Advancing Knowledge and Research: Developing a Doctoral Program in Clinical and Translational Science

Abstract 

In an emerging field, such as clinical and translational science, questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are developed and become generally accepted as broad national standards. This article outlines issues to be taken into account as curricula are planned, implemented, and evaluated. It also discusses how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes. Clin Trans Sci 2011; Volume 4: 359–362

Introduction

Questions regarding the purpose of doctoral education have been asked for as long as doctorates have been offered in the United States. ¹ A broad national debate about these questions has relevance at a local disciplinary level, where each doctoral program has a responsibility to its faculty and learners to be explicit in the educational goals and intentions that inform its programmatic structure. However, in recent work arising from the Carnegie Initiative on the Doctorate, Walker and colleagues discovered that learners and faculty lack a clear understanding of the purposes of many of the milestones in their doctoral programs. ¹

In an emerging field, such as clinical and translational science (CTS), questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are formed and become generally accepted as broad national standards. Faculty members involved in the design and implementation of a doctoral program in CTS must have a clear understanding of the intent of their program so they can differentiate it from related disciplines within their institution while still reflecting the uniqueness of their individual program within the defined disciplinary base. Two of the greatest challenges for doctoral programs in CTS are that the field is not yet clearly defined and that the question of whether CTS is multidisciplinary or interdisciplinary has yet to be uniformly determined.

Delineating an Educational Philosophy

Whether the emerging field of CTS is viewed and characterized as multidisciplinary or interdisciplinary will influence the philosophy of educating trainees in the field. The distinction in terminology lies in the degree of integration between fields ( Figure 1 ). In multidisciplinary activities, experts from different fields work together on a research problem but focus on their specialty within the problem and then separate unchanged. In interdisciplinary activities, experts from different fields work together to integrate and synthesize ideas and methods in a new manner, with the potential to create an entirely new field. ²

Figure 1.

Distinction between multidisciplinary and interdisciplinary endeavors. Adapted, with permission, from L. Tabak, Director of the National Institute of Neurological Disorders and Stroke, presentation at the Convocation on Facilitating Interdisciplinary Research, Washington, DC, January 29, 2004.

In large “team science” research questions, ³ such as those posed by the growing body of CTS researchers, is it optimal for experts in distinct fields to work together on a problem with little integration of their thought processes or methodologies? Or is there a need for CTS to become interdisciplinary and thus require additional training and depth of knowledge? And in either case, what is the role of a CTS expert as team leader? Is it to support a system that allows individuals from separate disciplines to make worthy contributions to a common problem, or is it to facilitate the integration of knowledge? How much knowledge of each separate discipline should the CTS leader have? These are questions that must be addressed at a national level to allow the definition of CTS as a field to progress and to clarify the intent of a CTS doctoral program.

Interdisciplinary doctoral programs have been termed a “paradox,” ⁴ because rather than encouraging the depth of knowledge traditionally required in doctoral programs, they tend to encourage breadth of knowledge and the ability to engage with multiple communities of practice. If a CTS doctoral program is envisaged as truly interdisciplinary, it will need to help learners achieve both breadth and depth of knowledge about a wide range of research methodologies and disciplines, and this will require active cooperation between different university departments, as well as a substantial investment of time and money in coursework on the part of the learners. This approach has already proved to be a challenge to training in other emerging fields, such as nanobiotechnology. ⁵ On the other hand, if a CTS doctoral program is seen as multidisciplinary, less depth of knowledge about each field may be needed, but the learner will require a substantial breadth of knowledge and skills to work effectively with a team of experts from various fields. Additionally, a CTS doctoral program needs to create courses that integrate the many skills and knowledge areas necessary to develop a new type of scholar, so that learners can differentiate the educational outcomes in their program from the outcomes in other programs.

Both educational philosophies are problematic in terms of doctoral education. With limited time and resources, learners may be reluctant to accept more coursework. Without appropriate depth of knowledge and skills, however, a CTS doctorate may become the target of criticism from leaders of other doctoral programs within a university. In addition, the large number of nonacademic, practical skills that are critical to leading teams (such as working in the regulatory environment, engaging the community, and bringing medical cures to reality ⁶ ) may cause some academics to view a CTS doctorate as more of a professional degree than a traditional research degree ( Table 1 ).

Table 1.

Distinctions between research doctorates and professional doctorates in clinical and translational science (CTS)

Domain	Research doctorate in CTS	Professional DOCTORATE in CTS
Purpose	To demonstrate an understanding of the development, design, implementation, and interpretation of the research process and its contribution to the advancement of knowledge. To produce research scholars who independently conduct research and make a substantive contribution to the discipline by adding to current knowledge.	To demonstrate knowledge of the research process and the administrative application of research in academic and nonacademic settings. To lead a team of multidisciplinary or interdisciplinary researchers.
Degree objectives	To prepare researchers to demonstrate the ability to conduct research in its totality. To educate research scholars to conduct research in areas that are of relevance and significance to advancing the field.	To prepare practitioners to apply skills and knowledge of the field to meet the needs and demands of the larger context. To prepare practitioners to identify issues in need of research intervention.
Knowledge base	To develop both a broad and specific theoretical knowledge base that allows for the mastery of one’s discipline and that reflects the educational competencies outlining the field.	To develop specific knowledge and skills that emphasize the applied nature of the discipline.
Research methods	To develop a breadth and depth of knowledge and skills that cover the spectrum of research methods applicable to the discipline and that emphasize the conceptual and theoretical underpinnings of the discipline. To develop the ability to synthesize and differentiate across the spectrum of research methods.	To develop a depth of knowledge base for select methods of research inquiry used in the application of research in specific areas of interest.
Milestones and assessment	To develop measures of assessment that demonstrate mastery of concepts and theories and (when appropriate) the application of knowledge and research methods that inform and advance the discipline.	To develop measures of assessment that provide evidence of the applied nature of knowledge. To demonstrate the practical significance of research and the connection between research and application.

Distinctions between a professional doctorate and a research doctorate are not always clear. ⁷ A generally accepted difference is that the field of study for a professional doctorate is a discipline that requires experience as a professional practitioner and therefore leads to research that has an application and connection to practice. ⁷ , ⁸ , ⁹ This contrasts with a Ph.D., which is focused more on the advancement of theoretical and methodological knowledge than on applied research. ¹⁰ Although professional doctorates are intended to be similar to Ph.D.s in terms of quality and rigor, they are frequently valued less by academics. ⁹

To arrive at a purposeful, rigorous, and structurally defensible doctoral program; individuals who are developing the program must consider questions not only about educational philosophy and goals but also about program structure, assessment, and other issues discussed below.

Developing Competencies and Designing Curricula

How to teach and assess research and other professional skills in doctoral programs in applied science disciplines has been an ongoing topic of discussion among educators at various conferences, including the Association of Clinical Research Training Conference held in 2010 in Washington, DC.

The scope of CTS is broad and involves the use of a complex and integrated array of basic and clinical science methodologies to execute research along a continuum from discovery to clinical practice. Because scientific inquiry in CTS has the goal of directly affecting the nation’s public health, it is imperative to create a curricular structure that organizes and documents the demonstration of competence. ¹⁰ , ¹¹ Given the nascent nature of CTS, it is an appropriate time to begin to outline the competencies that will define the varied and unique roles played by scientists in this field and will give rise to the curricular structure of the doctoral program.

Fundamental to designing a doctoral program is the creation of a competence framework that identifies the integration of knowledge, skills, and attitudes that are necessary to achieve success as a CTS professional. Specifically, the framework must: (1) reflect the mission of the program; (2) provide a broad, general structure of competence from which specific competencies can be created (curricular structure) ¹² ; (3) differentiate between competency at the doctoral level and lower educational levels by specifying the degree of mastery expected; and (4) reflect the context and uniqueness of individual programs. In the framework ( Figure 2 ), two types of competencies must be defined: foundational competencies (i.e., what learners need to know to execute their roles) and functional competencies (i.e., the skills and attitudes that allow learners to function as professionals).

Figure 2.

Competency framework.

The question then becomes, What is the general foundation of knowledge for a doctorate in CTS? According to Forrest et al., ¹¹ one of the goals of creating competencies within doctoral programs is to specify the essential or general knowledge and skill base expected of learners regardless of their particular areas of content specialization. This general foundation allows programs to define more clearly the areas of specialization that naturally branch out from the core curriculum. With competencies clearly articulated, it becomes possible to develop learning and behavioral objectives that provide operational definitions of the competencies.

Equally important are the following questions about breadth and depth: How broad should the acquisition of knowledge and skills be? What degree of detail is required to establish competence at the doctoral level? Is this level of expertise reflected in the learning objectives? Answers to these questions are imperative, but creating a competency‐based educational framework is challenging because the unique conceptual and methodological contributions of CTS to the health sciences have yet to be fully articulated. ¹¹ Essential steps to be taken are determining disciplinary distinctiveness by outlining the unique objectives that define CTS and deciding how CTS tasks differ from tasks in other related fields in public health (e.g., epidemiology) and biomedical sciences. Only with a clear awareness of what learners should know and be able to do can meaningful assessments be implemented.

Assessing Competence and Developing Educational Milestones

Any assessment strategy starts with explicitly stated behavioral (or instructional) objectives that operationally define the competencies. Within a competency‐based educational framework, it is usually advisable to assess multiple objectives simultaneously because this places the focus on the integration of skills, rather than on the individual skills that make up the integrated whole. ¹³ , ¹⁴ For this reason, all assessment options (performance assessments, portfolios, extended projects, etc.) that allow for the assessment of integrated skills and knowledge should be investigated. When choosing assessment methods, it is important to note that a variety of assessment opportunities should be used to gather a wide range of overlapping evidence on which to base the judgment of competence, ¹⁴ rather than relying on any one assessment opportunity or method.

Before specific tools are chosen, each one should be evaluated in terms of its technical qualities, ⁹ , ¹² including its reliability (how consistent will the scores from this tool be?), validity (is this tool actually measuring what it intends to measure?), and utility (is it feasible to use this tool, given time and cost constraints?). After the assessment tools have been chosen, it is advisable to develop a table of specifications that links the tools to competencies they are intended to assess. ¹⁴ This table will provide evidence of the completeness of the assessment strategy and will document the degree of overlap between different tools and the competencies they target.

The next step is for program developers to decide how and to what standard performances will be judged. Training assessors, developing assessment handbooks, and outlining a review process for assessors will help standardize the procedure. ¹⁴

At various points throughout the program, it is crucial to provide opportunities in which learners can demonstrate their current level of competence in different ways and can be given explicit feedback to improve their future performance. ^13,14 This will give learners multiple opportunities to demonstrate their understanding of core knowledge and to practice requisite skills, within and across courses, before having to demonstrate their competence in a high‐stakes situation, such as a candidacy examination.

Determining how to assess the competence of learners is integral to establishing the milestones for any educational program. In the case of a CTS doctoral program, what are the end goals? This question is best addressed with milestones that are consistent with the educational philosophy of the program and reflect the competencies underlying its educational structure ( Figure 3 ). Specifically, milestones should allow for competence to be demonstrated and evaluated in a way that is consistent with the program goals and the level of mastery expected of the learner. In CTS, critical thinking, knowledge of research design, execution of methods of inquiry, professional skills, leadership abilities, and the mentoring of future CTS researchers are some of the global areas that define the knowledge, skills, and attitudes required of doctoral level learners.

Figure 3.

Educational program planning model. (Note that program implementation and program evaluation are outside the scope of this article).

In doctoral programs in similar research fields, the demonstration of competence typically employs the following milestones: (1) completion of didactic coursework, (2) candidacy examination, (3) experiential research internship, (4) dissertation proposal, and (5) completion and defense of the dissertation. ⁹ , ¹⁰ , ¹¹ Didactic coursework covers the breadth and depth of content necessary to conceptualize, interpret, and apply knowledge in the field, while the candidacy exam provides an opportunity to demonstrate what has been learned and how well learners integrate and apply their knowledge. Research experience parallels coursework and contributes to skill development, while the dissertation provides an opportunity for learners to offer their informed judgments about complex issues, based on their understanding of the theories, methodologies, and design that underpin their discipline. ⁹

Regardless of the assessment methods used or the milestones chosen, the goal of any assessment strategy is to collect evidence, beyond a reasonable doubt, that the learner is a competent professional. ¹⁴ To this end, evidence must be collected purposively. ¹³ In some cases, however, substantial potential evidence is lost because of its ephemeral nature. ¹³ For instance, working in small groups is often used as an instructional strategy, but because instructors cannot attend every group meeting during the entire instructional period, they often are unaware of all the work that is done in the meetings. Having learners summarize small‐group experiences can help instructors keep track of them, ¹³ and it will allow the information to be used as evidence of habits of mind, collaborative skills, and other essential but difficult‐to‐document competencies associated with functioning within a multidisciplinary or interdisciplinary team.

It is important to keep in mind that each of the assessment opportunities and milestones used throughout a doctoral program provides only a snapshot of learner competence. It is the cumulative effect of all of the evaluations that provides evidence of competence in the field. ¹² , ¹³ , ¹⁴

Conclusion

The educational structure of any doctoral program needs to reflect the educational philosophy of the program, whether multidisciplinary or interdisciplinary, applied or theoretical. While questions about the nature of CTS and about the broad competencies that CTS programs must foster are part of a debate that is best conducted at the national level, they are perhaps the greatest challenge to professional identity formation within the field today and represent a stumbling block to moving forward not only with national doctoral competencies but also with individual doctoral programs.

This article has outlined issues that program developers need to consider as the curricula are planned, implemented, and evaluated. It has also discussed how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes. Because doctoral learning takes place in laboratory and classroom environments, the objective of any assessment strategy is to document the learning and its effective application across these environments. Milestones should be just one part of a clearly defined assessment strategy. They must be rigorous and provide evidence that learners have acquired the specific knowledge, skills, and attitudes that will allow them to contribute significantly to their particular area of specialization in CTS. To do this, milestones must provide a concrete illustration of the level of breadth and depth across competencies expected of learners at the doctoral level.

The development of doctoral programs in CTS is a process that requires intense debate and clarity of purpose and thought. We encourage educators to become involved with the ongoing efforts to define the field of CTS at the national level so that rigorous and academically challenging doctoral programs in CTS can be established to train learners who will advance the field and make significant contributions to public health both at home and abroad.