Professional development outcomes associated with interdisciplinary research: An integrative review.

BACKGROUND: Interdisciplinary research among health care professionals has gained importance over the last 20 years, but little is known about its impact on career development. PURPOSE: This study examined professional development outcomes associated with interdisciplinary research. METHODS: An integrative review was conducted using Whittmore and Knafl's framework. PubMed, Embase, PsycInfo, Web of Science, and CINAHL were searched to identify studies. FINDINGS: Thirteen studies were included. The majority used bibliometric analyses, finding that moderate level of interdisciplinary collaboration was associated with a greater amount and higher quality of publications. Interdisciplinary publications allocated more credit (i.e., had more authors). Interdisciplinary research proposals had less funding success than single discipline proposals. Important cultural and personal aspects of interdisciplinary research (e.g., work and communication styles, research goals) have not been assessed to date. DISCUSSION: Rigorous qualitative studies are needed to characterize benefits and challenges of interdisciplinary research to scholars and to institutions.

Developing the new Columbia core curriculum: a case study in managing radical curriculum change.

Curricular change is essential for maintaining vibrant, timely, and relevant educational programming. However, major renewal of a long-standing curriculum at an established university presents many challenges for leaders, faculty, staff, and students. We present a case study of a dramatic curriculum renewal of one of the nation's largest Master of Public Health degree programs: Columbia University's Mailman School of Public Health. We discuss context, motivation for change, the administrative structure established to support the process, data sources to inform our steps, the project timeline, methods for engaging the school community, and the extensive planning that was devoted to evaluation and communication efforts. We highlight key features that we believe are essential for successful curricular change.

Cultural competency training for public health students: integrating self, social, and global awareness into a master of public health curriculum.

Cultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.

Columbia Public Health Core Curriculum: Short-Term Impact.

We evaluated a transformed core curriculum for the Columbia University, Mailman School of Public Health (New York, New York) master of public health (MPH) degree. The curriculum, launched in 2012, aims to teach public health as it is practiced: in interdisciplinary teams, drawing on expertise from multiple domains to address complex health challenges. We collected evaluation data starting when the first class of students entered the program and ending with their graduation in May 2014. Students reported being very satisfied with and challenged by the rigorous curriculum and felt prepared to integrate concepts across varied domains and disciplines to solve public health problems. This novel interdisciplinary program could serve as a prototype for other schools that wish to reinvigorate MPH training.

MPH education for the 21st century: motivation, rationale, and key principles for the new Columbia public health curriculum.

Public health is at a watershed moment. The world's health needs are changing, and complex problems require interdisciplinary approaches and systems-based solutions. Our longer lives and changing environments necessitate life-course and structural approaches to prevention. This argues strongly for public health graduate education that adequately prepares trainees to tackle emerging challenges and to lead now and in the future. Nearly a century of scholarship and scientific advances may offer a blueprint for training the next generation of public health leaders. We articulate a case for change; discuss some of the foundational principles that should guide public health education; and discuss what such a change might look like building on prior scholarship, on the examples set by other disciplines, and on our own experience.

MPH education for the 21st century: design of Columbia University's new public health curriculum.

Because public health challenges are changing rapidly, over the past 3 years, we have turned a critical eye to the master of public health program at the Columbia University Mailman School of Public Health. Under a process dubbed "curriculum renewal," we engaged more than 170 faculty, staff, and students (and hundreds of alumni and employers of our graduates) in an initiative to develop a completely new design for master of public health education that launched in fall 2012. We have described its design and structure and presented some preliminary evaluation data.

An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States.

OBJECTIVES: We examined whether periodontal treatment or other dental care is associated with adverse birth outcomes within a medical and dental insurance database. METHODS: In a retrospective cohort study, we examined the records of 23,441 women enrolled in a national insurance plan who delivered live births from singleton pregnancies in the United States between January 1, 2003, and September 30, 2006, for adverse birth outcomes on the basis of dental treatment received. We compared rates of low birthweight and preterm birth among 5 groups, specifying the relative timing and type of dental treatment received. We used logistic regression analysis to compare outcome rates across treatment groups while adjusting for duration of continuous dental coverage, maternal age, pregnancy complications, neighborhood-level income, and race/ethnicity. RESULTS: Analyses showed that women who received preventive dental care had better birth outcomes than did those who received no treatment (P < .001). We observed no evidence of increased odds of adverse birth outcomes from dental or periodontal treatment. CONCLUSIONS: For women with medical and dental insurance, preventive care is associated with a lower incidence of adverse birth outcomes.

A comparison of regression approaches for analyzing clustered data.

OBJECTIVES: We used 3 approaches to analyzing clustered data to assess the impact of model choice on interpretation. METHODS: Approaches 1 and 2 specified random intercept models but differed in standard versus novel specification of covariates, which impacts ability to separate within- and between-cluster effects. Approach 3 was based on standard analysis of paired differences. We applied these methods to data from the National Collaborative Perinatal Project to examine the association between head circumference at birth and intelligence (IQ) at age 7 years. RESULTS: Approach 1, which ignored within- and between-family effects, yielded an overall IQ effect of 1.1 points (95% confidence interval [CI]=0.9, 1.3) for every 1-cm increase in head circumference. Approaches 2 and 3 found comparable within-family effects of 0.6 points (95% CI = 0.4, 0.9) and 0.69 points (95% CI = 0.4, 1.0), respectively. CONCLUSIONS: Our findings confirm the importance of applying appropriate analytic methods to clustered data, as well as the need for careful covariate specification in regression modeling. Method choice should be informed by the level of interest in cluster-level effects and item-level effects.

Race and risk of schizophrenia in a US birth cohort: another example of health disparity?

BACKGROUND: Immigrant groups in Western Europe have markedly increased rates of schizophrenia. The highest rates are found in ethnic groups that are predominantly black. Separating minority race/ethnicity from immigration in Western Europe is difficult; in the US, these issues can be examined separately. Here we compared rates of schizophrenia between whites and African Americans and evaluated whether the association was mediated by socioeconomic status (SES) of family of origin in a US birth cohort. METHODS: Study subjects were offspring of women enrolled during pregnancy at Alameda County Kaiser Permanente Medical Care Plan clinics (1959-66) in the Child Health and Development Study. For schizophrenia spectrum disorders, 12 094 of the 19 044 live births were followed over 1981-97. The analysis is restricted to cohort members whose mothers identified as African American or white at intake. Stratified proportional hazards regression was the method of analysis; the robustness of findings to missing data bias was assessed using multiple imputation. RESULTS: African Americans were about 3-fold more likely than whites to be diagnosed with schizophrenia [Rate Ratio (RR) = 3.27; 95% confidence interval (CI): 1.71-6.27]. After adjusting for indicators of family SES at birth, the RR was about 2-fold (RR = 1.92; 95% CI: 0.86-4.28). Using multiple imputation in the model including family SES indicators, the RR for race and schizophrenia was strengthened in comparison with the estimate obtained without imputation. CONCLUSION: The data indicate substantially elevated rates of schizophrenia among African Americans in comparison with whites in this birth cohort. The association may have been partly but not wholly mediated by an effect of race on family SES.

Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit.

BACKGROUND: Gram-negative bloodstream infections (BSIs) cause 20-30% of late onset sepsis in neonatal intensive care unit (NICU) patients and have mortality rates of 30-50%. We investigated risk factors for late onset Gram-negative sepsis in very low birth weight (<1500 g) NICU patients. METHODS: We performed a case-control study as part of a larger 2-year clinical trial that examined the effects of hand hygiene practices on hospital-acquired infections. In this substudy, a case was a very low birth weight infant with a hospital-acquired Gram-negative BSI; control subjects, matched on study site and hand hygiene product, were chosen randomly from the patients who did not have Gram-negative BSIs. Potential risk factors were analyzed by Mantel-Haenszel methods and conditional logistic regression. RESULTS: There were 48 cases of Gram-negative BSI. In multivariate analysis, we found that the following variables were significantly associated with Gram-negative BSI: central venous catheterization duration of >10 days; nasal cannula continuous positive airway pressure use; H2 blocker/proton pump inhibitor use; and gastrointestinal tract pathology. CONCLUSIONS: These analyses provide insights into potential strategies to reduce Gram-negative BSIs. Catheters should be removed as possible and H2 blockers/proton pump inhibitors should be used judiciously in NICU patients. The association between nasal cannula continuous positive airway pressure and Gram-negative BSIs requires further investigation. The association of gastrointestinal tract pathology with Gram-negative BSIs identifies a high risk group of neonates who may benefit from enhanced preventative strategies.

Serologic evidence of prenatal influenza in the etiology of schizophrenia.

CONTEXT: Some, but not all, previous studies suggest that prenatal influenza exposure increases the risk of schizophrenia. These studies used dates of influenza epidemics and maternal recall of infection to define influenza exposure, suggesting that discrepant findings may have resulted from exposure misclassification. OBJECTIVE: To examine whether serologically documented prenatal exposure to influenza increases the risk of schizophrenia. DESIGN: Nested case-control study of a large birth cohort, born from 1959 through 1966, and followed up for psychiatric disorders 30 to 38 years later. SETTING: Population-based birth cohort. PARTICIPANTS: Cases were 64 birth cohort members diagnosed as having schizophrenia spectrum disorders (mostly schizophrenia and schizoaffective disorder). Controls were 125 members of the birth cohort, had not been diagnosed as having a schizophrenia spectrum or major affective disorder, and were matched to cases on date of birth, sex, length of time in the cohort, and availability of maternal serum. MAIN OUTCOME MEASURES: Archived maternal serum was assayed for influenza antibody in pregnancies giving rise to offspring with schizophrenia and matched control offspring. RESULTS: The risk of schizophrenia was increased 7-fold for influenza exposure during the first trimester. There was no increased risk of schizophrenia with influenza during the second or third trimester. With the use of a broader gestational period of influenza exposure-early to midpregnancy-the risk of schizophrenia was increased 3-fold. The findings persisted after adjustment for potential confounders. CONCLUSIONS: These findings represent the first serologic evidence that prenatal influenza plays a role in schizophrenia. If confirmed, the results may have implications for the prevention of schizophrenia and for unraveling pathogenic mechanisms of the disorder.

Graduate Education for the Future: New Models and Methods for the Clinical and Translational Workforce.

This paper is the third in a five-part series on the clinical and translational science educational pipeline, and it focuses on strategies for enhancing graduate research education to improve skills for interdisciplinary team science. Although some of the most cutting edge science takes place at the borders between disciplines, it is widely perceived that advancements in clinical and translational science are hindered by the "siloed" efforts of researchers who are comfortable working in their separate domains, and reluctant to stray from their own discipline when conducting research. Without appropriate preparation for career success as members and leaders of interdisciplinary teams, talented scientists may choose to remain siloed or to leave careers in clinical and translational science all together, weakening the pipeline and depleting the future biomedical research workforce. To address this threat, it is critical to begin at what is perhaps the most formative moment for academics: graduate training. This paper focuses on designs for graduate education, and contrasts the methods and outcomes from traditional educational approaches with those skills perceived as essential for the workforce of the future, including the capacity for research collaboration that crosses disciplinary boundaries.

Building Interdisciplinary Research Models Through Interactive Education.

BACKGROUND: Critical interdisciplinary research skills include effective communication with diverse disciplines and cultivating collaborative relationships. Acquiring these skills during graduate education may foster future interdisciplinary research quality and productivity. OBJECTIVE: The project aim was to develop and evaluate an interactive Toolbox workshop approach within an interprofessional graduate level course to enhance student learning and skill in interdisciplinary research. We sought to examine the student experience of integrating the Toolbox workshop in modular format over the duration of a 14-week course. METHODS: The Toolbox Health Sciences Instrument includes six modules that were introduced in a 110-minute dialogue session during the first class and then integrated into the course in a series of six individual workshops in three phases over the course of the semester. RESULTS: Seventeen students participated; the majority were nursing students. Three measures were used to assess project outcomes: pre-post intervention Toolbox survey, competency self-assessment, and a postcourse survey. All measures indicated the objectives were met by a change in survey responses, improved competencies, and favorable experience of the Toolbox modular intervention. CONCLUSION: Our experience indicates that incorporating this Toolbox modular approach into research curricula can enhance individual level scientific capacity, future interdisciplinary research project success, and ultimately impact on practice and policy.

Paternal age and risk of schizophrenia in adult offspring.

OBJECTIVE: The study examined the relation between paternal age at the time of birth and risk of schizophrenia in the adult offspring. METHOD: Data from the birth cohort of the Prenatal Determinants of Schizophrenia study were used in this study. Virtually all members of this birth cohort had prospective information about paternal age at the time of the offspring's birth. Subjects with schizophrenia and other schizophrenia spectrum disorders (N=71) among members of this birth cohort were previously ascertained. In separate analyses, paternal age was modeled as a continuous variable and as a categorical variable, and its relation with the risk of adult schizophrenia and other schizophrenia spectrum disorders and with the risk of schizophrenia separately were examined. RESULTS: There was a marginally significant, monotonic association between advancing paternal age and risk of adult schizophrenia and schizophrenia spectrum disorders. The association held after the analysis controlled for the effects of maternal age and other potential confounders. Similar results were observed when only subjects with schizophrenia were included in the analysis. CONCLUSIONS: Advanced paternal age at the time of birth of the offspring may be a risk factor for adult schizophrenia.

Relative risk for genetic associations: the case-parent triad as a variant of case-cohort design.

The contribution of this paper is to conceptualize the case-parent triad within an epidemiological framework. We propose that the case-parent triad design is a variant of the case-cohort design. The affected offspring of case-parent triads come from a source cohort of all offspring of parents in a population. We first demonstrate that if the source cohort is restricted to offspring of a certain parental mating type then the relative risk in relation to genetic exposure can be estimated simply from the ratio of the number of exposed to the number of unexposed affected offspring. We then extend the logic to studies including offspring of all parental mating types; provided that the allele frequencies and possible parental mating types are specified, a valid relative risk can still be estimated. Compared to prior descriptions of the case-parent triad design, the proposed approach is readily understandable, epidemiologically meaningful and provides a relatively simple perspective for estimating valid measure of effect. Also, by allowing the potential sources of selection bias to be revealed more easily the design is made more accessible both conceptually and practically to epidemiologists.

Approaches to preparing young scholars for careers in interdisciplinary team science.

To succeed as a biomedical researcher, the ability to flourish in interdisciplinary teams of scientists is becoming ever more important. Institutions supported by the Clinical and Translational Science Awards (CTSAs) from the National Institutes of Health have a specific mandate to educate the next generation of clinical and translational researchers. While they strive to advance integrated and interdisciplinary approaches to education and career development in clinical and translational science, general approaches and evaluation strategies may differ, as there is no single, universally accepted or standardized approach. It is important, therefore, to learn about the different approaches used to determine what is effective. We implemented a Web-based survey distributed to education leaders at the 60 funded CTSA institutions; 95% responded to the survey, which included questions on the importance of preparation for interdisciplinary team science careers, methods used to provide such training, and perceived effectiveness of these training programs. The vast majority (86%) of education leaders reported that such training is important, and about half (52%) of the institutions offer such training. Methods of training most often take the form of courses and seminars, both credit bearing and noncredit. These efforts are, by and large, perceived as effective by the training program leaders, although long-term follow-up of trainees would be required to fully evaluate ultimate effectiveness. Results from the survey suggest that CTSA education directors believe that specific training in interdisciplinary team science for young investigators is very important, but few methodologies are universally practiced in CTSA institutions to provide training or to assess performance. Four specific recommendations are suggested to provide measurable strategic goals for education in team science in the context of clinical and translational research.

Strengthening the career development of clinical translational scientist trainees: a consensus statement of the Clinical Translational Science Award (CTSA) Research Education and Career Development Committees.

The challenges for scholars committed to successful careers in clinical and translational science are increasingly well recognized. The Education and Career Development (EdCD) of the national Clinical and Translational Science Award consortium gathered thought leaders to propose sustainable solutions and an agenda for future studies that would strengthen the infrastructure across the spectrum of pre- and postdoctoral, MD and PhD, scholars. Six consensus statements were prepared that include: (1) the requirement for career development of a qualitatively different investigator; (2) the implications of interdisciplinary science for career advancement including institutional promotion and tenure actions that were developed for discipline-specific accomplishments; (3) the need for long-term commitment of institutions to scholars; (4) discipline-specific curricula are still required but curricula designed to promote team work and interdisciplinary training will promote innovation; (5) PhD trainees have many pathways to career satisfaction and success; and (6) a centralized infrastructure to enhance and reward mentoring is required. Several themes cut across all of the recommendations including team science, innovation, and sustained institutional commitment. Implied themes include an effective and diverse job force and the requirement for a well-crafted public policy that supports continued investments in science education.

Sharing facilities and administrative cost recovery to facilitate interdisciplinary research.

PURPOSE: Despite increasing interest in interdisciplinary research, researchers consistently cite institutional barriers as deterrents. Researchers, administrators, and others have suggested developing processes for sharing facilities and administrative (F&A) cost recovery as one way to support collaborative research. Therefore, the authors reviewed current policies for sharing F&A cost recovery and user satisfaction with them. METHOD: In 2010, through reviewing institutional Web sites and surveying researchers and grants administrators from a range of institutions, the authors identified different policies currently employed and assessed user satisfaction with them. RESULTS: Whereas most respondents (80.7%, 205/254) agreed that a standard policy for sharing F&A cost recovery would facilitate interdisciplinary collaboration, only 35.4% (90/254) reported that their institutions had such a policy. Among the 85 respondents who answered questions about their institution's policy, most (66 [77.6%]) reported that the policy applied to grants with multiple principal investigators or coinvestigators across departments or schools, and 68 (80.0%) reported satisfaction with the policy. Respondents from institutions with policies were significantly more likely to endorse the notion that policies are helpful compared with those who reported that their institutions did not have such policies or were unsure of their existence (89% versus 76%, P = .014). The authors detected no significant differences in satisfaction scores based on policy type, whether determined by investigator effort, space allocation, or other considerations (P = .29). CONCLUSIONS: These data support the need for institutions to establish formal policies for sharing F&A cost recovery as a way to promote interdisciplinary research collaboration.

Building interdisciplinary research models: a didactic course to prepare interdisciplinary scholars and faculty.

Many academicians assume that anyone can engage in interdisciplinary research, but it is clear that successful interdisciplinary efforts require mastery of specific competencies that can be learned and improved. This paper describes the development and implementation of a course designed for Master's, pre- and postdoctoral students and research faculty on models of interdisciplinary research skills, based on a set of core competencies. Major challenges included working through institutional structures that made it difficult to offer cross-school courses, and interpersonal challenges among a diverse group of students from a number of disciplines. Although universities may be poised for interdisciplinary research, strategies for faculty preparation and support are lacking. Institutions embracing the concept of team and interdisciplinary science must focus not only on the structural barriers and facilitators, but also on direct support to faculty. The didactic course described in this paper is one approach to enhance interdisciplinary research skills of scholars-in-training and faculty, and we recommend that similar efforts be widely implemented.