Our purpose in putting together this special issue of Healthcare Policy/Politiques de Santé was to share with you the experience of designing programs to build capacity in applied health and nursing services research in Canada. We have endeavoured to describe the Regional Training Centres' development and implementation from the perspectives of the various participants - funders, researchers, students and decision-makers. We learned a lot through the process of identifying the challenges and successes, and hope you enjoyed reading this issue as much as we enjoyed writing it.  

Just over a decade ago, the Canadian Health Services Research Foundation (CHSRF) and the Canadian Institutes of Health Research (CIHR) recognized that capacity needed to be built in the field of applied health and nursing services research in Canada. These funding agencies put out a call for proposals that encouraged a regional approach, partnerships and a focus on knowledge exchange. The result today is four Regional Training Centres (RTCs), each with a unique approach to training, but all producing the common outcome of graduates who have specialized knowledge and skills in applied health and nursing services research. Ploeg et al. (2008), noting the limited research skills among staff in community care agencies, have called for innovative approaches to building research capacity in applied health services. The RTC project is just such an approach, developed with a strong focus on partnerships among universities and decision-makers.

From the inception of the RTC initiative, CHSRF/CIHR wanted decision-makers to be involved in its development and implementation. To ensure this participation, half the members chosen to serve on the proposal review panel were decision-makers. Their participation ensured that the successful proposals addressed regional needs and demonstrated a realistic understanding of the Canadian health system.  

To encourage relationship and partnership building between the RTCs and decision-makers, the funders also planned two networking meetings each year. These meetings encouraged knowledge sharing, discussions of key issues relevant to all, problem solving and shared learning. Networking is a central theme across the RTC programs. In addition to these meetings, each centre has developed workshops, seminars and institutes that bring together students, faculty and administrators from universities, as well as decision-makers from the healthcare system.

Clearly, decision-makers play a central role in each RTC serving on Advisory Boards, offering paid residencies to students, participating in workshops and providing extra funding for such activities as networking and educational events. The decision-makers' involvement has ensured the success of the centres' activities and their alignment with the realities of the healthcare system. In addition to the residencies, the decision-makers assist students in developing thesis topics, guide them through methodological development and encourage and support their access to data and to members of the healthcare system. But the most critical component in the RTCs' success is the experiential learning that links students with decision-maker organizations.  

The RTCs have also developed a cohort of interdisciplinary researchers who have an understanding of the system's challenges, are connected to decision-makers and are able to conduct and evaluate research. Thus, students learn to appreciate the importance of evidence-informed decision-making.  

Moreover, students from other graduate programs have access to courses and seminars offered by the RTCs. As a result, graduates from other programs have also acquired expertise in applied health and nursing services research.

The RTCs attract students from a wide variety of backgrounds. The curricula have been developed in recognition that students enter the programs from many disciplines, including, for example, nursing, economics, education, biology and history. This diversity ensures that students appreciate multiple perspectives and forms of knowledge. The students learn from one another, try different approaches to issues and develop strong relationships that will continue into the future. RTC graduates report that the programs are student-centred and flexible. Students particularly appreciate the opportunities to learn from Executive Training for Research Application (EXTRA) Fellows and CHSRF/CIHR Chairs, who regularly participate in the centres' activities.  

Faculty in each centre also come from diverse backgrounds. The RTC initiative has allowed them to network with faculty and researchers from such disciplines as nursing, education, management, epidemiology, political science, economics and nutrition, thus encouraging cross-disciplinary learning and new research collaborations. These educators have learned new approaches to problem solving, reached beyond their disciplinary comfort zones and engaged in curriculum development and research that transcends their usual research and teaching foci. Participating as principal faculty in an RTC is not without its challenges - it is time consuming, service focused and often undervalued in academia. Nonetheless, faculty feel that the positive aspects overwhelmingly outweigh the negatives.  

One benefit of the faculty experience is knowledge translation and exchange (KTE). CHSRF/CIHR ensured that the RTCs educated their graduates using the linkage and exchange approach popularized by CHSRF. This requirement was a focus in the call for proposals, and all the centres have incorporated KTE into their programs. Each developed KTE expertise in accordance with regional needs and local expertise, and also ensured that decision-makers helped students acquire skills in this key area.

After four years of operation, the RTCs participated in a comprehensive, independent evaluation of the project. This mid-term review highlighted the success of the initiative: all four centres were achieving their objectives while utilizing unique approaches under a range of organizational models based on regional needs. Evaluators noted that the different approaches produced the same outcome - high-quality training programs in applied health and nursing services research. Another result of the evaluation was evidence of a high level of satisfaction among students and decision-makers involved in the RTCs' activities. Students believed they had gained a grasp of the realities and complexities of the healthcare system through collaboration with decision-makers and researchers. The evaluators also found that the students' knowledge of KTE was a key strength of the program.  

Central to this success story is the funding from CHSRF/CIHR, which provided stability over the first 10 years of the RTCs' operation. This timeframe enabled the centres to focus on program development and the successful launch of many initiatives. Given that current federal funding is expected to end in 2011/2012, we are now faced with the task of envisioning the RTCs of the future. Specifically, we must now explore options for sustainability, not only financially but also with respect to the management of human resources, student development and collaboration among the partners.

This special issue of Healthcare Policy/Politiques de Santé provides a comprehensive overview of the Regional Training Centres' activities. We hope you have discovered information that can assist you in creating training opportunities for students and in forging new partnerships. Healthcare delivery is complex and dynamic. Preparing well qualified researchers for the field is integral to improving both healthcare delivery and its management.  

Thank you for taking the time to read our stories.

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