A national curriculum and community of practice for health services and policy research training: Insights from the Health System Impact Fellowship National Cohort Training Program (HSIF NCTP)

3.1 Overview, theoretical framing and objectives of the NCTP

The collective goal of the HSIF NCTP was to deliver a comprehensive training program that cultivated leadership competencies necessary for addressing complex health system challenges with evidence-based solutions. The HSIF NCTP leveraged the concept of Communities of Practice (CoP)²⁴ to create both independent and collaborative learning opportunities in keeping with the HSIF NCTP's mandate to sustain and strengthen an active CoP within the Canadian HSPR landscape. This CoP approach created opportunities for knowledge exchange between fellows, academics, and health system leaders across different organizations and jurisdictions. Thus, more specifically, the HSIF NCTP aimed to achieve three specific CoP-related goals: (1) providing tools and learning opportunities in HSPR competency areas enabling the CoP to advance learning health systems nationally; (2) creating deliberate, ongoing networking opportunities that encourage diverse HSIF members to engage meaningfully, thereby strengthening CoP collaboration; and (3) laying the groundwork for the evolution and sustainability of the CoP within Canada's integrated HSRP ecosystem. Consistent with the concept of effective learning through a continuous cycle of concrete experiences and reflective observation,²⁵ the embedded nature of the HSIFs in health systems enabled the application of theoretical insights gained through the NCTP to develop additional HSPR competencies and address real-world challenges. Through regular virtual and in-person training activities, participants engaged in collaborative learning while building a professional network that supported their development as embedded researchers.

The HSIF NCTP was shaped by an interdisciplinary team of health system leaders, academics, and HSIF alumni, drawing on HSPR and educational frameworks. Central to the framing of HSIF NCTP training activities were the core competencies in HSPR developed by CIHR-IHSPR for the HSIF (Table 1), which defined essential capabilities for researchers working within health systems. The HSIF NCTP's use of this framework allowed the program to emphasize competencies essential for HSPR graduates to effectively navigate the complexities of healthcare environments. From an educational standpoint, the HSIF NCTP's pedagogical approach incorporated principles from Competency-Based Medical Education, which emphasized outcomes-oriented learning tailored to specific learner needs.^{26, 27} This framework helped structure learning activities that built specific skills required for embedded research roles. The HSIF NCTP also drew on adult learning theory,²⁷ recognizing fellows as experienced professionals who brought valuable perspectives to collective discussions.

The NCTP strove to reflect the competencies in the development of the training curriculum and delivery of the sessions in keeping with their relevance in learning health systems and the objective of the overall HSIF program. The TMWG core competencies are broadly similar to those developed by the Agency for Health Research and Quality (AHRQ) in the United States, although the domain grouping of the competencies differs, and the TMWG specifically includes a competency on Indigenous Cultural Safety and Humility. In the updated competency framework from 2022, AHRQ includes a total of 38 core competencies prioritized across eight domains.²⁸

3.2 Structure of the NCTP

The governance of the HSIF NCTP consisted of an Executive Committee, Advisory Committee, and several Working Groups, each of which fulfilled distinct roles in overseeing and directing the program. The HSIF NCTP was led by the Executive Committee and, through the Advisory Committee and Working Groups, supported by a broader consortium of co-investigators and collaborators from across Canada.

The Executive Committee, including HSIF alumni and mentors, was the primary decision-making body. The committee met monthly for decision-making and maintained continuous communication to support activities between meetings. The Advisory Committee, which included fellows, patients, and health system leaders, convened biannually with the Executive Committee to provide broad-based guidance on key considerations regarding the role of the NCTP within the Canadian HSPR ecosystem and approaches to sustainability. Supporting this governance structure was a dedicated NCTP Program Manager.

Furthermore, two Working Groups were established: (1) the Evaluation and Assessment (E&A) Working Group, tasked with designing and executing the program's evaluation framework; and (2) the Sustainability Working Group, initially focused on ensuring the program's long-term viability and exploring future opportunities for the Community of Practice (CoP). Over time, the latter evolved into the Learning and Training Exchange (LTE) Working Group, emphasizing practical application and collaborative curriculum design. The LTE Working Group assumed responsibility for aligning training activities with the overarching goals of the HSIF program.

Overall, this consortium encompassed the complete NCTP governance network—comprised of the Executive Committee, Advisory Committee, and two Working Groups (Evaluation and Assessment Working Group and Learning and Training Exchange Working Group) and the annual NCR Planning Committee—together with the extended group of co-investigators and collaborators. In total, 65 members from eight provinces participated, including 22 HSIF fellows and alumni, 14 HSIF mentors, and representatives from healthcare organizations, academic institutions, patient advocacy groups, and health system leadership. This structure enabled strategic partnerships across multiple groups, including (1) patients, patient researchers, and patient-focused organizations; (2) health system leaders; (3) university-based academics; (4) representatives from funding institutions; (5) professional development and training companies; (6) public and government relations firms; (7) private sector and industry representatives; and (8) non-governmental organizations.

With travel funding provided through IHSPR to enable and encourage full participation by HSIF fellows, core program activities included regular virtual learning sessions and an annual National Cohort Retreat. These activities were designed to facilitate cross-cohort collaboration and knowledge exchange while building networks that support embedded research careers.

4.1 Guiding principles

A commitment to continuous improvement was central to the HSIF NCTP, supported by a structured framework that emphasized inclusivity, a fellow-driven ethos, competency-based methodologies, and co-creation. These principles shaped both program structure and implementation. At the heart of the program was an iterative improvement process using the Plan-Do-Study cycle that engaged HSIF alumni, mentors, and current fellows in design, implementation, and evaluation, ensuring the training activities evolved to meet changing educational complexities in health systems and the related needs of the fellows and their learning expectations demands.

Training opportunities were developed through sustained interaction among HSI fellows, alumni, mentors, and NCTP committee members facilitated through co-creation and continuous evaluations of NCTP sessions and events. Through this collaborative process, strategies and co-created activities were proposed, ensuring alignment with the needs of learners and the HSPR CoP participants. The NCTP grant team—including current and alumni fellows, alongside academic and health system supervisors—shaped the program's trajectory. The NCTP actively embraced diverse viewpoints from across the educational spectrum, supported by experienced team leads and supplementary training. By employing inclusive practices, trainee perspectives were meaningfully incorporated at all project stages, guiding decision-making and program development.

4.2 Curriculum development and learning exchange: innovative learning framework

The NCTP had expanded to include a wide array of training events and activities to align with the enriched core competencies established by the CIHR-IHSPR Training Modernization Working Group (TMWG) (Table 1).^{9, 18} To implement these competencies effectively, the program established the Learning and Training Exchange Working Group (LTE-WG) which included current HSI fellows, alumni, and academic and health system mentors. The LTE-WG operationalized these competencies within the NCTP through a structured, competency-based learning framework aligned with the TMWG enriched core competencies and supported the professional development of emerging research leaders in HSPR.

At the foundation of the curriculum was a set of four complementary modalities offered each quarter, allowing for both conceptual breadth and practical depth. Specifically, each theme included one to two sessions drawn from (1) professional development presentations (1–2 h, expert-led); (2) skill-building workshops (3–6 h, professional-led); (3) Career Cafés (fellow-led, focusing on mentorship and career navigation); and (4) networking “happy hours” (1–2 h, also fellow-led) (Table 3). Guest facilitators from health system organizations regularly contribute to these sessions, covering topics such as leadership, project management, collaboration, and knowledge translation. These educational opportunities aimed to prepare and empower fellows in implementing meaningful changes in the health system and contributing to evidence-informed decision-making.

The Professional Development sessions and workshops were deliberately designed to integrate academic (didactic) content with operational (practice-based) learning to ensure both conceptual understanding and practical application. This integration occurred through a structured approach that combined expert-led instruction, collaborative exercises, and contextualized practice.

Workshop sessions followed a consistent structure: introduction to key concepts, interactive demonstrations, collaborative practice, and contextual application and reflection. Workshops targeted both technical and interpersonal skills, and to ensure relevance across diverse operational environments, the workshops often incorporated case studies, breakout groups, and encouragement of cross-disciplinary dialogue to foster adaptive thinking.

For example, Theme 1 in the NCTP curriculum was ‘Strong Start,’ which was focused on two of the professional skills competencies of Project Management and Leadership from the TMWG Core Competency Framework (Tables 2 and 3). This was delivered as a workshop for the delivery mode through a professional consultant with academic credentials with the aim of applied skill-building and included both didactic academic content and practice-based learning through hands-on exercises using project management tools and interactive discussions in breakout sessions with subsets of the workshop participants.

Another example is Theme 2—Learning Health Systems Part 1: Evidence to Practice. In this theme, sessions focused on the two research and analytic competencies of ‘Knowledge Translation, Communication & Brokerage’ and ‘Analysis & Evaluation of Health & Health-Related Programs & Policies’ from the TMWG Core Competency Framework (Tables 2 and 3). The sessions included Professional Development Session led by an expert in the field around the topic of ‘Are we ready to implement evidence to practice,’ and a Networking Happy Hour lead by one of the HSI fellows on the topic of ‘The building blocks of value-creating learning health systems.’ Similarly, this format provided opportunities to integrate academic content with applied content and learning through a variety of interactive formats with experts and learners from different backgrounds, in different settings and with different degrees of experience.

Some of the sessions in the first 2 years of the NCTP were designed to reflect competencies from the forthcoming refreshed Enriched Core Competencies developed by the TMWG. These competencies were included in the curriculum based on discussions and feedback from both the NCTP Executive Committee and the NCR Planning Committee. Several members of the NCTP Executive Committee were also directly involved in the TMWG, which enabled early integration of the refreshed competencies into session planning. As a result, while some session objectives may not align directly with the original competency framework in Table 1, they reflect an intentional effort to align with the updated direction of competency development.

4.3 Training design and chronology

In the initial 2 years of the NCTP, the curriculum was organized around eight central themes (Table 2). Each quarterly theme included multiple events that reinforced core competencies and facilitated networking (Table 3). Continuous feedback revealed a need to reconfigure the curriculum to avoid repetition and maintain high engagement. In September 2023, in alignment with the newly revised 2024 competencies (Table 2), the NCTP transitioned to a ‘refreshed’ 2-year curriculum featuring four quarterly themes each year (with the themes repeated across 2 years). While the same four themes anchor both years, the specific content and learning objectives for each theme evolve in the second year, building on foundational skills introduced in the first. This cyclical approach ensures fellows encounter new content and build upon previously acquired knowledge over time. ‘Strong Start (Project Management & Leadership)’ remained central in both years due to its foundational importance.²⁹

4.4 National cohort retreat

The annual National Cohort Retreat (NCR) was a flagship event of the NCTP, bringing together current fellows, alumni, and their academic and health system mentors for intensive learning and network building. Each annual retreat was organized by a dedicated Planning Committee comprising NCTP leadership, fellows, and alumni, who collaborated to select the retreat theme and co-designed, planned, and executed the two-day event. The chair role rotated among the NCTP Co-Principal Investigators, ensuring the retreat's alignment with the broader training objectives of the NCTP through the NCR—fostering engagement, professional development, and cross-sector collaboration.

The NCR was a cornerstone event designed to foster engagement and dynamic interaction, professional development, knowledge sharing, and collaboration among fellows, health system supervisors, and academic mentors across all cohorts. Spanning two full days, the retreat was strategically structured to provide immersive activities, panel discussions, and networking opportunities that strengthened connections within the cohort and with external partners.

By harnessing the expertise of HSPR leaders, the National Cohort Retreat (NCR) became a pivotal vehicle for expanding the Community of Practice (CoP) within the HSIF. Tactics to advance NCR goals included the participation of esteemed guests and speakers nationally and globally and engaging with diverse perspectives and innovative approaches during interactive sessions and workshops. This infusion of external expertise amplified the impact and reach of the HSIF CoP within the HSRP ecosystem.

The retreats evolved through different delivery formats in response to changing circumstances. The inaugural 2021 retreat was held virtually, followed by a hybrid model in 2022 that combined in-person Vancouver regional gatherings with virtual connections across sites. In 2023, the program transitioned to a full in-person format in Alberta and in 2024 in Saskatchewan, with travel support provided to ensure nationwide participation. The retreat structure balanced formal learning with relationship building through carefully sequenced activities. Morning plenary sessions typically featured Canadian health system leaders discussing emerging priorities, followed by interactive workshops where fellows practiced specific skills with expert facilitators. Dedicated networking periods allowed fellows to connect with potential collaborators and mentors, while evening social events rounded out the day to strengthen informal connections within the developing community of practice. The combination of structured learning and collaborative knowledge exchange created multiple pathways for participant skill development.

4.5 Evaluation and assessment

The Evaluation and Assessment Working Group was responsible for assessing the NCTP program and guiding improvements to the NCTP curriculum. The evaluation strategy centered on the Kirkpatrick Evaluation Model,³⁰ which examined four levels of educational impact—ranging from learner reactions to training sessions through to long-term organizational impact. Through iterative assessments guided broadly by the Plan-Do-Study-Act (PDSA) cycle,^31-33 the Evaluation Working Group administered regular surveys to measure reactions, learning, behaviors, and impact—enabling rapid adjustments to program content and delivery. These evaluations yielded valuable insights into the NCTP curriculum's strengths and weaknesses, informing targeted enhancements over time. A detailed report including participation, and both quantitative survey responses and qualitative comments through open-ended questions was analyzed quarterly for the training events in each theme and for each NCR event and approved by the NCTP Executive Committee. The comments from the NCR were used to inform the planning committee for the next NCR event. For example, fellows expressed a specific desire for unstructured or semi-structured sessions during the NCR to further cultivate connections and facilitate informal knowledge-sharing, which served as catalysts for improvements in their local health system or at a larger scope.

The performance of fellows with regard to their competencies and impacts, as well as the long-term organizational outcomes, is tracked annually by the CIHR IHSPR, which administers the HSIF awards program and the associated reporting. This includes tracking the number of fellows, their placements, their subsequent employment and career paths, and contributions to organizational goals. In addition, each HSI fellow and their academic and health system mentors are invited to complete pre- and post-assessments and provide qualitative impact statements to document competency development and perceived value to the system^{19, 21}