Partnering with Students to Develop a Capstone for a Graduate Health Informatics Program

Abstract

Objective This study aimed to assess the desirability, feasibility, and sustainability of integrating a project-based capstone course with the course-based curriculum of an interdisciplinary MSc Health Informatics program guided by a student-partnered steering committee and student-centered approach.

Methods We conducted an online cross-sectional survey (n = 87) and three semistructured focus groups (n = 18) of health informatics students and alumni. Survey data were analyzed descriptively. Focus groups were audio-recorded and transcribed verbatim and then analyzed using a general inductive and classic analysis approach.

Results Most students supported including a capstone project but desired an option to work independently or within a group. Students perceived several benefits to capstone courses while concerned over perceived challenges to capstone implementation, evaluation, and managing group processes. The themes identified were (1) professional development, identity, and career advancement, (2) emulating the real world and learning beyond the classroom, (3) embracing new, full-circle learning, (4) anticipated course structure, delivery, and preparation, (5) balancing student choice, interests, and priorities, and (6) concerns over group dynamics, limitations, and support.

Conclusion This study demonstrates the value of having students as partners at each stage in the process from methods conception to course curriculum design. With the steering committee and the curriculum developer, we codeveloped a student-centered course that integrates foundational digital health-related project knowledge acquisition with an inquiry-based project that can be completed independently or in small groups. This study demonstrates the potential benefits and challenges that health informatics educators may consider when (re)designing capstone courses.

Keywords

interdisciplinary education - digital health - health informatics - experiential learning - problem-based learning - students as partners

Background and Significance

Interdisciplinary education combines two or more disciplines to explore and better understand a common theme or central focus, with each person contributing from their perspective.[1] [2] In Canada, the Health Informatics Professional Competencies is a supported curriculum framework that involves the four domains of health science, information and computer science, business management science, and data science.[3] [4] [5]

Multidisciplinary fields like health informatics set the tone for interdisciplinary project-based or problem-based learning approaches as teachers and learners are likely to be trained in a variety of disciplines.[6] Interdisciplinary teaching methods in health programs often include small group teaching, case studies, experiential learning, problem-based learning, and traditional presentation lectures.[7] A systematic review identified eight domains of core competencies across the various subdisciplines of health informatics: data (e.g., statistics, analysis, modeling), information management, project management, leadership (e.g., change management), research and evaluation skills, health care, human factors (e.g., patients, stakeholders, communication), and systems development (e.g., health technology development, programming, and implementation).[8] Learning these core competencies and skills by didactic teaching is not always the most effective route. Student-centered learning may be a better approach where instructional strategies, assessments, and course content are centered on, with, or within students (i.e., self-ownership of learning).[9] Conceptual frameworks for student-centered learning design are constructivist in nature and involve behavioral, social, and motivational aspects of learning and knowledge generation not solely defined or directed by the teachers.[10] Some functions of student-centered learning environments are to incorporate learning that is rooted in relevant context and/or personal experiences, supporting self-regulatory and self-ownership of learning, and more meaningful activities tied to cognitive processes.[11] In student-centered learning, students have more choice in how they are assessed and are more active in their own learning.[12] Their experiences act as a basis for curricular development or improvements and can result in feeling more responsible for their learning and perceiving the content to be more relevant.[13]

For instructors to engage in student-centered curriculum development and/or negotiation, students should be given the opportunity to participate in decision-making processes, make changes to their learning through interpersonal cooperation with others, and develop a greater capacity to work with others from diverse backgrounds.[14] Student-centered curriculum negotiation can include sharing prior knowledge, selecting questions and topics for class assignments, and planning how to answer those questions.[14] A major curriculum change towards greater student-centered learning should consider the student voice in program (re)design.

The McMaster University Master of Science in eHealth is an academic graduate program launched in 2008 collaboratively by three existing disciplines and faculties—the DeGroote School of Business, the Faculty of Health Sciences, and the Faculty of Engineering. The program enrolls roughly 40 students per cohort, with a full-time thesis and full- and part-time course-based options that include four core courses (one per faculty + statistics) and electives from across the faculties. Full-time students complete an 8-month industry or research internship. All course-based students also complete a scholarly paper as their final milestone, often a literature review driven by the student's interest and supported by faculty and industry readers with related expertise. The program prepares students for professional work in health informatics; most of the students go on to pursue industry careers and the thesis stream is an option for those who wish to pursue research-based careers or further postgraduate studies.

Through a regular institutional and provincial quality assurance process, recommendations to strengthen the program included consideration of a design-focused capstone project as an alternative, complement, or replacement for the scholarly paper as a culminating milestone. Such a curriculum change could enhance interdisciplinarity by further supporting experiential learning, developing relevant competencies, and enhancing cross-faculty collaboration while leveraging and continuing to build relationships with, and support the needs of, community partners/employers.

Capstone projects often center around a complex real-life problem posed by an organization, interest group, industry sponsor, stakeholder, or a student's workplace, and provide learners with a forum to practice skills they anticipate utilizing in employment.[15] Capstone projects include student-informed, interdisciplinary collaborative inquiries in methodology, solutions, presentation, and division of tasks with an interdisciplinary-trained “moderator” (i.e., course instructor) to assist the learners.[15] [16] A capstone project amalgamates information and knowledge from an entire course or program and encourages students to think about their future careers or educational trajectories and engage in self-discovery as they anticipate transitioning to (future) professionals in their field rather than students in academia.[17] [18] An informal environmental scan of local and international interdisciplinary capstone course syllabi highlighted a range of curricula elements, including course deliverables, module content, resource requirements, and course lengths.[18] [19] [20] [21] [22]

Objective

The objective of this quality improvement study was to assess the desirability (positive perceptions and feelings towards the change), feasibility (if the program and faculties have the resources to implement/support the change), and sustainability (determine the likelihood that the change can be successfully maintained for future cohorts by analyzing pros/cons) of a new interdisciplinary design-focused capstone project course that would be integrated into a 20-month MSc course-based health informatics program in partnership with students and using student-centered curriculum development.

Methods

This mixed-methods quality improvement study, comprising a survey and focus groups that engaged current and former students, was managed by the program's Faculty of Health Sciences faculty coordinator (C.L.) and included the core faculty members from across the disciplines/faculties. Using a student-partnered approach, this study involved students through all phases of the research and curriculum development process.

The project was led by a steering committee of four program instructors/faculty members, the program internship coordinator, one alumnus of the full-time program, one alumnus of the part-time program, and a (then) current full-time student to guide methodology, decision-making, and course design. Two current students and one alumna were hired as research assistants and the curriculum developer who supported course development was an alumna. The student research assistants supported the environmental scans, initial design of the survey, recruitment emails, survey and focus group data collection, analysis, manuscript writing, and knowledge dissemination at conferences. We received a waiver for a full ethics review from the Hamilton Integrated Research Ethics Board as this was deemed a quality improvement study. We did not require written informed consent from participants; for the focus groups, they were made aware of and allowed the recording and informed that they could leave or choose not to respond to any of the question prompts. All files were securely housed behind our University firewall with only the project team having access.

Study Design and Data Collection

Student Survey

We used a cross-sectional survey to assess the feasibility and desirability of a capstone course for current students and alumni. The survey questions were co-developed and reviewed for clarity by the steering committee and student research assistants to ensure it was understandable for our target audience. The survey was exploratory and not externally validated. There were no other inclusion or exclusion criteria. The convenience sample of respondents were contacted through email via program distribution lists and the University's alumni office, and social media postings in a program-specific group. The invitations included a description of the study purpose and goals and a link to the survey. The survey introduction included a description of the program and the current curriculum milestones, a definition/description of a capstone project, and how it could be integrated into the program. The questions were exploratory and broadly asked students about their experience or expectations of writing the scholarly paper (the current final program milestone) and perceptions about a potential capstone project (see [Supplementary Appendix 1] [available in the online version]). Response options were level of agreement with statements (5- or 6-point Likert scale, from strongly agree, agree, neutral/neither agree nor disagree, disagree, strongly disagree, and unsure/not applicable) regarding the scholarly paper, group work, logistical considerations for the capstone, and exposure to interdisciplinary educational components. The survey of 18 questions was administered through Microsoft Forms between January and February 2023. The results were anonymous and analyzed in Excel. Respondents who provided their email addresses subsequent to completing the survey were included in a random draw for two CAD 50 gift cards.

Student Focus Groups

We employed a convenience sample of self-selected respondents who provided their email at the end of the survey to be contacted by a research team member. These students were emailed to participate in one of three focus groups aiming to further understand survey responses and why a health informatics capstone project may be desirable. No other criteria other than being a past/current student were required to be included in the focus group. Due to scheduling challenges, the three focus groups were attended by nine, five, and four students, respectively. Eleven semistructured questions were co-developed with the student research assistants and the project steering committee. Like the survey, the focus groups began with a description of the study goals and a definition/description of a typical capstone project. The focus group guide allowed for probing, follow-up, or rewording of questions based on learnings from the previous sessions (see [Supplementary Appendix 2] [available in the online version]). Participants were asked about their satisfaction with the scholarly paper milestone, interest in a capstone, key desired skills for their careers, optimal timing of a capstone project, benefits and challenges, strategies to accommodate part- and full-time students, and potential projects. The focus groups were facilitated between February and March 2023 by the lead investigator or a student steering committee member, both of whom have experience in qualitative research; the research assistants took notes during the sessions. The use of multiple investigators helped reduce (not eliminate) observer bias. We did not collect the demographic characteristics of participants. Each participant received a CAD 40 honorarium in recognition of their time. The three 1-hour sessions were held online through Zoom, audio-recorded and transcribed verbatim automatically, and then anonymized and double-checked for accuracy by a research assistant.

Student-Partnered Evaluations

Engaging students as partners was key to the project. To evaluate their experience, each student engaged with the conduct of the work as part of the research team was invited to provide feedback using an adapted version of the validated Public and Patient Engagement Evaluation Tool[23] as there are no tools available to evaluate student partnership engagement. We wanted to receive feedback on how the student partnership went and how the experience could be improved for the students involved (namely three on the project steering committee, two research assistants, and the curriculum developer).

Curriculum Co-Development

Following analysis of the survey and focus groups, the steering committee determined that a capstone course was desired and feasible, and decided to move forward with co-developing the curriculum with the full steering committee and a curriculum developer (program alumna and PhD). This was guided by principles of co-design for student-centered learning environments where students have opportunities to (1) access, produce, and organize course knowledge, (2) interact with peers and instructors, (3) receive and reflect on formative assessments, and (4) self-manage their learning after receiving feedback.[24] The curriculum development phases included problem analysis, ideation, and developing the course syllabus with students on the steering committee; future phases will include implementation and evaluation, to align with other student–instructor partnerships.[25] [26] [27] [28] The co-creation approach was supported by biweekly meetings and iterative course planning in which we gathered information on the content and implementation of interdisciplinary capstone courses by reviewing syllabi on program websites and informally interviewing local instructors. This was done to better understand the range of course deliverables, modules, resources, durations, operationalization, challenges, and effective strategies for managing a capstone program, which informed our course development.

Analysis

The survey data were analyzed by frequency and percentage of responses using descriptive statistics; the open-ended responses were summarized into similar themes per question based on a qualitative description content analysis approach, sticking close to the data.[29] A transcript-based analysis of the three focus groups was conducted via Microsoft Word using thematic analysis independently by two research assistants with prior university-based research work experience and one of them had formal education in qualitative data analysis at the PhD course level and previous qualitative research publications. The thematic analysis was based on a general inductive and classic analysis approach.[30] [31] We chose this analytical approach because the nature of the questions asked meant that the coding and organization of themes would be data-derived and based on the interview guide questions. After reading through each transcript, they were chronologically analyzed line by line. Sentences, words, or phrases relevant to the question(s) asked were coded into categories. The categories were further revised, consolidated, and grouped into themes based on similarities and patterns in the data.[30] [31] The codes and themes from both analyses were discussed with and reviewed by the primary investigator for consensus, coherence, and consolidation; we did not identify any disagreements with the data. Quotes were selected and presented that conveyed the themes we identified within and across focus groups.

Results

We received 87 survey responses; 55 (64%) from current students (18 part-time) and 32 (37%) alumni (5 part-time); due to the recruitment strategies employed, it is impossible to determine the response rate. Many students agreed (50.6%) or strongly agreed (25.3%) that they received sufficient interdisciplinary course experience. Most had not completed capstone projects but agreed or strongly agreed that a capstone would be valuable to their education (89.7%) and resume (83.9%). Forty-five students (52%) preferred a capstone while 17 (20%) preferred a scholarly paper. Students' perceptions about the benefits and challenges of a potential capstone project and the current scholarly paper program requirement are shown in [Figs. 1] and [2]; percentages are available in [Supplementary Table 1] (available in the online version). They agreed that a group-based capstone project supports interdisciplinary application of knowledge, group work and collaboration, and career-enhancing skills. Despite highlighting challenges in the scholarly paper process, most students agreed that the paper provided an opportunity for individual work and exploring a topic of personal interest in depth, while strengthening critical appraisal and writing skills. The consistent themes that came up from the open-ended responses to curriculum preferences and anticipated benefits/challenges included developing new skills, disapproval of group work, group time constraints, need for formal accountability in group work, student choice of scholarly paper or capstone based on postgraduation plans, exposure to real-world experiences and job opportunities aligned with preferences, and setting standards for the capstone beforehand ([Table 1]). Current students were unsure of how a capstone may work in this context and unsure of the overall impact of either program milestone.

Fig. 1 Students' perceptions about the benefits and challenges a capstone course would create (n = 87).

Fig. 2 Students' perceptions about the benefits and challenges of the scholarly paper program requirement (n = 87).

Table 1 Student open-ended responses to learning activity preferences and benefits and challenges of a capstone compared to a scholarly paper

Question	Themes
Do you think a group-based Capstone Project has greater benefits than potential challenges? For the question above, please explain your reasoning.	Unsure
	Timing
	Varied student timeframes for completion
	Challenging to pick a topic
	Gather all learnings
	Real-world group experience
	Appreciate different perspectives
	Utilizing skills from course group work
	Expand knowledge in other competencies
	More creativity
	More in-depth analysis
	More interesting
	More networking
	Learn from peers
	Fewer group participation issues at Masters level
	Reflects real-life challenges and environments
	Collaboration
	Group work expands skill set
	Varied backgrounds support learning about specific organizations and technological solutions
Would you prefer to do a scholarly paper individually or a capstone project in a group? Please explain your reasoning behind the above answer.	Unsure of impact of scholarly paper
	Unsure what a capstone would look like
	Prefer group work
	Learning more in capstone
	Varied priorities, for example, research versus industry
	Burnout from too much group work
	Need for the option
	Worried about unequal workload in capstone
	Connected to external organizations in capstone
	Become a knowledge expert during the scholarly paper process
	Need for better workflow processes for scholarly paper
Is there anything else you would like to add?	Positive benefits of capstone
	Unique student needs and experiences need to be considered
	Provide students an option to work independently either way
	Reach out to alumni more often
	Scholarly papers and knowing how to read and appraise research are valuable

Eighteen past and current students participated in the focus groups. Interconnected themes identified across the focus groups aligned with sentiments in the surveys: (1) professional development, identity, and career advancement, (2) emulating the real world and learning beyond the classroom, (3) embracing new, full-circle learning, (4) balancing student choice, interests, and priorities, (5) anticipated course structure, delivery, and preparation, and (6) group dynamics, limitations, and support (see [Table 2]).

Table 2 Desirability, feasibility, benefits, and challenges of a capstone course identified by focus group participants

Theme	Description	Selected quotes
Professional development, identity, and career advancement	Interest and orientation towards academic activities that involve industry partners, prepare for workforce, advance professional identity, and assist with job-seeking and resume-building	“One of the benefits for the capstone would be greater connections when it comes to internships. Having other organizations see the benefit of having eHealth students work on some projects, but I think it also depends on where the projects are coming from.” (F1, P5) “You could have an alumni representative for each role… that could help us to network with potential alumni, which I know a lot of people don't get the chance to do.” (F2, P3)
Emulating the real world and learning beyond the classroom	Appreciation for learning that reflects real-world contexts and current problems pertinent to the industry and skills that are useful in daily life and employment outside of academia	“This is actually pushing you into an industry-led situation… You're going to expose a lot more of the soft skills that employers are looking for, such as your creativity and your ability to apply the knowledge… actual work integrated learning which again is more realistic to the workplace and beyond that, it's the connections and the networking that you'll make through it.” (F3, P3) “The learnings can go well beyond what's in the classroom as well. But I also think the engagement that it solicits is also like a really big bonus to doing the capstone and like putting you in charge of your own project… As I'm doing my scholarly paper, I'm not as engaged. Like it's just mostly me, myself and I and no other third parties. I'm not working with anyone.” (F2, P3)
Embracing new, full-circle learning	Reflections on benefits of the capstone for positive and lasting learning experiences, envisioning greater interdisciplinarity, new compensatory or complementary skill development, and appreciation for a deep dive of a topic of interest	“It encompasses all the things that we've learned through our course in the program, such as like, doing a literature review, doing the research, and then presenting your findings. I think that is sort of like what the program thrives on, which is that interdisciplinary approach of it… With their different ideas coming with their different professional and academic backgrounds, I feel they could fill the gaps and serve the purpose of the interdisciplinary mode of this program.” (F3, P3) “I will be able to kind of encompass all of my learnings together and it kind of acts also like a like a reflection project… you're using all of those skills in this way, whether it's for a paper or project… which definitely makes you more conscious of what you learned, how you learned it, where to apply it.” (F2, P6)
Balancing student choice, interests, and priorities	Awareness of differences in students' interests and priorities within the program and their anticipation of future roles. Desire to consider a curriculum that offers students milestone choices that align with their professional and career preferences and schedules outside of school (e.g., work and family)	“I don't know how practical it would be in terms of staff and guidance… everyone has different priorities, right? If some people are looking for professional advancement, capstone is really, really great. If you're looking at maybe doing things on your own time, maybe looking more at academic research, then scholarly paper.” (F1, P4) “There needs to be different options and different pathways available to see what that individual student is lacking. Are they lacking academic preparedness? Are they lacking industry experience? Are they lacking project experience, right?... Leave the different opportunities open for pathways for students to pick and choose what they feel that they are lacking, what they are missing.” (F3, P2)
Anticipated course structure, delivery, and preparation	Discussions on potential logistics for the course structure, pros, and cons of various delivery modes (e.g., blended, online, in-person), how to prepare students for working on a capstone (e.g., pre-capstone workshops and modules), and how to choose topics/groups	“Having a variety of deliverables to work on in a real-world context would be really useful for us to practice and see how our skills could be applied in the real world.” (F2, P4) “It has to be realistic because if it's not, then it's just another thing that you had to do… It's not adding any benefit to your studies and what you have accomplished in this program… How is it different and why is it so different, right? What's the purpose behind it. What am I going to gain?” (F3, P2)
Group dynamics, limitations, and support	Reflections on challenges that may arise due to external limitations of industry partners technological limitations of software chosen, limited support/communication from the program, and group dynamics such as accountability, clashing priorities, and time commitments	“Formation of groups, number of students, the same interest, and also depends on the availability and the matching of industry partners. These are all unknowns that I think might that be a challenge.” (F1, P6) “I'm coming from an engineering background, so I would appreciate if I had someone with insights from Health Science background, or someone with insights from a management background to be on the team and that would, I think, play the whole project well, so everybody would have their own kind of niche where they could contribute to, but also caring about the others in a more compact sense.” (F2, P6)

Students were excited about the possibility of a capstone and envisioned an interdisciplinary approach that reflected real-world learnings and would better connect them to potential employers and alumni. The students reflected on their own professional interests and future roles and how that would affect their educational choices and agreed that a capstone would reinforce their preparedness for collaborative/interdisciplinary health informatics work, which raised the need for choice among culminating projects. For example, several participants valued the scholarly paper because they could explore a topic of interest independently and practice writing/research skills useful for future research-oriented careers or further education, though some downfalls included unclear preparatory information and communication issues between readers. Career trajectories could be created, strengthened, and modified based on the success of the capstone and enhance preparation for employment in the workforce in addition to strengthening soft skills that are useful beyond the classroom.

Students foresaw customizable, collaborative, and structured learning possibilities within an integrated culminating project. They considered logistical constraints and success factors for curriculum delivery, deliverables, timing, integration, and course structure, relating to the themes of managing diverse student interests, real-world learning, and experience beyond the classroom. We found that students want the program, faculty, and alumni to be more involved with learning, assessment, and accountability within a formally structured course, though the students recognized that this would involve more administrative, financial, and resource complexity. Mixed opinions about the nature of group work, technical limitations of existing software solutions, limited time provided by industry partners, and varied program supports could affect the success of a capstone. Challenges in group coordination, negative group dynamics, time management, availability of industry-sponsored projects, and overwhelming project complexity were noted by participants.

The capstone project course is intended to be completed over the final two semesters of the program. Student's voice is reflected in the group's size limits (one to four students) to allow for choosing independent exploration and to mitigate the logistical and personal challenges of working in larger groups. The content for foundational knowledge was informed by suggestions based on knowledge gaps student partners identified during their internships and postgraduation. The syllabus is provided in [Supplementary Appendix 3] (available in the online version only). Students and alumni who were integrated into this project, via the steering committee, or as research assistants and the curriculum developer, reported strong involvement with the project (see [Fig. 3]). They also felt that their insights would be useful to future cohorts and graduates to make the course content practical and interdisciplinary.

Fig. 3 Student engagement feedback questionnaire (n = 4).

Discussion

This quality improvement study sought to understand the desirability, sustainability, and feasibility of a curricular change (the introduction of a capstone project course) in a health informatics graduate degree program using a student-partnered approach. We found that a capstone project course is desirable for students and would enable a truly interdisciplinary approach with students working together with a greater range of community partners to design innovative human-centered solutions.

Capstones and Interdisciplinary Learning

Interdisciplinary learning approaches have positive social effects on students' understanding of their professional roles and that of their peers, as well as team-working skills such as communication, problem-solving, and team conflict resolution, though actual comprehension of informatics theories/content could be improved.[7] [32] This study demonstrates that students perceive these skills to be important to their professional development and believe that a capstone would facilitate these skills. More flexible thinking, higher-order cognition, critical thinking, and creativity can be achieved with interdisciplinary studies as the focus is on deeper learning and multisided arguments because the students acquire and integrate knowledge from different disciplines and, over time, become aware of the principles and strengths or limitations of each discipline.[2] There have been successful capstone projects embedded in other health informatics,[33] [34] public health,[35] and global health graduate degree programs,[36] and citing personal and professional benefits for students and employers. This study also adds to the literature to support the utilization of capstone projects in health informatics programs.

For an interdisciplinary program to be successful, faculty should have expertise and interest in interdisciplinary curriculum, and pedagogy focused on gradual and iterative collaboration, integration, and reflection, rather than memorization.[37] The challenges to implementing an interdisciplinary curriculum are lack of time and financial resources to plan and facilitate a course, course/program prerequisites preventing students from full participation, and unsupportive academic institutional systems that favor strong disciplinary boundaries for faculty.[7] [38] Interdisciplinary informatics programs address challenges in siloed health informatics work, such as a lack of synergy among software developers, health service researchers, and health practitioners, which may impact the usability, appropriateness, and integration of digital health technologies.[39] The capstone course will include faculty members from across the represented disciplines as mentors to student groups, allowing for the integration of the various perspectives in one course. Gaps between health informatics core competencies and industry needs/desires also exist due to the breadth of health informatics fields; for example, employers expect more technical skills in data analysis and database management than students may possess.[40] According to our findings, a successful capstone could address data analysis, project management, and leadership skills, which aligns with recommended health informatics knowledge/skills areas.[41] This problem-based learning provides an avenue for professional enculturation and improves self-efficacy when students are asked to reflect on their process.[42] This is beneficial for health informatics education programs that are geared toward industry careers postgraduation and well-connected with community employers through on-campus career and professional development offices.

Student-Partnered Curriculum Development and Evaluation

We co-developed a two-semester three-credit capstone course syllabus based on our findings and the principles of student-centered curriculum development that included an integration of modules across the disciplines, microlearning opportunities that mirror real-world experience in the sector, and preparation for postgraduation. We considered the student-centered learning principles with innovative approaches such as reflection exercises and multimedia options to promote creativity and flexibility to meet the individual needs of full- and part-time students. Other considerations included the timing of course modules and progression, various communication modes, leveraging virtual and in-person spaces, regular check-ins, and flexibility with project topic choices. Structured instructional strategies such as monthly check-ins with mentors, progress reports, and reflective writing assignments will maintain momentum and progress towards degree completion yet allow students to work independently or collaboratively with peers to conduct their background research, analysis, prototype solutions, and present findings.

There is great value in student involvement with curriculum design, resulting in better learning outcomes such as higher grades, better attendance rates, personal satisfaction with higher education, the transformation of the traditional power relations between teacher and learner, and shared respect, trust, tolerance, and responsibility among the learning community.[43] [44] After integration of the capstone into our curriculum, we plan to evaluate its effects on student learning and partner experience through quantitative assessments detailing the number of partners engaged, projects, and students. We will also incorporate annual mixed/qualitative assessments (e.g., results of start–stop–continue exercises within sessions, a student experience survey, a partner experience survey and/or exit interviews, and analysis of students' reflection assignments) to allow for content modification. We plan ongoing evaluations of student and instructor experiences each year and conduct focus groups after 3 years so we can gather longitudinal data on the long-term impacts and sustainability of the curriculum changes.

Strengths and Limitations

Our study contributes to a limited body of research on health informatics capstone courses and their potential to address core competencies required of health informatics students. The study also adds to the interdisciplinary health informatics education literature and shows the value of exposure to student-centered learning activities for students preparing for careers in health informatics. A major strength of this study is the active involvement of students and alumni in the decision-making process, ensuring their perspectives and needs were central to curriculum development. Including student partners, surveys, and focus groups was a conscientious effort to study a potential program change that empowered students to share their experiences, concerns, and desires in support of a more holistic and personalized student experience. The student partners reported strong engagement with the project. We note that the program change and course curriculum have been approved in Winter 2024 by the curriculum committees of the three collaborating faculties and will be offered for the 2024 incoming cohort of students.

We may have missed alumni who were unreachable through email or social media. Due to the convenience sampling used we missed the opinions of those who did not want to participate; they naturally may differ from those who chose to participate, so there is a risk of sampling bias. The survey was not externally validated so there may be limitations with survey validity, reliability, and acquiescence/social desirability bias. We did not use semantic differential scales so there may be a confirmation bias in the questions. Though we did our best to provide a nonjudgmental and inviting platform for open expression in the focus groups, the academic setting and group dynamics may have impacted the answers provided or risked social desirability bias in the presence of students' course instructors/academic advisors. We acknowledge the lack of generalizability of our findings and representativeness of our study sample which were limited to one program in one university and with only 18 focus group participants. We did not collect demographic information from respondents and focus group participants beyond the year of school they were in and their part- or full-time student status, so we were not able to systematically analyze other sociodemographic factors that may have influenced their perspectives, potentially leading to oversimplification of their responses and feelings.

We acknowledge there is a minor risk in removing the scholarly paper milestone, though students who wish to pursue an independent research study will still have the choice to select or switch to the full-time thesis stream. Future plans include evaluating the experience of students, faculty, industry partners, and employers and understanding how the change and its effects align with the overall mission (interdisciplinarity, collaboration, cultivating professionals to advance technology and health care) and values of the program (e.g., student-directed learning, diverse perspectives, collaborative teamwork, and experiential learning).

Conclusion

With the shift toward more student-centered learning activities, we collaborated with students and alumni to explore the feasibility and desirability of a health informatics capstone course that combines foundational knowledge acquisition in digital health with hands-on, inquiry-based projects. Health informatics programs should continuously prepare students to enter the changing workforce by reviewing and revising program curricula to better meet the practical, applied, and research learning needs of students.

Clinical Relevance Statement

Health informatics programs can better serve the learning styles and needs of students by engaging in students-as-partners/student-centered learning approaches for curriculum development. The addition of a capstone or enhancement of other culminating milestones in graduate programs enhances the soft and technical skills of future health informaticians making them better prepared for careers in health informatics. Capstone courses must be carefully planned to ensure relevance to students and meet the current needs of the health informatics industry and the population served.

Multiple-Choice Questions

• Question 1: How does a capstone course for a health informatics program enhance student learning?

  • Students do not need to understand technical aspects of health informatics.

  • Integrates foundational health informatics knowledge acquisition and application.

  • Eliminates the need for program instructors to monitor the course.

  • Students teach themselves without input from their capstone mentors.

  Correct Answer: The correct answer is option b. A capstone course can enhance student learning by combining and integrating knowledge learned in the classroom with more learning by applying this knowledge in a real-world or plausible problem-based or project-based scenario. Often capstone projects will include a community partner or industry project sponsor from an organization with a need for a solution to a defined problem.

• Question 2: What are the benefits of student-centered learning?

  • Students are less motivated to learn the material.

  • Students participate less in the classroom.

  • Students do not feel responsible for how or what they learn.

  • The content is more relevant and relatable to students.

  Correct Answer: The correct answer is option d. Student-centered learning is intended to involve students in curriculum choices, development, and pedagogical strategies with some flexibility in the content they want to learn and how they can most effectively and enjoyably learn the content. This results in students who are more motivated to learn, more engaged with the content, and therefore participate more actively in the classroom.

Conflict of Interest

All of the authors have an affiliation with the MSc eHealth program. N.W., C.L., V.M., N.G.B. (faculty members), and M.L. (internship coordinator) are employees of McMaster University and receive salary through program revenues. R.J., T.B., E.W., S.Z.D., and J.F. are alumni of the program.

Protection of Human Subjects

This study received clearance from the Hamilton Integrated Research Ethics Board.

• References

• 1 Bruhn JG. Interdisciplinary research: a philosophy, art form, artifact or antidote?. Integr Physiol Behav Sci 2000; 35 (01) 58-66
• 2 Ivanitskaya L, Clark D, Montgomery G, Primeau R. Interdisciplinary learning: process and outcomes. Innovative High Educ 2002; 27: 95-111
• 3 Kushniruk A, Borycki E, Monkman H. Toward an integrative and holistic approach to the discipline of health informatics. In: Rezaei N. ed. Multidisciplinarity and Interdisciplinarity in Health. Cham, Switzerland: Springer; 2022: 593-605
• 4 Kushniruk A, Lau F, Borycki E, Pratti D. The School of Health Information Science at the University of Victoria: towards an intergrative model for health informatics education and research. Yearb Med Inform 2006; 15 (01) 159-165
• 5 Monkman H, Mir S, Bond J, Borycki EM, Courtney KL, Kushniruk AW. Canadian employers' perspectives on a new framework for health informatics competencies. Int J Med Inform 2024; 183: 105324
• 6 Wessel C, Spreckelsen C. Continued multidisciplinary project-based learning - implementation in health informatics. Methods Inf Med 2009; 48 (06) 558-563
• 7 Cooper H, Carlisle C, Gibbs T, Watkins C. Developing an evidence base for interdisciplinary learning: a systematic review. J Adv Nurs 2001; 35 (02) 228-237
• 8 Davies A, Mueller J, Moulton G. Core competencies for clinical informaticians: a systematic review. Int J Med Inform 2020; 141: 104237
• 9 Neumann JW. Developing a new framework for conceptualizing “student-centered learning”. Educ Forum 2013; 77 (02) 161-175
• 10 Lee E, Hannafin MJ. A design framework for enhancing engagement in student-centered learning: own it, learn it, and share it. Educ Technol Res Dev 2016; 64: 707-734
• 11 Hannafin MJ, Land SM. The foundations and assumptions of technology-enhanced student-centered learning environments. Instr Sci 1997; 25: 167-202
• 12 O'Neill G, McMahon T. Student-centred learning: what does it mean for students and lecturers. In: O'Neill G, Moore S, McMullin B. eds. Emerging Issues in the Practice of University Learning and Teaching. Dublin, Ireland: AISHE; 2005: 1-10
• 13 Bovill C, Morss K, Bulley CJ. Should students participate in curriculum design? Discussion arising from a first year curriculum design project and a literature review. PRIME 2009; 3 (02) 17-26
• 14 Bron J, Bovill C, Van Vliet E, Veugelers W. 'Negotiating the curriculum': realizing student voice. Soc Educ 2016; 34 (01) 39-53
• 15 Kampf C, Stefan H, Labuz J. The rhetoric of the capstone project: working towards an explicit definition of the capstone project writing process. Paper presented at: International Professional Communication Conference; September 29, 2004; 89-96
• 16 Kidron A, Kali Y. Boundary breaking for interdisciplinary learning. Res Learn Technol 2015; 23: 26496
• 17 Schmid TJ. Bringing sociology to life: the other capstone mandate. Teach Sociol 1993; 21 (03) 219-222
• 18 Schroetter SA, Wendler MC. Capstone experience: analysis of an educational concept for nursing. J Prof Nurs 2008; 24 (02) 71-79
• 19 Bridgeman N. (2003). Project success: Defining, designing, constructing and presenting a capstone project. Paper presented at: 16th Annual Conference of the NACCQ, Palmerston North, NZ; July 2003; 211-216
• 20 Elwell GR, Dickinson TE, Dillon MD. A postgraduate capstone project: Impact on student learning and organizational change. Ind High Educ 2022; 36 (03) 334-343
• 21 Schwering RE. Optimizing learning in project-based capstone courses. Acad Educ Leadersh J 2015; 19 (01) 90
• 22 Radhakrishnan BD. Pragmatic framework for graduate-level sustainability capstone projects. Paper presented at: ASEE Annual Conference and Exposition, June 2018; 1-18
• 23 Abelson J. PPE Research-Practice Collaborative. Public and Patient Engagement Evaluation Tool (PPEET). 2015 . Accessed February 2, 2024 at: https://ceppp.ca/en/evaluation-toolkit/public-and-patient-engagement-evaluation-tool-ppeet/
• 24 Damşa C, de Lange T. Student-centred learning environments in higher education: From conceptualization to design. Uniped 2019; 42 (01) 9-26
• 25 Woolmer C, Sneddon P, Curry G. et al. Student staff partnership to create an interdisciplinary science skills course in a research intensive university. Int J Acad Dev 2016; 21 (01) 16-27
• 26 Goff L, Knorr K. Three heads are better than one: students, faculty, and educational developers as co-developers of science curriculum. Int J Stud Partners 2018; 2 (01) 112-120
• 27 Aksela M. towards student-centred solutions and pedagogical innovations in science education through co-design approach within design-based research. LUMAT 2019; 7 (03) 113-139
• 28 Cook-Sather A, Bahti M, Ntem A. What approaches might student and faculty partners take to curriculum-focused partnerships?. In: Cook-Sather A, Bahti M, Ntem A. eds. Pedagogical Partnerships: A How-to Guide for Faculty, Students, and Academic Developers in Higher Education. Elon, NC: Elon University Center for Engaged Learning; 2019: 181-216
• 29 Sandelowski M. Whatever happened to qualitative description?. Res Nurs Health 2000; 23 (04) 334-340
• 30 Cyr J. Focus Groups for the Social Science Researcher. Cambridge, United Kingdom: Cambridge University Press; 2019: 1-131
• 31 Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: Sage Publications; 2014: 1-249
• 32 Reynolds E, Wilson GM. The power of interprofessional education to enhance competency-based learning in health informatics and population health students. J Health Adm Educ 2018; 35 (03) 377-387
• 33 Custis LM, Hawkins SY, Thomason TR. An innovative capstone health care informatics clinical residency: interprofessional team collaboration. Health Informatics J 2017; 23 (01) 69-79
• 34 Hackbarth G, Cata T, Cole L. Developing a capstone course within a health informatics program. Perspect Health Inf Manag 2012; 9 (Summer): 1b
• 35 Mackenzie SLC, Hinchey DM, Cornforth KP. A public health service-learning capstone: Ideal for students, academia and community. Front Public Health 2019; 7: 10
• 36 Chamberlain S, Gonzalez N, Dobiesz V, Edison M, Lin J, Weine S. A global health capstone: an innovative educational approach in a competency-based curriculum for medical students. BMC Med Educ 2020; 20 (01) 159
• 37 Spelt EJ, Biemans HJ, Tobi H, Luning PA, Mulder M. Teaching and learning in interdisciplinary higher education: a systematic review. Educ Psychol Rev 2009; 21: 365-378
• 38 Rosenfield PL. The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Soc Sci Med 1992; 35 (11) 1343-1357
• 39 Pagliari C. Design and evaluation in eHealth: challenges and implications for an interdisciplinary field. J Med Internet Res 2007; 9 (02) e15
• 40 Patel JS, Vo H, Nguyen A, Dzomba B, Wu H. A data-driven assessment of the us health informatics programs and job market. Appl Clin Inform 2022; 13 (02) 327-338
• 41 Bichel-Findlay J, Koch S, Mantas J. et al. Recommendations of the International Medical Informatics Association (IMIA) on education in biomedical and health informatics: second revision. Int J Med Inform 2023; 170: 104908
• 42 Dunlap JC. Problem-based learning and self-efficacy: how a capstone course prepares students for a profession. Educ Technol Res Dev 2005; 53 (01) 65-83
• 43 Brooman S, Darwent S, Pimor A. The student voice in higher education curriculum design: is there value in listening?. Innov Educ Teach Int 2015; 52 (06) 663-674
• 44 Lubicz-Nawrocka TM. Students as partners in learning and teaching: the benefits of co-creation of the curriculum. Int J Stud Partners 2018; 2 (01) 47-63

Publication History

Received: 14 March 2024

Accepted: 27 August 2024

Accepted Manuscript online:
10 September 2024

Article published online:
11 December 2024