A comprehensive approach to building capacity for D&I research necessitates investment in training new investigators to grow the field. TIDIRH was developed to address a lack of D&I training opportunities available to investigators in the United States and elsewhere. An intended feature of TIDIRH was to offer a transdisciplinary program of training that was not restricted to a focus on a particular disease or implementation setting (e.g., clinic, community). TIDIRH offered a unique opportunity to train a diverse group of investigators in how best to effectively integrate research evidence into clinical and public health practice and policy. By all accounts, we judge the inaugural session of TIDIRH a success. Trainees not only reported using skills gained from their TIDIRH experience to secure funding for D&I research, they also are helping to build an appreciation for and understanding of D&I as an important scientific pursuit through formal and informal interactions with their colleagues.
Trainees provided feedback throughout the week on how to improve TIDIRH. Even though the agenda built in time for discussion during and after sessions, we still had more content than could be fit into the long days. We learned that we must build in enough flexibility during the training to make iterative corrections for time and content. It is likely that we will continue to struggle with achieving the “right” balance of covering what we believe to be essential material, while allowing enough time for questions, interaction, emerging issues, and development of individual projects. One approach we are taking for TIDIRH 2012 is to assign and send readings for most of the presentations to trainees four to six weeks prior to the training. The recent publication of the first comprehensive text on D&I research in health
 will be used as a text and help to provide background to trainees prior to meeting.
Fine-tuning the TIDIRH curriculum will continue to be a dynamic process. In addition to turnover of faculty from year to year (resulting from the change in host institution), maturing of the field and changes in healthcare delivery and policy will likely necessitate modifications to the TIDIRH curriculum. Consequently, we will continue to engage a group of core planning faculty at least six to seven months prior to the training, in order to allow for appropriate changes to TIDIRH content. For example, plans for the coming year include presentations from officials from the new Patient Centered Outcomes Research Institute (http://www.pcori.org).
While developing the TIDIRH curriculum, core faculty devoted much time to agreeing on a single ‘model’ to guide the training. In retrospect, however, we realize that it is not necessary, practical, or even advisable to agree on a single model for TIDIRH. Feedback from trainees suggests that they would have found it more useful to focus on a rationale for why D&I research is needed than to have consensus on a model to guide the field. Trainees would rather have available a presentation defining and justifying D&I research to use when presenting to their colleagues, especially colleagues in the basic biomedical sciences who often are unfamiliar with this type of applied research. For 2012, the training will begin with such a lecture and will include emphasis on commonalities among the over 60 models, theories, and frameworks that have been published for D&I
. Multiple models will be discussed throughout the week to guide different aspects of the curriculum and enable trainees to better select and use models to inform their D&I research.
One of the strengths of TIDIRH is that it was open to trainees representing diverse backgrounds, experiences, and interests and that it was not institution bound. However, this strength also presented a challenge. TIDIRH trainees were interested in developing a range of D&I studies in a variety of VA, clinical, community, and policy settings. Our interdisciplinary approach, however, meant that tailoring the curriculum to separate disciplines, disease outcomes, or contexts of interest to trainees was not possible. The small group sessions, which were supposed to provide an opportunity for trainees to get feedback on their individual projects, did not fully satisfy the desire for more tailored area-specific instruction. Consequently, in planning future institutes, we will try to organize trainees with like interests/implementation settings for the small group sessions and also plan to build in more one-on-one time with expert faculty to provide feedback on individual projects.
A related challenge to meeting the diverse interests of trainees was that TIDIRH was open to both junior and more established investigators. Training junior investigators, of course, has the advantage of developing new cohorts of investigators who may devote their careers (both research and teaching) to D&I. However, conducting D&I research requires a different skill set than basic scientists or even applied intervention researchers possess, and we believed that more experienced investigators interested in changing their focus to D&I would benefit from the training. We also reasoned that more established investigators would provide the added advantage of being better positioned to build capacity for D&I research at their home institutions and professional organizations. Nevertheless, we struggled with assessing the level at which an investigator was “too senior” to gain much from the training and the extent to which giving a valuable spot at TIDIRH to an already established investigator was justified. While we did not entirely resolve this dilemma, for TIDIRH 2012, we decided to give preference to applicants who demonstrate experience with, or within, healthcare delivery or community-based networks to facilitate more rapid and broader translation of TIDIRH training.
TIDIRH will continue its plan to increase capacity for D&I research by rotating local host institutions each year and by using a train-the-trainer approach in its design. Yet this annual summer institute, in addition to the other offerings currently available, is unlikely to meet the demand for comprehensive D&I training in the United States. Over 200 applications to TIDIRH were received in 2011 and again in 2012. Although the short-term evaluation presented here suggests that TIDIRH is beginning to meet its goals, there continues to be a need for sustainable strategies that have wider reach and at the same time build capacity for D&I training at academic and related health research institutions. In addition to the training opportunities mentioned earlier in this paper, resources such as the Dissemination & Implementation in Health e-Newsletter, which provides monthly updates on research practice and policy activities in D&I (email email@example.com to subscribe) and websites that are designed to increase the D&I potential of effective interventions and affiliated products (e.g., Make Research Matter (http://www.makeresearchmatter.org/ and Cancer Control P.L.A.N.E.T (http://cancercontrolplanet.cancer.gov/) help to create a community of practice. The NIH and VA will continue to support the annual TIDIRH but also are pursuing additional avenues for building the field, such as web-based learning opportunities. Continued investment in training the next generation of scientists is essential not only to advance the field of D&I but ultimately is needed to ensure that advances in science make a difference in improving health.