Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
Improving Canadian Women's Use of available Urinary Incontinence care
This study explores the barriers and facilitators influencing women’s decisions to seek care for urinary incontinence, aiming to support earlier intervention.
Background
UI is not life-threatening or majorly disabling, but it can have deleterious physical, psychological and economic consequences. Urinary soiling can cause rashes, ulcers, skin and urinary tract infections (1). Some of the psychological consequences observed include low self-esteem, poor body image, embarrassment, social isolation and depression (7,8). UI is estimated to cost incontinent Canadians $6,263 per annum from the direct cost of UI care and the indirect costs from loss of productivity (1). One study evaluated the facilitators to care seeking by interviewing some volunteers from a Leicester Medical Research Council trial on urinary symptoms. The main groups of facilitators identified were raised awareness, symptom triggers, personal triggers and others (19). To identify barriers and facilitators to the care-seeking-decision-making process. This was done by interviewing women currently being treated for UI. We made the presumption that these women had gone through the decision-making process, experienced the barriers and facilitators and will be able to reflect on their experience. According to previous studies, women affected by UI live with the condition for an average of 1-3 years before seeking care (21,22). This delay provides an opportunity to explore the circumstances of the transition from living with UI and not desiring care to eventually seeking care. By increasing understanding of how the barriers and facilitators influence the decision-making process we aimed to learn where to focus the efforts to prompt women suffering from UI to seek care.
Project team
- Philip Bhoorasingh
- Sterling Lewis
TRP supervisors
Project advisory committee
- Jacqueline Cahill
- Catherine Barr
- Prof. Jennifer Skelly
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Improving outcomes in pediatric multi-system trauma care in ontario through knowledge implementation and translation
This study assesses pediatric trauma management in general emergency departments across Canada, identifying key sources of practice variation and highlighting knowledge translation (KT) as a promising strategy for improving care.
Background
Traumatic injuries are the leading cause of death and disability in children both in Canada and worldwide, and are associated with high direct and indirect costs to our health care system. In children, falls and motor vehicle collisions are the two main mechanisms of injury responsible for morbidity and mortality. This type of trauma tends to injure multiple systems at once (multisystem trauma) in children given their small size, pliable musculoskeletal system, and less protected internal organs. In Canada, health care providers (HCPs) face a challenge in delivering optimal trauma care because of population dispersion over large distances. This is particularly true for paediatric trauma patients, as there are fewer trauma centers treating children, i.e. paediatric trauma centres (PTC). Canadian data show that at least 45% of children live more than one hour away from a PTC and that 88% of injuries happen within a 10-mile radius of home. This means that most pediatric patients have no easy access to PTCs when injured.
The TREKK (Translating Emergency Knowledge for Kids) network highlighted that the most pressing clinical information needs among HCPs managing paediatric patients in EDs without paediatric expertise (hereon referred to as general EDs) pertained to paediatric multi-system trauma and severe head injuries. Although data do not yet exist detailing practice variations in paediatric trauma at the resuscitation level, some studies have demonstrated significant practice variation in the acute management of paediatric trauma patients between paediatric and adult trauma centers. Canadian data also suggest that general EDs have lower adherence to guidelines compared to pediatric EDs when managing different simulated paediatric resuscitations due to a lower rate of paediatric exposure.
The combination of these findings suggests that practice variation is an important factor in suboptimal delivery of care. As such, our team set out to perform a more detailed needs assessment on paediatric trauma management at general EDs. We identified five potential sources of practice variation and selected KT as the opportunity with the most potential for rapid and significant impact on practice variation.
Project team
- Gabrielle Freire
- Zi Teng Li
- Hui-Yu Lu
- Naomi Zingman-Daniels
TRP supervisors
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Improving patient experience in the Pre-Anesthesia Clinic
This qualitative study explores patient and family experiences at Sunnybrook’s Pre-Anesthesia Clinic to inform patient-centered improvements in surgical preparation.
Background
The pre-anesthesia clinic (PAC) aims to optimize patients for their surgery. This is important because it provides coordination of care between various healthcare providers and patients. Additionally, this process aims to reduce the risks of surgery. This project is necessary because optimized preoperative care is linked to improved post-operative outcomes, reduced recovery times and postoperative complications and pain, and lessened anxiety5,6. This project aims to discover and describe the patient and family experience during their PAC visit. We took a patient-centered approach, prioritizing the patient perspective, to ensure that recommendations for improvement are aligned with patient values and needs. We conducted a Quality Improvement study involving 50 qualitative interviews with patients in the PAC. Based on our initial Needs Assessment, our findings indicate that healthcare providers’ beliefs of opportunities for improvement are not always echoed by patients (Appendix I). Patients do not mind waiting for longer periods of time during their visit if they understand the purpose of their appointment and are alerted of delays. Early access to multiple modalities of information is pivotal to patient satisfaction and positive experiences. Healthcare providers play an integral role in building patients’ confidence and capacity for self-advocacy. In order to provide better patient and family experiences, it is essential to break down existing silos and provide seamless care delivery. These findings convey what patients need and expect from our healthcare system. Understanding the problem directly from patients will help healthcare organizations create change ideas that are patient-centred and align with patients’ needs. The limitations of this study were that this study only pertained to the Sunnybrook PAC and may not be reflective of other PACs, and there was no member-checking of themes. For future investigations, we plan to conduct focus groups (with patients, families and staff) to co-create and implement change ideas using these results.
Project team
- Raja Ravi
- Agnes Ryzynski
- Andrew Wan
TRP supervisors
Project advisory committee
- Dr. Ed Etchells (QI expert)
- Dr. Lesley Gotlib-Conn (Qualitative research expert)
- Ms. Guna Budrevics (patient engagement)
- Lindsay Senese (patient partner and advocate)
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Improving the care of ICU patients: a primer on analgesia, sedation and delirium
Being in the Intensive Care Unit (ICU) can be really challenging for patients and their families. Patients experience pain, agitation, delirium, fear, anxiety and many other frightening feelings. They also sometimes require sedation, which can also lead to further complications. There is a wealth of evidence to improve the management of analgesia, sedation and delirium in the ICU, however it is very challenging to apply on everyday practice. Therefore, my project aims to bridge the gap between evidence and practice by way of a tailored educational intervention aimed for physicians in training in the ICU.
Background
In critically ill patients, effective management of sedation, analgesia, and delirium (SAD) is essential to optimize outcomes, reduce ICU length of stay, prevent long-term cognitive and psychological sequelae, and enhance the experience of both patients and families. Despite the availability of guidelines and validated tools, variability in practice and knowledge gaps among ICU providers remain common.
Aim:
To improve understanding and clinical application of best practices related to sedation, analgesia, and delirium among ICU clinicians through a structured knowledge translation initiative.
Project Components:
- Needs Assessment: Identify knowledge/practice gaps through literature review and local ICU feedback.
- Content Development: Curate evidence-based educational material (e.g., guidelines, algorithms, bedside tools).
- Engagement & Networking: Leverage clinical networks and stakeholder feedback to promote uptake.
- Dissemination: Share key messages via interactive workshops, digital formats, or brief summaries suitable for bedside use.
- Evaluation: Assess impact via pre-post knowledge tests or feedback surveys (to be determined based on scope and feasibility).
Innovation/Value:
This project bridges evidence and practice, using a pragmatic, clinician-centered approach to support consistent and informed SAD management—contributing to safer, more humane ICU care.
Project team
Federico Carini
TRP supervisors
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Improving the uptake of TAVR in Ontario
Using TAVR as a case study, this report explores barriers to implementing medical innovations in Ontario hospitals and recommends strategies to improve adoption through timely, user-informed approaches.
Background
In this report, we highlight the importance of appropriate, timely and user-defined implementation techniques as a critical component of the successful uptake of medical innovations. We use the uptake of transcatheter valve replacement therapy (TAVR) as an example. An uptake of TAVR in the Ontario hospitals was researched through a survey of the decision-makers across the University of Toronto-affiliated teaching hospitals. The survey aimed to identify the barriers to successful implementation of TAVR – an alternative lifesaving intervention for patients at risk for surgical complications. The insights gained from this study can be used to inform implementation of other medical innovations in the Ontario hospitals and beyond. We have found that funding and physician preference are the main barriers to TAVR use. In addition, clinical guidelines and patient co-morbidities are key factors influencing physicians' decision making with respect to TAVR. Based on these findings and previous literature, we have recommended strategies to address some of the barriers to TAVR use. This case example highlights the potential flaws to implementation of medical innovations and the possible preemptive measures that can be addressed early to increase the uptake of life-saving medical innovations.
Project team
- Abimbola Saka
TRP supervisors
Project advisory committee
- Michael Farkouh
- Laura Hartman
- Harindra C. Wijeysundera
- Maral Ouzounian
- Neil Fam
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Improving time to diagnosis for neuroendocrine tumors
This study investigates the prolonged diagnostic delays in neuroendocrine tumor (NET) patients, revealing that physician-dependent factors—particularly misdiagnoses—are key contributors.
Background
Neuroendocrine Tumors (NETs) represent a spectrum of rare, highly heterogenous, slow-growing tumors that arise from neuroendocrine cells in a multitude of organs [1]–[3]. The most common sites for NETs are the gastrointestinal system and the lungs, accounting for 65% and 25% of all cases respectively [4]. However, NETs are not limited to these two regions, they can also arise in areas such as the pituitary, thyroid, pancreas, ovaries, and adrenal glands [5]–[7]. NETs usually occur in late adulthood but can occur in children and adolescents as well, where aggressive forms lead to both higher morbidity and mortality [4], [8]. Previously considered rare tumours, recent statistics paint a different picture: Prevalence and incidence of NETs are on the rise, with a doubling of the incidence in Canada between 1994 and 2009 [5], [9]. The current incidence rate in Canada is 5.86 per 100,000 [9]. Moreover, this increase in incidence of NETs has been reported worldwide [5], [9], [10], with a seemingly upward trend [9], [11], [12]. Today, due to prolonged survival of patients with active disease, there are currently more people living with NETs than there are people living with some non-neuroendocrine tumours such as esophageal, gastric and pancreatic cancer [9], [10], [13]. One of the biggest problems affecting NET patients is the frequent delay in reaching a diagnosis. In fact, the delay is often substantial: A recent international survey has shown that the mean reported delay time from first symptom to confirmed diagnosis was 52 months – or just over 4 years – but can be as long as 9 years [17], [18]. This has severe consequences, leading to increased suffering for patients, and putting a pressure on our health care system [17]. The aim of this project is to determine why these long delays occur in the diagnosis of Neuroendocrine tumours by determining where in their diagnostic journeys do patients face the delay and identifying the factors that lead to diagnostic delays. We confirmed that majority of the patients experience a delay in diagnosis, some more than 7 years. This delay was in large part due to the time to suspicion, meaning patients were tested and treated for other disorders while NETs were not suspected. Interestingly symptom profile and severity did not affect time to diagnosis. Thus it seems that delay in diagnosis is likely a result of physician dependent factors.
The majority of participants diagnosed in a timely manner received no misdiagnoses, while those with long diagnostic journeys received several misdiagnoses including gastroenteropancreatic, respiratory or gynecological in nature (Figure 9). In fact, among the participants who reported a delay in diagnosis, the most prevalent misdiagnoses are gastroenteropancreatic, respiratory and psychiatric. Most notable here is the high frequency of reported psychiatric misdiagnoses. There are multiple explanations for that observation. It could be the case that receiving a psychiatric misdiagnosis is associated with a subsequent delay in diagnosis. An equally plausible explanation is that the distress experienced during a lengthy diagnostic journey is enough to affect the mental health of patients. The experiences shared by participants who received a psychiatric misdiagnosis hints to the former explanation. Some participants who indicated a psychiatric misdiagnosis provided text responses throughout the survey that highlight their experiences. These quotes and associated contextual information are provided in Table 6. Interestingly, it seems that female patients experienced psychiatric misdiagnosis more often than male patients (Table 7). While increasing awareness of NETs is recommended across all clinical disciplines, it is conceivable that special focus should be given to psychiatrists for the reasons described above. One must also consider the fact that NETs have been reported to have both neurologic [36] and psychiatric effects [37]–[41]. This could magnify the probability of symptom misattribution. Psychiatrists should be made aware about NETs and their manifestations so that they can re-refer a NET patient to the appropriate specialist, putting the patient back on the right diagnostic track.
Project team
- Majd Ghadban
TRP supervisors
Project advisory committee
- Dr. Jackie Herman
- Dr. Radhika Yelamanchili
- Dr. Greg Fairn
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Increasing Awareness of Functional Neurological Disorder (FND) among Various Stakeholder Groups to Enhance Patient Care
Through our capstone, we aim to improve the knowledge and perceptions of various stakeholders regarding FND, assess gaps in FND care, and determine areas for collaboration and support ultimately for the benefit of this severely underserved population.
Background
Functional Neurological Disorder (FND) is the most common neurological diagnosis that you might have never heard of. It is the 2nd most common reason to see a neurologist, representing up to one-third of outpatient Neurology visits. Unfortunately, society at large and many healthcare providers lack awareness regarding this highly stigmatized and misunderstood disorder, contributing to further distress of patients and families.
Patients with FND often exhibit a combination of various neurological symptoms from motor and sensory deficits to seizures and cognitive decline that are not compatible or congruent with other known medical conditions. The hallmark of FND is its fluctuating or waxing and waning pattern of symptoms, resulting from abnormal communication of neural networks. As symptoms of FND come and go, patients are unfortunately suspected to be malingering or faking their symptoms.
Diagnosis relies on clinical assessment by a limited number of FND-trained experts in Neurology and Psychiatry. As a result, the majority of patients endure a lengthy diagnostic journey (6-8 years), perpetuating patients’ diagnostic uncertainty and feelings of invalidation, while increasing healthcare utilization and costs.
A family member of a patient with FND has told us, “When you’re diagnosed with Parkinson’s, the world is kind to you. When you’re diagnosed with FND, the world is not nice to you,” reflecting the various medical, psychosocial, economic, and systemic issues surrounding FND.
Project team
TRP supervisors
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INNOVATE Digital Campus: Empowering Canadian Health Startups
The INNOVATE digital campus is a centralized online hub that connects Canadian health startups with the people, services, and infrastructure needed to accelerate innovation.
Background
The INNOVATE digital campus creates a curated Canadian network that facilitates access to existing services for startups and mandates active engagement of its members. It unifies silos and stakeholders by creating a one-stop shop. Silos in the healthcare innovation ecosystem hinder the advancement of innovation because Canada lacks a critical mass in any one physical place. Our digital campus will connect innovators with access to different people, resources, and communities to create that critical mass.
The primary target stakeholder for our digital campus is healthcare startups. One of the most pressing needs of this group is accessing the right people and the right infrastructure at the right time in order to bring novel, innovative ideas to the healthcare market quickly, efficiently, and successfully. To address this need, we are providing a digital campus that uniquely helps startups to lower barriers to accessing the right people and available resources, resulting in their idea getting to market faster to ultimately provide Canadian patients with better access to cutting-edge healthcare innovations.
Our greatest risk is users being unwilling to actively engage and contribute to the digital campus which would impact the appeal of our community. To mitigate this, we are flexible in modifying the platform to encourage users to be active on the campus by iterating quickly and releasing more exclusive features for users to engage and enjoy. As alumni of the University of Toronto’s Translational Research Program, our team has years of experience in research and innovation which has enabled a deep understanding and strong connections in this space. To build out our idea, we plan to recruit a software engineer, marketing expert, customer relationship manager, and business development professional.
Health systems are becoming increasingly more integrated, for example, Ontario Health recently started absorbing five provincial agencies to become one integrated “super agency”. This shift to connecting different pockets of the ecosystem to deliver a more unified and streamlined healthcare experience to patients is happening right now. Leveraging this need for health systems integration, we aim to connect the ecosystem by creating a centralized hub to help startups bring their idea to market faster to provide Canadian patients with quicker access to healthcare innovations.
Project team
- Alireza Aleyasin
- Evan Foster
- Oscar Palacio
- Sally Moy
TRP supervisors
Project advisory committee
- Heather Frazer
- Paul Santerre
- Mel Barsky
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Innovating medical education: a focus on integrating ‘endocannabinology’ into curriculum at the Temerty Faculty of Medicine at the University of Toronto
This study develops and evaluates a patient-centered medical curriculum on the endocannabinoid system to address knowledge gaps among Canadian medical students.
Background
Background: For centuries, cannabis has been recognized for its medicinal properties but its use and research were restricted during most of the 20th century. Recently, modern discoveries related to the endocannabinoid system (ECS) and the effects of cannabinoids on this and other systems have increased interest in clinical applications. However, the rigorous scientific evidence required for medication intended for human use approval has not been met. This issue is particularly evident in creating effective treatment and follow-up plans, as well as underestimating the risks of adult cannabis use and its potential impact on public health. As a result, there is a significant knowledge gap among Canadian medical students and physicians-in-training regarding the physiology and modulation of the ECS, due to current curricula focus on teaching about "medical cannabis" rather than the ECS, leading to patient-centered medical training being displaced within medical education.
Objective: This study aims to integrate the study of the physiology and modulation of ECS into the medical curriculum at the Temerty Faculty of Medicine, University of Toronto.
Methods: This study uses a mixed-method approach to understand curriculum development and implementation in medical education. Participants include medical students, physician-in-training, and faculty members with procedures like workshops and clinical case discussions. The curriculum's effectiveness will be evaluated using pre- and post-tests, surveys, and feedback from participants, with statistical analyses used to evaluate the data collected.
Results: The study will demonstrate that teaching the ECS in medical curricula with a patient-centered approach improves medical students' knowledge of the ECS. This will lead to more effective treatment and follow-up plans and better risk assessment for cannabis use.
Expected Outcomes and Future Directions: Integrating the study of the ECS in medical curricula can enhance medical students' understanding of its role in patient care, leading to better outcomes and advancing medical knowledge.
Project team
- Danny Puente Proano
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Innovation in Surgery: Supporting a Culture of Innovation among Surgery Residents at the University of Toronto
This study explores barriers to innovation among University of Toronto surgery residents and offers recommendations to support translation of their ideas into impact.
Background
The University of Toronto has a rich history of innovation and excellence. However, to continue pushing the envelope of innovation, the University of Toronto’s Department of Surgery has an urgent, unmet need – to help surgery residents translate their ideas into impactful interventions. To address this need, we must first understand the current barriers to innovation faced by surgery residents then identify interventions to minimize them. The objective of this project is to understand the journey of residents through their training and identify the challenges preventing them from effectively translating their ideas. This project was guided by a phenomenological approach using semi-structured interviews with surgery residents interested in innovation, as well as department heads and faculty members within the Department of Surgery. The results of this project suggest six major barriers, including skill and knowledge gap among surgery residents, lack of time and bandwidth and a pressing need for mentorship. The recommendations suggested by the interview participants include having a structured academic program that focuses on innovation and translation and having an Entrepreneur-In-Residence (EIR) within each surgery division. Finally, based on these results, this project provides recommendations to improve the innovation culture within the Department of Surgery, University of Toronto.
Project team
- Sidhesh Kumar Jothilingam
TRP supervisors
Project advisory committee
- Marc Jeschke
- Dale Podolsky
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