ResearchattheFMS:CurrentStatusandFutureDirections

DonaldT.Simeon,PhD

GuestLectureattheFMS,UWI,StAugustine

January24,2017

Acknowledgments

• Interviews• L.Baboolal• B.Bassaw• C.Carrington• C.Charles• D.Dan• G.Hutchinson• L.Jaisingh (MOH)• R.Naidu• C.Oura• K.Sealey (MOH)• TSeemungal

• Reports• D.Crichlow• E.Greenidge• M.Lewis• S.Roberts

Overview• Currentstatus

• Structure

• Researchoutputanduptake

• ChallengesandOpportunities

• Futuredirections

• Approachestoincreaseresearchoutputanduptake

• Systemic,targeted,collaborations

• Conclusion

CurrentStatusofResearch

Structure• DeputyDean– ResearchandGraduateStudies• ResearchEthicsCommittee

• ResearchClusters• TropicalMedicine:InfectiousDiseases• Lifestyle-relatedNCDs• Dementia,NeuroscienceandMentalHealth• PublicHealth(Vet,MedandDental)• NaturalProductsandHerbalMedicine• EthnicityandHealth• Surgery

• Othersgroups,individualsinallSchools

ResearchOutput• Publications(primaryproxy)

• ResearchDegrees

• Othermeasures

• Conferencepresentations

• Innovation– patents,etc.

• Proposalspreparedandsubmittedforfundingor

implemented

Methodology• Numberofpublications• Sourcesofdata

• PubMed(T&T,UWIandFMSassearchterms)

• AnnualFacultyreports(2010-2015)

• Limitations• Inconsistencies– duplications;omissions

• QualityofJournals

• Studentresearch• FocusonPhDandMPhilDegrees

• Others

Publications1990– 2015(AllT&T– PubMed)

0

20

40

60

80

100

120

140

160

180

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

SourceofPubMedT&TPublications2010-2015

UWI (Faculties) #ofPublications %

MedicalSciences 360 65

ScienceandTechnology 21 4

SocialSciences 10 2

FoodandAgriculture 8 1

HumanitiesandEducation 4 1

NonUWI 151 27

FMSPublications2010-2015(PubMedandFacultyReports)

38

5447

55

87

78

5156

61 6356

42

89

110 108

118

143

120

0

20

40

60

80

100

120

140

160

2010 2011 2012 2013 2014 2015

PubMed OtherPublicationsfromFacultyReport Total

DisparitybetweenPubMedandFacultyReports

• AuthorsnotreportedasbeingaffiliatedtoFMSinsomepublications

• JournalsnotindexedinMedlinedatabase• NewJournals,peer-reviewprocess

• Books

• DisciplinesnotcoveredbyPubMed• IndexMedicus:medicine,nursing,dentistry,veterinarymedicine,healthcaresystems,preclinicalsciences

• Multi-disciplinaryresearchteams

FMSPublications,bySchool

0

10

20

30

40

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015

MEDICINE VETERINARY PHARMACY DENTISTRY NURSING

PublicationsbySchool2010-2015

0

50

100

150

200

250

300

350

400

450

MEDICINE VETERINARY PHARMACY DENTISTRY NURSING

No.ofAcademicstaff,bySchool

School NumberMedicine 82

VeterinaryMedicine 28

Dentistry 17

Nursing 10

Pharmacy 10

No.ofPublicationperAcademicStaff(2010- 2015)

8.20

4.94

4.50

2.65

0.60

4.68

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

Pharmacy Medicine VeterinaryMedicine Dentistry Nursing AllFMSStaff

JournalswithMostPublications(2010-2015)

JOURNAL No.

%of

Total

Impact

Factor

WestIndianMedicalJournal 89 12.9 0.29

ArchivesofPhysiologyand

Biochemistry 12 1.7 2.05

InternationalJournal of SurgeryCase

Reports 8 1.2 0.63

BritishMedicalJournalCaseReports 7 1.0 0.32

PanAmericanJournalofPublicHealth 6 0.9 0.56

StudentResearch

• Undergraduateresearch• YR02SchoolofMedicine

• Verysuccessful,prizesatCHRC,publications,etc.

• 32 groupprojectsduring2015-2016academicyear

• OtherSchools• Groupvs.individualprojects

• Graduatestudents• DM

• 13programs,requireresearchprojects

• 170studentsenrolledduring2015-2016

• MPH• Requireresearchprojects

• 25 studentsenrolled2015-2016

• MSc• 5 programswith32students

enrolled2015-2016

ResearchDegrees• Pre-ClinicalSciences• 12currentlyenrolled(7PhD,5MPhil)

• Biochemistry(6),MolecularGenetics(5),Physiology(1)

• 7graduatedbetween2012-2015• 5PhDs– averageduration8.8years• 2MPhils– averagetime4.5years• Challengesidentified

• Procurementofresearchmaterials

• Lackofreagents,resourcesandequipment• Lackofadequatesupervision

• Para-clinicalSciencesandVetSchool• AlsohaveMPhilandPhDstudents

ResearchUptake• UWIStrategicPlan

• Sharingoffindingswithkeystakeholders

• Clinicalpractice• LeddevelopmentofCaribbeanGuidelinesforAsthma,DepressionandMaternalCareinPregnancy.AlsocontributedtoDMandHypertension

• Informhealthpolicyandprogramming• Nodataavailable

• Innovations• Nodataavailable

• Researchcitations• Notexamined

CurrentStatus:Summary• Structure

• Inplace,timeforreview?• ResearchClusters

• Collaborations– Departments,Schools,Faculties,campuses,external• Researchawards– atregionalandnationallevels

• Productivity• IncreasingnumberofpublicationsbutnotinallSchools• Notallstaffmembersequal

• Fewwithmanypublicationsandmanywithveryfew?

• Studentresearchhaspotentialforstrengthening

• Uptake• Contributiontoclinicalpractice• Policyimpactandinnovationunclear

ChallengesandOpportunities

Challenges

• Lackoftechnicalsupport• Statistician,epidemiologist,RAs,post-docs

• MaintenanceofLabfacilitiesandequipment

• Administrativesupportforgrantmanagement• RoleofOfficeofResearchDevelopmentandKnowledgeTransferisunclear

• BursaryandLegalOffice• Notverysupportiveingrantreporting/communication

• EthicsapprovalfromMOHandRHAs• Unstructuredsystem– causesdelays

Challenges

• Inadequatetimeforresearch• Heavyteachingandserviceloads

• Limitedfunding• Conductofresearch• Alsoneededforpublicationfees

• Needforresearchskillstraining• Insufficientcapacityinresearchdesignandmethodology

• Conversionofcompletedresearchtopublications

• Researchculture

• Insufficientmentoring

Opportunities• Attractiveforinternationalcollaboration• Increaseinfundingopportunities• Shareexpertiseandbuildlocalcapacity

• Exchangeprogrammese.g.students

• Geography• Tropicalbutveryaccessible

• Diseaseprofile• HighratesofNCDs• Infectioussuchasvectorborne,HIV,etc.

• Ethnicdistribution/Biologicalandculturaldiversity• Goodnaturallabforgeneticandotherresearch

Opportunities

• Scopeformulti-disciplinaryresearch• WithinFMSandwithotherFaculties

• OtherUWICampuses,regionallyandinternationally

• Experiencedstaff• Internationalcollaboratorsandgrants• Canengageinmorestructuredmentorship

• MOHisawillingpartner• Researchuptakeandfunding

FutureDirections

TheWayForward• StrengthentheresearchsystemattheFMS

• EstablishmentofaResearchCentre

• Specificinterventionstoincreaseresearchoutput

• Moresupportforstudentresearch

• Strengthenframeworksforcollaborations• IncludingwiththeMOHandregionalinstitutions

• Strengthensystemsforresearchuptake

Strengthentheresearchculture

HealthResearchSystems

thepeopleandstructuresthatgovern,manage,

demand,generate,communicateoruseresearch

evidencetopromote,restore,improveormaintainthe

stateofhealthanddevelopment

Attributesoffunctionalhealthresearchsystems

• Stewardship

• Financing

• DevelopingandSustainingResearchCapacity

• KnowledgeProduction,TranslationandUtilization

• Stewardship• vision(policy),priorities(agenda),coordination,ethicalstandards• planningandexecution

• FinancingFunction• Secureresearchfunds• Grantwritingcapacity

• DevelopingandSustainingResearchCapacity• Build,strengthenandsustainthehumanandphysicalcapacitytoconducthealthresearch

• KnowledgeProduction,TranslationandUtilization• Producescientificallyvalidatedresearchoutputs• Translateandcommunicateresearchtoinformhealthpolicy,healthpractice,andpublicopinion

• Promotetheuseofresearchtodevelopinterventionstoimprovehealth(innovations)

AResearchCentreattheFMS• Raisedmanytimesinthepast– recentproposals

• EmergingInfectiousandLifestyle-relatedDiseasesResearchCentre

• CentreforEmergingDiseasesandGlobalHealth(C-EDGE)

• Bestapproach• SpecializedUnitorAll-Inclusive?

• CaribbeanInstituteforHealthResearch(CAIHR)• FormerlyTMRI.SpecializedunitsatMonaandCaveHill;similarapproachisbestforStAugustine?

• Focusonstrengths,existingclusters,gaps….• Fordiscussion

FMSResearchCentre• Agendaguidedby

• Regionalpriorities– HealthResearchAgendafortheCaribbean

• Nationalpriorities– collaborationwiththeMOH• UWIpriorities(StrategicPlan)• NeedtopromotemoreInnovation

• Funding• Grantwriting– internationallycompetitiveproposals• MOH

• Addressnationalprioritiese.g.RDIgrants• FromDevelopmentagenciessuchasIDB,%ofbudgetforresearch

• UWIOfficeofResearch• InternationalopportunitiessuchasEULAC,NWO,etc.

• Privatesectore.g.banks,Bhagwansingh,Methanex

TargetedInterventions

• ToincreasethequantityandqualityofresearchattheFMS

• Basedonneedsandevaluations• Someidentifiedindiscussionswithstaff

• Resultsof2001FMSStaffSurvey• Targetedallacademicstaffwith88%responserate

• Researchproductivity,Challenges,Funding

• Literaturereview• Systematicreviewsofsuccessfulstrategies

• ReasonsforrejectionofmanuscriptsbytopJournals

SpecificInterventions

• Buildcapacity- trainingworkshopstoaddress• Researchskills– studydesigns,methodology• Writingskills(proposalsandmanuscripts)

• Technicalresources– biostatistician,epidemiologist,researchassistants,etc.

• Peersupport– mentors,coaches

• Incentives- protectedtimeforresearch,funding,awards,publicationcosts,performance-basedculture

• On-linefacilities– EQUATORNetworkhttp://www.equator-network.org

InitiativesimplementedinResidencyprogramme

Alweis etal2015

Demonstratedsuccessovertimewithinterventionsincluding:• Researchdirector• Journalclub• Seminars• Protectedtime• Staff– hiredabiostatistician• Definingresearchrequirementsinjobdescription• Mentoring• Celebratingresidentsuccesses• Incentiveplans(rewardproductiveresidents)

ResearchOutputoftheProgramme

Alweis etal2015

StudentResearch• Reviewincorporationofresearchinalltrainingprogrammes• Canbestrengthenedwithmoretechnicalsupport

• ChallengeswithResearchDegreesforPre-Clinicalidentified

• Needforevaluation• Publications– numberandqualityintermsofduration,etc.• Researchuptake• Follow-upaftercompletionofDegrees• Roleofpost-docs,exchangeprogrammes,etc.

StrengtheningCollaborations• UWI

• WithinFMS• Needtosharewhateachisdoing– FacultyResearchDayisagoodfacility

• OtherFaculties– HEU,SALISES,Behavioural Sciences,Engineering

• OtherCampuses includingCAIHR,CDRC

• Otherregionalpartners• SuchasWINDREF,PAHO

• International• Facilitategreateraccesstofunding,technicalexperience

• ShouldalsoincludeSouth-South– countriessuchasBrazil(EULAC)

• Needforinfrastructuralsupporttofacilitateeaseofcommunication

• Needtoshowcasework– highimpactpublications,conferences

CollaborationswiththeMOH• SupporttoMOHtodevelopresearchagenda

• MOUbetweenMOHandUWItobeestablished• Focusonoperational/healthservicesresearch

• ConductedbyUWIstudents(andstaff)

• DatabasesbeingestablishedatMOH

• FundingusuallyavailablefromMOH• E.g.currentIDBfundsforNCD• Budgetlineforresearch• Researchcommitteetobeestablishedforresearchgrants• Historyofcollaboration– e.g.NESTT,BOLD,Dementia

• Forumtoshareresearchfindingsandresearchinterests• WithMOHpolicymakersandpolicyinfluencers

ResearchUptake• Outreachmustbeapriority

• RoleinKnowledgeTranslation• Goingbeyondpublicationsandscientificreports• CollaborationssuchaswithMcMastersHealthForum

• Innovation• CollaborationswithIndustry

• Herbalmedicines,MedicalMarijuana,etc.

• Apps,patentsforclinical/diagnostic/screeningtechniques,instruments,etc.

• Publications• Needtoimprovethenumbersinhighimpactjournals

StrategiestoImprovePublicationsSystematicreviewcomprising9articles(FranzandAmosun,2011)

• Successfulinterventionsincluded:• Writingsupportgroups

• Writingcourses

• Writingretreats

• Writingcoaches

• Combinationsoftheabove

InConclusion• Excellentresearchbeingconductedandproductivityisincreasing• RoomforimprovementasnotallSchoolsoracademicstaffmembersareatacceptablelevels

• Opportunitiesformoreinternalandexternalcollaborations• Potentialformoreresearch,ofhigherqualityandimpact• Bothsystemicandtargetedapproachesareneeded,includingmoretechnicalsupport• Needforgreaterfocusonresearchuptakeandinnovation