Translational Research and Medical Education:
Preparing Students to Interface Research and Patient Care
Templeton Smith
Class of 2012, WVU SoM
tsmith65@mix.wvu.edu
Scott Cottrell, Ed.D.
scottrell@hsc.wvu.edu
Terry Stratton, Ph.D.
terry.stratton@uky.edu
James Shumway, Ph.D.
jshumway@hsc.wvu.edu
2010 SGEA Annual Meeting
Small Group Discussion
April 16, 2010
1:00-2:30 P.M.
Objectives
To better understand translational research (TR) and
identify strategies to prepare medical students for their
roles in translational research through:
• Identifying and discussing elements of TR that
medical students should be expected to understand
and apply;
• Identifying TR learning outcomes essential to
complying with Liaison Committee on Medical
Education (LCME) Standard ED-17-A; and
• Discussing optimal methods of teaching and assessing
TR-related learning outcomes.
Outline
I.
Foundation of LCME Standard ED-17-A
A. Historical context of TR
B. Define TR
II. LCME and Standard ED-17-A
III. Identify and discuss TR learning objectives that fulfill
the LCME Standard ED-17-A
IV. Discuss how to teach and assess these learning objectives
in a medical school curriculum
V. Identify and discuss TR learning objectives beyond those
applicable to LCME Standard ED-17-A
Foundation of
LCME Standard ED-17-A
Historical Context
Of 101 articles, published between 1979-83 in six
major basic science journalsa promising novel
therapeutic or preventive therapies:1
– 1:4 technologies resulted in a published randomized trial
– < 1:10 entered routine clinical use within 20 years of the
basic science index publication
– By 2002, only ONE had had major clinical impact
a. Science, Nature, Cell, Journal of Experimental Medicine, Journal of Clinical
Investigation, and Journal of Biological Chemistry
NIH Roadmap for Medical Research
• Launched in September 2004
• Address “roadblocks” to research
• Re-engineer how biomedical research is
conducted by:
– Overcoming “specific hurdles”
– Closing defined gaps in knowledge
– Catalyzing translational research
http://nihroadmap.nih.gov/aboutroadmap.asp
Association
of American Medical
Colleges (AAMC):
Translational
Research
Translational research (2003):
– Identifies clinically relevant questions raised in the
interpretation of results from animal and molecular or
cellular research;
– Targets questions raised by epidemiologic studies or
clinical trials; and
– Addresses data from basic research, clinical or
population studies resulting from advances in genetics
and genomics.3
Translational Research
Translational
Research
• While the goals of TR mirror those of traditional clinical
research, the former focuses on expediting their clinical
application4 by improving communication and
reinforcing its bidirectionality among basic scientific
research, clinical research, patient care, and healthcare
policy.5, 6
• TR strives to foster new therapeutic insights by enabling
clinical research and medical observations to elucidate
scientific research and strategic approaches for their
clinical implimentation.7
Translational Research
Translational
Research
• Translational research “fosters the multidirectional and
multidisciplinary integration of basic research, patientoriented research, and population-based research, with the
long-term aim of improving the health of the public.”
• Types of translational research
– T1 research catalyzes translation between basic research and
patient-oriented research.
– T2 research facilitates the movement between patient-oriented
research and population-based research.
– T3 research promotes interaction between laboratory-based
research and population-based research.
Rubio et al.8
Translational Research
Translational
Research
Figure 1 Model for
translational research, as
proposed by the Evaluation
Committee of the
Association for Clinical
Research Training.8
• T1 research seeks to foster new or improved scientific understanding or patient care.
• T2 research facilitates improved patient outcomes, optimization of medical practices,
and improved community health.
• T3 research promotes further scientific understanding of human health and disease.
Teaching Medical Students TR
Despite teaching the latest scientific
advancements in the classroom, medical
school curricula have struggled to
prepare students for incorporating such
new scientific discoveries into their
future practices.9, 10, 11
Translational
Research
LCME
Accrediting authority for medical
education programs leading to the
M.D. degree in the U.S. and Canada
• Standard ED-17-A
Translational
Research
LCME
Standard
ED-17-A
• “The curriculum must introduce
students to the basic principles of
clinical and translational research,
including how such research is
conducted,
evaluated,
explained to patients, and
applied to patient care. ”
Translational
Research
LCME
Standard
ED-17-A
• Medical educators must now modify their
schools’ current curricula accordingly.
• However, the standard does not specify
any required criteria, and only minimal
suggestions as to how to address this
standard, thus leaving much to the
discretion of medical educators.
Results of Discussion on How to Satisfy
LCME Standard ED-17-A
Translational
Research
General
Information
• N=6
• 2 Ph.D., 1 Ed.D, 1 M.A., 1 M.H.A, 1 unknown
• TR knowledge
•
•
•
•
1 very knowledgeable
2 somewhat knowledgeable
2 not knowledgeable
1 unknown
• None have participated in TR studies or
unknown.
Translational
Research
Basic
Principals
of TR
TR Learning Outcome
E R I
1. Concisely define translational research.
2. Identify the relationship between translational research, translational medicine,
clinical research, and evidence-based medicine.
3. Understand the purpose(s) of each translational research phase (T1, T2, T3).
4. Understand how translational research will influence medical practice.
5. Describe how translational research can enhance the development of improved
medicinal therapies.
6. Understand the NIH Roadmap.
7. Identify social and economic trends that contributed to the development of
translational research as a research discipline.
8. Identify which medical disciplines may most easily assimilate into a framework of
translational research.
9. Understand the relationship between translational research and the prevention of
disease.
10. Examine the relationship between translational research and public health.
11. Identify classic examples of translational research and their medical consequences.
5
Please do not publish results without permission of T. Smith (templeton.smith.iii@gmail.com).
1
6
4
4
2
1
4
2
2
2
2
5
1
5
1
4
2
3
3
3
3
E – essential
R – relevant
I – irrelevant
“Know how
such research is conducted
Translational
Research
…”
TR Learning Outcome
E R I
1. Identify ethical issues specific to translational research and their implications.
2. Understand how translational research is funded.
3. Understand the benefits of interdisciplinary collaboration between basic, clinical and
community-based research.
4. Understand the methodology of each translational research phase (T1, T2, T3).
5. Utilize translational research resources and literature to help identify potential
translational research studies.
6. Derive clinically relevant questions aligned with basic and community-based research
findings.
7. Propose an appropriate translational research study design to address a medical
question.
8. Participate in an existing translational research study as a graduation requirement for
the M.D. degree.
9. Conduct an original translational research project as a graduation requirement for the
M.D. degree.
6
1
3
2
2
3
1
2
4
2
3
5
1
2
3
1
2
2
2
2
4
Please do not publish results without permission of T. Smith (templeton.smith.iii@gmail.com).
1
E – essential
R – relevant
I – irrelevant
“Know how
Translational
such research is …
Research
evaluated … ”
E R I
TR Learning Outcome
1. Assess the strengths and limitations of study designs of translational
4 2
research studies.
4 1
2. Interpret ethical issues specific to translational research.
3. Propose strategies to identify health issues and disparities in a
3 3
community.
4. Interpret how a translational research study may influence patient care 5 1
and/or healthcare policy.
Please do not publish results without permission of T. Smith (templeton.smith.iii@gmail.com).
E – essential
R – relevant
I – irrelevant
“Know how such research is …explained to patients, and
applied to patient care.”
Translational Research
TR Learning Outcome
E R I
1. Summarize evidence from the literature on a clinical problem that informs
patient care decisions.
2. Synthesize and articulate conclusions of translational research to a research or
medical colleague using an appropriate lexicon.
3. Synthesize and articulate conclusions of translational research to a patient or
patient proxy using an appropriate lexicon.
4. Assess a patient’s understanding of one’s explanations of translational
research conclusions.
5. Present results of translational research to research or medical colleagues
using appropriate visual aids.
6. Incorporate translational research findings into patient care decisions.
7. Identify how clinical observations may precipitate basic, clinical, or
community-based research.
Please do not publish results without permission of T. Smith (templeton.smith.iii@gmail.com).
4
2
3
3
4
1
5
1
1
5
4
2
4
1
E – essential
R – relevant
I – irrelevant
Translational
Research
Comments
• “Communicate (2, 3, 4); Knowledge (1); Skill/Behavior (5, 6)”
What methods can validly assess
Translational
Research
specific TR knowledge
and skills?
• Simulations or OSCEs with secretly expert patients (M.D.,
R.N., etc.), who can evaluate the encounter and the
student’s technique, unbeknownst to the student.
• Have students critique grants and classify types of TR.
• Have students suggest appropriate tests (PCR, FISH, etc.)
to solve simulated clinical problems and narrow a
differential diagnosis.
• Have students reflect on potential opportunities for TR in
their patient portfolios.
• Utilize journal clubs to teach TR.
• Integrate TR studies into lecture.
• Have students identify health disparities in the community.
References
Translational
Research
1. Contopoulos-Ioannidis D, Ntzani E, Ioannidis J. Translation of highly promising basic science research
into clinical applications. Am J Med. 2003;114:477-84.
2. National Institutes of Health. NIH Roadmap: Accelerating Medical Discovery to Improve Health
<http://nihroadmap.nih.gov/aboutroadmap.asp>. Accessed 14 Oct. 2009.
3. Association of American Medical Colleges. Information technology enabling clinical research. Washington, D.C.:
Association of American Medical Colleges; 2003.
4. Littman BH, Di Mario L, Plebani M. What’s next in translational medicine? Clin Scien. 2007;112:217-27.
5. Kleinman MS, Mold JW. Defining the Components of the Research Pipeline. Clin and Transl Sci. 2009;2:312-14.
6. Crist TB, Schafer AI, Walsh RA. Translating basic discoveries into better health care: the APM’s recommendations for
improving translational research. Am J Med. 2004;116:431-4.
7. Cosmatos D, Chow S-C (eds). Translational Medicine: Strategies and Statistical Methods. New York: CRC Press, 2009.
8. Rubio DM, Schoenbaum EE, Lee LS, Schteingart DE, Marantz PR, Anderson KE, Platt LD, Baez A, Esposito K.
Defining translational research: implications for training. Acad Med. 2010;85:407-5.
9. Report IV – Contemporary issues in medicine: basic science and clinical research. AAMC Medical School Objectives
Project. 2001.
10. NIH Roadmap for Medical Research. <http://nihroadmap.nih.gov/overview.asp>. Accessed October 14, 2009.
11. Westfall JM, Mold J, Fagnan L. Practice-based research – “Blue Highways” on the NIH roadmap. JAMA.
2007;297:403-6.
Thank You!