Choosing the right path

Graduate education has opened up new doors and opportunities for Jennifer Donnan. After graduating with an MBA in 2014, Jennifer has set her sights on completing a PhD in pharmacy. In her doctoral research she is exploring ways to quantitatively capture patient preferences to support patient-clinician shared decision making, which can lead to more appropriate use of medications, and result in more of the intended benefits.

Where are you originally from?
I am from St. John’s, Newfoundland.

Are you the first person in your family to go to graduate school? If so, how did that shape your graduate experience?
No, I am not the first to do graduate school, but I am the first person to be interested in pursuing research. I am not sure exactly how it shaped my experience, but I was navigating the process with little advance awareness, or knowledge of what to expect. Coming from a professional degree program, I also did not have many friends or classmates that looked to graduate school as an option post-graduation.

Why did you choose to pursue a graduate degree?
Initially, when I decided to pursue my master’s it was because I had a mentor who had been completing her master’s degree. The confidence and skills she gained from the program, and how she applied it to her workplace, inspired me. I aspired to be in a role like hers in the future and by taking on graduate training I thought it would give me an edge to take on more advanced pharmacy work.

While my initial vision for my career did not fall into place as I had originally set out, I really could not be happier. Taking on graduate training opened up new doors and opportunities that I never even considered before starting graduate school. I took on a job as a pharmacy research specialist working on new and exciting provincial government health care initiatives. However it became clear to me that to really pursue innovative research independently, I would need to have doctoral level training and qualifications.

I actually applied and was accepted into a PhD program in 2010 (with a wonderful supervisor, who is still a mentor) but decided just before I started that I was doing it for the wrong reasons, as I was not able to study in an area I was interested and passionate about at Memorial. In 2014 I started working at Memorial’s School of Pharmacy and some fantastic new faculty had joined the school whose research and experience matched my own research interest areas. It did not take much to convince me to start the PhD program, it was like it was meant to be!

Why did you choose Memorial for graduate studies?
I was an active member of the MUN School of Pharmacy for many years prior to my doctoral studies. I watched our School of Pharmacy grow over the preceding 10 years, leading the way with a new entry-to-practice PharmD program that is second to none in the country. I am proud of the quality of education that our current and future students continue to receive, despite our small numbers and limited space resources. Our faculty and staff continue to raise the bar by: creating new knowledge in drug discovery and delivery; inspiring and supporting pharmacy practice change; and improving health outcomes through smart delivery of evidence-based pharmaceutical care. I wanted to continue to be a part of that momentum and the positive impact that the MUN School of Pharmacy has on our province and the influence it has nationally and internationally.

In 2015 when I started my PhD, I was a mature student with 10 years of work experience, a husband and two children. Pursuing a PhD was not only a personal decision, but one that impacted my whole family. Staying close to home, established careers and our support networks were very important to us. Though I was also not willing to sacrifice the quality of my education just to be able to do it from home. It had to be the right opportunity for me jump on board. My co-supervisors were extremely supportive and created a personalized training program for me that I never thought would be possible. The stars seemed to align for me with a wonderful university, fantastic supervision, and being able to stay at home. For that I am extremely grateful!

How would you describe your experience as a graduate student at Memorial?
I have had an incredible experience as a graduate student at Memorial. I was blessed to have world class supervision who went above and beyond to ensure I received a well-rounded program that not only built on my knowledge and expertise, but also prepared me for career opportunities after graduation.

I have now (nearly) completed two graduate degrees at Memorial. An MBA in 2014 and PhD (anticipated October 2019). Both programs have been incredible opportunities for intellectual growth and personal reflection and each for very different reasons.

The MBA allowed me to stay intellectually challenged as I was home on two maternity leaves with my children. It challenged me to think about myself and how to learn and engage with colleagues and classmates. It also broadened by understanding of the world through content that I never had the opportunity to explore before. Even though I never planned to run my own business, or strive for some “chief” level career, the MBA made me think and understand the world differently.

For the PhD, I was lucky to have a lot of research experience and training before starting the program. What was the most valuable for me, aside from specific focused research skills that I gained, was the opportunities outside of my research. I developed skills for doing thorough peer reviews for journals, I learned effective teaching and communication skills, and I had the opportunity to build a professional network of researchers across the country and around the globe. These are things that will help me moving forward in my academic career.

What is your degree program and area of specialization?
I am doing my PhD in pharmacy, within the health outcomes stream. My specialization is in pharmacoepidemiology, choice modelling and quantitative benefit risk assessment.

Why did you choose this area of study?
I had been interested in pharmacoepidemiology since my undergraduate training, but my interest really took off in my post graduate residency training. I got to see how evidence based medicine influenced real patient care decisions. So this side of my research focus was a natural progression of work I had already been doing.

With respect to the patient preferences and choice modelling piece, I think on a personal level, I really do weigh the risks and benefits of all the decisions I make and tend to be a little on the risk averse side of choice. The idea of learning about decision modelling and gaining a deeper understanding on how people make decisions and choices was fascinating and a totally new area for me. It was exciting that I could become an expert in an emerging area of research, one that is gaining a lot of attention internationally. We are only at the beginning of fully understanding how we can integrate patient preferences into the balancing of risks and benefits of medications to come up with personalized medication recommendations.

What is your research/thesis about?
My research has focused on how we can capture patient’s preferences towards characteristics of their medications. We are seeing a big push in health care towards more patient-centered care. Part of this means actively involving patients in shared decision making when it comes to screening, treatment and other health interventions. Previous research has shown that patients’ decisions differ from that of their physician, as physicians tend to underestimate the importance patients place on aspects of their care. For example in my specific research, I am looking at diabetes medications. There are actually many medications that are used to lower blood glucose levels, and each medication has different benefits, side effects, administration routes and schedules and costs.

When we can measure patient preferences towards the characteristics of medication alternatives, and we know the chance that each of the benefits and side effects will occur, we can make better informed choices about what medication would be most appropriate. For example if a doctor has two medications for the patient to consider, one has a risk of amputation, while the other has a risk of developing cancer. Knowing patient’s preferences towards each of those outcomes helps us understand the trade-offs they would make when making their choice. This knowledge then can support clinicians as they strive towards more patient-centered care.

What is the goal of your research?
My actual thesis work is really exploring how we can capture patient preferences and integrate them into benefit-risk analysis. This means that I am looking at average patient preferences at the population level. Moving forward I would like to explore ways that this work can support shared decision making at the individual patient-clinician visits.

Why did you choose this research topic?
As a pharmacist I know that not all medications that are prescribed are taken appropriately, and sometimes not at all. I believe that if patients are more on board with the medications they have to take, and those medications are in line with their preferences, then perhaps we can improve the appropriate use of medications and ultimately have patients experience more of the intended benefits as a result.

How do you work with your supervisor? Does your work involve other students?
Right now we are working together by Skype as he has moved on from Memorial. But in the beginning it was very much a team based approach. We had weekly team meetings that included other grad students and research staff where we would discuss individual research projects, support one another and learn from others challenges and experiences.

My supervisor has always been very keen to provide a learning experience that extends beyond the course work and research required to complete my degree. He has provided opportunities to work on additional research projects, expanding my scope of experience. I also co-peer-reviewed several manuscripts for Journals and now have no trouble doing them independently. He also identified and supported my attendance at courses, conferences and workshops, nationally and internationally, introducing me to key researchers in my field.

What are the implications of your research project for the province, the country and the world?
Right now my research is just scratching the surface of understanding patient preferences for medications. My hope is that as I continue with this research after graduation that I will be able to build on this knowledge and see how it can impact and support direct patient care.

There is still a dearth of guidance and recommendations for the best approach to integrate patient preferences into the benefit risk assessment. I am hoping that I can fill in that gap to answer some of those unanswered questions, and contribute to establishing best practices for research in this area. That would have national and global impact.

Have you received any recent awards and/or honours?
I think the accomplishment that I am most proud of is receiving a CIHR Fellowship. Aside from the honour of receiving the award, it has also allowed me to focus full time on my research without having to balance part time work. This also meant being able to contribute to research outside my own thesis work, broadening my experience and building a stronger skill set.

I have also been accepted into a Drug Safety and Effectiveness Cross Disciplinary Training Program (DSECT) twice in the last three years. This has provided valuable training, mentorship and collaboration opportunities outside of my core graduate program.

I also want to acknowledge NL Centre for Applied Health Research for a doctoral award that provided financial support for research expenses, and the NL Support unit for a stipend award during my early training.

What are you planning to do after you complete your degree?
I just recently accepted an Assistant Professor position in the School of Pharmacy which will begin in September.

Do you have any advice for current and/or future graduate students?
Never commit too fully to a specific career path. Life has a strange way of guiding you where you need to go. Taking chances and trying new things opens up opportunities that you cannot always anticipate.

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