Internship report
Natalia Godoy Casasbuenas Research Promotion and Development Knowledge Management, Bioethics and Research Supervisor: Dr. Luis Gabriel Cuervo February 10th - June 13th
1
Table of Contents I. Introduction.................................................................................................. 3 II. Background................................................................................................. 4 III. Terms of reference .................................................................................... 5 IV. Duties and Responsibilities (Internship Activities) ................................ 6 A.
Bellagio Application .......................................................................................................................... 6
B.
A proposal to implement knowledge translation tools in public health graduate
programs .............................................................................................................................................................. 7 C.
Case study:............................................................................................................................................. 9
D.
Research Interest Group .............................................................................................................. 10
E.
Internship activities within PAHO............................................................................................ 10
F.
Activities outside PAHO ................................................................................................................ 12
V. Discussion .................................................................................................... 14
2
I.
Introduction
As part of my masters in Public Health at the Ecole des Hautes Etudes en SantÊ Publique, I decided to do my end of studies’ internship at the Pan American Health Organization, Regional Office for the World Health Organization in Washington D.C. Between February 10th 2014 and June 13th 2014 I worked as an intern in the Department of Knowledge Management, Bioethics and Research under the supervision of Dr Luis Gabriel Cuervo with the Research Promotion and Development team. Since my medical studies back in Colombia I have always been interested by the work and views of this international organization. Now, as I am finishing my studies of Public Health, I consider that doing an internship at PAHO was definitely a good choice for improving my knowledge and research skills as well as acquiring more experience in this field. The main project I undertook was focused on scaling up knowledge translation capacity in the region of the Americas by integrating knowledge translation skills within Masters of Public Health. Beside this main project, I also wrote a case study, organized a Research Interest Group meeting and participated to additional internship activities in and outside PAHO. Overall, I feel honored with this opportunity of internship within the KBR department in such prestigious organization. Not only I improved my professional skills but also met extraordinary people and took advantage of the many opportunities that were offered. It truly was an edifying experience.
3
II.
Background
In September 2013, the 21st Cochrane Colloquium was held in QuĂŠbec City hosted by the Canadian Cochrane Centre and the University of Laval. During that meeting, leading experts in cooperation with the Pan American Health Organization met to brainstorm about how to better scale up knowledge translation training efforts within public health graduate programs in the region1. Among the objectives of this Cochrane Colloquium, one was concerning evidence to policy in graduate programs as a way to scale up EVIPNet. Indeed, despite the successful implementation of this knowledge translation platform in countries like Mexico, Peru, Brazil and Chile, there is still a big bottleneck to scale up knowledge translation in the region of the Americas: the shortage of a trained workforce with the skills of Knowledge Translation. The Cochrane Collaboration is a non-for-profit organization with collaborators from over 120 countries working together to produce credible and accessible health information, using scientific research synthesis and promoting knowledge translation. The Cochrane Colloquium is amongst the best networking environments for knowledge translation.2 Many key stakeholders (e.g. authorities in health and technology, opinion leaders and members from academia, among others) attended this international workshop. It was agreed that knowledge translation should become an integral part of public health programs, similarly to what was done with critical appraisal and epidemiology. This was considered the first approach to systematically address this issue of scaling up knowledge translation capacities in the Americas. This gave rise to the project I focused during this four months: giving a proposal of a public health curriculum with knowledge translation skills included.
1http://2013.colloquium.cochrane.org/meetings/evidence-policy-graduate-programs 2
http://www.cochrane.org/about-us
4
III. Terms of reference As agreed with the supervisor, listed below are the Terms of Reference issued the 4th of November 2013: 1. A proposal to implement a standardized knowledge translation curriculum for postgraduate health programs resulting from collaboration and consultations with key partners 2. A report of the updated assessment of the compliance of PAHO Guidelines with standards for WHO Guidelines, and recommendations to enhance or maintain good compliance. 3. Contributions towards updating surveys on the implementation of PAHO´s Policy on Research for Health (CD49/10) in the PASB and Member States 4. A report of her internship identifying what was gained, what was achieved, and what can be done for improvement. 5. Participate in activities organized for interns including the Research Interest Group (conducting Brown Bag lunches and a study case) among others.
5
IV.
Duties and Responsibilities (Internship Activities) A.
Bellagio Application
During the first month of my internship I was supporting Dr Cuervo with the application for a conference in partnership with the Rockefeller Foundation at Bellagio (Italy). The idea of applying to this kind of program follows the initiative of including knowledge translation skills within public health graduate programs as agreed during the Cochrane Colloquium meeting held in Québec last year3. The main objective for doing this Bellagio conference is to have a deliberative dialogue among key knowledge translation experts in order to discuss the content and delivery a pilot curriculum to be tested subsequently in a series of Masters of Public Health programs throughout the Americas. Achieving equitable health outcomes and the progressive realization of universal health coverage will require using the best scientific knowledge and other sources of quality relevant information to inform health care delivery and policies. With the creation and further implementation of the evidence policy curriculum for graduate programs, future professionals will be trained in knowledge translation tools. This will complement over efforts to improve the health of vulnerable populations and will also constitute a pioneering approach for narrowing the “know-do gap’. The Rockefeller Foundation Bellagio Center's mission is to promote innovation and identifying impact-oriented solutions to critical global problems. The Bellagio Center's conference program provides space for small conferences, teams, and workshops who share in the Foundation's mission to expand opportunities for poor or vulnerable people and to help ensure that the benefits of globalization are shared more widely4.. Despite this application, our project did not get through the selection process. Nevertheless, it was a good training for future applications to this kind of conference.
3 4
http://2013.colloquium.cochrane.org/meetings/evidence-policy-graduate-programs http://www.rockefellerfoundation.org/bellagio-center
6
B. A proposal to implement knowledge translation tools in public health graduate programs This was the main project described in my Terms of Reference. As part of my second year´s master of public health we are asked to conduct a research project during our internship. Since I had the internship interview with Dr Cuervo, he explained me about this project and I found it very interesting. But also challenging because it was something new, different and rather promising. Since my arrival at the Pan American Health Organization and during the first month while I was preparing the application for the Bellagio Conference I got immersed with this topic and sorting ideas about how to better approach this task as part of my thesis. The EHESP has a clear mandate as what has to be considered a possible research topic to conduct as part of the program´s thesis. More particularly, the topic must enable the contribution of an actual, original clarification. Identifying knowledge translation tools for inclusion in public health graduate programs is certainly an innovative initiative and I considered it a good topic for my master´s thesis. These were the research questions on which I based my work:
What are the skills to be included in MPH curricula to build a cadre of knowledge brokers in Latin America?
What are the enabling conditions and obstacles to carry out the process of knowledge translation in the region of the Americas?
I decided to use a qualitative approach for data collection because one of the main reasons for conducting this kind of study was to allow for exploration of the process, meaning, and understanding people have constructed in the process of evidenceinformed policy-making. I conducted a total of total of 14 in-depth interviews with different experts in the research and policy-making field coming from six different countries of the region (Colombia, Peru, Chile, Argentina, Mexico, Brazil and Dominican Republic). During the first three interviews I was accompanied by Dr Cuervo who gave me feedback at the end of interview. This allowed me for further refinement of interview technique.
7
The grounded theory analysis was undertaken in this study. This type of analysis is common in qualitative research in public health and aims to categorize respondent´s accounts so that they can be summarized. It was done in two successive steps: 1. Coding participant ideas into categories 2. Interpreting codes through comparative methods. The findings were organized in three sections according to the categories that emerged from the analysis 1. The enabling conditions for knowledge translation 2.The adverse conditions for KT and the elements for inclusion within MPH programs 3. KT skills to include within MPH programs. The lack of infrastructure, the difference between researchers and policy makers concerning time opportunities and agendas and also sometimes the political and economic context arose as the main barriers for conducting this process. On the other side, involving decision makers in the research process from the beginning as well as transforming the use of scientific evidence to inform decisions as part of the culture were considered the main facilitators for evidence use. The Knowledge Translation skills identified were:
Communication skills o
How to disseminate information
o
How to interpret scientific results
Skills on appraising the evidence: o
Skills on synthesizing and giving format to the evidence o
How to do a Systematic Review How to make a policy brief
Skills for interacting with policy makers o
Understanding the policy process
o
Participating in deliberative dialogues
Most experts agreed that the best way to integrate these skills was to do it in a transversal way. The proposed curriculum therefore incorporates the four core areas of public health (epidemiology, biostatistics, social and environmental determinants of
8
health and public health), the skills to be included and the teaching approach to be used giving it a matrix framework. The results we obtained from the testimonies of these experts working throughout the region of Latin America and the Caribbean are interesting and valuable. Despite the limitations for conducting the study, particularly the sampling and participant selection, the findings are consistent with the initial perception that arose during the 21st Cochrane Colloquium meeting in QuĂŠbec by confirming that there is a paucity of knowledge brokers in Latin America and the Caribbean and there is a need for a systematic approach to address this issue. Despite differences between decision-makers and researchers, there was agreement on the need to have professionals with communication skills to translate results from a scientific study to decision-makers and the general audience. Teaching future students how to communicate is not an easy task. Widening the scope of the kind of teachers involved in this process by inviting journalists or more specifically, scientific journalists, would be one innovative solution. Certainly, the findings of this study will contribute for further research in that matter and will be used as a support for future discussions with universities and other stakeholders interested.
C.
Case study:
As part of the expected products stated in my terms of reference, I had the opportunity of writing a case study on a topic of my election. I decided to do it on how research and accident helped in the discovery of the first chemotherapeutic agents. I have always been interested in cancer research since my studies in medical school and also for personal reasons. Some years back, I had the opportunity of reading about this topic and during my stay in this department I thought this was a good moment to explore more about it. This case study was translated by myself with help from Isabel Lansberry, fellow intern in the Translation Department and now appears on the PAHO website in both languages.
9
D.
Research Interest Group
I had the opportunity to organize one of the Research Interest Group held by the Research Promotion and Development team and helped out with two others. On April 7th, we were glad to welcome Dr. Olivier Grimaud coming from France to participate into one of the Research Interest Group meetings. Dr Grimaud is a public health physician and Deputy Director of the Epidemiology Department at the National School of Public Health in France. He opened his discussion with a presentation of his current research on health inequalities regarding stroke onset and care and it was followed by a deliberation on the global challenge of tackling health inequalities with a specific focus on chronic disease management. The participants coming mainly from PAHO were glad to attend the meeting and having the opportunity to learn about the French Public Health System.
E.
Internship activities within PAHO
Along with the projects outlined in my Terms of Reference I had the chance to contribute to several other projects and activities. With Dr Cuervo and Rachel Hutchinson, I had the opportunity to peer review an article for the British Medical Journal. This was a very interesting task where I was able to learn more about the skills to carry out this process and to develop a more critical thinking towards scientific articles and the requirements for publication. Additionally, I attended and participated in the retreat of the Knowledge Management Research and Promotion Department held on April 2nd at the Organization of American States. All the KBR staff and other interns participated in the retreat. The aim of the retreat was to develop a vision for the department and identify future lines of work and priorities. It was a very good experience and for me and it was the opportunity of getting to know more about the Department. On April 28th, I attended a funding meeting for expanding health research capacity in the Americas proposed by COHRED and PAHO to USAID. With Rachel Hutchison who, we both took the meeting minutes and together we compiled the final report of the meeting.
10
I also helped moderating a virtual Blackboard conference between COHRED, PAHO and other funders the next day. I attended several other important meetings at PAHO Headquarters including:
The Biannual Assessment of Work: Strategic Objective Final Assessment for the Strategic Plan 2008-2013
International Women´s Day event, which was introduced by PAHO´s Director, Dr Carissa Etienne, and followed by a film "To Educate a Girl".
The Directors dialogue with staff
I also contributed with the departmental Research Newsletter, where I wrote about the case study I did, about the Research Interest Group I organized with Dr Olivier Grimaud and about the Virtual Couse for developing evidence informed guidelines based on the GRADE approach. Finally, also at PAHO I became member of the Toast Masters association to develop and improve my public speaking skills. Every Tuesday, twice a month, toastmasters members and guests meet at PAHO to attend a learn-by-doing workshop in which participants improve their speaking and leadership skills in a no-pressure atmosphere. It was not only a good opportunity to improve these skills but also a great way to meet new people and hear interesting speeches. I also took advantage of being here to learn Portuguese, one of the four official languages of the Pan American Health Organization. I attended the beginners level taught by Ms. Fernanda Roliz, a very charismatic Brazilian teacher.
11
F.
Activities outside PAHO
During the first week of my arrival here at PAHO and also at Washington I got the opportunity to attend an important meeting at the OAS. On February 12th, the Pan American Health Organization/ World Health Organization (PAHO/WHO) and the Organization of American States (OAS), signed an agreement to join forces to strengthen education and human development in the Americas through the joint promotion of scholarship opportunities for the citizens of the region in training programs designed to enhance health and the production of research on health issues. After the meeting I had the fortune to meet Marie Levens, Director of the OAS Department of Human Development, Education and Employment as well as Dr. Francisco Becerra, PAHO/WHO Assistant Director. I also met Nelly Gochicoa, working in the Department of Human Development Education and Culture of the OAS and an old childhood friend, Ana María Ortiz. Additionally I also had the fortune to attend several prestigious conferences such as the ones listed below: Joint World Health Organization and World Bank conference on Universal Health Coverage 2030, during which I had the opportunity to meet eminent speakers such as Margaret Chan, WHO´s Director General, Carissa Etienne, PAHO Director and Tim Evans. I also was very pleased to listen to Ban Ki Moon, Jim Yong Kim, Lawrence Summers and Michael Bloomberg Organization of American States Policy Roundtable on Women and Drugs in the Americas. I went to the first Summer Seminar organized by the UNIC (United Nations Information Center) where I met Deputy Director Stefania Piffanelli who had the pleasure to share with us her experience in the United Nations and gave us some advice and recommendations for applying to the organization as young professionals. As part of the internship program at PAHO I attended the visit at the World Bank organized by Farida Kerouani and Rachel Hutchinson. During the visit, we had a presentation explaining the history, the aims and the current lines of work of this Organization.
12
Finally, throughout my internship and during my stay in Washington I met interns working in other organizations such as the Organization of American States and the Inter-American Development Bank. With the groups of interns within PAHO we got the possibility to share many joyful experiences together. We visited some of Washington´s museum´s, photographed Cherry Blossoms, went biking to Kenwood, assisted to some of the free concerts at the Kennedy Center and even ran 5km for charity. The relationships I built during these four months of internship at PAHO are memorable and for them I will always be very grateful.
13
V.
Discussion
This experience as an intern at the Pan American Health Organization has been an amazing one. As a student and future professional in Public Health this opportunity has allowed me to expand my knowledge in this field and also to grow from a personal point of view. Since my arrival at the Department of KBR I was gratefully surprised with the level of trust and responsibility with which we are assigned to do our tasks. We are offered with the opportunity, the materials and support from our mentors to do it and it is up to us to respond to that moment. By carrying out my thesis project as part of the tasks I was assigned to do here, I was responding to that moment. The topic of scaling up knowledge translation skills by integrating them in graduate public health programs for the region in the Americas was a challenging one. However, the efforts and the tools were available to go deep in this area and explore this new initiative. For me it was the opportunity to learn something new, to explore qualitative methods of research and to get in touch with different experts in this field. By accomplishing this project I have gathered the intellectual tools and skills to do it, I have improved my level of autonomy and taken advantage of Dr Cuervo´s mentorship and experience. Additionally, the other projects I realized here at PAHO have given me the possibility to expand my abilities to work as part of a team. As we also have the opportunity to meet interns coming from different backgrounds, we get the chance to share and learn from each other. Being part of PAHO for these four months has also extended my knowledge and understanding of international organizations. I have learned about PAHO´s mission and objectives as well as how they answer to international mandates and calls to action. Attending the KBR departmental retreat was also a good opportunity to understand its functioning and get to know all the staff. I will always gladly remember the level of confidence with which the Departmental Director, Marcelo d´Agostino valued our opinion and participation in the retreat. This experience working in such prestigious organization far exceeded my expectations and I am very thankful for it. I feel I made most of my stay at Washington D.C by taking advantage of the broad range of opportunities we are offered and by having the willingness and motivation to learn.
14