An Innovative Undergraduate Inter-Disciplinary Research Course: Development, Implementation, and Student Perspectives

Research has become increasingly complex resulting from advances in omics, technology, data science, and healthcare. Healthcare research aims to improve quality of life for individuals and populations; however, many health problems are complex and multifaceted. Thus, multiple perspectives and levels of expertise are needed to explore research questions in these areas.^1,2 Collaboration among multiple disciplines is essential in research as it is difficult for any individual discipline to have the expertise or research ability to address these complex problems.^1,3 Moreover, the collaboration between disciplines has been identified as a key element to decrease disciplinary specialization, which results in professional barriers, profession-specific jargon, and “siloed” approaches to solving problems.^1,4,5 Interdisciplinary research advances scientific discovery by allowing the perspectives and ideas of different disciplines to work synergistically to solve complex multifaceted healthcare problems.⁶

Undergraduate students are encouraged to learn about and participate in research and ample opportunities exist at many universities⁷ taught by faculty who specialize in single areas of expertise.⁵ Funding agencies, like the National Institutes of Health (NIH) and National Science Foundation (NSF), however, emphasize the importance of interdisciplinary research.^6–8 Creating interdisciplinary research opportunities and engaging students early in their academic careers at the undergraduate level is needed as this participation will subsequently foster the development of skills and abilities needed by interdisciplinary researchers after graduation.^1,2

This article describes the development and implementation of a pilot course designed for undergraduate students interested in engaging in interdisciplinary research. It also explores the students’ perspectives on collaborating with an interdisciplinary team and the lessons learned from the project that will be used to refine the future course.

Methods:

Before designing this course, our healthcare research team conducted a mobile health (mHealth) study to obtain symptom data from children with serious illness who were at high risk for significant symptom distress. The study participants were undergoing either a stem cell transplant or other cancer treatment therapies.⁹ Study participants reported their symptoms, such as pain, fatigue, nausea, and vomiting with a smartphone app. At the study’s conclusion, the research team created “symptom visualizations” (line charts, bar charts) to represent and track the dynamic nature of symptoms and to highlight milestones in treatment. The researchers then shared these symptom visualizations with the with the study participants, their parent caregivers, and their clinicians. Each of these three groups expressed an interest in seeing more visualizations to enhance symptom communication and management around the presence, timing, severity, and impact of experienced symptoms.¹⁰ While the research team is interdisciplinary consisting of a physician-researcher, nurse scientist, and physiology graduate student, it is heavily rooted in healthcare. The need to expand the research team’s ability to create meaningful symptom visualizations, through the addition of team members with skills in data science and data visualization, was the catalyst for the development of this course. The mHealth research study was conducted independently and not purposefully designed to inform the course structure or design.

Course Objectives

The course was designed and led by a School of Nursing postdoctoral fellow who was involved in the mHealth study and School of Nursing faculty member. The decision was made to pilot the course with a small number of students to assess the approach and determine best practices for teaching interdisciplinary research principles. Course objectives were created which included: 1) students will collaborate with a multidisciplinary team to analyze symptom reported data; and 2) students will create meaningful, interpretable, and engaging graphic symptom visualizations to support enhanced communication of symptom timing, duration, and severity.

Course Framework and Theory

The Theory of Connectivism¹¹ was incorporated to guide the course design. Connectivism is one of the newest educational learning theories. The theory’s principles include: 1) knowledge and learning are tied to diversity of opinion; 2) learning is a process that includes connecting resources of information and supporting the ability to make connections between ideas and concepts; 3) maintaining and nurturing those connections is required for facilitating continual learning; 4) decision-making is a process of learning; and 5) the aim of connectivism teaching is producing activities that support accurate and up-to-date knowledge.¹² These principles were integrated in the course through: 1) the enrollment and engagement of multidisciplinary students and health professionals; 2) the inclusion of up-to date peer-review articles and resources to support the dynamic direction of student interests and their decision-making about effective symptom visualization techniques; and 3) having multidisciplinary team meetings and a final presentation of student visualizations with immediate feedback and active discussion.

Course Design

This course was conducted at a university in the Southeastern United States. Because the course was piloted during the COVID-19 pandemic, a virtual platform was used for weekly class meetings. Students from any undergraduate or graduate discipline were considered for enrollment. Interested students submitted their resumes and were interviewed by the postdoctoral fellow to gauge their interest in working with and learning from an interdisciplinary group of students and health professionals. Four students from diverse fields of study (computer science, biostatistics, graphic design, and biology) were selected for the pilot course. The 3-credit course was scheduled through their individual programs of study as either a research internship or an independent study. Each student had a department faculty advisor and a course contract stating the objectives and outlining assignments due during the semester. The assignments designed by the department faculty advisor consisted of a mid-term paper and end of semester paper that summarized the student’s work on the project.

In addition, two teaching assistants were involved with the implementation of the course. The first was a graduate nursing student who assisted with the course objectives and syllabus development and conducted interviews near the end of the semester with students. The second teaching assistant, a graduate student in exercise science, attended the weekly class and provided office hours to assist students with weekly assignments. Despite the small number of enrolled students, the purpose for using two teaching assistants was to explore the needs of the students throughout the semester and examine ways to enhance their success through additional course support.

Course Activities

The goal of this project was to develop a course that introduced undergraduate students to interdisciplinary healthcare research and exposed them to an interdisciplinary collaborative experience. A one-hour class was held weekly with the course instructor and teaching assistants throughout the semester. Weekly assignments included healthcare publication readings and projects to be completed before the next week’s class. Weekly projects involved students using the study team’s mHealth data to perform statistical or visual analyses to create symptom visualizations. During class, students presented their work to the entire class for review and discussion. Their presentations included a description of their discipline and how their discipline influenced their work. For example, the biostatistician student was interested in “getting to know the data” and performed statistical analyses such as symptom frequency counts, histograms, and correlations while the graphic design student was interested in “seeing the data” and created visualizations depicting symptom occurrences. Students were encouraged to engage with classmates and ask questions about how different disciplines influenced the work. Students used statistical and visualization software resources such as Microsoft Excel (Microsoft Inc., Redmond, WA, USA 2018), SAS 9.4 (SAS Inc., Cary, NC USA), Tableau (Tableau Software Inc., Seattle, WA USA), R (R Software, Miami, FL USA), Python (Python Software Foundation, Wilmington, DE USA), and Canva (Canva Pty Ltd., Sydney Australia).

Three times during the semester, students presented their symptom visualizations to a total of nine volunteer healthcare clinicians who were invited to attend class as “guest reviewers.” This experience was designed to give students an understanding of the healthcare clinician’s perspective when looking at symptom visualizations for their patients. Guest reviewers (physicians, nurse practitioners, nurses, and informaticists) attended class and gave students feedback on their symptom visualization projects.

Weekly assigned readings were discussed in class. Readings were purposefully selected to familiarize students with the symptom distress pediatric cancer and stem cell transplant patients experience and thus give them a context and understanding of symptom science research. The readings also aimed to develop the students’ understanding of how healthcare researchers report research findings and to facilitate an understanding of formats to present clinically meaningful information. Finally, the readings also aimed to provide students with a foundation of techniques for visualizing mHealth data.

As this was a pilot course conducted to assess the design and methodology, voluntary interviews with students were conducted near the end of the semester. A teaching assistant interviewed the students to obtain their perspectives on the interdisciplinary aspects of the course, explore what they learned throughout the course, and elicit their suggestions for improvement.

Grading

Students received frequent timely informal formative feedback. Students also received summative feedback through project and course grades. Student grading was based on the department faculty advisor’s grade of the written projects, as well as the post-doctoral fellow’s grading of class attendance, class presentations, and demonstration of interdisciplinary teamwork.

Results:

Throughout the first five weeks of class, students met virtually each week during scheduled course sessions. Students collaborated by learning about each other’s respective disciplines, critiquing each other’s work, and providing suggestions for modifications of weekly projects. This time allowed them to learn about each other’s disciplines and plan for collaborative team-based projects. By week six, the students gained enough familiarity with each other’s disciplines to begin working together on projects, these sessions met outside of the weekly scheduled course time and were conducted virtually. The week six assignment was to have students create two symptom visualizations, one for a child (Figures 1a and 1b) and one for a clinician (Figure 2) that would be meaningful and interpretable. The student biostatistician conducted statistical analyses and the results were the basis for the other students’ symptom visualizations. Figures 1a and 1b are symptom education illustrations for children. Figure 2 was designed as an mp4 that depicts changes in symptom intensity over time (see supplementary material to view the graph in motion). During week seven, three healthcare clinicians (a physician, a nurse, and a nurse practitioner) were invited to serve as guest reviewers for the students’ projects. Reviewer’s gave feedback and suggestions on the symptom visualizations. This format created a realistic interdisciplinary platform for student engagement. Specific feedback included labeling the visualizations with significant health events, incorporating legends to orient the viewer, and changing colors to enhance visibility of important information. Students incorporated the feedback into their week eight symptom visualization assignments and again were critiqued by a new set of three guest reviewers (two informaticists, and a nurse practitioner).

Figure 1a and 1b.

1a. Child-friendly Symptom Visualization Handout. 1b. Child-friendly Symptom Pie Chart.

Figure 2.

Symptom Intensity Bar Chart.

The final weeks of the course emphasized advanced interdisciplinary work and collaboration between the students. Students met throughout the week and worked together on their symptom visualizations and on supporting the success of the team with their unique discipline-related skills. For example, the biostatistician student conducted statistical analysis and created basic visualizations, then the student with knowledge of color theory and graphic design principles further enriched the symptom visualizations. The biology student applied principles from relevant literature to inform their work and create clinically meaningful visuals. The computer science student coded programs that allowed the symptom visuals to be viewed as animated mp4s, like movies, that accentuated the changes in symptoms over time. Figure 3 depicts a radar graph of symptoms that shows mean pain score for older and younger age groups for each treatment group (transplant or cancer treatment). Figure 4, the symptom severity stream graph is a type of stacked area graph that shows the flow of symptom intensities over time.

Figure 3.

Radar Graph Mean Pain Score Comparisons for Age & Diagnosis.

Figure 4.

Symptom Intensity Stream Graph.

The students requested an additional critique session with guest reviewers, so in the final week of the course three additional guest reviewers (a nurse practitioner/nurse scientist, a hematologist, and a pediatric nurse who works in the hospital with this patient population) were invited to attend class. Students presented their advanced visualizations, and the reviewer feedback was overall very positive about the presentations of the symptom information. Both the hematologist and nurse practitioner emphasized the potential usefulness of using the visualizations to promote symptom discussion and education for patients and parents. The hematologist noted the symptom visualizations would be helpful discussion resources if used in medical team rounds for patient plan for care discussions. They also suggested the symptom visualizations might be used as an educational resource for residents learning about symptom patterns in this population. The reviewers liked the novelty of the radar graphs and noted since these graphs are used in many children’s video games they may serve as useful visualizations for children to better understand their symptoms. Table 1 lists additional feedback clinicians gave to the students on the symptom visuals.

Table 1.

Clinician Feedback on Student Symptom Visualizations.

This was insightful from the standpoint of seeing symptoms over time.

The students’ visualizations showed us symptoms in ways we haven’t seen them.

These symptom pictures seem so intuitive and could open conversations with children about what they are feeling.

The pictures give a good jump off point to discuss symptoms during a patient visit.  I think overall the concept is great and real time results that look back over a week would be helpful.

It would be great to see this information in the EHR.

Something like this could be useful in rounds.

The stream graph presents a powerful story, I really like it.

Henrik Ibsen famously said, “A picture is worth a thousand words”. These students provided good evidence for that statement.

Though very different the visualizations were very successful in conveying symptom information.

Interviews

Near the end of the semester, we offered students the opportunity to voluntarily give course feedback through interviews. One of the teaching assistants conducted semi-structured interviews. The interview prompts were designed to explore the undergraduate students’ perspectives of interdisciplinary research and what they learned, describe their experiences working with students from other disciplines, give suggestions for course improvement, and express their thoughts about having healthcare clinicians review and give feedback on their work. All interviews were completed in less than 20 minutes and audio-recorded for transcription. Table 2 displays the main questions and student responses.

Table 2.

Student Interview Responses

Interview Prompts	Student Response
Describe your previous interdisciplinary research experience.	I havenť had too much research experience outside of this class. Not any really.
Describe your thoughts about working on an interdisciplinary team.	The interdisciplinary team is like multiple intersections kind of melding together to bring broader perspective to the situation. I think what I saw was really unique for if you were to try to create something, you need a statistician to analyze it, you need a coder to program it out. You need the bio person to understand it, and then you need the graphic designer to make it presentable. I liked how like we were kind of covering all the bases. I could say that it was interesting at first, solely because it was like we spoke different languages. Working together you can just figure out what each other needs, and then talk about that.
Tell me your thoughts about the course activities.	The weekly readings helped me understand what the kids are going through (symptom distress). We also had readings for color theory and design and that helped me gear my projects towards this specific situation a little bit better. Yeah, I really enjoyed those weekly presentations. I think thaťs the place where I'm learning the most, I think even more so than the readings, where I get to see how other people are thinking, what information they're looking for and all those kinds of things. I really enjoy doing those weekly presentations.
Describe how you learned from others in different fields of study.	…her presentations from the beginning were like, very statistic heavy, with all these kinds of like statistics terms I've never heard of so immediately, I was being exposed to something new that I could learn about. Although I was intimidated at first, I realized that everybody was in a position to learn from other people. And I was able to relax and just be like, okay, we're all here to learn. I learned every time we talked about how our disciplines helped us decide which direction to go. The interdisciplinary focus of this course allowed me to expand my skillset and learn from my peers of different academic backgrounds.
Describe your thoughts on having health care clinicians and researchers view your work.	That was super helpful…it was nice to have someone in the field tell me what was and what wasnť like what they were looking for in a visualization. Having the doctors or the nurse practitioners come in and tell me what they liked, and seeing the difference between what both groups wanted. The doctors were more interested in like symptoms and stuff like that. Whereas the nurses were more interested in more of the emotional side, or like how the kids were feeling rather than the clinical side. That was really interesting for me, especially seeing how they're from different backgrounds, and so they'd have different opinions, some of them like stacked histogram, some of them didn’t.
Describe any challenges related to the interdisciplinary work	It has been hard for me to do the data side of things, the more technical side of things by myself. So having to rely on some of the other team members to give me some of those statistics or these programs. It has been kind of hard to coordinate getting the information and then have enough time to create the visualizations.

Discussion:

This pilot course was successful in bringing students from diverse fields of study together to collaborate on a healthcare project. Each student used their unique skills, learned about other disciplines’ skills, and experienced collaboration with other disciplines to create symptom visualizations for the study team that will be used to increase symptom awareness and communication for seriously ill children, their parent caregivers, and clinicians. Through interviews it was discovered some of the students initially felt uncomfortable and intimidated by the thought of working with other disciplines, mostly due to their inexperience with it. Using the theory of connectivism gave students a platform to learn about and collaborate with other disciplines through engagement and active learning. Our approach also enhanced their learning by having students present their own discipline’s influence on their projects each week which enabled all to develop a multidisciplinary appreciation. As the semester progressed, students began to better understand the essence of the other disciplines (core subject matter, theories, and methods) and realized that by combining their knowledge and skills with other disciplines they could make connections and learn from each other to enhance their work. They co-created advanced symptom visualizations such as an animated mp4 bar chart using advanced coding techniques (pandas, mathplotlib) (Python Software Foundation, Wilmington, DE USA) and applied color theory and design principles for a color blindness schema. Student feedback indicated they learned and expanded their skillsets from collaborating with multiple disciples.

The interview data gave broader insight into the students’ perspectives of their interdisciplinary experience. The findings showed that overall students perceived the benefits of working as interdisciplinary team, especially the value of communication in this course. This is consistent with a previous study that reported the importance of communication among interdisciplinary students who created an app to improve maternal and newborn health.¹³ An additional perceived gain by the students was that the course broadened their perspective by exploring different viewpoints through discussion with other students and clinicians. A previous study also demonstrated the students’ recognitions of the benefits of a wider perspective.¹⁴ In a study conducted by Imafuka, students noted differing perspectives could create challenges when working together, however, increased communication could address the issue.¹⁵ Similarly, students in our course gradually perceived the enjoyment of being part of the interdisciplinary team and learning from other disciplines throughout the semester.

The approach of using guest reviewers exposed students to “real clinicians” from multiple healthcare disciplines and gave them additional exposure to other disciplines. The guest reviewers provided feedback on the clinical significance of their work and gave suggestions for improvement. This approach also showed the students how different healthcare clinicians may use the data to improve care for their patients. For example, the physicians expressed using the symptom visualizations to plan care, the nurses noted the symptom visualizations could be communication resources, and the informaticists commented on the ability to have the symptom visualizations in the electronic health record. Students noted they enjoyed having diverse healthcare disciplines review their work and liked the authenticity of the experience.

The approach of using relevant literature was impactful as students learned about the significant symptom distress children with serious illness experience and discovered the importance of designing visualizations that are easy to interpret and clinically meaningful for different viewers (children and clinicians). They explored data visualization platforms (Tableau, Python, R) they had not previously used, experimented with new visualization techniques to visualize symptom data (radar charts, stream graphs), incorporated graphic design strategies into creating visuals, explored animation using matplotlib (an open-source framework), and identified the meaningful types of data visualizations for clinical use.

University COVID-19 teaching protocols necessitated the course meet virtually each week. This likely made interdisciplinary collaboration more difficult for the students as people tend to collaborate more easily when working in close proximity. However, the students were successful using the virtual platform and co-created meaningful symptom visualizations. The virtual platform may have enhanced our ability to have guest reviewers attend as this was a more convenient way to have busy healthcare clinicians volunteer their time.

Lessons learned and Future Directions:

Overall, the pilot course achieved the project’s objectives and a future larger course that includes healthcare students across multiple disciplines is currently being planned. However, several important lessons were learned that will inform future course implementation. Due to the reliance on the students who could conduct statistical analyses, we would propose students have at least one semester of college-level statistics that includes using statistical software, otherwise, we suggest course faculty ensure there are enough students who have a statistical background to work in groups with students from other disciplines.

Three of the students noted they would like more time to delve into the weekly readings. The readings enriched their understanding of symptom distress, exposed them to how healthcare researchers report their findings, and gave them insight into designing effective visualizations. Additional class time will be allotted to allow for a more thorough discussion about the readings.

Conclusion:

Introducing interdisciplinary collaboration at the undergraduate level is achievable and is key for continued successful work between disciplines. This pilot interdisciplinary research course gave undergraduate students the opportunity to communicate ideas, listen to other perspectives, and integrate methods to develop symptom visualizations for the research team. All four of the students are currently in the process of formally joining the healthcare research team and are continuing the work they started.

Key Points:

• Introducing interdisciplinary collaboration to students at the undergraduate level can help prepare students for a realistic research career.

• The Theory of Connectivism was a useful learning approach that gave students a platform to learn about and collaborate with other disciplines through engagement and active learning.

• Students perceived several benefits of this interdisciplinary course including exposure to new concepts, ideas, and opportunities for collaboration with other disciplines.