One of most dreaded question you can ask a PhD student is, “what are you going to do after you graduate?” There are many career paths one can take with a PhD, both within and outside of academia, but how to navigate which one to pursue? It is estimated that only 14% of evidence-based research will ever make it to the clinic. Of those that do, it takes an average of 17 years to become widely used. This means that widespread medical interventions are nearly 2 decades behind scientific discovery. Why does it take so long for cutting-edge research to make an impact on patients’ lives? Dissemination and implementation (D&I) science is an emerging field that bridges the gap between evidence-based research—like that done by PhD students to get their degrees—and routine practice in the clinic.
What is D&I Science and why do we care?
Every intervention must go through the bench-to-clinic pipeline. It starts with proving efficacy in the lab, then demonstrating effectiveness in human clinicals trials, then adoption by individual hospitals, and then finally becomes accepted general practice. Blockages can occur in any of these steps, which can slow or stop the intervention’s flow through the pipeline. These setbacks aren’t always due to scientific or medicals issues. Some non-scientific blockages include competing demands on frontline providers, differences in expectations and priorities between researchers and clinicians, and lack of knowledge, resources, or skills within the hospital. For example, a new brain cancer treatment might have a 100% success rate, but relies on MRI imaging which might preclude its use at a rural hospital without this equipment. These obstacles prevent valuable treatments from being adopted and implemented worldwide.
The goal of D&I science is to overcome these obstacles and help interventions flow through the bench-to-clinic pipeline. D&I researchers identify blockages at all steps and design strategies to overcome them. In addition to scientific methods, strategies include effective global health planning, policymaking, and integration of evidence-based interventions. There is a focus on designing strategies that can be tailored to diverse (especially low-resource) environments and populations, such as a rural hospital with limited resources. Researchers accomplish this through a variety of methods, some theoretical and some applied.
What are some career paths in D&I?
To understand the diversity of D&I career options, let’s use an example. Imagine a study found that handwashing is good to prevent the spread of unwanted disease, and now the job is to increase the frequency of hand washing in hospitals and the public. D&I practitioners throughout the pipeline use different techniques to accomplish this goal.
The first step to implementing any intervention is to develop a plan. D&I scientists in methods development design new theories, models, and frameworks to conceptualize a problem and draft ways to systematically approach, measure, and interpret implementation strategies. They tend to be academics working on the theoretical side of D&I looking for ways to systematically approach implementation of different interventions in a variety of contexts. They can use the frameworks to give insight into why a strategy succeeds or fails and tailor them to different blockages, environments, or assumptions. Academics draw from multiple fields including social science, psychology, and physics to create their frameworks and models. Since D&I is such a new field and there isn’t a consensus vocabulary or resource for researchers to use, there is a push to establish a standard practice for the field with methods developers at the forefront of the movement.
In our example, D&I researchers would use the standard theories and frameworks to identify barriers to increasing hand washing frequency in hospitals and the public. They may conduct surveys of local hospitals to determine why physicians and the population aren’t washing their hands and tailor the implementation strategies based on the answers. While handwashing is a well-known concept, practitioners may not be familiar with new research about its proper usage or benefits. Many other interventions may be completely unknown. This would mean that knowledge is a barrier to the success of the intervention. At a national level, an implementation strategy to overcome this barrier would be to educate physicians and the public about the benefits of handwashing. This could be achieved through new CDC guidelines, infographics, and media coverage. At a local level, mandatory training on proper handwashing techniques for physicians and community hand washing sessions for public outreach could be instituted. D&I methods developers would identify the barriers, like in this example, and use D&I theories and frameworks to design measurable solutions to them. Once a plan is made, however, it needs to be put into practice to benefit society.
In some cases, experimentally testing every implementation strategy can be prohibitively time-consuming, expensive, and complex. There is a new push in D&I to employ computational models to dissect and address the complexity of different methods. Researchers can use these models to simulate implementation strategies under different assumptions and parameters before testing them in real life, increasing the likelihood of success. Models and methods from a variety of fields are employed in computational D&I, with systems-based approaches being the current favorite in the field. In the hand washing example, computational D&I scientists might simulate the effectiveness, cost, and trajectory of a particular model under different settings, resource loads, or assumptions and see how these factors affect outcomes. The insights from these simulations could inform how to improve the implementation strategy used or how the model could be adapted for another setting.
At the end of the pipeline are implementers who, as the name suggests, are D&I researchers responsible for rolling out, or implementing, new programs for hospitals, clinics, schools, etc. These are the on-the-ground people working to integrate an intervention within a real-world setting. In a sense, they are the experimentalists of the D&I world. They actively experiment with different implementation strategies and observe how they pan out in real life. The results from an implementer’s experiment are used to improve D&I theories and frameworks. Many implementers are also academic methods developers. In our example, implementers would work at national and local levels to increase hand washing frequency. At the national level, implementers might work with state and government policymakers to draft new CDC guidelines and state hospital regulations. They may work with graphic designers to create engaging, easily digestible infographics on the benefits of handwashing to be distributed to the public. They may also work with media outlets to deliver scientifically accurate information about handwashing techniques on TV. At a local level, implementers might work with hospital staff to format training sessions or work with local governments to get more hand washing stations installed around town. In an industry setting, they may work with factories and companies to support the growing need for handwashing supplies by implementing ways to manufacture and ship soap more efficiently.
What skills do I need to start a career in D&I?
The specific skills you require will depend on what aspect of D&I research you want to pursue, but there are a few general transferable skills that will help you in any career path you choose to go into. Fortunately, these are all skills you should be building during your PhD!
Collaboration and leadership: D&I is an interdisciplinary field, meaning you will have to interact with people with different backgrounds and knowledge. D&I projects are often team-based and being able to play nice with others is critical to ensuring a project succeeds. In addition, as a member of a team, you may be in charge of overseeing a smaller subgroup of individuals, thus leadership skills are equally important to your success.
Networking: Since you can’t know everything, developing personal relationships is important to bring together the necessary people and skills to optimize efficiency and likelihood of success. In many cases who you know is just as important as what you know. To build a network, go to seminars or conduct informational interviews with people in positions you aspire to have. Most researchers love to talk about their work, so don’t be afraid to email them for an in-person (or virtual) chat!
Science communication: Science communication is arguably the most important skill to develop for success in D&I (and all other) careers. The purpose of D&I is to bridge the gap between evidence-based research and the general public and getting people to adopt an intervention. To do this, the public needs to understand what you are talking about. Being able to present complex scientific information in an accurate and engaging way is fundamental to public outreach. In addition, you will be working with many people with different backgrounds and being able to communicate with them effectively will ensure project success.
Critical thinking and reasoning: D&I is a science and requires rigorous testing and analysis to further the field. The questions in D&I are also complex necessitating critical thinking and reasoning skills to develop and evaluate new implementation strategies, dissect the barriers to success, and assess the needs of a community. Fortunately, one of your jobs as a PhD student is to critically evaluate and investigate scientific hypotheses.
Qualitative and quantitative skills: D&I is a broad and interdisciplinary field that brings many types of methods and evaluations together. Mixed methods are heavily employed by researchers, requiring both qualitative and quantitative analytical skills. The type of D&I research you want to perform will determine the specific skills necessary. For example, computational modelling may require more quantitative skills than a policy-based career.
What are some resources for D&I?
D&I is an emerging science with a plethora of resources. There are many institutions, journals, and fellowships specifically for D&I. For beginners, there are classes, workshops, and reviews to get you acquainted with the vocabulary, models, and basics of the field. Below are some national and local resources to learn more about D&I.
D&I societies and journals:
- Society for Implementation Research Collaboration
- National Implementation Research Network
- Society of Clinical Psychology Dissemination and Implementation website
- Consolidated Framework for Implementation Research
- Consortium for Implementation Science
- RTI-UNC Evidence-based Practice Center
- Implementation Science journal
- Implementation Science News
National Policy Fellowships and training opportunities:
- AAAS Science and Technology Policy Fellowship
- National Institute of Health Implementation Science Webinar Series
- List of Policy Fellowships
- MOST Policy Initiative: Fellows work with Missouri state officials to incorporate scientific resources and perspectives into policy decisions and community outreach.
- Washington University: Luckily, Washington University is one of the best places to learn about D&I!
- Center for Dissemination and Implementation: Center at the Institute for Public Health at the medical school that hosts many D&I events/speakers and has many resources.Center for Diabetes Translation Research: NIDDK-funded center that focuses on D&I in diabetes.
- Center for Public Health Systems Science: Center through the Brown School that focuses on D&I in public health.
- Dissemination and Implementation Research Core: Core within the Institute of Clinical and Translational Sciences (ICTS) that helps advance translational research into the clinic.
- Implementation Research Institute (IRI): 2-year training opportunity in D&I applied to mental health.
- Institute for Informatics (I2): Institute that focuses on developing and applying informatics to a variety of problems. Houses the Center for Population Health Informatics (CPHI).
- Mentored-Training for Dissemination and Implement Research in Cancer (MT-DIRC): 2-year training opportunity in D&I applied to cancer.
- Prevention Research Center (PRC-STL): Collaboration between the Brown School and the School of Medicine for D&I research in preventive medicine.
- The Washington University Network for Dissemination and Implementation Research (WUNDIR) meetings: An informal seminar for researchers interested in D&I. They are welcoming and this is a great place to start and listen in on new D&I science. It is hosted by the Center for Dissemination and Implementation.
D&I science is a broad, highly interdisciplinary field with many career options. It is an emerging field and, consequently, D&I researchers often wear many hats. They can be both methods developers and implementers, or methods developers and computationalists, or implementers and computationalists, etc. D&I is also not limited to public health, although it is one of the bigger portions of the field and the focus of the example here. D&I research is being applied to issues in education, workplaces, racial injustice, vulnerable populations, social service settings, policy, and many others. There is lots of room for new thoughts, skills, and people in the field. If you’re interested in making a difference in the world, consider a career in D&I!
I’d like to thank Dr. Beth Prusaczyk, Dr. Ross Brownson, and Dr. Cynthia Vinson for talking to me and providing a bunch of resources for D&I. I’d also like to thank Kayla Nygaard and Jennie Hazen for being amazing friends and editing my early drafts.