With the previous year’s experience as an MT-DIRC fellow under my belt, I was ready to dive in to each session with both feet, taking full advantage of the expertise of the faculty and other fellows. During one session following lunch, fellows Ted Skolarus, Rebecca Selove, and I came together to resurrect a conceptual paper that we conceived the previous year but had fallen by the wayside over the course of a busy semester. In a postprandial stupor, I doubted that we would be able to tackle such a complex issue. Within 5 minutes, though, I was fully engaged in drafting a paper that has shaped how I and many of my colleagues approach studying the implementation of complex innovations in cancer. During another session, fellow Bogda Koczawa challenged me to consider the global implications of my domestic research on cancer survivorship care plans, resulting in our collaboration on an appeal to global oncologists to consider the role of D&I in their work. Interactions with other fellows during downtime – morning jogs, at dinner, and over drinks – were just as invigorating and productive.

That week in June 2015 was bittersweet. Throughout the week, I couldn’t help lamenting that it would be my last summer at Washington University as an MT-DIRC fellow. I comforted myself with the knowledge that I had an entire year remaining in the fellowship, with calls scheduled each month to work with Ted, Rebecca, and our mentor, Enola Proctor; in the previous year, we had met each month, sharing successes and challenges, and cultivating the concept papers that we had included in our MT-DIRC applications into competitive research proposals. We would continue our work in the coming year.

Indeed, just a month after I left Washington University, our mentoring calls resumed, and I was excited to continue learning from my colleagues. Later that summer, I had another flash of the bittersweet feeling that I experienced during that last week at Washington University: I had been awarded pilot funding to conduct the research that I had proposed with the help of Enola, Ted, and Rebecca. As thrilled as I was to receive the award, I worried that I might never have the opportunity to develop a proposal quite as methodically and collaboratively as I did with my MT-DIRC mentoring team.

In late September, though, I had a revelation at the Society for Implementation Research Collaboration’s 3^rd Biennial Conference, where two hundred experts in behavioral health came together to share insights regarding implementation science. Occasionally, I would encounter a participant with a badge labeled “Implementation Research Institute fellow”. IRI, a program that predates MT-DIRC, has been training behavioral health scientists in implementation research for 6 years. During a break at SIRC, I saw several generations of IRI fellows enthusiastically discussing an issue in implementation science. That’s when I realized: You can take the fellow out of the training program, but you can’t take the training out of the fellow.

Next month, I will submit a proposal for Cancer Research Network pilot funding that I developed in collaboration with fellow Erin Hahn, leveraging our training in methodical, collaborative proposal writing. In the months to come, we will submit an R01 application; in December, I will have dinner with dozens of MT-DIRC fellows at the Dissemination and Implementation Conference. Having undergone training that has transformed my scholarship and established invaluable relationships, I no longer dread the day that I will no longer be an MT-DIRC fellow; I look forward to a long career as an MT-DIRC alumna.

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At the heart of D&I research is the use of existing evidence.  In the case of cancer screening and early detection there is sufficient evidence on what primary care providers should be doing.  This includes practice guidelines, formal strategies, and even accreditation linked standards of care. What D&I science brings to the table is the “how.” In my case the “how” focuses on optimal cancer screening and early detection in federally qualified health centers. These centers treat most of our countries un- and underinsured and can benefit from detailed approaches for their settings.

For most academics, true community-academic partnerships (e.g., with clinic administrators, providers, and patients) tend to be a challenge. Few academic institutions have a history of or a structure for sustained community-academic partnership, especially among underserved communities.  In order to be effective, D&I science requires such partnerships.  This suggests that MTDIRC fellows may foster the creation, and/or expansion, of community-academic partnerships.

Real world assessment has been called for in public health research for decades, but not so much in cancer prevention and control. The application of D&I approaches in cancer prevention research, such as the ubiquitous Reach Effectiveness Adoption Implementation and Maintenance (REAIM) framework, offers great promise. Each of the REAIM steps asks investigators to look through a pragmatic lens, especially for the first (Reach) and last (maintenance) steps.  Hopefully, the questions and assessments on “Reach” will move the spot light to those in greatest need while the questions and assessments on “Maintenance” will foster a dialogue beyond limited short-term research funds.

The training and collaborations provided by MTDIRC can help address inequity in cancer screening and early detection.  The key elements in D&I science encourage academics to “apply” what is known and understand “how” this was done.  Most importantly, the process is focused on impacting practice.

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MT-DIRC_2016

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There were many highlights to the week but of particular interest was the session on pragmatic frameworks from Anne Sales.  Anne led the group through several emerging approaches for moving evidence-based innovations into practice (e.g., the ideas of process mapping, practice mapping, and root cause analysis).

Larry Green and Rachel Gold taught us about some critical skills on how to balance fidelity with adaptation.The sessions by Larry and Rachel highlighted both the science and the art of adaption, keeping in mind the real world context for D&I research.

The team of Cindy Vinson, David Chambers and Ken Wells covered the under-studied area of sustainability. The group did an outstanding job of covering not only existing assessment tools, but the gaps and research opportunities.

All-in-all it was a great week that highlighted the vibrancy of the field of D&I research. It is all captured in a song on day 3.

As we look forward to fall, we’ll be talking with you about these and many other issues during upcoming calls.

Cheers to all!!

-Ross

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The program is focused on D&I research relevant to cancer and attended by mid-career academics from a range or disciplines relevant to cancer control including public health, epidemiology, psychology and health services research with a strong representation of oncologists (very impressive cohort of surgical oncologists) and nurses, which keep conversations relevant to what happens to patients in a real world setting. The curriculum is comprehensive and includes large group sessions with a lot of lively debate (plus occasional light-hearted but thought-provoking banter from faculty) and small group discussions relevant to specific projects aimed to get you to the submission of a grant application stage. This focus on the outcome makes the program more personalised and applied than the usual didactic session that one may catch at conference or a course. More importantly, the program does not end at departure time – the mentoring continues with regular skype conferences and email contact. At conclusion of my week in St Louis, I left with a plan for a small grant application, idea for 2 papers with co-authors lined up and a preliminary plan for collaborative project with one of the faculty. Not bad for a week’s work!

While the grant schemes commonly discussed are not entirely relevant to the Australian setting, the principles are the same, and in fact, the discussion opens up opportunities to consider the US funding schemes and international collaborations. The key here is to focus on what happens after the residential part and take advantage of the network of colleagues around the world with the same interest. This is truly the opportunity (as well as the challenge).

The post An Innocent Abroad – Australian reflections from MT-DIRC 2015 appeared first on MT-DIRC.

Last year, my friend and urology colleague, Ted Skolarus, introduced me to the work he is doing to improve prostate cancer care in the VA, which opened my eyes to the scope and breadth of dissemination and implementation research in cancer.  From there I was fortunate to learn more about the field from Bryan Weiner here in Chapel Hill, and became excited about the possibilities for translational research focused on opening up the bottlenecks between what seem like the right things to do and what actually gets done.  I learned that in addition to superb local mentorship from Anne Sales, Ted was also in the inaugural class of postdoctoral fellows in the NCI-supported Mentored Training in Dissemination and Implementation Research in Cancer (MT-DIRC) fellowship out of Washington University in St. Louis.  Bryan subsequently connected me with Sarah Birken, one of Ted’s co-MT-DIRC fellows here on our faculty at UNC.  With advice and guidance from them, it became clear how this field of inquiry aligned with the logical next steps of our group’s work in bladder cancer, and I was fortunate to have the privilege to bring my embryonic ideas to MT-DIRC this summer.

When I was a kid, I went to a French language immersion summer camp in Minnesota.  As a clinician-researcher many years later, I had similar feelings about my initial experience at MT-DIRC.  The other “campers” were friendly, interesting people from all over the world.  The faculty were not only collegial and fluent in this new (to me) language, but in the case of MT-DIRC, clearly world leaders in this area of science.  The combination of didactic lectures, panel discussions, and working groups provided a great introductory immersion, helping me start to understand the language and customs, and social activities provided opportunities to network and get to know the diverse participants.  As a D&I neophyte, I’m still on the steep part of the learning curve, but left the summer institute with increased enthusiasm, a substantially stronger footing, and gratitude for the opportunity to learn this highly relevant field in this unique program.  I look forward to continuing this mentored learning process over the next two years and strongly encourage those with an interest in translating knowledge to practice to apply.

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http://diconference.academyhealth.org/callforabstracts/cfa

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Check out our accomplishments page to see all that our first year cohort has achieved since June 2014! We can’t wait to see what collaborations and innovations our 2014 & 2015 fellows continue to achieve.

Here at MT-DIRC we talk the talk so with this new website, we wanted to make sure we walked the walk. As described under our curriculum page, we are working on developing and refining D&I training competencies and will be implementing and testing them with this program. Any updates regarding our curriculum can be found under our curriculum page.

You will be able to find updates about our application process and the application when available from the site. We will add and update open access resources & links available to D&I researchers on our Links page. Information related to D&I conferences, trainings and other important dates will be available under our events tab. And of course, we will share all that our fellows have accomplished under our accomplishments page.

This will be the last time you hear from me for a while as we plan to share the blog section with faculty and fellows in the program. The blog will give them a chance to describe their experience within the program as well as share the projects they are working on.

As always, if you have any additional questions about the MT-DIRC program or have feedback about our new webpage, feel free to contact me at [email protected].

Thank you for visiting our webpage!

-Maggie Padek, MPH,MSW, Program Coordinator

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