Herbert, Julia L.; Borson, Soo MD; Phelan, Elizabeth A. MD; Belza, Basia PhD, RN; Cochrane, Barbara B. PhD, RN
The complexity of health-related issues affecting older adults calls for collaboration among health care disciplines to provide evidence-based clinical care. However, the tradition of separate “academic silos”1 in major academic institutions prevents the development of needed cross-disciplinary training models, resulting in a lack of practitioners experienced in working collaboratively with those trained in fields outside their own. Few opportunities for cross-fertilization occur during the typical training of health professionals and researchers on aging, yet this is the period when professional values, methods, and identities are most actively developing. The value of future gerontologic and geriatric research—and perhaps the entire scientific research enterprise—rests on a commitment to interdisciplinary mentoring and teamwork, as highlighted in the 2008 Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce.2
The University of Washington (UW) is a large, state-sponsored university with six health sciences schools: medicine, nursing, dentistry, social work, pharmacy, and public health. In 2007, the university established the Center for Interdisciplinary Geriatric Research (hereafter, “the Center”) with the participation of all six health sciences schools through the RAND Health and John A. Hartford Foundation's Building Interdisciplinary Geriatric Health Research Centers Initiative.3 This initiative provided two years of pilot funding for interdisciplinary aging research projects, supported the establishment of new interdisciplinary aging-research relationships, and encouraged interdisciplinary mentoring and faculty development on aging issues.
The Center's leadership consists of two codirectors based in the UW Schools of Nursing and Medicine. Functional cores, composed of senior faculty members from the university's six health sciences schools, advise the codirectors and lead Center initiatives. Program faculty across the UW and its affiliated institutions who are interested in geriatric health care research participate in Center-hosted events.
Charged with the goal of fostering and expanding geriatric research, the Center piloted a two-year, interdisciplinary mentoring model. That model, the consultancy model, is the topic of the present report.
Much published literature exists on the topic of mentoring,4–12 but there is much less on interdisciplinary research collaboration.13–15 Not surprisingly, few publications describe the process of interdisciplinary mentorship of researchers or relevant models for its implementation.3,16 Here, we describe an innovative researcher–mentorship model—the consultancy model—that can be implemented on a small scale, within the constraints of limited funding and established training programs. The goal of this model is to create opportunities for both short- and long-term developmental mentoring by fostering interdisciplinary connections among researchers. In our implementation of the model, which was carried out between September 2007 and June 2009, the short-term mentoring component was focused on developing problem-solving skills and giving immediate feedback to researchers. The Center welcomed researchers in all areas because there is so much overlap between topics in geriatrics and topics in other areas of medicine (e.g., biostatistics, epidemiology, rehabilitation medicine) and because many difficulties in starting a research program are nearly universal (e.g., grant writing, determining clinical versus research time). The long-term component sought to introduce researchers with similar interests and diverse backgrounds who otherwise might never meet.
The Consultancy Model and Our Use of It
The Center adopted and adapted the consultancy model developed for the Paul Beeson Physician Faculty Scholars in Aging Research Program, a program also funded by the John A. Hartford Foundation. In this model, participants take turns presenting research or career challenges to a group of senior faculty who engage in problem solving around each challenge. This model offers two primary advantages over other mentorship models. First, the model allows junior faculty members to remain grounded in their home disciplines while still benefiting from cross-disciplinary mentorship and support; an enduring commitment is not required, overcoming one of the major difficulties faced in interdisciplinary and transdisciplinary training.15 Second, the model is flexible enough to accommodate sessions of varying length and with a range of participants. In our version of the model, consultancies were held monthly, lasted one hour, and included lunch. Center leadership recruited challenge presenters from junior faculty and consultants from senior faculty via word of mouth and established departmental e-mail lists. Two to three challenges related to research or career issues were presented at each session. Three consultants were recruited for each consultancy session, chosen for expertise that matched, as closely as possible, the nature of the challenges to be presented, and for distinct disciplinary perspectives that were as broad as possible.
Three to four weeks before the consultancy session, junior faculty challenge presenters were sent e-mails detailing the format of the session and the challenge presenter role. They were asked to submit their challenges to the consultancy facilitators (S.B., E.P., B.C.) in advance of the session. The facilitators confirmed that challenges were suitable and succinct enough for the session format, contacted challenge presenters with preliminary feedback, and identified senior faculty panelists to address each particular challenge. Open invitations to join the audience for each session were issued via e-mail to faculty members at UW and its affiliated institutions.
Session flow was directed by Center leadership and aided by a prominently displayed poster with the session agenda (see Figure 1 for a session flowchart). To help with process improvement, sign-in sheets and feedback forms were collected from all attendees at the close of each session, with additional feedback collected from the challenge presenters. Participants invited to complete the process/outcomes survey were informed regarding human subjects considerations before they chose to proceed with the survey. The UW institutional review board approved all data collection modalities reported herein.
Between September 2007 and December 2008, the Center held 13 consultancy sessions, each with two to three challenge presenters and three consultants at each session. Overall attendance (including audience members) at the consultancies ranged from 7 to 21, with a total of 65 individuals attending at least 1 of the 13 consultancy sessions.
During these sessions, 29 individual presenters representing 11 disciplines presented 32 challenges. Three-fourths of the presenters brought challenges of an interdisciplinary nature, defined as either arising directly from an interdisciplinary work experience (e.g., how to communicate effectively within a group) or being easily addressed by an interdisciplinary panel because of the universality of the challenge (e.g., how to prepare a competitive career development award grant application). Challenges fell into two broad categories: career-oriented and research-specific challenges. Two presenters opted to discuss clinical or administrative issues not falling into those two categories.
Examples of a challenge representing each category are described below:
* Career challenge: How to balance administrative responsibilities with research and teaching responsibilities. The presenter was a junior faculty member who was feeling overwhelmed with managing competing research and teaching responsibilities while staying on top of the various administrative duties that accompany both. On the advice of the panel, the presenter planned to review previous unfunded grant proposals to find salvageable work, carefully consider opportunities for future collaborative versus solo work, and discuss time management strategies with colleagues having similar levels of administrative responsibility.
* Research challenge: How to adapt an existing, nonfunded grant into a more fundable proposal. The presenter had written a grant that had not been funded and was hoping to rework it on a tight timeline and submit it for a new call for proposals. After receiving input from the panelists to carefully consider the participant's true research interests and career goals and the purpose of the new call for proposals, the presenter determined that the proposal was not a good fit for the new call and planned to seek out more relevant funding opportunities.
Outcomes of the Consultancy Model
The consultancy sessions consistently received high ratings on the postsession feedback forms. Ninety-eight of the 106 responses to the question about the quality of the sessions were “very good” or “excellent.” Additionally, 97 out of 104 responses agreed or strongly agreed that the session met a need that was not being met elsewhere. A majority of responses (81 out of 99) indicated willingness to participate again in the future as a panelist or as a presenter. An average of seven feedback forms were collected at the end of each session (which was an average of 60% of session participants; our impression was that the consultants tended not to submit feedback forms for their sessions, whereas the participants and challenge presenters nearly always did so).
During the two years of the consultancy program, 15 of the 29 challenge presenters responded to a postconsultancy follow-up interview or a Web survey, with each response given at least one week following their sessions. Some respondents answered only a subset of the survey questions. Overall feedback was positive. When asked on the Web-based survey to rate their experience with different aspects of the consultancy, all 13 participants who responded to that question felt that their participation in consultancy sessions would enhance their ability to conduct interdisciplinary research. Additionally, 12 of the 13 responding presenters reported finding the consultancy feedback helpful and said they felt supported during their session. A majority (11 of 13) reported appreciating the opportunity to network, said that they would be willing to present another challenge (11 of 13), and felt they were given adequate guidance to present their challenge (8 of 13). All 15 postconsultancy follow-up respondents reported planned or completed action on their challenges as a result of session suggestions. Examples of feedback comments included
Finally, I received a couple of very concrete and practical suggestions that I can act upon immediately!
Although there were multiple disciplines represented, they were mainly researchers and/or practitioners. What about administrators, funders, computer programmers, persons developing public health advertisements, or public opinion that might shed a different light on the opinion?
I met some people at the meeting that I introduced to my colleagues, as their work is very similar.
Before I forget, I really want to thank you for the opportunity to present my challenge to this group. They were thoughtful, dynamic and deeply probing—really allowed me to consider aspects of the ... proposal that were not immediately obvious to me. This is a terrific resource!
Many respondents also noted that they appreciated the diversity of experiences of their fellow participants. The most frequent recommendation was to allocate additional time for discussion.
In February 2009, after the completion of the consultancy sessions, we conducted an Internet-based, one-time survey of all attendees to capture their views of the long-term implications of the consultancy model and understand other incidental benefits. The survey was modeled after the 2008 Tobacco Harm Reduction Network Survey, which described the extent of networking interactions between researchers with a common area of professional interest who were geographically diverse and represented multiple disciplines.17 Of all participants in the process, 35 responded to the survey (54% of the total attendees). Most respondents were affiliated with the school of medicine (13) or the school of nursing (12), with one or two respondents each from the schools of dentistry, pharmacy, social work, and public health. Respondents were mostly women (29), reflecting the overall composition of attendees, and held academic positions including assistant professor (7), associate professor (6), and full professor (10).
Respondents to the survey indicated a significant increase in interdisciplinary connections, with many leading to collaborations. New connections made between Center consultancy session survey respondents that were attributed to their participation in the sessions are illustrated in Figure 2, which was created using UCINET's NetDraw feature. Five main types of connections are represented, respectively, as gradually darker and thicker lines between nodes: exchange of information, ongoing contact, formal collaboration, a major influence in thinking, and an influence in thinking along with another significant interaction such as a formal collaboration. (Node size corresponds to faculty rank, with the largest nodes representing full professors.) Cross-disciplinary networking is particularly visible between respondents from the disciplines of nursing and medicine, the two disciplines with consistently high levels of faculty participation. (Note: We did not perform statistical network analysis and thus can only describe trends that participants reported to us.)
In addition to the increase in cross-disciplinary collaboration, the consultancy model also increased participants' individual capacity for research. The following intangible benefits were found to result from the consultancy model to a moderate or great extent (3 or 4 on a 4-point scale): created an opportunity to network with a key individual (25 of 33 respondents); increased access to or knowledge of research resources, investigative tools, study subjects, and/or data (24 of 33); generated new questions, knowledge, and/or understanding (24 of 33); increased ease of access to expertise outside my discipline (23 of 33); created new opportunities to mentor or be mentored (18 of 32); and enhanced opportunities for participation in grant proposals (17 of 32).
Findings of the present study suggest that the consultancy sessions strengthened opportunities for interdisciplinary connection and were perceived as filling a need that was not met in participants' other academic and research activities. It is worth noting that prior research has shown that informal relationships may have greater impact in terms of career trajectory than formally assigned ones18 and that peer mentoring offers some advantages over traditional junior– senior mentoring relationships.19 The consultancy model is unique in offering the opportunity for both informal and peer mentoring within the context of an organized institutional program and complementary to established formal mentoring relationships (i.e., relationships already established within one's discipline).
The sessions were advertised as a way for challenge presenters to gain insight from experienced faculty researchers, and many took advantage of the opportunity to ask fundamental career development questions as well as research questions. Perhaps because of the nature of the Center's mission and the text of the session invitations, the challenges often had an interdisciplinary theme. Although many of the challenges were thematically similar, each consultancy session involved a different group of presenters, panelists, and audience members, thus ensuring continued novel discussion.
Although only half of the survey respondents reported outcomes (to a moderate or great degree) that included new opportunities for participation in grant proposals or to mentor/be mentored, it is worth noting that these two outcomes are the most time-intensive, particularly when compared with a less intensive outcome, such as accessing resources or expertise. That the consultancy sessions enabled half of respondents to engage in these more intensive outcomes despite the relatively short time period during which the sessions were held indicates a strong tangible benefit from the sessions—for session participants and audience members alike. It has been reported that short-term mentoring relationships result in higher job satisfaction and organizational commitment for mentors,20 and the frequent reporting of intangible outcomes resulting from the sessions may offer additional evidence for why these interactions tend to be positive. Although the survey requested information about outcomes as a direct result of the sessions, having prior contact with a colleague could make it easier for the sessions to catalyze additional levels of collaboration.
The consultancy model also helped mitigate many of the traditional barriers that impede the formation of successful interdisciplinary collaborations including but not limited to difficulty in incorporating indirect cost sharing in grant proposals, geographical separation, a lack of available suitable mentors, and pressure on faculty in tenure-track positions to invest their time and energy in departmental research.21 Short-term findings suggest that consultancy sessions inspired interdisciplinary collaboration across some common institutional barriers, perhaps by facilitating novel mentoring relationships and introducing a low-risk forum in which to “try on” interdisciplinary perspectives.
The sessions consistently received high ratings and enthusiastic positive feedback; however, audience attendance at individual sessions could be somewhat unpredictable. Even so, this had no detectable effect on the perceived value of the sessions. Statements on the feedback forms, for instance, asking whether the session met a need that was not being met elsewhere, were highly subjective. Further, repeat participation and feedback from a few dedicated individuals occurred, which might be seen as a limitation in its potential to introduce a reporting bias, but could be seen as a strength—denoting the presence of a small group of “early adopters” who may catalyze the development of new research collaborations within the institution. Specific feedback was collected from only 15 of our 29 challenge presenters about their experiences, and although their feedback was consistently positive, they represent only about half of those who had the experience of presenting their challenges to an expert panel.
Network survey respondents were not asked to report on their prior relationships with other named colleagues. The gerontology research community at the university is small relative to many research interest groups, and prior contact between researchers may have aided in the formation of more enduring collaborations, potentially overrepresenting connections made from the sessions. On the other hand, the connections depicted in Figure 2 are based on the responses received from 35 respondents, even though all 65 session attendees named on the survey are represented as nodes on the plot. The 54% survey response rate may thus have led to underrepresentation of actual connections.
Although nearly everyone who participated in the consultancy program found it beneficial, and conversations tended toward the lengthy and lively, it was difficult to obtain advance commitments from busy researchers to attend as challenge presenters and consultants. To this end, we found it instrumental to have a “point person” to help presenters construct their challenges and to reconfirm the date and time with senior researchers in the week preceding the sessions.
Our experience with the Center's consultancy program has shown that interdisciplinary consultancy sessions offer a feasible and valuable adjunct to structured faculty mentoring and development programs.22,23 The consultancy model effectively encourages productive, informal mentoring relationships. Advantages of the consultancy model include flexibility in session format and participant pool, the ability to develop a network of scholars with complementary expertise, an option to receive time-limited input where one-on-one mentorship is neither desired nor practical, and the opportunity for problem solving outside the social and political constraints of a departmental work circle. The ease and economy with which a consultancy program can be established make it ideal for a variety of groups and settings. (An overview of the consultancy process is available from the John A. Hartford Foundation.24)
The authors wish to thank Keith Provan for providing the survey for network analysis used by the Tobacco Harm Reduction Network, which the authors adapted into the Process and Outcomes Survey for this study. The authors are indebted to John Beilenson for introducing the Beeson consultancy structure document to coauthor Elizabeth Phelan, who shared the consultancy process with the University of Washington Center for Interdisciplinary Geriatric Research.
This study was funded in part by the Building Interdisciplinary Geriatric Health Care Research Centers Initiative, a joint program of RAND Health and the John A. Hartford Foundation.
The University of Washington institutional review board approved all data collection modalities reported herein.
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