The Southern California Clinical and Translational Science Institute (SC-CTSI) at the University of Southern California and Children’s Hospital Los Angeles was created in 2007 and funded by the NIH through a Clinical and Translational Science Award (CTSA) in 20101 with the overall goal of accelerating translation of scientific discoveries to improve human health. Since the SC-CTSI’s inception, our key educational goal has been to train a cadre of early-stage clinical and translational scientists (CTSs) to improve the health of diverse and underrepresented minority populations, such as those found in Los Angeles County.2 This goal aligns well with the Institute of Medicine’s recommendation to ensure that biomedical research addresses community needs by including the community in its design and conduct.3
Within this framework, two collaborative cores within the SC-CTSI (Workforce Development and Community Engagement) developed a series of didactic courses, workshops, and seminars to help CTSs attain competency in community-engaged research. However, this educational effort lacked opportunities to develop knowledge and skills from direct experiences4–7 within the communities served by the SC-CTSI and outside the traditional academic setting. Thus, in 2013 the two cores created the Community Mentorship Program (CMP) to complement existing didactics. The primary goal was to expand the early-career CTS’s academic mentoring team by bringing on a mentor from a community-based organization (CBO) and thereby creating an opportunity for the CTS to present their research to a community-based audience identified by, and with guidance from, the CBO mentor, and to receive feedback from the mentor and community about their presentation skills, the importance of their research, and their research approach.
By pairing early-stage CTSs with CBO mentors, the CMP provides CTSs with the opportunity to learn about community needs, how their research could affect communities, how to present their research to the lay community, and translational opportunities. Here, we describe the CMP and provide a preliminary evaluation after the program’s pilot period.
For the pilot period (2013–2015), the CMP’s recruitment goal was to identify CTS–CBO mentor pairs who would work together for one year. The CMP team recruited early-stage CTSs from among those participating in the NIH Mentored Career Development Award (KL2) training program of the SC-CTSI at the University of Southern California8 and Children’s Hospital Los Angeles. Clinicians from any field (e.g., physicians, occupational or physical therapists, pharmacists) pursuing mentored research career development opportunities, with or without previous community-engaged research experience, were eligible. The team then matched each of these CTSs with a CBO mentor. The process required extensive coordination within the CMP team to ensure effective matches (see Figure 1).
From a pool of 11 active KL2 scholars, the CMP team purposively selected 3 who recognized the importance of integrating the community voice into their work and had the desire to expand their work outside the clinical or academic setting. To recruit a CBO mentor for each CTS, the team identified and invited individuals at organizations with a mission or goal aligned with the CTS’s research and with whom the team had worked in the past. The 3 CBO mentors were required to have experience in research (within or outside an academic setting), strong ties to the community, the ability to speak to the community’s interests and needs, an interest in being a mentor, and time for the program. (For the characteristics of the CTSs and CBO mentors matched for the pilot, see Chart 1.)
The roles and responsibilities of CBO mentors were explained and agreed to by each individual. These included providing a community-based perspective on the CTS’s research, helping the CTS enhance their communication skills by providing feedback on a presentation conducted in a community setting, and meeting with the CTS during the year. CBO mentors were each provided a $500 stipend for their work on this project.
Each CTS–CBO mentor pair was asked to agree to, complete, and sign a three-page memorandum of understanding (MOU) at an in-person meeting. Using a template created by the CMP team, each pair developed an MOU that described the following:
- CTS and CBO mentor roles and responsibilities;
- competencies to be attained by the CTS (e.g., improved skills communicating about research to a community-based audience, engaging with communities as a strategy for identifying community health issues);
- planned activities with timelines (i.e., identifying community-based opportunities for the CTS to present their research, developing an oral presentation utilizing PowerPoint slides, designing a feedback/evaluation form); and
- expected one-year outcomes (e.g., presenting an oral presentation to a community-based audience that would inform the CTS’s research).
Each pair participated in regular check-in conference call meetings (minimum three times per year), where the CMP team reviewed their progress and outcomes according to the MOU. If the CBO mentor or CTS identified any challenges, the CMP team discussed and brainstormed ideas to address them. In addition, if either the CTS or CBO mentor identified new opportunities of interest (e.g., grant proposals, conferences), they were discussed; if agreed to, the MOU was amended with the authorization of the CMP team.
At the end of each pair’s pilot year, a member of the SC-CTSI Community Engagement core not directly involved with the CMP team conducted separate evaluation exit interviews with each CTS and CBO mentor and elicited their suggestions for programmatic changes and additions. These semistructured interviews (duration: 45 minutes to 1.5 hours) were conducted in person. All interviews were audio-recorded and transcribed. Given the small number of interviews (n = 6), a qualitative content analysis9 was conducted by hand. Identified themes were organized around the interview questions: reasons for involvement in the CMP and previous experience in community-engaged research, successes, challenges, impact on the work of both the CTS and CBO mentor, challenges in meeting goals, and future recommendations (for the questions, see Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/A381). The CMP team received approval from the institutional review board at the University of Southern California.
Each of the three CTS–CBO mentor pairs communicated through a combination of phone calls, e-mails, and face-to-face meetings during the year. Check-in conference calls with the CMP team were scheduled on a regular and an as-needed basis (range 3–8 calls). All pairs were successful in meeting CMP goals by completing at least one community-engaged activity within the program timeframe that informed the CTS’s research; all exceeded program expectations (see Chart 1). Additionally, the CMP team ran the pilot of the program effectively, without encountering any major administrative roadblocks.
Program evaluation: Feedback from CMP participants
The 20 themes identified in the qualitative content analysis are presented with representative quotations in Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/A381. Here, we focus on participants’ overall evaluations and the challenges and successes they identified.
In general, the CTSs perceived the CMP as an opportunity to develop new networks and colleagues outside academic walls. They reported that participation in the CMP helped them build greater trust in the community and gave them an opportunity to learn more from individuals who are affected by the health issue their research addresses.
It felt good to listen to them [the audience] before I presented. They were so engaged … [it was] really eye opening to start with questions like that. So as I let them talk, they became even more engaged because now I was listening to them. I think that was very different from how I’d done it [engaged audiences] before. It made it so much easier for them to hear what we’re doing here … and what we have found so far. (CTS)
The CBO mentors felt that participating in the program provided them with an opportunity to learn more about the research topic and to jump-start new projects with the CTS. Two of the mentors noted they had identified other projects to work on with the CTS or had helped the CTS extend the research project to the next logical step. All three CTS–CBO pairs mentioned that they would continue to work together after completing the CMP.
This was the perfect opportunity to not only mentor somebody, provide them some information and guidance in your area of expertise, but at the same time learn something that perhaps you were not aware of … you can also get into different types of collaborations … it’s not [just] a one-year thing. (CBO mentor)
Among the challenges described by the CTSs and CBO mentors were the extent of time needed to be successful and the importance of making sure this was a priority for both parties. In addition, the CTSs noted difficulty finding additional funding to maintain this productive relationship.
We highlight one CTS–CBO mentor pair that experienced challenges at the start of the program to illustrate why a strong support structure is needed for this type of program. In community-engaged research, the onus for ensuring success of the research is typically on the researcher: The research is generally the priority for the researcher, and the researcher provides most of the resources to drive the research agenda. In this instance, the CTS was new to community-engaged research and did not realize she was responsible for scheduling meetings with her CBO mentor, ensuring that the project remained on track, and driving much of the collaborative effort. Several months into the pilot, the CMP team identified that this CTS–CBO mentor pair had not been meeting regularly and had made little progress toward meeting the MOU goals. To facilitate interactions, the CMP team implemented monthly conference calls with this pair to provide additional support. These calls were designed to confirm that the pair was making progress, to address any challenges they were facing, and to discuss next steps. The implementation of these calls helped get this pair back on track and ensured that both parties were accountable to their project. The pair appreciated this support, as the CTS noted:
I think they [the CMP team] sensed that things weren’t really moving forward and they needed to take a more proactive role, and that was really helpful. That’s when things started moving.
Each CTS–CBO mentor pair identified a number of successes, such as new partnerships, better mutual trust and understanding, new knowledge and skills, and progress in meeting their program/research goals. One CTS noted that on the basis of her experience in the CMP, she identified a new aspect of the research that should be addressed. As a result, she refined her conceptual model and “all of a sudden everything just clicked! It all came together.” Additionally, each pair described aspects of the program that exceeded their expectations. For example, the CTS in the pair that faced challenges at the start of the program indicated that after doing the presentation, she was surprised by how engaged the community was and how many people wanted to remain informed about her work.
One CTS–CBO mentor pair explained that the CMP provided them the “momentum” to accomplish goals they had always wanted to address. This pair had an existing professional relationship for several years prior to their participation in the CMP; however, this relationship had not included the partnership or exchange of ideas that the CMP made possible. This pair created a training manual for promotoras (community health workers) to educate the community. They attended a national conference to present their work and found out they were the only ones in the country doing such work. Because of the CMP, the CBO mentor reported the pair had created “something that’s not available anywhere in the country so we’re really pioneering something really exciting, to increase awareness—just creating something for the organization which is really exciting.”
Lessons learned from the pilot
Among the lessons we learned during the pilot period, three stand out. First, providing academic credit for CTSs (i.e., continuing medical education credit), a stipend for CBO mentors, and central resources for scheduling and conducting meetings (i.e., the CMP team scheduling and hosting conference calls) are needed to justify or, in the case of central resources, to reduce the time allocated to the CMP by the CTS–CBO mentor pairs. Second, a future dissemination and implementation strategy will most likely need to provide didactic community-engagement skills training for CTSs at the outset of their participation in the program. Third, the CMP team’s long track record of working together most likely explains why we did not encounter major administrative hurdles. This may limit the generalizability of our program to other settings.
On the basis of the success of this pilot, the CMP will be scaled up and eventually become a requirement of the SC-CTSI’s KL2 program. We plan to formalize the CMP and develop a version that has strong dissemination and implementation characteristics (i.e., high relative advantage, adaptability, trialability, and low complexity)10 to meet needs across the CTSA Consortium; we plan to test its effectiveness in enhancing research translation produced by early-career CTSs. Broader adoption of the CMP will allow for a robust evaluation and the ability to track more CTS–CBO mentor pairs over time to see how this experience has an impact on their work in both academia and in the community. We believe that providing clinician–scientists with this type of experience will inspire them to continue to conduct research that has a measurable impact on improving the health of diverse communities throughout the United States.