Reflections on My Fellowship with the Implementation Science Team at NCI
By Prajakta Adsul, MBBS, MPH, PhD
The Cancer Prevention Fellowship Program is a postdoctoral program that trains future leaders in the field of cancer prevention and control. Selected through a competitive process, the program is truly multidisciplinary in that it brings researchers from basic biology, clinical, behavioral, epidemiological, and social sciences to develop and further refine their focus on cancer prevention. I was fortunate to come in through this fellowship with eight other women in 2016. In addition to the structured coursework and formal meetings, the fellowship provides a unique opportunity to gather information on the research activities from a wide range of scientists across the various NCI divisions. Fellows are then able to use this information and, in line with their research interests, choose a mentor(s) to work with during their fellowship. Prior to joining NCI, my research focused on evaluating the outcomes associated with implementing evidence-based practices and programs in routine clinical and community settings. In every study, although I explored the contextual determinants in which implementation took place, I did not explicitly study the strategies or outcomes associated with implementation. In my information gathering interviews with members of the implementation science team, I realized this was the science gap that I was most interested in filling!
Over the past years, I have been engaged in several initiatives with the team that have collectively increased my knowledge around the science of implementation and expanded my skills in applying the implementation science concepts to cancer prevention and control research. One of my first projects was with the Comprehensive Cancer Control National Partnership (CCCNP) , which I’ve written about before. This was an exciting project where I was able to learn about advancing research partnerships , how we could think of technical assistance as an implementation strategy, and how state-based cancer prevention and control practitioners benefitted from participating in centralized technical assistance (manuscript forthcoming). This project also helped expand my professional network to scientists and staff at national organizations, including the Centers for Disease Control and Prevention, American Cancer Society, and George Washington University, among others. For the past year, I have been co-chairing the CCCNP workgroup focused on improving HPV vaccination uptake, and we have been using lessons learned from our projects to improve technical assistance moving forward.
Along with research at a national level, I have had opportunities to build upon the research that I started as a Fogarty-funded Global Health Equity Scholar. Specifically, I have collaborated with Dr. Maribel Almonte, from the International Agency for Research on Cancer (IARC), who leads the Prevention and Implementation group. As a part of my training, I was able to visit IARC in Lyon, France, last fall and meet with the scientific team members of the Early Detection and Prevention Group who are leading several cancer screening initiatives across the world. This opportunity gave me a sneak-peek into how the IARC functions differently from NCI and to learn about cancer research as a global health priority. Together, we have been writing about how implementation science theories, strategies, and measures could inform the implementation of cancer screening interventions in low- and middle-income countries. We have also collaborated on a multi-country cervical cancer screening study (ESTAMPA) to evaluate the pragmatic aspects of study design using the PRECIS-2 criteria, which was presented at the biennial International Cancer Screening Network meeting held in Rotterdam, Netherlands, this June. Attending international meetings and collaborating with international agencies like IARC has exposed me to the scientific advances in the field but also showcased the potential gaps that can be filled using the science of implementation.
Within the team, these collaborations have reinforced my commitment to pursuing implementation science in the context of cancer prevention and control and enabled me to contribute effectively towards facilitating small group discussions both at the Training Institute in Dissemination and Implementation Research in Health (TIDIRH) and Cancer (TIDIRC). Using these opportunities to discuss the application of implementation science theories, methods, and measures across topics relevant to the cancer control continuum with the trainees has helped me improve my own grant writing skills. Recently, our team launched the inaugural Implementation Science in Cancer Consortium, which is an initiative to bring together researchers and practitioners from across the US to develop project ideas that could have a big impact for research in the context of cancer and implementation science. I had the distinct privilege to co-lead discussions, with Dr. Rachel Shelton, about how we could be using implementation science as a tool to achieve health equity.
All these experiences have contributed tremendously towards improving my skillset in implementation science, increasing my comfort level in developing research ideas, and in finding my space on the “subway line” of translational research. I do note, however, that this is a unique pathway to implementation science compared to many that began with formal training through institutes like the Implementation Research Institute (IRI), Mentored Training in Dissemination and Implementation in Cancer (MT-DIRC), and TIDIRH/TIDIRC. I am curious to learn more from peers who are developing themselves as implementation scientists: What has helped you? In addition to formal training, what other resources have you found helpful? For folks that have been conducting implementation science, what are some tips you would share?
Share your comments or tweet me at @PrajaktaAdsul .
Dr. Prajakta Adsul is a former Cancer Prevention Fellow with the Implementation Science team in the Office of the Director in the Division of Cancer Control and Population Sciences at the National Cancer Institute.