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.
Perineal Model with 4th-Degree Tear for Obstetrics Resident Training
Severe perineal tears are rare events, making it difficult for residents to receive adequate training.
Background
Up to 65% of vaginal deliveries are complicated by some form of tear or episiotomy. Severe tears can lead to long-term complications; however, they are rare enough that residents have few opportunities to receive training from experienced obstetricians. Residents who receive simulation-based training have improved performance, but we do not currently have a model for 4th degree perineal tears.
Project team
- Shirley Hutchinson
TRP supervisors
See our community directory for more on committee members.
Pilot Marshal Project
The Pilot Marshal Project aims to support researchers as they implement Pilot Projects within unique and complex environments.
Interventions that are found to be effective on an individual scale, or within a specific context, often fail when implemented in a separate context.
Using the SUPPORT-Dialysis Pilot Project as a case study, we will identify key barriers and facilitators to Pilot Project implementation. Based on these findings, we will develop a Process Model to help guide the process of translating research into practice.
Background
In April 2023, the SUPPORT-Dialysis pilot study was launched at Toronto General Hospital. The study aims to determine the feasibility of using an electronic patient-reported outcome measures (ePROMs) assessment and response toolkit to improve symptom and distress screening and management support for patients on dialysis.
One month after the launch of the SUPPORT-Dialysis pilot study, it was found that several patients flagged as needing symptom management support were not referred for additional symptom care support by their nephrology clinicians. When translating research from the lab to the bedside or across different patient populations, many issues arise during the initial implementation of clinical trials or pilot projects.
The capstone project aims to use the SUPPORT-Dialysis pilot as a case study to determine and address the barriers and facilitators to successful implementation of pilot projects.
Project team
- Owen Jones
- Sara Macanovic
TRP supervisors
Project advisory committee
- Dr. Karen Born, Assistant Professor (teaching stream) and program director of the MHSc in Health Administration in The Institute of Health Policy, Management and Evaluation (IHPME)
- Dr. Sonia Rodriguez-Ramirez, Transplant nephrologist, UHN
- Dr. Katherine Rud, SSHRC-funded Postdoctoral Fellow, School of Social Work, University of Windsor
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Precision over Presumption: GeneXpert MTB/RIF Ultra Assay Implementation for Airborne Deisolation of Suspected Pediatric Tuberculosis Patients at The Hospital for Sick Children
At The Hospital for Sick Children (SickKids), suspected pediatric tuberculosis (TB) patients remain in airborne infection isolation (AII) for prolonged periods due to delayed microbiologic confirmation. Current practice relies on three negative acid-fast bacilli smears, with turnaround times of 2–6 days, extending isolation unnecessarily. This strains clinical decision-making, hospital resources, and impacts patient and family well-being. Although the GeneXpert MTB/RIF Ultra assay offers faster and more sensitive TB detection, it has not been implemented on-site due to cost and workflow concerns. This project addresses the need for timely, efficient, and cost-effective TB testing to safely reduce isolation duration.
Background
Delayed microbiologic confirmation of pediatric pulmonary tuberculosis (TB) at The Hospital for Sick Children (SickKids) prolongs airborne infection isolation (AII) and strains institutional resources. Current Ontario practice typically requires three negative respiratory acid-fast bacilli (AFB) smears performed offsite at Public Health Ontario before discontinuing isolation, with turnaround times averaging 2–6 days. During this period, patients occupy private rooms and require enhanced infection control precautions, contributing to increased hospital costs, reduced bed availability, and potential delays in care. Prolonged isolation also negatively affects children and families by limiting mobility, procedures, and direct interaction with care teams.
Molecular diagnostics, specifically the GeneXpert MTB/RIF Ultra assay, provide a rapid and highly sensitive compared to smear microscopy, with sensitivity estimated to be 300–600 times greater. The National Tuberculosis Controllers Association and the Association of Public Health Laboratories recommend that two negative GeneXpert MTB/RIF Ultra results from sputum samples collected at least eight hours apart can guide safe deisolation. Despite these recommendations and demonstrated benefits internationally, adoption in Canadian pediatric hospitals has been limited due to concerns regarding upfront costs, laboratory workflow integration, and validation across diverse pediatric specimen types.
This quality improvement project aimed to implement on-site GeneXpert MTB/RIF Ultra testing at SickKids to reduce diagnostic turnaround time, shorten AII duration, and optimize resource utilization. A hospital-perspective micro-costing approach was conducted using institutional financial data and published literature. Costs included diagnostic testing, personal protective equipment (PPE), and daily hospitalization expenses. A cost-benefit analysis compared two on-site GeneXpert tests (≥8 hours apart) with the standard workflow of three early morning negative smears. A scenario analysis further examined cost savings among patients who remained hospitalized after isolation discontinuation.
Implementation required extensive stakeholder engagement. Informal interviews with infectious diseases physicians and participation in TB clinic rounds demonstrated strong clinical support for rapid molecular diagnostics to improve decision-making. Presentations to departmental leadership and Infection Prevention and Control teams highlighted projected operational and financial benefits, facilitating discussion of potential policy updates aligned with national recommendations. Cost analysis and stakeholder feedback directly supported administrative approval for implementation.
Performance verification and formal validation are planned for Health Canada–approved sputum specimens and will later extend to gastric aspirates, stool, and bronchoalveolar lavage samples to evaluate accuracy, precision, limit of detection, and potential interference in pediatric populations.
Overall, on-site GeneXpert MTB/RIF Ultra implementation will improve rapid clinical decision-making, reduces isolation duration, and produces meaningful cost savings. Beyond financial benefits, earlier deisolation enhances patient and family experience, improves access to procedures, and supports more effective care delivery. This project will establish a practical implementation framework and barriers that will inform adoption at other Canadian hospitals, with adaptation to local workflows and laboratory capacity.
Project team
- Abigail Mathews
TRP supervisors
- Dr. Joseph Ferenbok
- Dr. Edyta Marcon
- Dr. Melissa Greenblatt, Assistant Professor, Department of Laboratory Medicine and Pathobiology, Clinical Microbiologist, Department of Pediatric Laboratory Medicine, Hospital for Sick Children
See our community directory for more on committee members.
PrEP Access Navigator (PAN): Creating a Comprehensive ‘Application Cheat Sheet’ for the Trillium Drug Program
The PrEP Access Navigator (PAN) seeks to address the significant barriers uninsured individuals aged 23-64 face when applying to Ontario’s Trillium Drug Program (TDP). By simplifying the complex application process, PAN aims to make Pre-exposure Prophylaxis (PrEP) more accessible, reducing financial, procedural, and digital obstacles. This innovative, patient-centric digital tool provides tailored guidance, empowering vulnerable populations to navigate the system with ease and efficiency, ultimately improving health outcomes and reducing HIV transmission rates.
Background
Accessing life-saving medications like PrEP is a challenge for many uninsured individuals in Ontario due to barriers associated with the Trillium Drug Program (TDP). Financial constraints, complicated paperwork, and a lack of digital support deter individuals from completing the application, leaving vulnerable populations at heightened risk of HIV transmission. The PrEP Access Navigator (PAN) seeks to address these challenges by functioning as a virtual "cheat sheet" that simplifies and personalizes the application process. By guiding users step-by-step, PAN ensures they receive the support they need to overcome application hurdles.
PAN’s development follows the Translational Research Framework from the University of Toronto, progressing through two phases: 'Understand' and 'Act.' During the 'Understand' phase, informal research and consultations with academic literature identified accessibility barriers. The 'Act' phase focuses on iterative development and usability testing, where 20 participants will provide feedback on PAN’s initial version during secure, Zoom-based prototyping interviews. This feedback will inform thematic analysis and guide improvements for subsequent versions.
Integration with existing networks, such as the AIDS Committee of Toronto (ACT) and pharmacies, is expected to enhance service efficiency and patient experience. PAN’s streamlined approach aims to increase PrEP uptake and reduce HIV transmission rates, demonstrating how digital tools can bridge healthcare accessibility gaps. Beyond addressing immediate barriers, PAN provides a replicable model for improving access to other healthcare services, setting a precedent for equitable, patient-focused digital interventions. Partnerships and further pilot testing will ensure PAN’s impact continues to grow.
Project team
TRP supervisors
See our community directory for more on committee members.
Primary Stroke Prevention: Comparison of Information Sharing Preferencesof At-risk Patients with Family physicians practices
This mixed-methods study examines stroke literacy and communication gaps among at-risk patients, stroke survivors, and family doctors, revealing a need for more integrated and personalized stroke prevention efforts in Canada.
Background
Thousands of Canadians suffer from stroke yearly. Stroke can be life-altering or fatal. Much of stroke prevention in Canada is geared towards secondary prevention, but greater efforts are needed to improve primary stroke prevention. We utilized a mixed study design using quantitative (surveys) and qualitative (focus groups, interviews) methods to study stroke literacy in at-risk public (e.g. patients with hypertension, dyslipidemia, and atrial fibrillation), stroke survivors and family doctors. We also examined the preferences and experiences of physician-patient communication on stroke and risk factor modification in all three groups. While our findings support existing literature showing inadequate stroke literacy in at-risk patients, we discovered novel gaps in patient education provided by family doctors regarding stroke and its risk factors.
Key findings:
- Lack of awareness regarding stroke risk factors, prevention, resources/programs, post-stroke complications and effect of stroke on quality of life among at-risk patients.
- Limited communication about personalized stroke risk, risk factor management and prevention between family physicians and patients with preventable risk factors.
- Need for an integrated approach to deliver information about stroke prevention to at-risk patients.
Project team
- Saddaf Syed
- Gurpreet Jaswal
- Tazeen Qureshi
- Alejandro Fernandez
TRP supervisors
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Project POTS (Postural Orthostatic Tachycardia Syndrome)
POTS patients in Canada are often misdiagnosed, dismissed or poorly managed. Physicians often refer these patients to other specialists rather than initiating care themselves. There is a need to equip physicians - particularly in primary care - to recognize, diagnose & manage POTS.
Background
POTS or Postural Orthostatic Tachycardia Syndrome is a chronic & disabling condition caused by a dysfunction of the autonomic nervous system. It primarily affects women of reproductive age and is underdiagnosed and under-recognized. It takes a POTS patient 2-12 years to get a diagnosis. Our study focuses on identifying and addressing the barriers to POTS diagnosis & care at the primary care level. We will engage primary care physicians to understand their experiences and co-create an intervention that improves the patient journey for POTS patients in Canada.
Project team
- Asnia Shah
- Mikhail Lobo
- Linette Penney
- Vedant Shukla
TRP supervisors
Project RxPerspectives: Evaluating the Proposed Expansion of Psychologists' Scope of Practice in Ontario from the Point of View of the Public
This project sets out to complete an independent, public-interest-oriented evaluation of a proposed policy from the Ontario Ministry of Health that would grant psychologists prescriptive authority over certain psychotropic drugs, as well as the ability to order and interpret related laboratory tests such as bloodwork. This project centers the perspectives of people with lived experience accessing mental health care, aiming to generate primary evidence that can directly inform policy decision-making.
Background
Mental health service accessibility remains a persistent challenge in Ontario, with many individuals experiencing long wait times, fragmented care pathways and financial barriers to accessing psychiatric services. Primary care providers (including family physicians and nurse practitioners) also face systemic constraints, including high patient volumes, competing clinical demands and uneven geographic distribution, which may limit their capacity to meet growing mental health needs.
A key player supporting mental health in Ontario are psychologists who can assess, diagnose and treat mental health conditions across the province; however, Ontario’s psychologist workforce operates within a constrained scope of practice that does not include prescriptive authority. As such, in response to these system pressures, the Ontario Ministry of Health has proposed expanding the scope of practice for psychologists to include prescribing authority for select psychotropic medications as well as the ordering and interpretation of specific laboratory tests to support drug monitoring. The Ministry has suggested that this policy could improve access to care, reduce pressure on physicians, and enhance care coordination and collaboration between psychologists and primary care providers, including physicians and nurse practitioners.
However, scope-of-practice expansions are not inherently equity-promoting. In Ontario, most psychological services are not publicly insured through the Ontario Health Insurance Plan (OHIP), and access is largely mediated by private insurance or out-of-pocket payment. As a result, expanded prescriptive authority may primarily benefit individuals who already have access to privately funded psychological services, while leaving others (e.g., low-income individuals) excluded. Without careful implementation, the policy may unintentionally widen existing inequities in access to mental health care. Therefore, there is a clear need for an independent, public-interest-oriented evaluation of the proposed policy that centers the perspectives of people with lived experience accessing mental health care. As such, our aim is to generate primary, community-centric evidence that can be presented to the ministry to directly inform and support policy decision-making.
Project team
- Muhammad Anas Ansar
- Muhammad Anns Asif
- Sarah Li
TRP supervisors
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Prospective Assessment of Translation in Healthcare
Application and review processes for Disease Team grants were misaligned with the needs of applicants and reviewers.
Background
Our project addresses a problem in the Ontario Institute of Regenerative Medicine’s (OIRM’s) evaluation of Disease Team grant proposals. Applicants preparing for clinical trials were often unaware of their project’s place in the Disease Team funding spectrum. Further, reviewers found it challenging to convey their feedback in a succinct, tailored manner, given the wide variety of proposals they receive.
Project team
- Vaishnavi Batmanabane
- Meghan Lofft
TRP supervisors
See our community directory for more on committee members.
Rare Direct
This study explores the diagnostic experiences of Canadian rare disease patients and caregivers, combining survey data with an international environmental scan to identify needs and inform strategies for faster diagnoses.
Background
For patients with rare genetic conditions, getting a diagnosis is a struggle. While there is abundant research on the challenging aspects of this diagnostic process, most of the research is not taken from the patients’ perspective. Our research focuses on the patients' and caregivers’ perspective, in hopes that by better understanding this stakeholder, we could devise potential ways to address their specific needs, thereby improving their experience of this process in a manner that may contribute to a more timely diagnosis. After discovering the general need for timely diagnosis of rare disease patients, we went to the literature to further define the need. There, we found many sub-needs within the larger need for timely diagnosis. We wanted to specifically define how do the Canadian patients, our primary stakeholder, view this problem. To answer this question, we surveyed patients, asking questions geared towards understanding their views of their diagnostic odyssey. At the same time, we wanted to understand how other locales are attempting to fill this need, by doing an environmental scan on how different countries approach this need for timely diagnosis for patients.
Project team
- Renee Hofstedter
- Anat Segal-Shalev
- Weixi Li
TRP supervisors
Project advisory committee
- Nick Watkins (Genetic Counsellor, Mount Sinai)
- Lucy Osborne (U of T)
- Robin Hayeems (CHES, Child Health, Sick Kids)
See our community directory for more on committee members.
Re-Imagining Occupational Smoke Mitigation Strategies for Canadian Wildland Firefighters: A Participatory Study
Our team united with a common passion for tackling the problem of air pollution exposure and our current mission is to improve health and safety for wildland firefighters in Canada who are exposed to smoke for many months.
Focused on enhancing respiratory protective equipment tailored to the unique challenges of wildland fire contexts, our interdisciplinary team aims to empower and engage with those on the front lines. Our overarching goal is to develop innovative solutions that effectively mitigate risks, ensuring the well-being of wildland firefighters, and bridging the gap between evidence and impact to protect our protectors during wildfire season.
Background
Our project emerged from a shared concern for the health and safety of wildland firefighters facing increasingly challenging conditions.
Recognizing the critical role respiratory protective equipment plays in their well-being, we assembled a diverse team of engineers, researchers, and experienced wildland firefighters. Through collaborative efforts and a human-centered design approach, we aim to improve and innovate existing equipment to better align the demands of wildland firefighting.
By combining technical expertise with on-the-ground insights, we aspire to contribute meaningful advancements to the field, ultimately enhancing the protection and resilience of those who safeguard our wildlands during fire seasons.
Through iterative collaboration and a deep understanding of on-the-ground realities, our project aspires to make meaningful advancements in the field, ultimately contributing to the heightened protection and resilience of those who tirelessly safeguard our wildlands.
Project team
- Sumegha Jain
- Janna Mohamed
- Arani Ravichandra