medical research knowledge transfer

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• Published: 04 March 2022

Challenging medical knowledge translation: convergence and divergence of translation across epistemic and cultural boundaries

• John Ødemark 1 &
• Eivind Engebretsen 1  

Humanities and Social Sciences Communications volume  9 , Article number:  71 ( 2022 ) Cite this article

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• Cultural and media studies
• Language and linguistics
• Medical humanities
• Science, technology and society

In this article, and the topical collection accompanying it, we aim to challenge so-called knowledge translation (hereinafter KT) in medicine and healthcare. The abbreviation ‘KT’ refers to a variety of scientific practices and research activities, bound together by the common goal of ‘bridging the gap’ between science in laboratories and clinical application, and, more generally, putting research-based knowledge into policy and practical care. Our objective, then, is to challenge KT by working through and with the convergence and divergences between different translational epistemologies. As KT has had a massive impact on practical healthcare, global health, and knowledge policy, as well as governance relating to sustainability, a critical examination of KT is of huge academic and societal significance. The point of departure for the contributors to this collection is the observation that KT is based upon a reductive understanding of translation and knowledge transmission. Standard models of KT take translation and knowledge transmission as a phenomenon for granted, and accordingly downplay the complexity of translation as an entangled material, textual and cultural process, which inevitably affects the ‘original scientific message’. By contrasting KT with historical, cultural, and epistemic differences from its scientific ‘prehistory’, and by analysing it with reference to broader humanistic and material views of translation, we aim to develop concepts of medical translation that can cope with contemporary epistemic and cultural differences.

Introduction

This collection aims to challenge so-called knowledge translation (hereinafter KT) in medicine and healthcare. The abbreviation ‘KT’ refers to a variety of scientific practices and research activities bound together by the common goal of ‘bridging the gap’ between science in laboratories and clinical application, and, more generally, putting research-based knowledge into policy and practical care (Strauss et al., 2009 ; Woolf, 2008 ). KT has been particularly important in medicine but has also played an important role in other forms of science-based policy, for instance in climate change governance (Machen, 2018 ).

So-called translational research first emerged in the biomedical field in the 1990s. This research was, from the very beginning, explicitly presented as a solution to the challenge of slow and insufficient uptake of research discoveries in everyday clinical practice. Translational research thus emerged as a solution to what we can call a temporal and a quantitative problem; the flow from science to practice was too slow, and the amount of new knowledge transported from science to society too little. Accordingly, translational research set out to solve problems related to the social efficiency of biomedical research, the time lag between science and everyday practice in the clinic, and the quantitative dilemma concerning the amount of new medical knowledge turned into practice in the healthcare system (e.g., Mankoff et al., 2004 ).

KT is little concerned with the entanglement of the cultural and the biomedical aspects of knowledge. Hence, the view of translation in KT contrasts sharply with the celebration of difference now dominant in the human sciences. The turn to translation in the humanities attempts to tackle cultural and epistemic difference in a global age. Besides, the term translation has been applied to extra-lingual transfer, such as cultural translation—also encompassing social phenomena such as migration (Buden and Nowotny, 2009 ). These expansions of ‘translation’ beyond the linguistic can in fact be construed as a return to older, more material notions of translation. Pre-modern conceptualizations of translation, for instance, encompassed boundary crossings such as the translatio of Saints (referring both to the ritual transfer of holy bodies and the texts documenting them), and the translatio studii et imperii (the transference of power/knowledge from old to new empires) (Evans, 1998 ; Wintroub, 2015 ). As the concept of ‘translation’ and the crossing of epistemic, cultural, and linguistic boundaries have become increasingly important in the human sciences, one could think that KT formed a part of this new translational paradigm. The turn to translation in medicine is, however, of a radically different kind. It is aimed at preserving the identity of the scientific message, not at celebrating epistemic or cultural difference.

The objective of this collection, then, is to challenge KT by working through and with the convergence and divergences between different translational epistemologies. As KT has had a massive impact on practical healthcare, global health, and knowledge policy, as well as governance relating to sustainability, a critical examination of KT is of huge academic and societal significance. The point of departure for the contributors to this collection is the observation that KT is based upon a reductive understanding of translation and knowledge transmission. Standard models of KT take translation and knowledge transmission as a phenomenon for granted, and accordingly downplay the complexity of translation as an entangled material, textual and cultural process, which inevitably affects the ‘original scientific message’. By contrasting KT with historical, cultural, and epistemic differences from its scientific ‘prehistory’, and by analyzing it with reference to broader humanistic and material views of translation, this collection aims to develop concepts of medical translation that can cope with contemporary epistemic and cultural differences.

In the rest of this introductory article, we will discuss how views on translation from translation studies, and the human sciences more broadly, can supplement current models of KT. Our guiding assumption is that such a supplement can lay the foundation for an expanded model of KT that is able to cope with epistemic and cultural differences, and the inevitable entanglement of the socio-cultural and the biomedical (cf. Engebretsen et al., 2017 , 2020 ; Ødemark et al., 2021 Footnote 1 ). Firstly, we will give a short description of KT as a translational practice, then we will sketch ways of supplementing KT with models of translation from other disciplines.

KT as a kind of translation

KT, then, was devised as an answer to a problem of governance and efficacy: the need to implement new, scientifically warranted knowledge in medical and social practice. The assumption behind this was—and still is—that relevant, biomedical knowledge exists, but that there is a knowledge cleft between state-of-the-art scientific knowledge and the social places and institutions, like hospitals and clinics. Hence, the all-important task for KT, as a combined scientific and social instrument, is to reduce the gap between theory and practice by making medical practice knowledge based. We see this clearly in WHOs definition of KT:

Knowledge translation (KT) has emerged as a paradigm to address many of the challenges and start closing the “know-do” gap . KT is defined as “The synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health.” (World Health Organization, 2019 . Ageing. Knowledge translation, our emphasis).

Here KT is construed as a ‘paradigm’ that addresses medical challenges. These challenges have everything to do with the opposition between theory and practice. The space that translation crosses is between science and social practice, and the objective of KT is to close the ‘know-do gap’.

We can use this spatial definition of translation to relate KT to other forms of translation. Etymologically, translation is all about crossing spaces. Footnote 2 While inter-lingual translation crosses the space between languages, KT aims to cross the space between biomedical knowledge and practical healthcare. Ideally, there should be an equivalence of some sort between the message produced by science and its application in practice, and in socio-cultural spaces like hospitals and clinics. In other words, the aim of KT as a form of translation is to close or bridge the gap between knowing and doing, and thus reduce the distance between these poles.

In anthropology, cultural studies and cultural history, the space crossed by translation is often defined as cultural, that is, as a space between different cultures. P. Burke has, for instance, observed that the concept of ‘cultural translation’ emerged ‘to describe what happened in cultural encounters when each side tries to make sense of the action of the other’ (Burke, 2007 , p. 8, our emphasis). Indeed, questions concerning the commensurability of knowledge from different disciplines, places and times have also long been associated with ‘translation’ in disciplines the history and philosophy of science as well (often through an import from anthropology) (Severi and Hanks, 2015 ). In KT, however, there is little sustained reflection about the crossing of cultural and epistemological spaces. Nor has KT been accompanied by theoretical reflection on translation as a creative and performative process of knowledge production.

While ‘translation’ has emerged as a key theoretical concept to deal with epistemic and cultural difference in the human sciences, KT denotes a scientific and purportedly non-cultural practice that defines the social and cultural as a ‘barrier’ to the transmission of knowledge already formulated in the laboratory and confirmed by randomized controlled trials. The materialization of ‘translation’ in medicine thus contrasts with the attention to epistemic and cultural difference and the productivity of texts in the humanities.

Bearing this lack of epistemological and socio-cultural reflexivity in mind, prominent medical researchers have questioned the epistemological aspects of KT and argued that the time has come to ‘drop the knowledge translation metaphor’ (Greenhalgh and Wieringa, 2011 ). While wholly in line with the epistemological diagnosis leading to this criticism, we will nevertheless claim that an expanded notion of the ‘translation metaphor’ might help us devise forms of KT more attuned to biological, epistemological, and cultural complexities . Thus, while we argue that KT is based on a simplistic view of translation and knowledge production, we also maintain that KT as a practical form of knowledge production and knowledge transmission might benefit from incorporating more theoretical notions of translation as an entangled material, textual and cultural process.

Current notions of KT as a translational practice actually resembles inter-lingual translation practices that aim for semantic and pragmatic equivalence between an original source text (ST) and the new target text (TT) (e.g., Nida and Taber, 1969 ). Using another analogy from inter-lingual translation, we could even say that the current construal of knowledge production and translation in KT comes close to the now deeply compromised literary view of translation where the translator’s work is ‘invisible’ (Venuti, 1995 ), and/or the translator merely an ‘ancillary’ instance (Bergman, 1984 ) in the re-production of meaning and knowledge. Indeed, given this view of KT, the translator is doomed to be a traitor—not of artistic genius but of the scientific logos —the ‘evidence’ found in the laboratory and confirmed by randomized controlled trials. In translation studies, in contrast, it is commonplace that the original source text (ST) can never be fully recovered by the target text (TT), that inter-lingual translation implies semantic shifts, and that the ST must be ‘rewritten in domestic dialects and discourses, registers and styles’ pertaining to the TT and target culture (TC) (Venuti, 2009 ).

KT rejects the productivity of translation. The translational paradigm established in so-called actor network theory (ANT) and science and technology studies (STS) offers yet another contrast to KT in terms of the productivity of translation. ANT and STS studies have asserted that the productivity of translation is the very condition for all knowledge and scientific effects. New work in the history of science has also been concerned with translation. By following ‘science in action’, empirically orientated scholars have come to focus their attention on the construction of science. STS and ANT have emphasized that translation is never simply a discursive process, but a material and cultural practice, conducted in complex contexts inhabited by variously interacting interests (Wintroub, 2015 ). B. Latour even maintains that his understanding of translation solves—or rather dissolves—the ‘old’ formulation of the issue of cross-disciplinary and cross-cultural commensuration. He presents a pragmatic solution that simply points to the fact that cultures and natures have always been translated, and that the activity of relating and translating is undertaken with reference to yardsticks that do not belong to the ‘nature’ of the things related, but to the instruments of commensuration. Instruments of translation are inevitably produced, and in practice, the problems of commensurability will be solved:

Worlds appear commensurable or incommensurable only to those who cling to measured measures. Yet all measures, in hard and soft science alike, are also measuring measures, and they construct a commensurability that did not exist before their own calibration . Nothing is, by itself, either reducible or irreducible to anything else. Never by itself, but always through the mediation of another. How can one claim that worlds are untranslatable, when translation is the very soul of the process of relating ? (Latour, 1993 , p. 113, our emphasis).

The task acceding to Latour is therefore to identify the instruments of translation at work in particular acts of commensuration.

In the next section we will examine the key instruments of translation in KT. To understand how they operate, however, we must first relate these instruments of translation to its underpinning epistemology, evidence-based medicine (EBM).

The translation instruments of KT

KT is often seen as an operationalization of the epistemological premises of EBM, making research evidence available for clinical use through translation. Or, as one paper has it in the title, KT is about ‘ shortening the journey from evidence to effect’ (Davis et al., 2003 , our emphasis). KT is, then, the instrument used in this ‘shortening’.

Around 2000, several researchers drew attention to the fact that many innovative research results never left the laboratory setting. There was an increased attention to the ‘disconnection between the promise of basic science and the delivery of better health’. It was this recognition that inspired a completely new range of knowledge production in medicine, which now increasingly has been referred to as ‘translation’ (Sung et al., 2003 ). This concern with evidence and its social and clinical efficiency was a product of a new biomedical paradigm that gradually became hegemonic in the post-war period. The Canadian Institute of Health Research was a pioneer in conceptualizing KT, and it is hardly a coincidence that KT was first defined in Canada. It was here also that the shift towards evidence-based medicine (hereinafter EBM) first began (Solomon, 2015 ).

The epistemological premise of EBM is that all knowledge is inherently biased, and that such bias needs to be balanced by intersubjectively valid expert claims. Characteristic of the epistemological paradigm of EBM is the idea that knowledge is independent of the expert. Hence, knowledge does not dwell in the body of the ‘initiated’ doctor, but in a textual world available to the expert and the layperson alike (Timmermans and Berg, 2010 ). Accordingly, everyone may become an ‘expert’ by drawing on the ‘best evidence’. This, moreover, is made democratically available through systematic reviews . Hence, the EBM paradigm actively seeks to undermine the personal and/or ‘traditional’ authority of medical doctors and experts, and to control bias and prejudice by constructing a new textual authority, accessible to people outside the medical profession, which in turn rests on basic science. Until the 1950s, the medical doctor was the embodiment of knowledge, and s/he did not need any documentation of his or her epistemological authority, except the degree and the professional experience (Weisz et al., 2007 ).

Randomized controlled trials (hereinafter RCTs) are often referred to as the ‘gold standard’ of modern clinical medicine. (A well-known example is the comparison of the effects on groups of patients that are offered a specific intervention or drug with a group that is given a placebo.) With the introduction of RCTs in the 1950s, knowledge became increasingly independent of the observer. It was, we could say, dislocated from the individual professional, and relocated in institutions and textual forms, like expert panels and clinical guidelines. A further consequence of this was that medical evidence within this development was considered translatable through texts and accessible to everyone (we will return to this in more detail below).

Three entangled processes in the history and sociology of medical knowledge were central in the development of translation as a medical research area. These processes also developed three instruments of medical translation, which constructed new ‘yardsticks’ or ‘measuring measures’ for the production of medical knowledge, as well as its social application (cf. Latour above). These instruments of translation were:

Firstly, a set of new research methods were developed. In sum, these research methods formed a supplement to the two traditional fields of medical research, namely basic research and clinical research. It is crucial that the translational methods in question allowed for a stepwise testing of findings and results developed in the laboratory setting, first on animals, and then on humans, (originally, to test the efficacy of drugs). The aim of this new translational research was to integrate methods and knowledge from basic sciences, such as genetics and molecular biology, into clinical interventions, which could be further tested through RCTS. To gain clinical significance, it was claimed, results from laboratory research should be prepared for testing on large populations in RCTs (Solomon, 2015 ).

Literature reviews

Secondly, new text genres grew from the development of RCTs. Proponents of KT and translational research devised a set of textual genres with the aim of summarizing research for clinical use. Different forms of cognition and text production were set to work; both content analysis (in systematic literature reviews) and statistical analysis (meta-analysis) were introduced as a manner of evaluating the RCTs of a particular treatment or intervention. Moreover, this textualizing of medical knowledge formed the basis for so-called clinical guideline recommendations . In these texts, reviews of several trials were operationalized into normative practical guidance for clinicians. Through the new guideline methodology, based on statistical meta-analysis of clinical trials, evidence became detached from the expert. (Timmermans and Berg, 2010 ; Solomon, 2015 ).

Clearing Houses

Thirdly, new institutions were established, bringing together scientists, clinicians and bureaucrats in so-called ‘Clearing Houses’ or ‘knowledge centres’, with the aim of facilitating the production of research reviews. Guideline development groups were also established, either as new institutions or as departments in already established units, such as the national health agencies, to promote and organize the development of guidelines (Weisz et al., 2007 ). An example of one such institution is the Cochran Collaboration in Oxford, certainly the most famous Clearing House, which organized medical research information in systematic ways. Another important epistemic practice was holding consensus meetings, taking place primarily in the 1980s and 1990s (Solomon, 2015 ). Here, specialists came together to discuss contested issues and make clinical recommendations. These meetings were, in one way, a result of this new realization of knowledge bias (thought to be compensated for by the presence of many experts), but on the other hand, they were still based on the authority of expert opinions.

With the rise of evidence-based medicine and the concomitant idea of an evidence-based practice, medical knowledge became translatable in a new way. The ability to translate—from basic science to practical healthcare action—is now the key to the implementation of medical knowledge. Although very different, all these methodological, technical, and textual practices share the common purpose of translating knowledge from ‘bench to bedside’, or from basic research into clinical practice.

The cultural model of KT

We have observed that KT has been conceptualized as a process with distinct stages: the production of knowledge (basic research); the testing of knowledge (RCTs); and the dissemination of scientifically warranted knowledge (guidelines). The most common current model of how these separate stages should be integrated in the process of translation comprises three stages, moving from the production of scientific knowledge to its application:

T1: A passage from basic science in laboratories to clinical research on populations (this is also known as translational research, cf. above), and further on

T2: A passage from clinical research to clinical recommendation, often in terms of the development of clinical guidelines based on systematic reviews of clinical trials, and ending in

T3: A passage from clinical recommendations to routine clinical practice (Woolf, 2008 ).

In this model, medical translation of knowledge is construed as a process of testing and synthetizing scientific results produced in the laboratory, to prepare it for sound clinical application and scientifically warranted healthcare. The process begins in a place emblematic for modern science, the laboratory, with basic science (‘pure science’ in its most heroic form, we could say). The directionality of translation is from the place where science is produced to its application. Thus, translation is viewed as a linear process of knowledge production and transmission. Another influential model is the Knowledge-to-Action-Model developed by the Canadian Institute of Health Research . This proposes a knowledge creation pyramid divided into three stages of knowledge creation (knowledge inquiry, knowledge synthesis and knowledge tools), which is set to interact with what the institute calls an ‘application cycle’ (see figures in Graham et al., 2006 ). Here, the application of knowledge is depicted as spatially external to the production of knowledge.

In both the cited models, the aim is that concrete practices should be governed by science, and that application should follow from, and be a supplement to, knowledge creation. This is illustrative of the epistemology underpinning KT. In KT, translation is—if it is to be felicitous—non-productive; it should neither add to nor detract from the evidence and findings produced by basis research and RCTs. On the contrary, the purpose of translation in KT is to preserve and implement the original, scientific content in new socio-cultural contexts, resulting in (assumed) rational governance and practical healthcare in particular cases around the globe.

Using the idiom of translation studies to describe KT, we can say that the act of translation is a process of ‘copying the original’ where the translational act itself is a non-act, the translator a non-actor, and the purpose of translation is to be a ‘container’ of the original message, without adding, transforming or in any other way ‘betraying’ the original. Moreover, this lack of attention to textual and cultural factors is due to an uncritical acceptance of cultural models of translation, knowledge production and knowledge dissemination, that combine elements from two of the most persistent paradigms in the European history of ideas, namely Romanticism and Enlightenment ideas. In the case of KT, we find a combination of

(a) notions from esthetic and literary Romanticism: translation is the art of preserving, while ‘carrying across’, the artistic genius behind the original masterpiece

(b) an unquestioned Enlightenment model of knowledge dissemination: knowledge should trickle down from elites and theory into ‘popular’ practice, the bedside of everyday care.

Thus, it is possible to identify a set of persistent cultural models of knowledge, its creation, communication, and transmission at work in KT. Referencing G. Steiner, we could say that this manner of patterning knowledge and translation constitutes a topological constant, which ‘remain invariant when that figure [in our case, ‘translation’] is bent out of shape’ (Steiner, 1975 , pp. 448–449). KT, then, distributes value and translational directionality in ways that resemble ancient literary and philosophical ideologies of translation: The original is the source of value, and its admired qualities should be kept intact in every process of translation.

The epistemology behind such a view of knowledge and translation assumes that it is possible to separate the production of knowledge from its transfer. Accordingly, the scientific content to be translated is construed as being outside the process of translation; it belongs to a separate ‘cycle of action’ and ‘application’ (cf. citation of Graham et al., 2006 above). Knowledge, moreover, is said to have reached its culmination in the secluded space of the laboratory or the more mobile ‘seclusions’ of RCTs (testing the effect, transferability, reproducibility and relevance of knowledge), and it is the findings that should be transported to, and implemented in, situations of practical care. In line with this, so-called barriers and drivers of KT are essentially understood as social and cultural factors external to the production of knowledge (Davis et al., 2003 ). ‘Drivers’, we could say, helps knowledge keep its identity , and thus remain equivalent to the original ‘ST’ of the laboratory, while ‘barriers’ threaten to insert shifts and difference into the ‘original message’ produced in the laboratory. In the next section, we claim that an attention to the inevitable supplement of translation offers a model for tackling this constitutive dilemma of KT.

Supplementing KT with new models for translation

We have observed how various textual genres are mobilized in the different stages of the KT process, beginning in literary reviews and ending in so-called clinical guidelines, which prescribe manners of intervention in concrete cases (e.g., particular diagnoses), based upon the systematic reviews of the scientific state of the art as this is expressed in the literature. Hence, the translation process hinges upon textualization in such genres as systematic reviews and guidelines. These texts, moreover, in increasingly condensed and vernacular forms, must be able to transmit the science necessary to implement state-of-the-art care. Generally, this text production is conceived as supplementing a lack of knowledge among clinical practitioners. Thus, what we will call a textual supplement, namely a concern about target audiences (practitioners and patients), is inevitable, even in the creation of an ‘autonomous’ science restricted to the body as a bio-medical phenomenon.

It is our contention that KT, in its current forms, is based on an inadequate understanding of the textual and cultural supplements that affect the construction, dissemination, and application of knowledge (Engebretsen et al., 2020 , cf. Derrida, 1997 on ‘supplement’). In translation studies, the importance of cultural factors in translation has been thoroughly emphasized. A case in point is André Lefevere, who maintained that problems in translation are not primarily of a linguistic nature. Rather, questions of translatability have more to do with ‘discrepancies in the conceptual and textual grids’, than with ‘discrepancies in languages’ (Lefevere, 1999 ). Take the phrase ‘once upon a time’, the interpretation of which requires knowledge of a particular cultural genre, the fairytale. Cultural and textual framings such as this marker of genre cannot be read out of the sentence as ‘mere linguistic data’; that is, the phrase ‘once upon a time’ does not per se signify ‘this is fairytale’ and ‘this is fiction’; to understand that the phrase serves as a generic code signaling a suspension of ordinary reality requires cultural competence. Even linguistic translation, then, must also account for cultural factors, and ‘metadiscursive practices’ for producing, classifying and interpreting messages in various genres (cf. Briggs, 1993 ).

In philosophy, Jacques Derrida has radically asserted that translation is an integral part of all textual production. The translation, or target text, relates to the source text, in what Derrida has referred to as the logic of the supplement : it both adds on to the original and compensates for a lack in the original (Derrida, 1997 ). According to Derrida, the nature of the supplement is ambiguous, by both adding onto itself, being ‘a plenitude enriching another plenitude, the fullest measure of presence’, and completing something that is missing ‘the supplement supplements… adds only to replace’ (Derrida, 1997 , p. 44). Consequently, a translation does not only duplicate the original message, but it also completes the original message, by fulfilling one of the ST’s possible interpretations. This, moreover, implies that the necessity of interpreting and translating texts—the fact that texts do not speak for themselves, but are constantly objects of interpretation, and are scrutinized for their true meaning—‘always already’ characterizes the ST.

If supplementary interpretations and semantic shifts are an inevitable outcome of the transport of signs between texts, KT could become more effective if such shifts were defined as a creative potential rather than as a mere ‘barrier’. Accordingly, it is our contention that KT relates to the ‘original scientific content’ as a double supplement.

On the one hand, KT offers new approaches to the communication of scientific knowledge to different groups in the healthcare system, with the aim of supplementing a lack of knowledge among clinicians (and patients).

On the other hand, it demonstrates that a textual and cultural supplement, namely a concern with target audiences (clinicians and patients), is inevitable even in the creation of an ‘autonomous’ science. The individual patient is both the origin and the end of medicine.

Translation therefor both threatens and fulfills the original scientific message. This dual challenge from translation can be used to identify an inherent paradox in existing KT models. While these models presuppose that the principal duty of adequate KT is to implement the original scientific message in new social contexts and textual forms, without altering its content, the same models, paradoxically, also state that it is through translational modifications and adaption to new audiences, through synthesis and development of guideline recommendations, that the message becomes scientifically trustworthy and effective . It is in this sense that translation is simultaneously a threat, and the instrument, that is supposed to realize the potential of the original scientific message. However, existing KT models fail to draw the consequences from this paradox: translation is inherent in science and the division between science and its translation is both impossible and unproductive to maintain (cf. Engebretsen et al. 2017 ).

Clinical inference—singularity in culture and medicine

K. Popper maintained that science was all about problem solving. If KT is seen as ‘problem solving’, the problem it aims to solve—how to relate ‘hard’, natural, and biomedical science to practical healthcare—also implies a crossover between disciplinary domains that modernization theory claims have been separated in modernity. A case in point is Latour, who claims that modern knowledge production is based upon a construction of nature and culture as separate, ontological domains with concomitant epistemological approaches (focused upon causes and meaning respectively). Culture is a product of human creativity, while nature exists in a realm beyond the sphere of human productivity (natural laws work independently of human agency). Characteristic of the ‘modern’, however, are also the continuous processes of translation and meditation that link nature with culture/society. But these translations are balanced by processes of ‘purification’ that reestablish the borders between natural and cultural knowledge. Together these interacting processes create ‘hybrids’ of nature and culture that makes technological modernity work (Latour, 1993 , pp. 10–12).

Clearly, Latour’s description fits KT well: The KT translation process is a continuous attempt at keeping natural, biomedical science ‘pure’, while simultaneously making it into a ‘hybrid’ by turning medical knowledge into practical care. However, our analysis of KT also suggest a twist in relation to the binaries of modernization theory; it demonstrates that an orientation towards a target audience, clinicians, and patients, is inevitable, even in the creation of an ‘autonomous’ science. This is so because the individual patient is both the origin and the end of medicine , at least in the sense that curing, and caring for, individual human beings is the shared objective of medical practice and research. On the one hand, this surely shows that KT and medicine are ‘hybrid’ forms of knowledge through and through. On the other, it also demonstrates that medicine, as a practice, has an inherent relation to singularity that the language of modernity theory fails disregards (cf. Kristeva et al., 2018 ). We should not map the opposition between the nomothetic and the singular onto the opposition between the natural and the human sciences. The use the anthropologist Clifford Geertz made of practical medical reasoning to ‘free’ anthropology from a nomothetic social science can serve as a case in point.

In the introduction to the The Interpretation of Culture , Geertz used the medical notion of clinical inference to construct a new model for reading culture (Geertz, 1973 ). Clinical inference comes into play in situations where a medical practitioner meets individual patients manifesting specific symptoms. To make a diagnosis, the practitioner needs to relate these symptoms to a more general system of medical knowledge. Geertz’ application of a medical analogy has mostly escaped commentators, who have turned their attention towards the seminal text analogy, which enabled Geertz to study cultures as if they were texts . The text analogy enabled Geertz to align anthropology with a ‘soft’ humanistic approach—and marked his distance to the ‘harder’ social sciences, modeled upon the natural sciences. Geertz wanted to develop a meaning-centered and interpretative approach to the study of culture. To do this he turned to hermeneutics, often regarded as a mark of the ‘soft’ human sciences dealing with interpretation, in contrast to the ‘hard’, natural sciences—dealing with facts.

In the context of KT, it is therefore highly relevant that Geertz developed the text analogy as the basis for an interpretative anthropology that aimed at reading culture by turning to clinical inference, a form of practical reasoning from medicine. As we have seen, KT was born as a consorted scientific and governmental attempt to take control of the clinical inference and singularity of case-based reasoning that Geertz used to establish an interdisciplinary common trait between (clinical) medicine and interpretative anthropology. Based on clinical inference as a particular form of medical and diagnostic form of observation, description and interpretation, Geertz establishes a pattern of inference shared across the divide between the natural and the human sciences :

To generalize within cases is usually called, at least in medicine and depth psychology, clinical inference . Rather than beginning with a set of observations and attempting to subsume them under a governing law, such inference begins with a set of (presumptive) signifiers and attempts to place them within an intelligible frame. Measures are matched to theoretical predictions, but symptoms (even when they are measured) are scanned for theoretical peculiarities—that is, they are diagnosed . In the study of culture, the signifiers are not symptoms or clusters of symptoms, but symbolic acts or clusters of symbolic acts, and the aim is not therapy but the analysis of social discourse . But the way in which theory is used-to ferret out the unapparent import of things — is the same (Geertz, 1973 , p. 26, our emphasis).

Here, the cognitive common trait between medicine and a hermeneutic study of culture is the search for implicit meanings of symptoms and signifiers within a local context (a body, an etiology, a culture) by teasing out ‘the unapparent import of things’. It is such ‘unapparent import’ that may be lost if researchers hasten to subsume observations under general laws applicable across cases , rather than dwell on seemingly unimportant symptoms and signs.

Why should we bother with such assumed similarities to expand current notions of KT? This reading of Geertz tells us that medicine as a science—as a knowledge practice aiming for the practical effect of healing, caring, and curing—does not fit neatly into a clearly cut division of disciplines into the nomothetic and ideographic, general laws and singular events. This is so because the beginning and end of medicine as a total sociocultural and scientific fact is the singular existence of the individual patient, as what we could call a ‘biocultural unit’ (cf. Kristeva et al., 2018 ). Hence, we should not map the opposition between the nomothetic and the singular onto the opposition between the natural and the human sciences; medicine oscillates between nature and culture as well as the singular and the general.

In this introduction, we have claimed that the practice of KT might benefit from incorporating more theoretical notions of translation as an entangled material, textual and cultural process which inevitably impacts the ‘original scientific message’. It is our contention that concepts and practices of translation have an unexploited potential for bridging the gap between medicine and social/human sciences. Such interdisciplinary exchange can, in turn, contribute to an increased understanding of the interplay between medical cultures and the target cultures of KT, and thereby ultimately enhance the flow of knowledge within healthcare. Hence, rather than dropping the KT metaphor, we should extend it by taking advantage of discourses and practices of translation in the human sciences.

This introduction is based upon but expands these earlier works on KT and translation.

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Medical knowledge spans over a large scope—e.g. from the single cell to the whole human body. Hence, finding orientation between science and daily practice in healthcare is not an easy task. There is a vast amount of literature regarding knowledge and its transfer. The article presents a framework in order to structure methods of knowledge exchange and transfer corresponding to different levels of the healthcare system—societal, organizational, and group level. This framework will guide the selection of knowledge management methods, IT support, and architectural means in order to support the transfer of knowledge in hospitals and in the healthcare system.

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Kruse, P., Kummer, C., Jannack, A. (2015). Empowering Knowledge Transfer in Healthcare: A Framework of Knowledge Transfer Methods. In: Gurtner, S., Soyez, K. (eds) Challenges and Opportunities in Health Care Management. Springer, Cham. https://doi.org/10.1007/978-3-319-12178-9_25

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Characteristics and determinants of knowledge transfer policies at universities and public institutions in medical research--protocol for a systematic review of the qualitative research literature

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• 1 Institute for Public Health, Im Neuenheimer Feld 324, Heidelberg, Germany. [email protected].
• 2 Institute for Public Health, Im Neuenheimer Feld 324, Heidelberg, Germany. [email protected].
• 3 Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr.2, Heidelberg, 69115, Germany. [email protected].
• PMID: 26286398
• PMCID: PMC4545361
• DOI: 10.1186/s13643-015-0094-3

Background: Universities, public institutions, and the transfer of knowledge to the private sector play a major role in the development of medical technologies. The decisions of universities and public institutions regarding the transfer of knowledge impact the accessibility of the final product, making it easier or more difficult for consumers to access these products. In the case of medical research, these products are pharmaceuticals, diagnostics, or medical procedures. The ethical dimension of access to these potentially lifesaving products is apparent and distinguishes the transfer of medical knowledge from the transfer of knowledge in other areas. While the general field of technology transfer from academic and public to private actors is attracting an increasing amount of scholarly attention, the specifications of knowledge transfer in the medical field are not as well explored. This review seeks to provide a systematic overview and analysis of the qualitative literature on the characteristics and determinants of knowledge transfer in medical research and development.

Methods: The review systematically searches the literature for qualitative studies that focus on knowledge transfer characteristics and determinants at medical academic and public research institutions. It aims at identifying and analyzing the literature on the content and context of knowledge transfer policies, decision-making processes, and actors at academic and public institutions. The search strategy includes the databases PubMed, Web of Science, ProQuest, and DiVa. These databases will be searched based on pre-specified search terms. The studies selected for inclusion in the review will be critically assessed for their quality utilizing the Qualitative Research Checklist developed by the Clinical Appraisal Skills Programme. Data extraction and synthesis will be based on the meta-ethnographic approach.

Discussion: This review seeks to further the understanding of the kinds of transfer pathways that exist in medical knowledge transfer as well as what factors lead to the adoption of one pathway over another. The aim is to provide evidence for political and academic actors designing policies for the translation of medical knowledge and public-private cooperation.

Systematic review registration: PROSPERO CRD42015014241 .

Publication types

• Research Support, Non-U.S. Gov't
• Academies and Institutes*
• Decision Making
• Public Sector
• Public-Private Sector Partnerships
• Qualitative Research
• Research Design
• Systematic Reviews as Topic
• Technology Transfer*
• Translational Research, Biomedical*
• Universities*

• Research article
• Open access
• Published: 26 August 2008

Knowledge transfer in Tehran University of Medical Sciences: an academic example of a developing country

• Saharnaz Nedjat 1 ,
• Reza Majdzadeh 1 ,
• Jaleh Gholami 2 ,
• Sima Nedjat 2 ,
• Katayoun Maleki 2 ,
• Mostafa Qorbani 3 ,
• Mostafa Shokoohi 4 &
• Mahnaz Ashoorkhani 2  

Implementation Science volume  3 , Article number:  39 ( 2008 ) Cite this article

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In the past two decades, scientific publications in Iran have considerably increased their medical science content, and the number of articles published in ISI journals has doubled between 1997 and 2001. The aim of the present study was to determine how frequently knowledge transfer strategies were applied in Tehran University of Medical Sciences (TUMS). We were also interested in studying the determining factors leading to the type of strategy selected.

Methodology

All TUMS research projects that had received grants from inside and outside the university in 2004, and were completed by the end of 2006, were included in the study. In total, 301 projects were examined, and data on each of the projects were collected by the research team using a standardized questionnaire. The projects' principle investigators filled out a second questionnaire. In all, 208 questionnaires were collected.

Researchers stated being more engaged in the passive strategies of knowledge transfer, especially those publishing in peer-reviewed journals. The mean score for the researchers' performance in passive and active strategies were 22% and 9% of the total score, respectively. Linear regression analysis showed that the passive strategy score decreased with the increase in the number of years working as a professional (p = 0.01) and personal interest as the only reason for choosing the research topic (p = 0.01). Regarding the active strategies of knowledge transfer, health system research studies significantly raised the score (p = 0.02) and 'executive responsibility' significantly lowered it (p = 0.03).

As a study carried out in a Middle Eastern developing country, we see that, like many other universities in the world, many academicians still do not give priority to active strategies of knowledge transfer. Therefore, if 'linking knowledge to action' is necessary, it may also be necessary to introduce considerable changes in academic procedures and encouragement policies ( e.g. , employment and promotion criteria of academic members).

Peer Review reports

'What happens to research-based findings after they are completed and published?' This is a question heard more often with the qualitative and quantitative development of research. In the 2004 World Health Organization report on 'knowledge for better health', 'linking research to action' was emphasized, and countries were asked to take serious steps in transferring research-based knowledge [ 1 ]. Knowledge transfer methods have been classified into active and passive strategies from researchers' perspective [ 2 ]. In passive strategies, the aim is diffusion and basically changing the awareness of the target audience. Normally, these activities are of importance in the academic environment, and are indicated by the publication of articles in peer-reviewed journals. Conversely, active strategies are based on interaction with the users of research results, and the possibility of behavior change is higher in these cases [ 3 ].

Iran's health systems infrastructure is what makes its medical research unique among other countries. In 1985, Iranian medical schools were integrated into the Ministry of Health, and the Ministry of Health and Medical Education (MOHME) was created. Under this infrastructure, education, research, and service delivery were unified [ 4 ], and it was expected that knowledge transfer would take place more effectively. In addition, in the past two decades the number of scientific publications in Iran has considerably increased [ 5 ], and the number of articles published in ISI journals with medical science content has doubled from 1997 to 2001 [ 6 ]. Tehran University of Medical Sciences (TUMS) has 1,250 academic members, or 12% of the country's medical academic members. Also, TUMS-affiliated researchers publish more than 30% of Iran's medical scientific articles in international databases.

The first objective of this study was to determine the frequency of various knowledge transfer activities applied by researchers at TUMS, and the second objective was to find the determining factors leading to the type of strategy ('active' or 'passive'). The findings of this study build a foundation upon which interventions in knowledge utilization can be studied in the future.

Data-gathering tools

The tools for data-gathering consisted of two sections: the data-gathering form (checklist), which was filled by the research team using research proposals and final reports [see Additional File 1 ], and the researcher's questionnaire (self-administered) which was sent to the principle investigators (a maximum of three times at one month intervals) [see Additional File 2 ].

The content validity of the questionnaire was approved after literature review and peer review. Pre-testing was done to assess feasibility; face validity, and reliability. A pilot study was performed on 10 data-gathering forms by studying 10 files and creating necessary changes. Also, 20 researchers completed the questionnaire twice at two week intervals to assess repeatability and internal consistency of the questions. The intra-class correlation indicator, which was considered the repeatability indicator, was 0.69 and 0.72 for the domains under study (active and passive strategies domains). The internal consistency (Cronbach's alpha) of these domains was 0.63 and 0.76. The questionnaire included the following variables: the percentage of time the participants allocated to research activities, the 'reasons for choosing the research topic', and the researchers' performances in knowledge transfer activities.

In order to study their role in knowledge transfer activities, researchers were asked to mark all the activities they had carried out in the field of knowledge transfer (including active and passive strategies) from a list that was presented to them. We also left an open-ended question for the activities that were not listed in the above-mentioned questions. A score of zero was given if the activity was not carried out; a score of one if it was performed once, and a score of two if it was done more than once. The total score then was summed for each research activity. The following activities were considered 'passive' strategies of knowledge transfer: delivery of the project report or its summary to users; preparing articles and publishing reports in domestic and international peer-reviewed journals; displaying results on a website; posting or e-mailing articles or reports and/or their summaries for stakeholders without their request; and presenting the results in domestic or international conferences and seminars, and/or publishing research results in newspapers. The activities that were considered 'active' for knowledge transfer were as follows: preparation and delivery of content in plain language; holding briefings with stakeholders for presentation of research results; and presenting results to the media and participation in interviews. Also, we asked researchers to note the percentage of time, or 'percent effort' they allocated to each activity, including research, education, clinical service delivery, executive responsibilities, and others. Researchers were then asked to estimate their percent effort in a way that the sum would be equal to 100 (Question 6, Additional File 2 ).

Population under study

All TUMS research projects that received grants from inside and outside the university in 2004 and were completed by the time this study was performed (the second half of 2006) were studied. The number of research projects that met the inclusion criteria of this study was 315, out of which the data-gathering forms were completed for 301 projects (95.6%). Fourteen projects were not entered into the study due to unavailability of files. The researcher questionnaire was then sent to the principle investigators of these projects, and 208 questionnaires were collected. Non-responders included 32 researchers who were unavailable and 75 who did not respond after three requests, giving a final response rate of 74%. In order to assess whether a significant difference existed between those researchers who responded to the questionnaire and those who did not, their project proposal forms were compared. This was carried out by reviewing the 'problem statement' of the research proposals. We observed that 24% of the individuals who did not respond to the questionnaire mentioned choosing their topics on the basis of needs assessment. This proportion was 17% for those who responded to the questionnaire. The difference between these two groups was not statistically significant (p = 0.17).

Data analysis

Apart from the usual descriptive statistics for data analysis, multi-variable linear regression was used to control the effect of the potential confounders, including gender, number of years working as a professional, and tenure status (half-time or full-time). For these purposes, the data were analyzed with SPSS/version 11.5 statistical software.

Ethical considerations

This study was approved by the TUMS ethics review board as part of the reviewing process of TUMS research projects.

A total of 208 researchers participated, 130 of whom were male (62.5%). The age range was 25 to 72 years, and the mean age was 45.6 years (SD = 9.4). Regarding academic rank, 15% of researchers were non-academic members, 7% were instructors, and 33%, 26%, and 19% were assistant, associate, or full professors, respectively. Employment status included 181 (87%) full-time employees and 10 (4.8%) part-time employees. The remaining respondents did not answer this question. Number of years working as a professional ranged from one to 43 years, and the mean number of years working in the university was 14.3 (SD = 8.5). Aside from education and research, 123 individuals had executive responsibilities such as management of a hospital, school, department or ward, research deputy of the school, and/or research center, etc . Seventy-two individuals (34.6%) were involved solely in education and/or research.

The research projects were divided into three groups according to proposal type. There are two formats of proposals at TUMS. One is health system research, in which the end-users are policy makers, managers, and health system experts. The other format is for clinical and basic studies, where the researcher chooses which category the proposal most addresses. Nevertheless we confirmed the validity of their choice by checking whether the targets of research were clinical practitioners, basic researchers, or health system researchers. ( e.g. , a study that is carried out to better understand a topic and has no immediate clinical application is a basic study, a study whose results are directly used by the clinician is a clinical study, and a study whose results are used by managers and policy makers is a health system research study). The researchers were then divided into basic sciences (46 cases), clinical studies (101 cases), and health system research (61 cases). Comparing the duration of time allocated to research in these three groups showed that the mean percentage of time allocated to research in the basic sciences group was 41% (SD = 22), and a significant difference (p < 0.001) was observed between this group and the clinical (27%, SD = 16) and health system research (30%, SD = 19)groups, respectively. Researchers were asked about their reasons for choosing the research topic. Thirty-one participants (14.9%) stated 'personal interest or repeating others research'. This proportion was 23.9% for the basic sciences, 7.9% for clinical studies, and 19.7% in health system researchers (p = 0.02), whereas the remainder mentioned choosing their topics based on 'other organizations request or needs assessment'.

The knowledge transfer status (First objective)

Information gathered from the self-administered questionnaire.

Table 1 shows researcher behavior with respect to passive strategies of knowledge transfer. The first four rows of this table (publishing articles in peer-reviewed journals and presentations at conferences) are criteria which are valued in the assessment of academic staff members, whereas the other criteria are of no value. In all types of research, the researchers stated that publishing in peer-reviewed journals had the greatest impact in disseminating research results. Most basic science research was sent to international journals (71.7%), and most clinical and health system research was sent to domestic journals (74.3% and 57.3% respectively). The last row of this table shows that the least effort made by researchers is for publishing research results in newspapers, which was found in only eight out of 208 cases (4%).

Table 2 shows the active strategies of knowledge transfer. In all three fields of basic, clinical, and health system research, the step taken most often was 'preparing and delivering text in plain language'. 'Holding briefings with stakeholders for presentation of research results was also frequently cited for health system research, but presenting results in the media was of little significance.

Information gathered from files (research proposals and final reports)

A review of 301 research proposals showed that the total budget of the projects under study was a little less than US$1,290,000: US$324,280 for health system research, US$488,030 for clinical research and US$471,380 for basic research. The total expense considered for knowledge transfer for 301 projects was approximately US$13,200: US$12,790 for health system research, US$376 for clinical research, and none for basic research. This amount was spent on only seven cases (2.3%), of which five were health system research and two were clinical research. In this analysis, a significant difference was found to exist between the groups in this regard, and in the post hoc analysis this difference was insignificant among the clinical and basic research groups alone, but the cost for knowledge transfer activities in health system research was significantly higher than that for clinical and basic sciences.

A review of the project final reports showed that in 142 final reports and/or project summaries (47.2%) the target audience had been identified. In this case, a significant difference did not exist between the three groups (basic, clinical, and health system research) (p = 0.28). In 150 project reports (49.8%), a clear suggestion had been made to the target audience. Even here a significant difference did not exist between the groups (p = 0.11). Of all 150 final reports examined, 87.3% of these suggestions had somehow pointed to the manner of the measure to be taken, but in 37.3% it had been made clear as to who had to take what measure.

Determinant factors of knowledge transfer (Second objective)

In the 'passive' strategies section, the maximum score attainable was 18. The mean score for researchers' performance was 4.00 (SD = 3.03) that formed 22% of the total score. The maximum score attainable in the active strategies was six and the mean score of the researchers' performance in these strategies was 0.54 (SD = 1.02), which consisted of only 9% of the total score. Table 3 and 4 show the results of a linear regression analysis with the 'Enter' method. As shown in tables 3 and 4 , the dependent variables in these regressions are the scores of passive and active strategies, respectively. These scores were obtained from the number of activities the researchers claimed to have carried out, whereas the independent variables included gender, number of years working as a professional, tenure status (half-time or full-time), reasons for choosing the research topic, and type of research (basic sciences were taken as reference with respect to clinical and health system research). Controlling the confounding variables, regression coefficients show the effect of each of these variables on passive and active strategy scores. In table 3 , the number of years working as a professional and health system research (as compared to basic research) have a significant inverse relationship with the passive strategy scores, whereas choice of the research topic based on other organizations' request or needs assessment increases the score significantly. According to the results of the linear regression analysis in table 4 , health system research and executive responsibilities had a significant effect on this score.

This study shows that passive strategies hold a greater share of knowledge transfer activities as compared to active ones in TUMS. While TUMS researchers have gained 22% of the total score for passive strategies of knowledge transfer (including preparation of articles for publication in domestic and international peer-reviewed journals, presenting research results at conferences and seminars, etc ), when it comes to active strategies of knowledge transfer (preparation and delivery of texts suitable to the users, presenting results to mass media, and holding briefings with stakeholders) this percentage amounts to 9% of the total score. The result is that the score obtained for passive strategies of knowledge transfer is 2.44 times greater than the scores obtained for active strategies.

Regarding publication of results in journals, according to the research regulations of TUMS at the time of this study, sending at least one article for publication from each project was one of the requirements for completing the project. This is why publication of articles in peer-reviewed journals is the most common knowledge transfer activity. According to table 1 , basic science research studies are published more in international journals than in domestic journals as compared to health system research. This may be because basic science research is less dependent on the location of research. On the other hand, health system research studies that are more dependent on cultural, social, economic, and other contextual factors target domestic journals more than international ones.

When examining other passive strategies of knowledge transfer we observed that less than 19% of the researchers have displayed the results of their research on websites. The other point worth mentioning is that less than 4% of research results were published in newspapers. Newspapers and websites are important because they have broad geographical coverage and transcend time barriers, even though the evidence should be considered before presenting it to the media; not every research result can be disseminated. Tables 1 and 2 show the performance of TUMS' researchers is in accordance with the requirements of the academic promotion criteria. This emphasizes that incentive policies (recruitment, academic members' promotion, and granting financial rewards for publishing articles) are effective. On the contrary, other matters that can lead to implementation of research findings have not received similar attention. In fact, the current state of knowledge production dominant in this university (like most universities in the world) is passive, and for strengthening the connection of 'linking knowledge to action', basic changes are needed.

Valuing scientific productions (such as publishing articles in peer-reviewed journals and presentation of material at scientific conferences) are among the known factors affecting the knowledge transfer activities of academics [ 7 – 12 ]. The known methods of valuing are employment and promotion [ 8 , 13 , 14 ]. When matters such as professional progress are solely dependent on publishing in specialized frameworks, people are not motivated enough in transferring knowledge, and guaranteeing its utilization. For the sake of meeting communities' needs, current efforts are being made to revise the promotion and employment criteria from a new perspective [ 15 – 17 ]. On the other hand, intrinsic motivations such as researchers' perceptions, values, and beliefs are influential in this field; how these beliefs are shaped and to what extent they are influenced by education are matters which demand deeper qualitative approaches [ 18 ].

Regarding tables 3 and 4 , we note that the method of summing up the scores of knowledge transfer activities as equal weight for various cases is a simple and optional approach. Linear regression analysis was done by entering all variables into the model. This type of analysis was chosen because, compared to other models that try to keep fewer variables in the final model, it has an exploratory aspect, and from the authors' point of view a better understanding of the variables in this field is necessary.

However, the result of the linear regression analysis showed that the scores of passive strategies of knowledge transfer decreased with the number of years working as a professional. That is, considering that the other variables are constant, with every one-year increase in number of years working as a professional, this score decreases by 0.08. The relationship between choosing the research topic (choice based on other organizations' request or need assessment versus personal interest or repeating others research) and the passive strategy score is positive. The passive strategy scores increase by 1.68 as a result of change of 'reasons for choosing the research topic' from 'personal interest or repeating others researches' to 'choice based on other organizations' request or need assessment'. The health system researchers also registered a lower score as compared to the basic science researchers, which leads to a 1.55 reduction in the passive strategy score.

Where active strategies are concerned, two variables were significant: First, executive responsibilities can significantly reduce the active strategies score by 0.36. This can be explained by the shortage of time this group is faced with. Second, as compared to basic science research, health system research increased the active strategy score by 0.51.

As shown in the tables, health system research registered lower scores in the passive strategies of knowledge transfer as compared to basic sciences, whereas in the active field of strategies the reverse was true. The scores registered by health system research were higher than basic sciences.

Studies of researchers from other countries have shown differences in knowledge transfer activities among various specialties. In a study done on researchers in Canada it was seen that applied science researchers use plain and engaged dissemination measures more than basic science researchers. Apart from the field of research (applied or basic) the researchers' working locations (medical school and others) have also been taken into consideration. Comparing the various methods of knowledge transfer, both these variables were shown to be significantly effective. Their interaction has also shown to be effective in the number of publications in this study [ 19 ].

After studying the final project reports, it was shown that almost 50% of them had proposed a suggestion for utilization of results (although a formal compulsory framework does not exist for writing the final report and having an actionable message). This shows that researchers need to pay more attention to knowledge transfer and that by valuing activities in this field, results can be properly utilized. Also, the target audiences of these messages were clear in 47.2% of cases, even though there is no compulsion for mentioning the target audiences. This shows that if researchers receive basic training for increasing their communication skills we will achieve more satisfactory results. This matter has been mentioned in other references and also been advised [ 20 ].

Review of the research proposals showed that in only 2.3% of the 301 cases under study, expenses for knowledge transfer activities had been considered, amounting to 1% of the funds requested. There are two reasons for this observation: Some researchers fail to consider knowledge transfer to be a part of research at all, and those who evaluate the cost of research (proposal reviewers at TUMS) find these costs unacceptable.

No doubt knowledge transfer activities require financial resources, be it in the form of cash paid for direct costs (such as preparation and handing out pamphlets or the cost of setting up meetings), or indirect costs (such as purchasing knowledge transfer services). Many authors have stated the lack of these facilities and funds to be potential barriers to the knowledge transfer process [ 8 , 11 , 13 , 21 , 22 ].

Because many of the study's data are based on the self-administered questionnaire, it is possible that responders may have overestimated their knowledge transfer activities. This may be due to the social undesirability of the answers that point to lack of knowledge transfer activity. Therefore this study may be prone to information bias in describing knowledge transfer activities, despite the fact that the questionnaire had been evaluated for repeatability and internal consistency prior to the study. This information bias can affect the first descriptive objective but we do not assume the second objective, i.e. , study of determinant factors, to be biased as a result of this.

This study was carried out in one of the universities of a Middle Eastern developing country. Here we observe that, like many other universities in the world, many academicians still do not give priority to active strategies. Even though previous studies have shown that many factors affect the facilitation of knowledge transfer in the university [ 23 ], but the matter of giving priority to knowledge transfer largely depends on academic priorities which are shown in its policies. Therefore if knowledge transfer is to be a priority, it is necessary to introduce considerable changes in academic procedures and incentive policies ( e.g. , employment qualifications and promotion criteria). The universities also need to show commitment to knowledge transfer. This means that apart from creating the necessary motivation in researchers, support mechanisms should also be provided.

As previously mentioned, the main feature of Iran's medical research is that research and service delivery are under a common stewardship, which is an aftermath of integration of medical universities into the ministry of health. Therefore, it will be interesting to study the impact of integration on knowledge transfer in the future.

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Acknowledgements

This study had been sponsored by the deputy of research in TUMS through contract no. 85-03-74-4418. The authors appreciate Mr. Ramavandi's efforts in collecting the questionnaires of the study. We would like to thank Mandi Newton and Jacqueline Tetroe, the referees, for their valuable comments in reviewing the manuscript.

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Saharnaz Nedjat & Reza Majdzadeh

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School of Medicine, Golestan University of Medical Sciences, Golestan, Iran

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Graduate of School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

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SN and RM participated in the design, statistical analysis, and manuscript writing. JG designed and conducted the study. SN, MG, MS, and MA gathered the data. KM assisted in interpreting the statistical analysis and manuscript writing. All authors approved the final manuscript.

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Nedjat, S., Majdzadeh, R., Gholami, J. et al. Knowledge transfer in Tehran University of Medical Sciences: an academic example of a developing country. Implementation Sci 3 , 39 (2008). https://doi.org/10.1186/1748-5908-3-39

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“The Doctor as a Humanist”: The Viewpoint of the Students

Conference Report and Reflection by Poposki Ognen (University Pompeu Fabra); Castillo Gualda Paula (University of Balearic Islands); Barbero Pablos Enrique (University Autonoma de Madrid); Pogosyan Mariam (Sechenov University); Yusupova Diana (Sechenov University); and Ahire Akash (Sechenov University)

The practice of Medicine as a profession has become very technical; doctors rely on fancy investigations, treatment algorithms and standardized guidelines in treating patients. In a lot of universities, medical students and residents are trained without appreciating the importance of art and the humanities in delivering good care to patients and their families. Factual knowledge is imposed on us, as students, from scientific evidence delivered by highly specialized professionals: those who know more and more about niche subjects.

As a result, when someone decides to become a doctor , it seems that scientific training is the sole priority, with most attention being given to the disease-treatment model. As medical students, we are taught very specific subjects, leaving little or no space or time for any cultural enrichment programs. And yet, Personal growth as a doctor and a human being cannot be achieved unless one is exposed to the whole range of human experience. Learning from art and artists can be one such means of gaining these enriching experiences. We can learn from historians, and from eminent painters, sculptors, and writers, as well as from great scientists. How do we achieve these ends? The following essay summarizes and reviews one attempt at providing answers. The 2nd “Doctor as a Humanist” Symposium took place at Sechenov University in Moscow from the 1 st to the 3 rd of April, 2019, to explore the holistic perspective of interpersonal treatment.

To begin our essay, we would like to clarify some key concepts, such as culture, humanism and humanities, as they were employed at the conference. Culture is a complex phenomenon that includes knowledge, beliefs, artistic production, morals, customs and skills acquired by being part of a society, which can be transmitted consciously or unconsciously, by individuals to others and through different generations.

The humanities are academic disciplines that study the cultural aspects and frailties of being human, and use methods that are primarily analytical, critical, or speculative, which distinguish them from the approaches of the natural sciences. Humanism is the practice of making the human story central. Consequently, the studies of humanities, so invested in human stories, is one aspect of practicing humanism.

Technological and practical progress in medicine has been impressive in the past fifty years. Nevertheless, patients still suffer from chronic conditions such as heart failure, chronic lung disease, depression, and many others. These are conditions where technology cannot significantly change the outcomes or reverse the underlying condition. One of the ways to alleviate suffering is through compassion and empathy where the doctor is a professional who listens to, understands and comforts the patient, as well as engaging the patient as a fellow human being. We need arts and humanities as doctors’ tools to comfort and, perhaps, even to heal. We also need them to remind us that we are ‘merely human’ ourselves, and that we share our humanity with our patients, as equals.

Unquestionably, there are fundamental requirements that every physician must internalize; the conference goal was to explain that one such requirement is the humanistic view. Opera, poetry, philosophy, history, the study of dialectics, biographical readings, and even volunteering abroad can be means of engaging the world for positive change. Sometimes called  “soft” skills, these are in fact necessary and valuable qualities to empower ourselves as persons, as well as doctors. The 2nd The Doctor as a Humanist Symposium placed the corner stone in a global project that aims to understand medicine as a multidisciplinary subject, and to establish the concept of humanistic medicine both as a science and an art where the patient and the doctor are human beings working together.

STUDENT PARTICIPATION

The event united experts in Medicine and the Humanities from all over the world. The speakers (doctors, nurses and students) were from Russia, the USA, the UK, Spain, Italy, Germany, Mexico and more. Each day’s program was both intense and diverse, and included plenary lectures and panel sessions. Medical students were highly involved in all parts of the conference, offering us a great chance to introduce our projects, share our opinions on various topics, and discuss our questions connected with the role of the humanities in medicine.We participated in roundtable discussions, which were chaired by experts from different countries. Even though this made us nervous, at the same time it was very important for us, as students, to be a part of it. We discussed the future of medical humanities from various perspectives, and above all our thoughts and ideas were listened to and commented on, on an equal basis with the world’s experts. For once, we could see that our views were being taken into consideration, and we hope that in the future this will be the norm and NOT the exception. We are the future of medicine, and our voices should be heard, too.

At the end of the first day there was a students’ session, where we gave our opinions on the relative importance of the medical humanities from a multicultural viewpoint, and on this particular roundtable there were students from Russia, Spain, Iran, Mexico, Italy, as well as a Nursing resident. One of the students during the session shared her view that “I would like to see medicine through the lens of humanism and empathy, and also implement all its principles in my professional life on a daily basis”. All participants agreed, and although we were representing different countries and cultures there was no disagreement about this. Even though we have not yet faced many of the obstacles of the world of medicine, we can see the role of compassion in clinical practice better perhaps than our seniors. We shared our points of view about this question and its relevance in the different countries. It was an incredible moment, as experts and professors demonstrated a great interest in our ideas.

The program was extremely diverse; however, the main idea that most speakers expressed was how to find, sustain and not lose humanist goals. Brandy Schillace gave an impressive presentation entitled “Medical Humanities today: a publisher’s perspective”, which studied the importance of writing and publishing not only clinical trials, but also papers from historians, literary scholars, sociologists, and patients with personal experiences. The nurses Pilar d’Agosto and Maria Arias made a presentation on the topic of the Nursing Perspective that is one of the main pillars of medical practice. Professor Jacek Mostwin (Johns Hopkins University) shared his thoughts on patients’ memoirs. An Italian student, Benedetta Ronchi presented the results of an interview on medical humanities posed to the participants and speakers during the symposium. The plurality of perspectives made this conference an enriching event and showed us how diverse ideas can help us become better doctors. More importantly, it reminded us of our common humanity.

A significant part of the symposium was dedicated to Medicine and Art. Prof Josep Baños and Irene Canbra Badii spoke about the portrayal of physicians in TV medical dramas during the last fifty years. The book “The role of the humanities in the teaching of medical students” was presented by these authors and then given to participants as gifts. Dr Ourania Varsou showed how Poetry can influence human senses through her own experience in communicating with patients. She believed that many of the opinions and knowledge that we have internalized should be unlearned in order to have a better understanding of the human mind. The stimulus of poetry makes this possible. Poetry allows us to find new ways to express ourselves, and thus increase our emotional intelligence and understanding of other people’s feelings.

One of the most impressive lectures was by Dr Joan.B Soriano, who spoke about “Doctors and Patients in Opera” and showed how the leading roles of physicians in opera have changed over the centuries. People used to consider the doctor as the antihero, but with time this view has transformed into a positive one that plays a huge role in history.

It is important to be professional in your medical career, but also to be passionate about the life surrounding you; for instance, Dr Soriano is also a professional baritone singer. For students, this Symposium was full of obvious and hidden messages, which gave us much lot of food for thought. As Edmund Pellegrino, the founding editor of the Journal of Medicine and Philosophy , said: “Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities.”

CHOOSING ONE WORD

To conclude our summary of the students’ viewpoint each of us chose One word to encapsulate our thoughts about the symposium.

The Doctor as a Humanist is a multicultural event where everyone can learn and contribute to this global necessity to put the heart and soul back into medicine. Of course, we are aware and delighted that other organizations are championing the cause of the Humanities in Medicine, and in some cases, such as https://www.dur.ac.uk/imh/ , they have been doing so for many years.

As medical students, we appreciate how we have been placed at the centre of the symposium, which we believe has made this new initiative rather special. We hope that students of Medicine and from other disciplines come and participate in future symposia.

If you want to learn more, and see how you can participate, please contact the International student representatives, Mariam ( [email protected] ) and David ( [email protected] ).

Acknowledgements

Assistance provided by Jonathan McFarland (c) and Joan B. Soriano (University Autonoma de Madrid) was greatly appreciated during the planning and the development of the article.

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A dynamic system of innovation activities, including invention, the transfer of knowledge, and the introduction of new products and processes, generates outcomes that range from new modes of mobile communication to new vaccines to counter a pandemic. Historically, participation has tended to be limited to higher-income countries, regions, and economies, and within these locations, participation has tended to be limited to higher-income men. These trends are changing.

Intellectual property indicators, such as patenting and trademarks, show where new products and processes are emerging. Patenting and trademark activity by middle-income countries is increasing. This increasing participation of middle-income countries in IP registration and other innovation activities results in both collaboration opportunities and competition challenges. Additionally, with the global supply chain reliant on international S&E capacity, this interconnectedness generates widespread risk in terms of national security, transmission of disease, and disruption in global and domestic economies.

Both international collaboration and collaboration across sectors within and between countries contributes to globally important innovation activity. Domestically, annual statistics on knowledge transfer at universities and federal labs show growth in research collaborations, technology licensing, and support for startups.

Indeed, the process of innovation, from R&D to invention to the release of a new product or process, can be a long one. Thus, introduction of a new product or process in U.S. businesses is assessed over a 3-year period with the most recent data from 2015 to 2017. In this time frame, one in four U.S. firms reported having introduced a product or process innovation. Federal science investments supported many of the industries with higher-than-average innovation intensities, including health-related industries and industries that produce information and communication technologies. These industries are integral parts of the domestic economy, perform high levels of R&D, and compete globally. Thus, federal science investments play an important role in the overall innovation ecosystem in the United States.

The regional and demographic differences in invention activities (patenting) and innovation activities (trademarking) show that these critical activities are unevenly distributed among demographic groups and among geographic regions. Whereas Black or African American firm owners account for only 2% of all firms, and Hispanic or Latino firms account for only 5% of all firms, these firms reported slightly higher-than-average rates of process and product innovations. Women also participate throughout the system, although their numbers are fewer than those for men. Majority-women-owned firms report higher innovation rates than majority-male-owned firms.

Geographically, county data for the United States on patenting and trademark activity show that the intensity of innovation activities takes place unevenly across the country, with more dense activity in urban and metropolitan areas, along the coasts, and in the Northeast. This is consistent with patterns from other countries as well, where R&D, highly skilled workers, and patenting tend to concentrate in metropolitan areas (Planes-Satorra and Paunov 2017). Concentration supports local growth at the same time that other regions, lacking these attributes, grow more slowly. The underparticipation of large sections of the population provides an opportunity to increase innovation in multiple dimensions.

The data highlighted in this report also illustrate shifts in the locations and types of R&D activities and associated outputs. Chief among these shifts is the rise of China as a global contributor to inventive output and to the transformation of new ideas into innovations, recent cautions about both quality and incentives notwithstanding. Another clear shift is the growing role of universities in private-sector innovation. The last decade has seen a 50% increase in the number of university licenses and license options to private-sector entities. This growth is due to university technology transfer to startups and other small companies, a trend somewhat at odds with the long-term decline in share of firms and employment accounted for by these companies in the U.S. economy.

Invention, knowledge transfer, and innovation are indispensable to improving national and global health, well-being, and security. The indicators reviewed in this report suggest that the global S&E enterprise remains healthy and productive and that long-term trends will continue in the direction of greater output and productivity. The federal government funded basic research decades ago that enabled the rapid development of vaccines for the coronavirus pandemic. The decades-long investment in genetic sequencing and vaccine research bore fruit in the 2020 effort to bring effective vaccines to everyone.

The data in this report raise some questions as well. According to U.S. Census data, more than 400,000 new firms (less than one year old) have been created annually in recent years, but technology transfer data shows impacts for just a few thousand startup firms each year. Clearly, there is unmeasured activity here or dark innovation (Martin 2016). Preliminary information in this report on government sharing of OSS and household innovation, and geographic data on new trademarks provides part of the answer, but not all. Taken together with the Indicators 2022 thematic reports, regional variation matters.

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Characteristics and determinants of knowledge transfer policies at universities and public institutions in medical research—protocol for a systematic review of the qualitative research literature

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Universities, public institutions, and the transfer of knowledge to the private sector play a major role in the development of medical technologies. The decisions of universities and public institutions regarding the transfer of knowledge impact the accessibility of the final product, making it easier or more difficult for consumers to access these products. In the case of medical research, these products are pharmaceuticals, diagnostics, or medical procedures. The ethical dimension of access to these potentially lifesaving products is apparent and distinguishes the transfer of medical knowledge from the transfer of knowledge in other areas. While the general field of technology transfer from academic and public to private actors is attracting an increasing amount of scholarly attention, the specifications of knowledge transfer in the medical field are not as well explored. This review seeks to provide a systematic overview and analysis of the qualitative literature on the characteristics and determinants of knowledge transfer in medical research and development.

The review systematically searches the literature for qualitative studies that focus on knowledge transfer characteristics and determinants at medical academic and public research institutions. It aims at identifying and analyzing the literature on the content and context of knowledge transfer policies, decision-making processes, and actors at academic and public institutions. The search strategy includes the databases PubMed, Web of Science, ProQuest, and DiVa. These databases will be searched based on pre-specified search terms. The studies selected for inclusion in the review will be critically assessed for their quality utilizing the Qualitative Research Checklist developed by the Clinical Appraisal Skills Programme. Data extraction and synthesis will be based on the meta-ethnographic approach.

This review seeks to further the understanding of the kinds of transfer pathways that exist in medical knowledge transfer as well as what factors lead to the adoption of one pathway over another. The aim is to provide evidence for political and academic actors designing policies for the translation of medical knowledge and public-private cooperation.

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Universities and public institutions play an important role in the development of new technologies in medicine. Footnote 1 A 2010 study examining all pharmaceuticals developed between 1998 to 2007 found that of those pharmaceuticals classified as scientifically novel, more than 30 % originated from universities and were later developed by pharmaceutical or biotech companies [ 1 ]. This illustrates the role the public sector and the interaction between private and public actors play in the development of new medicines and medical technologies. The nature of this interaction has a great impact not only on the kinds of medicines that are developed but also on how well they are accessible. For example, the first candidates for the HPV vaccines preventing cervical cancer, Gardasil, and Cervarix, were developed by public institutions and universities [ 2 ]. These were later licensed to Glaxo Smith Kline and Merck Sharpe and Dohme. As the licenses were exclusive, only these two companies had the right to develop and sell the resulting vaccines when they came to market in 2006 and 2009 [ 3 ]. The resulting lack of competition has led to high prices, making it difficult for poorer populations to afford vaccination. However, HPV disproportionately affects the world’s poor, with over 80 % of the cases occurring in developing countries [ 4 ].

As the case of the HPV vaccine illustrates, furthering the understanding of how universities and public institutions transfer their technologies is of great interest to public health professionals. However, while university technology transfer in general has attracted an increasing amount of scholarly attention, the transfer of knowledge in the development of new medical technologies specifically has rarely been addressed.

However, “anyone studying technology transfer understands just how complicated it can be” [ 5 ]. Defining the terms “technology” and “transfer” is the first challenge.

According to the “system’s view of technology” [ 6 ], technology can be described as a system of processes and products and the knowledge of their use and production. The process of innovation is an evolution of this system and its configuration. Basic principles serve as a guide for further development, and breakthroughs result from the culmination of prior, smaller changes to it. These then in turn form the basis for new developments in a continuous evolutionary process of innovation. This evolutionary process of innovation makes it difficult to demarcate individual technologies [ 6 ].

In addition to “technology”, the term “knowledge” has also been used, albeit without a clear distinction between the two terms. Sahal argues that whenever a technology is transferred, the knowledge of its use and its production process has to be transferred with it. Thus, “the knowledge base is inherent, not ancillary” [ 5 ]. For the purpose of this review, the broader term “knowledge” is used and defined to include “technology”. According to the “system’s view of technology”, any new knowledge, or minor modification of existing knowledge, is part of the innovation process, making it unnecessary to demarcate specific technologies [ 6 ]. Therefore, this review involves studies that address the exchange of any scientific knowledge generated by a researcher at a public institution or university.

The scope of the word “transfer” has been the subject of discussions as well. One definition commonly used in empirical studies is “transfer of physical devices, technological processes, or ‘know how’ from your organization to another” [ 7 ]. In medical research, two types of knowledge transfer can be discerned. The first consists of the utilization of basic medical research for the “development of new methods for diagnosis, therapy, and prevention and their first testing in humans”, while the second describes the “translation of results from clinical studies into everyday clinical practice and health decision-making”. [ 8 – 10 ] In this study, we address the first type of knowledge transfer. However, as the two processes are closely related, our conceptual findings might be relevant for the study of knowledge translation into practice as well.

A suggested model of “transfer” in the context of university research was developed by Bradley, Hayter, and Link [ 11 ]. Their “new model of university technology transfer” distinguishes two main types of technology transfer—formal transfer (through the technology transfer office) and informal transfer (informal exchange with colleagues, conferences, etc.). They argue that the scientist, as the originator of the knowledge, is central to the transfer process. He/she decides whether or not to declare an invention to the institution’s technology transfer office (TTO). If the researcher declares the invention, the TTO can decide whether to patent the discovery or not. If it chooses to patent, it markets the innovation to a third party or founds a new company to commercialize the invention, a so-called spin-off; if it does not patent the invention, the knowledge enters the public domain or is claimed by the scientist. However, new knowledge that is not declared by the scientist as an invention can be transferred informally, at conferences, through joint publications or informal meetings. According to Bradley, Hayter, and Link, these different transfer pathways can happen in various ways and often simultaneously [ 11 ]. However, this concept is limited in scope, as it only includes transfer processes that arise from a, usually patentable, discovery and ends with the adoption of a product. It does not take into account collaborative research, especially if it precedes discovery, and transfer processes that do not have the goal of commercializing a product. This gap is filled by the concept of academic engagement, which includes all “knowledge related collaboration by academic researchers with non-academic organisations” [ 12 ]. Academic engagement differs from the alternative view of technology transfer in so far as the focus is less on “transfer” and more on “collaboration” between institutions, often based on individual interaction. Its focus is broader, it does not stipulate an immediate financial objective but acknowledges that some collaborations aim at generating a more vague kind of utility. Combined, academic engagement and the alternative view of university technology transfer provide a comprehensive basis for analyzing knowledge exchange between public and private research entities. This study seeks to review the qualitative literature on the formal or informal transfer of medical knowledge from public and academic research institutions to private entities. We aim to improve the understanding of public-private knowledge transfer by addressing four key questions: What is the context in which knowledge transfer occurs? What are possible transfer pathways? What is the process by which a pathway is chosen? Who are the actors involved in the decision-making and what power do they have?

Methods/design

This review will include studies that address any kind of formal or informal method to transfer knowledge created at public institutions or universities to the private sector; and the factors that determine which of the possible policies is adopted. However, the scope of this literature review is limited to qualitative studies. Qualitative research “is most revealing when the variables of greatest concern are unclear” [ 13 ]. The questions of what the possible knowledge transfer methods are and what determines which strategy scientists and university staff apply are therefore properly addressed through qualitative research.

Search strategy

The search strategy aims at finding both published and unpublished studies. A three-step search strategy will be utilized. In the first step, keywords for the search have been developed based on the PICo approach. The PICo mnemonic has been developed for systematic reviews of qualitative literature, its components are population (P), phenomenon of interest (I), and context (Co). In comparison to quantitative reviews, it does not include an outcome, as “the expression of the phenomena of interest is the outcome.” [ 14 ] In the case of this review, scientists at universities and public research institutions represent the population, knowledge transfer, the phenomenon of interest, and medical research and development the context.

The databases to be searched are PubMed and Web of Science. The search for unpublished studies will include ProQuest and DiVA. Initial keywords included: research, development, medical, pharmaceutical, biomedical, university, academia, publicly funded, technology, innovation, results, discovery, knowledge, patent, transfer, translation, commercialization, transfer method, transfer pathway, transfer process, license, formal, informal. For full search terms, see Table  1 . The keywords were used in a cursory search of PubMed, Web of Science, ProQuest, and DiVA. The first results of this limited search were evaluated for relevance and the search terms were refined accordingly and adapted to the respective database. In the second step, a full search of the databases was undertaken using the refined and prespecified search terms.

A pre-selection based on title and abstract will be identified by applying the inclusion and exclusion criteria. A random set of 10 % of the studies will be pre-selected in duplicate (RJ, KB) to test the criteria for inclusion and exclusion and establish a consensus on the selection procedure. The remainder of the studies will be pre-selected by one researcher (RJ), unclear cases will be discussed in the review team.

The research team then scans the full text articles, again applying the inclusion and exclusion criteria.

Studies published in German and English and between 1995 and 2014 will be considered for inclusion in this review. This is because the major international agreement regarding the protection of intellectual property, “Trade Related Aspects of Intellectual Property” (TRIPS), including medical inventions, entered into force on 1 January 1995 and led to a restructuring of technology transfer nationally and internationally [ 15 ].

The resulting studies will be critically appraised for their quality using the qualitative research checklist developed by the Critical Appraisal Skills Programme (CASP) [ 16 ], and data will be extracted. The data will be analyzed using the meta-ethnographic approach. To ensure relevance to policy makers, the synthesis will be framed in accordance with the health policy triangle, a policy analysis framework developed by Gill Walt and Lucy Gilson (1994).

Inclusion criteria

The systematic review will include primary research studies that focus on qualitative data, cover technology transfer policies at universities or public institutions and address at least one of the following: a) content – possible technology transfer policies (spin-off, types of licenses, informal transfer, etc.), b) context – individual or institutional determinants of the adoption of technology transfer policies, c) process – procedural characteristics of decision-making regarding technology transfer, and d) actors – information about parties involved in the decision-making regarding technology transfer. The studies must also cover medical research as a single study subject or within a range of study subjects, (medical meaning pharmaceuticals, diagnostics, medical devices and procedures), have an empirical or systematic approach and be peer reviewed or dissertations.

Exclusion criteria

The systematic review will exclude works that are commentaries, theoretical texts, books, and meeting reports that do not specifically address medical research and development or focus on an industry perspective or on effectiveness and performance of technology transfer.

Critical quality appraisal

Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological rigour using the qualitative research checklist developed by CASP in 2012 [ 16 ]. It evaluates theoretical approach, study design, data collection, data analysis, and ethics on the basis of ten questions. Any disagreements in grading that arise between the reviewers will be resolved through discussion. The score (1–10) of each included study will be indicated in the final report, and the possible influence of quality issues on the overall synthesis will be discussed.

Data extraction and synthesis

Data extraction and synthesis will follow the meta-ethnography approach first developed by Noblit and Hare. It describes an approach whereby major themes, “metaphors” are identified and then compared across studies. They describe three major strategies, of which we will follow the “lines-of-argument synthesis” (LOA). This approach is appropriate in cases where “many studies suggest a lines-of-argument or inference about some larger issue or phenomenon” [ 17 ]. It allows for the synthesis of studies that are diverse and offer an illustration of different aspects of a larger “whole”. This is likely to be the case in this study because the included studies are going to cover various aspects of knowledge transfer. Synthesis “involves building a general interpretation grounded in the findings of the separate studies” [ 18 ]. The findings, or key metaphors, will be identified using open coding in MAXQDA to allow for systematic analysis of a larger number of studies and facilitate oversight. After extracting the data of the first two studies, the review team will evaluate and if necessary revise the extraction strategy. The coded metaphors will be grouped according to their content so related metaphors can be analyzed and translated into each other across studies. These translations and their relationships will be reported in the synthesis. Data extraction and synthesis will be done in duplicate. The synthesis of the systematic review should not just be well-grounded in theory, but it should also be relevant and appropriate for policy makers. Embrett and Randall have examined the health and health equity policy literature. They have stated that issues raised by scholars in this field rarely make it to the policy agenda, identifying the common misuse and nonuse of political analysis theory as one of the reasons [ 19 ]. Therefore, this study uses the health policy triangle as a policy analysis tool to ensure the synthesized evidence will be relevant and useful to policy makers.

The health policy triangle is a policy analysis tool developed by Gill Walt and Lucy Gilson. It states that the adoption of policies depends on four aspects: context, content, process and actors [ 20 ]. In the context of this review, these aspects are:

Context: What is the context in which knowledge transfer occurs?

Content: What are possible technology transfer policies?

Process: How is the transfer policy negotiated within the institution and with external partners?

Actors: Who is involved in the decision-making at the university / public institution?

The health policy triangle will be used to frame the synthesis in a meaningful way. Its categories are broad enough to accommodate all findings and categories that might emerge from the data and can therefore be applied in conjunction with the meta-ethnographic approach.

This review seeks to further the understanding of the kinds of transfer pathways that exist in medical knowledge transfer as well as what factors lead to the adoption of one pathway over another. The aim is to provide evidence for political and academic actors designing policies for the translation of medical knowledge and public-private cooperation. Understanding the importance of technology transfer and its effect on access to medicines and equality in health, in conjunction with improved knowledge of how this transfer comes about and why might aid individual, institutional and political actors in shaping a research environment that is conducive to global health.

For the purpose of this study, the term “public research institution” includes all medical research entities primarily funded from public sources.

Abbreviations

Human papilloma virus

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Acknowledgements

We acknowledge financial support by Deutsche Forschungsgemeinschaft and Ruprecht Karls-Universität Heidelberg within the funding programme Open Access Publishing.

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Institute for Public Health, Im Neuenheimer Feld 324, Heidelberg, Germany

Rosa Jahn & Olaf Müller

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Correspondence to Rosa Jahn .

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Competing interests.

RJ is a longstanding and active member of the worldwide student organization “Universities Allied for Essential Medicines” (UAEM). This organisation works in the area of access to medicines, with a special focus on technology transfer policies that ensure global access to the resulting products.

Authors’ contributions

RJ conceived of the study, developed the protocol and drafted the first and final manuscript. KB conceived of the study, developed the protocol, and revised the manuscript for important content. OM: conceived of the study, developed the protocol, and revised the manuscript for important content. All authors read and approved the final manuscript.

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Jahn, R., Müller, O. & Bozorgmehr, K. Characteristics and determinants of knowledge transfer policies at universities and public institutions in medical research—protocol for a systematic review of the qualitative research literature. Syst Rev 4 , 110 (2015). https://doi.org/10.1186/s13643-015-0094-3

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Received : 10 February 2015

Accepted : 16 July 2015

Published : 19 August 2015

DOI : https://doi.org/10.1186/s13643-015-0094-3

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