.
Collate a list of current AHRQ T32 trainees (pre- and postdoctoral)
that includes information about research interests, current project work (intra-
and inter-institutional), leisure interests (to integrate a more informal
component), and contact information.
"Research interests" could be specific or more general. Also,
information to supplement research interests could include: area(s) of
expertise, research and/or statistical methodologies of interest, and theories
of interest (and discipline in which they are housed).
Another option for this listing (or a complementary action) is to
create a searchable database of trainees (similar to academic institutions'
Extend the list/directory to alumni; a particular effort could be
made to reach out to recent alumni (i.e., those one 1-2 years out).
Establish "Career Ladder" interest groups (again with a memorable
name) for trainees heading towards a postdoctoral degree and/or academia, the
private sector, the government, a think tank, etc.
- One possible way to capture the attention of trainees might be to
title these groups using their words. For example, "Major Players in... [various
Collate curricula and include them in a searchable database.
Curricula could also be mapped onto the core health services research
competencies to highlight where opportunities for improvement exist and/or to
allow programs to highlight specifically (and uniquely) how they are ensuring
training in the core health services research competencies.
Identify brokers within AHRQ T32 programs (e.g., directors,
faculty, and trainees) who could create buy-in for working collaboratively
Brokers could begin with the questions identified in the "Engagement
and Evaluation" portion of the recommendations and report back (perhaps during
the periodic check-in call and/or webinar as part of the routine activities).
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