The TRP is designated to be a “Professional” program but there is no formally recognized profession of Translational Research within the scope of health science or healthcare. What then does it mean to understand the TRP as a professional program, Translational Research as a profession, and perhaps more significantly, professionalism broadly as applied to healthcare and the health sciences?
As it turns out the academic designation is perhaps the easiest to deal with. A graduate program, masters or PhD is understood to be a course of advanced study. A master’s degree historically has been understood as a step towards a PhD that moves a student beyond a bachelor’s information dump towards a better understanding and more critical thinking required in PhD programs. However, some master’s programs are intended to provide students with advanced understanding towards a specific field of work—think law, engineering or business. These types of programs generally have been course-based (rather than thesis-based) and have prioritized domain-specific knowledge or applied research to support a career trajectory rather than groom students specifically for PhD programs.
Recently, a range of professional master’s programs have been developed that seem to aim to provide students with advanced standing but are generally only loosely affiliated to a specific profession or field of work. These programs seem to focus on the credentialing to be able to give students a professional advantage or designation and provide degrees as a measure of accomplishing a minimum standing in a series of courses.
Perhaps at the other end of the professional program spectrum has seen the rise of professional programs that continue the tradition of advance study but also incorporate professional-oriented skills or competencies. This type of program, in the context of graduate degrees, is more difficult to categorize according to established taxonomies, because it may not be specifically affiliated with a specific professional domain, may not have a basic or discovery research focus, but may still allow for advanced study as well as a focus on skills and competencies that may be understood to be transferable and professional.
The TRP falls into this latter—ill-defined class of “professional” master’s programs. It is intended to allow students to pursue self-directed advanced study—the self-directed nature and a current lack of a formally designated profession of translation means it is not affiliated with a specific profession (our students are interprofessional). The TRP is not thesis-based so it does not require a written tomb for graduation—though students produce reports, white papers, artifacts, and other forms of deliverables. The lack of a thesis, however, does not mean that students are not engaged in research and the generation of new knowledge. In practice, most Capstone Projects to date have involved a high level of research and methodological rigour, including research ethics approvals and highly structured protocols. However, these have generally been focused on innovation and impact rather than publication.
Admittedly, articulating the skills and research accomplishments of our graduates is an important area for improvement. Demonstrating the depth of understanding and the achievements of students in familiar research domains (despite the ‘professional’ designation of the degree) means that our students have significant value to the research community both before and after the program, and are not barred from pursuing PhDs or other advanced study opportunities when they choose to.
The opportunity for students to pursue advanced study while simultaneously developing transferable workplace skills, means that the program provides an unconventional type of educational experience that blends the rigour of a traditional masters degree with knowledge that allows students to excel in areas that involve multidisciplinary collaboration, creative problem-solving, teamwork, navigating ambiguity and leadership—not usually competencies historically prioritized by traditional research masters programs.
This is perhaps half of the “what” of the TRP related to its professional designation. The “How” and the “Why” of professionalism will remain for Part 2: Defining Professionalism and Part 3: Significance of Professionalism in Translational Training.
Every graduate degree should, at least in my opinion, offer the opportunity for students to achieve a credential, learn something of significance and find avenues for personal (and professional) growth. These outcomes, however, are by any means guaranteed or consistent either between programs or between students within a program. This makes it hard to, with any certainty, tell a student what they will get, but this is what all students want to be answered: “What will I get from the TRP? Why should I invest my time and energy?”
What you will gain from any experience, any graduate program will–at least in my experience–be greatly determined by what you are prepared for and open to. Why does one person have an epiphany when another sitting next to them doing the same thing, experiencing the same lesson, does not? An unwavering truth of any experience is that, generally, what you get out of it will depend on: who you are—that is your character and characteristics; your purpose and motivation; and the nature of the program—it’s content, structure, and philosophy.
The TRP is designed to be focused on facilitating the process of learning. This means that you are given back control over your learning. This is antithetic to most conventional wisdom still pervasive in traditional paradigms of pedagogy because takes away control from the institution and its agents, and places the measure of “success” and achievement on individually defined accomplishments.
For educators, giving up control is not easy—it’s a lot more work to try to inspire learning than to assign marks for standardized responses. But for learners, taking on the responsibility of control is, perhaps, even harder. First and foremost, you are not conditioned to focus on your individual learning–you are conditioned to base your educational self-worth on grades. And even though intellectually you may understand that getting an A on a test is not the same as remembering, understanding or being able to apply the material on that test, fighting decades of conditioning is hard. It requires a cognitive restructuring and cultural shift on the part of a learner to allow themselves the space to think differently, to push themselves out of their comfort zones, to dedicate themselves to personal challenge, to the less travelled path in an undiscovered country of uncertainty and ambiguity.
Also, self-directed learning is hard. It takes initiative, dedication and humility—you have to be able to admit ignorance and be open to being wrong. It involves a high degree of self-awareness, honesty and self-permission to fail. This is not, at times, easy or pleasant. You will face challenges, potholes and sometimes long frustrating periods of featureless nothingness—sometimes it can feel like rolling a boulder uphill. But then there are the chances to explore and observe, appreciate and reflect; moments of joy, epiphany, friendship, and moments of EUREKA!
This is what the TRP provides, an opportunity for personal and professional growth and the prospect for collaborative self-directed learning. A sandbox for you to play where your peers become more than passive disinterested spectators—they become the experts, touchstones, instruments of feedback who enrich, support and ground your experience. All this is hard to internalize in the abstract—without experiencing it—so it also requires trust–a leap of faith, if you will. But the TRP Team have done this before and together with you we can do it again. The way is simple, but not easy.
For those of us, we happy few who make the effort, who learn to learn, who contribute to our own growth and the learning of others, the effort is extremely rewarding–not just for a year or two, but for a lifetime. It is a calling–not just a degree.
This is our mission: to challenge you to think differently so that you can apply knowledge to improve people’s lives. It is a purpose to improve and grow together. It is a commitment to that if, and when, you decide to take up arms against the sea of healthcare challenges, we will support you. And it will not end when you graduate. You will pay it backward and forward, and as you do your thirst for impact, your drive for creative collaborative problem-solving, for like-minded-translators, will continue to grow.
So, what will you get from the TRP? Why should you invest your time and energy?
You get a mission and a community united by the noble calling to improve lives, through medicine, health and care—you get to: learn with purpose.
There is currently no official or globally recognized profession of Translational Researchers. Nor, is there any one profession involved in the landscape of translating observations into research or impact. Our program attracts a variety of people from a variety of different backgrounds, who have a variety of objectives and personal goals. Asking what “job” or “career” the TRP may help you attain, misses the point of what the program is trying to help you achieve.
The point is that TRP is a guided mechanism, a platform for you to learn and explore your passion and ideas. Our goal is to challenge students to stretch their perspectives, open themselves up to new points of view, and learn to be better more creative and innovative problem-solvers. We provide you with a framework for tackling translation, a community for you to practice and engage with; access to institutional resources and personnel, and we provide you with guidance and help facilitate your learning. BUT it is you who must provide the direction, the drive and the curiosity to use the opportunities to establish your trajectory, your career, your own individual development plan.
The TRP is about self-directed learners who want to learn to deal with complexity and navigate ambiguities in complex problem spaces as they unfold. The TRP is about adapting, collaborating and asking for help. It is about learning to be your own guide and your own champion. It is about gaining confidence and resilience to take risks and learn from faulty strategies. It is about you learning to become the better you that you want to become. It is about the process of growing and learning.
So, the answer to what career path or job the TRP can help you attain is meaningless–TRP can help in just about any career path. Some of our students have gone on to find jobs in hospitals, industry, and government organization. Others have changed the way they practice medicine or the way they approach patient care; others will do things I cannot even yet imagine or articulate. The real question is “How will you use the TRP to shape your potential?”
What are your passions? What are your goals? What career or job will you attain or improve or develop if you learn to apply the competencies and skills you gain through the TRP? Those are much more important questions that will actually help YOU answer what career path you should plan for, what job you should decide to attain, or what pivot you may want to make in your life’s journey.
That is at the heart of our program and our philosophy.
Joseph Ferenbok, PhD
Translational Research Program in Health Science
Design Thinking and Solutions in Medicine, Health & Care
Opinion | Joseph Ferenbok
Date: August 30, 2019
Over the last several years there has been a rise in the application of Design Thinking for creative problem-solving in healthcare. Having been an early adopter and proponent of Design Thinking it has pained me over the last several years to admit and realize the limitations and short-comings of Design Thinking in health and medicine. I do not wish to be fatalistic, but I do not believe that the approach is completely without merit, and using a human-centric strategy is (in my opinion) significantly better in many cases especially in healthcare contexts than many other approaches (if your goal is to improve quality of life or patient experience). However, there are a number of nuances to Design Thinking that are incongruous with innovation in health and care because of the specialized ethical and regulatory constraints.
One significant point of contention is the focus on and use of language associated with finding “solutions”. Although in many cases the identification of needs and framing of problems within Design Thinking positions the outcome to the process as a human-centric “solution” to the identified problem. This can be extremely problematic and borderline unethical in healthcare. For one, the nature of problems in health and care tend to be more on the side of complex “wicked” problems of design rather than absolute binary problems that have definitive solutions. For example, the redesign of a process or practice in a hospital will not in all cases ‘solve’ the identified problem. To reduce the spread of opportunistic infections the proposed solution seems simple—get people to wash their hands. Hand washing as a “solution” as part of anti-microbial stewardship has been advocated for decades. Even if handwashing was performed 100% of the time by everyone, it would not entirely “solve” the spread of opportunistic infections. The reality is that many of the problems in health and care are complex and multi-factorial and no one “solution” is likely to the absolute magic bullet for prevention.
Even highly effective solutions, like vaccines, are not in and of themselves ‘solutions’ to medical problems because they, like many other interventions, are deeply embedded in ideologies, practices, customs and beliefs that complicate how problems are solved. The Anti-vaxxer movement, if nothing else, adequately makes this point.
However, the variability of outcomes, implementations and contexts of healthcare-related solutions are not the main reasons why I find the use of Design Thinking as a preferred way of creative problem-solving in health–related domains problematic. All of these can be pragmatically overlooked, in my opinion, when juxtaposed to the potential good that human-centric empathy-based innovation may contribute to improving healthcare delivery. But there is the rub, if we are to claim a human-centric approach based on empathy in healthcare and its delivery, we cannot avoid or ignore the patient or the patient experience. At some level, healthcare innovations that are human-centric must (directly or indirectly) improve the experience or quality of life of a patient. To understand the lived experience of a patient to define needs-based problems is at best irresponsible and at worst unethical to throw around notions of absolute “solutions”. To engage people, patients, physicians or family members in a design-based problem-solving exercise and even accidentally imply that the process will result in a “solution” can be seen as misleading or overpromising. Added to the moral implications of these possible perceptions of promising someone in a vulnerable position a potential “solution” to their problem, in healthcare, there are ethical considerations around issues of voluntary participation and informed consent. Working with potentially vulnerable populations looking for hope the language around finding solutions has implications around the nature of participation, informed consent and coercion. Telling a patient, who may be facing significant emotional and physical strain that participation or inclusion in a project that employs the Design Thinking vocabulary may not be the most responsible protocol when there are issues of informed consent involved.
More problematic, however, than then ethical debates about what constitutes voluntary “informed” consent is the moral issue of false hope. The idea that Design Thinking involves testing a solution to a problem—especially when patients may be directly or indirectly involved. Any possible implication (intended or unintended) that a concept, drug or intervention is a “solution” to patient’s need without solid evidence can be misleading and morally irresponsible. Even the promise of co-developing a “solution” with patients has the unfortunate consequence of reaffirming existing differences and power imbalances between the practitioners and the people they are trying to problem solve with/for—promising a fix, a cure or a solution in healthcare may evoke false hope in a vulnerable population beyond the scope of the design project.
On the one hand, I realize this argument is extremely abstract and likely not even something that practitioners have confronted. It is not intended to undermine the important innovations in health-related contexts that Design Thinking has facilitated, but medical/healthcare solutions, have deep emotional implications for people who are living with the issues frameworks and practitioners are trying to address, stop, or alleviate, and this requires an additional level of understanding and ethical conduct that Design Thinking does not evoke. So, alongside with the process-related issues I have with Design Thinking in these domains, suggesting, Design Thinking, a preferred framework for structuring an approach to innovation in health-related domains, is problematic from an ethical perspective.
Surely, there are other frameworks we can use that promise more contextual integrity without overpromising their outcomes.
Congratulations to TRP Senior Advisor & LMP Prof Avrum Gotlieb, on being one of four UofT researchers to receive the Connaught Global Challenge Award. The project will support the development of a Translational Hub, a collaborative community to mobilize knowledge & commercialization to improve impact on health & patient outcomes. Read an excerpt from UofT News below.
Professor Avrum Gotlieb, in the Department of Laboratory Medicine and Pathobiology, will receive $247,000 to build capacity for translational research that enables scientific discoveries to move out of the lab and into the real world, where they can improve patient care, health-care policy and products like pharmaceuticals.
Gotlieb, whose academic research is focused on cardiovascular disease, is also a senior program adviser with U of T’s Translational Research Program, which seeks to move knowledge “towards mechanisms, techniques and approaches that support the prevention, diagnosis and treatment of disease.”
The Connaught award will support the development and implementation of a Translational Hub – a community dedicated to educational programs, research collaborations and community-building that’s focused on knowledge mobilization and commercialization to improve impact on health and patient outcomes.
“Creation of a community to provide support and infrastructure at the U of T will expedite the growth and development of our local translational infrastructure and its global reach,” said Gotlieb in his project description.
Read about the 2019 winners of the Connaught Global Challenge Award.
Throughout its history, the Institute of Medical Science (IMS) at the Faculty of Medicine has developed a tradition of incubating new multidisciplinary programs. In 2011, the IMS stepped forward to explore and develop a graduate program in translational research. After much consultation, a proposal was put forward and approved and the first cohort of 17 students began in September 2015.
In October 2018, the TRP had an external review. The reviewers noted that “There is no question in the reviewers’ minds as to the value, uniqueness and innovation of this exciting and visionary program. In every meeting concerning this new program, there was high energy, and positivity regarding its format, content…” Then they noted that the TRP, “would never have flown without the immense efforts of the IMS director and his support, thus all future success of the MHsc program will reflect strongly back to the IMS program due to its generosity in providing a nurturing environment for its beginnings.” But they also noted that the apparent growth and trajectory requires more strategic thinking about faculty development, evaluation and retention; and that “a new and more appropriate administrative home” will need to be found.
Responding to this feedback, Dean Young has decided that the Translational Research Program (TRP) will move its administrative home to the Department of Laboratory Medicine and Pathobiology no later than July 1st, 2019.
The move marks a major milestone for the IMS and the TRP. It marks the successful initiation and incubation of a new innovative multidisciplinary program. It marks the effective implementation of a new curriculum and a significant contribution by the IMS to the training of professionals in a burgeoning field of inquiry; and it will provide the TRP with the opportunities for greater capacity for faculty development, review and promotion.
However, this milestone will not mark the end of the program’s relationship with the IMS. The TRP faculty will remain cross-appointed to the IMS, TRP students will continue to be engaged with IMSSA and other co-curricular programming at IMS, and students from TRP and IMS will have continued access to modules from across the academic units. In fact, this is an opportunity to bring another department into our family, to become more engaged with more researchers and students, and to build new bridges and establish new collaborations moving forward—at the end of the day, we all remain part of one Faculty, and we all remain dedicated to training and research that will advance improved medicine, health and care.
“We must be willing to let go of the life we’ve planned, so as to have the life that is waiting for us.”
– Joseph Campbell