The role of internships and mentorship
In interviews and in semiannual reports, a majority of trainees and mentors stated that embedding students in PHOs had been positive, which reflects the results of the online survey . First and foremost, they reported that the placements provided a unique opportunity for trainees to acquire an understanding of the role and functions of the public health system and to connect with the reality of conducting public health research “on the ground.”
According to exit interviews, the placements enabled trainees to interact with public health practitioners and to understand PHIs. Embedding of trainees in PHOs created the opportunity to experience the development, implementation, and evaluation of interventions: “I was able to reflect and question public health interventions thanks to my internship and my mentor's team that showed me what effective interventions are and how to evaluate them” (EI-17). Likewise, trainees and mentors in telephone interviews reported: “the possibility of experiencing public health” ... “to know the conditions for the implementation of the action” (TI-T8), “to understand priorities” (TI-T6). Trainees gained an understanding of patterns of interactions and relationships within PHO: “My internship allowed me to better understand the situation on the ground, the necessary conditions for innovations, coalitions and changes” (SAER-16).
The placements allowed trainees to appreciate the range of research activities in PHOs and the finality of PHIR: “I saw what can be done in population health research” (EI-27). It also permitted trainees to identify the multidimensionality (e.g., contextual, ethical dimensions) of public health research problems and understand what research questions are of interest to practitioners, according to interviews with mentors. Trainees acquired a knowledge of the processes involved in PHIR and how research informed programs: “I gained a deeper understanding of the structure of public health research, how the evidence is constructed, how decisions are made: all this was new to me” (EI-25). Trainees learned to get closer to decision-makers and to invite knowledge users on their teams from the research onset. Indeed, in exit and in telephone interviews, trainees characterized placements as thought-provoking and formative experiences in public health research.
Simultaneously, the placement was an opportunity to assess the gap between research and practice, and experience intersectorality, which one trainee defined as “the needed reconciliation of the public health practice and the research practice” (EI-27). By being in the practice environment, trainees discovered that they had to learn how to do research in relation with partners, to develop intersectoral working relationships with practitioners (EI-10), to focus research on a common goal with decision-makers (EI-11).
For trainees, mentorship was key to penetrate the field of public health: “The main quality of mentoring is getting us into the public health environment to conduct our projects” (EI-5). This integration was critical for internship success:
“Insertion into a research team makes it possible to engage in learning about research. Mentoring provided me with access to the senior researchers who helped me with my learning, such as how to coordinate a project, make a budget, acquire methodological knowledge, manage a database, and so on. I had access to several researchers who were open and who stimulated the learning of early career researchers. … I have greatly benefited from the leadership of these researchers and their contacts with productive external members” (EI-35).
A successful mentorship involved a reciprocal commitment between mentor and mentee. Engaged and available mentors, who were skilled in PHIR, respectful of trainees, and who drew upon trainees’ strengths, were perceived as successful. For example, one trainee said:
“Not only were my learning objectives and career goals present in all discussions with my mentor, but also the public health vision and purpose. ... The exchanges contributed to the further elaboration and application of public health concepts in my research work” (EI-11).
An engaged trainee whose project fitted the PHO’s priority was seen as stimulating by mentors. Altogether, a good fit between the mentor and the trainee, immersion of the trainee in the mentor’s research team, and productive mentoring dialogs set the conditions for success.
Mentors helped trainees refine their competencies, develop research methods applied to the local context, and provided opportunities for networking and research partnerships. Beyond the mentoring relationship, trainees noted the importance of the research capacity at the PHO and of the leadership of the mentor.
Benefits of internships and mentorship
The internships and mentorship allowed trainees to apply research skills in context and integrate learning. Integration of learning about PHIR happened in multiple ways: changes in attitudes, a recognition of the complexity of PHIs, a gradual deepening of PHIR, and the development of cross cutting competencies, as shown below.
The confrontation with the realities of the public health field affected trainees’ attitudes towards research. It was a shock for some trainees: “I changed my research topic” (TI-T8). Internships and mentorship encouraged openness: “The program forced us to open up to the world and take a systemic approach; it permitted to get out the dominant train of thought” (EI-16). Trainees became more critical of their research and asked “what is the use of what we do?” (e.g., EI-16, EI-19). Trainees said that they gained maturity and confidence: “I gained more insights as I progressed through my internships” (EI-34); “I built my capacity to ask questions and discuss public health problems” (EI-17). Trainees alluded to a “process of maturation” (EI-16, EI-35) in the ways of seeing things and looking for solutions to public health challenges. Internships and mentorship strengthened trainees’ perspectives on population health intervention research. They said: “The program brought a refreshing perspective by bringing together researchers and decision-makers; without the Program, I would not have had the potential to influence practice” (TI-T6); “It expanded my knowledge and the range of what I thought I could do” (EI-2); “[It] made me realize the importance of knowledge translation” (EI-27). Trainees spoke of becoming more open to the realities of core public health functions and to the need for research to inform practice and have an impact: “I quickly learned this: to change things, it is not sufficient to have knowledge but you need the know-how to put it in practice” (EI-37); “How can we attract attention of decision-makers, how can we measure change?” (EI-3).
Trainees discovered the complexity of real-world public health problems and interventions. They experienced the influence of context on PHIs, including the power relationships between various stakeholders engaged in PHIs (e.g., practitioners; managers): “Now I see the importance of taking into account the realities on the ground” (EI-11).
Many trainees said that they felt better equipped to understand complexity, health equity, and the need for knowledge translation; they also developed critical thinking skills. Trainees started to ask questions like “so what” and “how and under which conditions” can an intervention be successfully implemented.
“Now I ask myself: “what’s the point?”, “what’s it for?”, “what do we do next?”, “what will the managers who work at the Agency do with this?” Thanks to my internship, I familiarized myself with the milieu and saw how, with my mentor, I could get managers and decision-makers to listen. Now I know that my thesis will serve in practical ways the development of healthy public policies” (EI-19).
Trainees gained research experience: “[The internship] ... allowed me to develop a more complex research plan” (EI-3). This is also reflected in their willingness to revisit their conceptual frameworks and adopt a more transdisciplinary approach to research. In some instances, trainees revised their research protocol to more effectively respond to public health priorities. One trainee made this statement:
“The approach to intervention research was a discovery. This changed the way I look at the research process, and got me to think about research in terms of how it should be led in order to influence intervention and be used by decision-makers. Addressing ethics, considering the complexity of evaluation of interventions, all this knowledge has changed my way of thinking and influenced the choice of the theoretical framework of my thesis. This has influenced my way of seeing my research topic. I now have a more systematic view of innovation” (EI-16).
The mentors corroborated in interviews, and in internships reports, that the internships permitted trainees to reorient their research according to their observations.
Throughout their internships, trainees experienced the challenges of applying the principles of intervention research and developed cross-cutting competencies essential to PHIR such as interdisciplinary and intersectoral communication, partnerships, networking, and knowledge translation. Trainees improved their capacity to interact with researchers and knowledge-user partners from different disciplinary perspectives. They expressed comments such as this one:
“I developed an openness to other disciplinary horizons, learned to adjust my language, to involve various actors to address a particular issue, how to work in partnership. I would not have done this so thoroughly without the 4P” (EI-23).
Mentorship in applied public health settings enabled trainees to learn about processes of knowledge translation, including exchange between researchers and decision-makers, and sharing of knowledge “in an appropriate and effective manner” (SAER-30). Trainees also learned to produce research results useful to public health. Summing up her experience, one trainee said:
“My mentor put me in close contact with the stakeholders at the regional level. ... My ability to produce useful results was enhanced. ... The 4P Program brings legitimacy to the trainee, which translates into an authorization to observe, engage in dialogue with practitioners and key decision makers in public health, be heard and considered. This legitimacy and the quality of the knowledge exchanges are linked, and this shapes things to come, i.e. the translation of knowledge into action. The trainee presence in the public health milieu shaped a reciprocal relationship with the mentor” (EI-5).
A majority of trainees spoke of placements as having broadened their research network and facilitated professional connections with practitioners and decision-makers. Networking and knowledge exchange practices with mentors and knowledge users represented the starting point in learning to engage in collaborative PHIR with members of PHOs.
Overall, former trainees said they acquired competencies not taught in doctoral programs. Field placements acted as catalysts for achieving mastery of the 4P Program core competencies. One trainee put it this way:
“The 4P Program acted as a buffer zone between doctoral studies and the reality of the practical environment. It has shown its full worth in accompanying us in the milieu and by facilitating linkages with this milieu” (EI-26).
Nevertheless, many trainees mentioned they had less than perfect public health internships and mentorship experiences in both exit (about 12 out of 33 trainees since 2009) and telephone interviews (about 7 out of 18; sample of trainees since 2003). For example, trainees said: “my mentor was not available” (EI-19; TI-T3; TI-T14; TI-T16); “It was difficult to establish a good mentoring relationship with my mentor” (EI-19); “I don’t think my mentor understood her role” (EI-27); “My research topic was not a priority for the PHO. I didn’t work with the mentor’s team. As a result, I couldn’t develop my skills in collaborative research as I expected” (EI-13); “My mentor’s team was dynamic but there was no opportunity to exchange with other research teams” (EI-06). In telephone interviews, one trainee explained that her/his internship fell short of her/his expectations for a number of reasons: she/he was not asked by her/his mentor to participate in regular team meetings, there were no real opportunities to develop collaborative projects, and no opportunity to be integrated as a full researcher in a PHO after her/his placement (TI-T3).
Internships and mentorship influenced trainees’ career path. Trainees reported that internships opened doors to employment opportunities outside academia and enabled opportunities for collaboration. However, unfavorable experiences could reorient research careers away from public health. Trainees and mentors alike identified characteristics of successful placements, including the volume of research activity in the PHO, the dynamism of the PHO’s sector of activity to which the trainee was attached, and the PHO focus on intervention research.
Public health managers, for their part, felt that three conditions had to be met for successful internships: (1) integration of the trainee within the organizational framework of the PHO, (2) alignment of the trainee research topic with the PHO’s and the research team priorities, and (3) contributions of trainees to innovative research, practice, and evaluation within the PHO. In their eyes, the contribution of the Program was through the insertion of trainees in cutting-edge research and emerging initiatives in public health.
The mentors, trainees, and public health managers provided advice for how to strengthen the quality and improve the impact of research internships. They advised to improve (1) the fit between the trainee, the mentor, and the PHO (ensure the best alignment of the interests of each, make explicit the aspects of the collaboration, and establish the basis for a successful milieu-trainee relationship); (2) the skill sets of mentors (train mentors in PHIR skills, and support them to fulfill their mentoring role); and (3) the development of PHIR skills (a combination of an increased exposure of trainees to PHIR, a stronger intervention focus in trainees’ research, and a more structured mentoring process focusing on the acquisition of specific PHIR skills).