From Patient to Advisor: Establishing a Patient Council for Dry Eye Research

From Patient to Advisor: Establishing a Patient Council for Dry Eye Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Patient to Advisor: Establishing a Patient Council for Dry Eye Research Natalia A. Warren, JB Adams This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8484290/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objective To assess the effectiveness of a multiphase training program that jointly prepares patients and researchers for collaboration in dry-eye patient-centered research. Design: Cross-sectional, mixed methods study. August–September 2025. Subjects: Initial cohort: Dry eye patients/caregivers (8) and researchers (3). Age 18–75. High school to postgraduate education. Eastern and Central time zones. English fluency. Access to computer, internet. The participants were selected through purposive, snowball sampling. Eight (83%) females and 3 (27%) males were included. One female dropped out during Phase 1 and was replaced. One female dropped out after Phase 2 and was not replaced. The final cohort included 7 (70%) females and 3 (30%) males. Age > 30–75 years. Intervention: Participants completed a structured three‑phase training program beginning with online informational modules on patient-centered research literacy, including study design and research methods; progressed to book studies with quizzes and live virtual discussions to develop in‑depth disease knowledge; and culminated in group simulations, designing a mock research study, and replicating real‑world teamwork. July 2023–June 2025. Main outcome measures: Quantitative: effectiveness/value of training, self-reported pre- and post-training knowledge gains, using 5-point Likert scales. Qualitative: responses to semistructured interviews. Results Quantitative: Statistically significant gains in self-reported knowledge were observed across all three phases of training; Wilcoxon signed-rank tests, W = -22.5, P < .01; effect sizes for each phase were large, r = .96, .91 and .91, respectively. Qualitative: Phase 1 (Research Fundamentals), informative but occasionally tedious; Phase 2 (Mastering Dry Eye), valued for in-depth content and small-group discussions; and Phase 3 (Research Practicum), valuable, although some participants expressed frustration/low interest. Conclusions This structured, multiphase training program effectively prepared patients and researchers for collaborative engagement in dry eye patient-centered comparative effectiveness research (CER). Statistically significant gains in self-reported knowledge were observed across all three phases, with large effect sizes. The emphasis on disease-specific education and interactive learning was valued. Future adaptations may be needed to better support participants with limited research experience. The results support the decision to establish a dry eye patient research advisory group, the Dry Eye Patient Council. Patient-centered research patient involvement patient engagement patient advisory council dry eye ocular surface disease Plain English Summary This study examined whether a three‑part training program could help dry eye patients learn to work with researchers on patient‑centered research. The participants were adults with dry eye disease (or caregivers) and researchers who were 18-75 years old, lived in the U.S., spoke English, and had access to a computer and the internet. Ten completed the program. The training ran from July 2023 to June 2025 and included three phases: Phase 1: Research Basics Participants completed online modules on the fundamentals of patient‑centered research, including how studies are designed and conducted. Phase 2: Mastering Dry Eye The participants read a book about dry eye disease, took quizzes, and joined virtual discussions to deepen their understanding of the condition. Phase 3: Research Simulation The participants worked in teams to design mock research studies, gaining hands‑on experience. The study assessed knowledge gains using before‑and‑after surveys and participant experiences through interviews. The results revealed significant increases in knowledge across all three phases. Feedback about the training experience included the following: Phase 1 was informative but sometimes tedious. Phase 2 was valued for its depth and small‑group discussions. Phase 3 was useful, but some participants felt frustrated or less engaged. Overall, the program effectively prepared dry eye patients to collaborate with researchers. The participants especially benefited from disease‑specific education and interactive learning. Future versions may need added support for those with limited research experience. These findings supported the creation of a new patient advisory group for dry eye research, the Dry Eye Patient Council. Introduction Dry eye-related research has largely ignored the patient perspective despite the profound impact that the disease and related comorbidities can have on quality of life (Guo & Akpek, 2020 ). Among hundreds of published dry eye studies, only one (Warren et al., 2024 ) meaningfully incorporated the patient perspective across its design, implementation, and analysis. In contrast, three studies (Saldanha et al., 2017 ; Saldanha et al., 2019 ; Saldanha et al., 2018 ) that appeared patient-centered treated patients as subjects rather than as collaborators in the research process. The absence of patient cocreation renders most dry eye research incomplete. This limitation is not solely the fault of researchers. For over 15 years, including patients as partners rather than just subjects has been a hallmark of disease-specific and community-based research initiatives (PCORI, 2024b ; Research Involvement and Engagement, 2025 ). However, dry eye researchers have lacked access to a trained, disease-specific patient advisory body. Without such a structure, there has been no mechanism to support authentic, sustained patient engagement. In response to this deficiency, and modeled on other advisory groups, (Ehlers et al., 2017 ; Khan et al., 2019 ; Wennerstrom et al., 2018 ) the Not A Dry Eye Foundation established the Dry Eye Patient Council to give patients a voice in research and researchers access to the lived experiences and priorities of patients. This initiative brought together patients, caregivers, and researchers to participate in a two-year training program addressing both dry eye complexity and the foundational principles of patient-centered CER. Intervention The effort to establish the Dry Eye Patient Council began in mid-2023 through the Not A Dry Eye Foundation ( www.notadryeye.org ), a nonprofit organization led by patients, funded through a two-year Patient-Centered Outcomes Research Institute (PCORI) Engagement Award (Warren, EASO-29000/2023). The project’s purpose was to equip patients and caregivers with the skills to participate meaningfully in patient-centered research. Candidates for membership in the patient council were selected through purposive and snowball sampling on the basis of lived experience. Researchers were also selected through purposive and snowball sampling on the basis of their research focus. The initial cohort included eight patients/caregivers and three researchers aged 18–75 years, with high school-to-postgraduate education, residing in two time zones (Eastern and Central), 8 (83%) of whom were female and 3 (27%) of whom were male. One female dropped out after Phase 2, leaving 7 (70%) females and 3 (30%) males in the final cohort; ages > 30–75 years. All the participants were fluent in English and had access to computers, the internet, and Zoom. An Engagement Agreement outlined an estimated time commitment of approximately 40 hours of participation per grant year. Training The training emphasized three domains: (1) foundational patient-centered CER literacy, (2) an in-depth understanding of dry eye, and (3) practical experience in developing a dry eye-related research study. Training was delivered in three progressive phases: Phase 1: PCORI Research Fundamentals (Fall 2023). Self-paced modules introducing key research(PCORI, 2024a ) and multistakeholder team(PCORI) concepts. Phase 2: Mastering Dry Eye (spring 2024). Seven-module education series focused on the science of dry eye. Phase 3: Dry Eye Patient Council Practicum (spring 2025). Simulated team-based experience preparing mock dry eye-related research studies. Phase 1: PCORI Research Fundamentals Training In September 2023, participants started PCORI’s online course, Research Fundamentals (PCORI, 2024a ) and Building Effective Multi-Stakeholder Research Teams .(PCORI) The self-paced courses introduced participants to core patient-centered CER concepts (see Supplemental Material 1). Phase 2: Mastering Dry Eye The participants engaged in a structured seven-module experience based on the authoritative text Your Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope. (Maskin & Warren, 2022 ) Quizzes were administered through TalentLMS ( https://www.talentlms.com/ ), an online learning management system (LMS). Training materials included a 100-page study guide (see Supplemental Material 2), glossaries, videos, slide sets, and challenge questions for real-time, live, small group virtual (Zoom) discussions (see Supplemental Material 3). The instructional design and technical content were reviewed by experts. The modules were delivered every three weeks beginning in April 2024. The curriculum emphasized the progressive layering of concepts—from basic eye anatomy to more complex topics such as pathophysiology, comorbidities, contributing factors, symptoms, diagnosis, treatment, and disease management. Each module followed a 4-step process. 1: LMS video overview 2: Assigned readings and glossary terms 3: Open-note quizzes 4: Live virtual session with review and discussions Quizzes measured knowledge acquisition, with a passing criterion of 80% accuracy. Unlimited retakes were allowed until the criterion was met. Challenge questions required oral articulation of key concepts and terminology. The course concluded with an online oral examination conducted in front of the entire group, during which participants were required to pronounce medical terms aloud and provide their definitions. All the participants passed and advanced to the research practicum. The pedagogical approach balanced structure with adaptability. Learners progressed at their own pace within each module window while benefiting from scheduled discussions. This blend of self-guided study and interactive facilitation prepared participants for collaborative engagement in the final phase. Phase 3: Research Practicum Beginning in January 2025, the six-session practicum simulated a professional collaborative experience. The participants were assigned to one of three teams to codesign mock research study proposals. Each team included one researcher and several patients or caregivers. Teams prepared contracts to set team norms and expectations, identified research topics, conducted literature reviews, and selected one topic to pursue. A patient-centered CER-aligned template guided proposal development. Teams also prepared slide presentations. Before Session Five, proposals and slide presentations were submitted for review by PCORI Ambassador judges via a preestablished scoring rubric (see Supplemental Material 4). During their presentations, participants shared speaking responsibilities and responses to questions. Teams submitted addenda addressing judges’ questions before the final session, where judges selected the strongest proposal. Assignments promoted methodological rigor and inclusive engagement. Participation fostered confidence and the ability to address the technical, ethical, and strategic dimensions of collaborative research. Methods The study received IRB exemption. Approximately 4 months after training concluded, one-on-one virtual semistructured interviews were conducted via Zoom with participants who completed the training (n = 10). The participants provided verbal consent. The items were developed in accordance with the tailored design method (Dillman et al., 2014 ) guidelines for survey research, including procedures for conducting phone interviews. The participants were read questions aloud and shown PowerPoint slides to focus their responses (see Supplemental Materials 5 and 6). The interviews were audio recorded and transcribed via the Zoom transcription tool, deidentified except for patient or nonpatient status, and saved in Microsoft Word and Excel files. The responses to the quantitative questions used 5-point Likert scales (e.g., very effective – not at all effective) (see Supplemental Materials 5 and 6). Statistical analysis was conducted via Microsoft Excel 2024 and SAS Release 3.82 Enterprise Edition. Significance was set at 0.05. Patient participants reported having dry eye for an average of 7.9 years (range 2–40 years). Open-ended responses were analyzed using inductive thematic analysis, a method for identifying, analyzing, and reporting patterns or themes in qualitative data.(Braun & Clarke, 2006 ) The responses were reviewed to identify recurring patterns and justifications that elaborated on the participants’ quantitative ratings. Themes were developed on the basis of participant language and aligned with corresponding survey items, allowing the integration of qualitative insights with quantitative findings. The second author conducted the interviews; the first author coded and synthesized the results, which were reviewed collaboratively. Disagreements were resolved by consensus. To ensure rigor, the authors followed Sandelowski ( 1986 ) criteria for credibility, fittingness, auditability, and confirmability. To maintain credibility, the authors ensured that the findings accurately reflected the participants’ perceptions. To ensure fittingness, only participants who completed phases of training were included. To maintain auditability, an audit trail was maintained throughout the research process. For confirmability, the findings were based only on participants' quotes from the research data source, and these quotes characterized the data as a whole. Results Quantitative Results The participants rated Phase 2 highest in value, effectiveness, and quality (Phase 1 range: 3.38–4.13; Phase 2: 4.2–5; Phase 3: 3.6–4.7). The textbook in Phase 2 received the highest individual score for effectiveness (5), whereas the team contract in Phase 3 scored lowest (2.7). Overall, the training met the participants’ objectives (M = 4.5), and Phase 2 was most likely to be recommended (M = 4.7). The engagement levels in Phases 2 and 3 were high (M = 4.4). One participant did not recall Phase 1 modules, and one struggled to answer questions about Phase 3 (see Table 1 ). Table 1 Quantitative Results: Number of Ranked Responses, Total Score, Mean Response Options a Items b 1 2 3 4 5 Total n Mean/Median e Phase 1. PCORI c Online Modules How valuable 1 0 1 3 3 31 8 3.88 How effective Video 0 3 1 2 2 27 8 3.38 Quizzes 0 2 0 2 4 32 8 4 PPT d Slides 0 1 0 4 3 33 8 4.13 Knowledge Pretraining 4 3 2 0 0 16 9 2 training 0 1 2 3 3 35 9 4 Phase 2. Mastering Dry Eye How valuable 0 0 0 1 9 49 10 4.9 How effective Text book 0 0 0 0 10 50 10 5 Study Guide 0 1 0 5 4 42 10 4.2 Quizzes 0 1 0 2 7 45 10 4.5 Discussion sessions 0 0 2 3 5 43 10 4.3 Final Exam 0 0 2 1 6 40 9 4.44 Quality Mastering Dry Eye training 0 0 0 2 8 48 10 4.8 Quizzes 0 0 2 2 6 44 10 4.4 Discussion sessions 0 0 2 3 5 43 10 4.3 Study Guide 0 0 2 4 4 42 10 4.2 LMS 0 0 1 4 5 44 10 4.4 Text book 0 0 0 1 9 49 10 4.9 Engagement 0 0 1 4 5 44 10 4.4 Knowledge Pretraining 0 3 5 1 1 30 10 3 Posttraining 0 0 0 6 4 44 10 4 Phase 3. Practicum How valuable 0 0 1 1 8 47 10 4.7 How effective Study Guide 0 2 3 0 4 33 9 3.67 Instruction sessions 0 0 4 2 2 30 8 3.75 Team Contract 1 5 1 2 1 27 10 2.7 Assignments Written 1 0 1 0 7 39 9 4.33 PPT slides 1 0 1 0 7 39 9 4.33 Addendum 1 0 3 0 5 35 9 3.89 Quality Practicum 0 1 1 3 5 42 10 4.2 Contract Effect 0 2 2 3 3 37 10 3.7 Materials 0 2 1 6 1 36 10 3.6 Prepared for Council 0 1 1 1 3 24 6 4 Engagement 0 0 1 4 5 44 10 4.4 Knowledge Pretraining 4 2 3 0 1 22 10 2 Posttraining 0 0 4 3 3 39 10 4 Overall Met objectives 0 0 2 1 7 45 10 4.5 Compensation 0 0 1 2 7 46 10 4.6 Likely to recommend PCORI modules 0 1 2 3 4 40 10 4 Mastering Dry Eye 0 0 0 3 7 47 10 4.7 Practicum 1 0 0 4 5 42 10 4.2 Abbreviations: LMS, learning management system; PCORI, Patient-Centered Outcomes Research Institute; PPT, PowerPoint slides. a Response options were on 5-point Likert scales (1 = low, 5 = high). The values represent the number of responses per item. b All items are abbreviated. See Supplemental Material 5 for the full text of each item. c PCORI online training modules are available on the Patient-Centered Outcomes Research Institute (PCORI) website: https://www.pcori.org . d PowerPoint (PPT) slides provided by PCORI were used in the training. e Median scores for knowledge items, pretraining and posttraining. Mean scores for all other items. Please place Table 1 here. Each phase was independently evaluated using the Wilcoxon signed-rank test to assess within-subject self-reported knowledge gains. Across phases 1, 2 and 3, the median scores for self-reported knowledge increased from pre‑training to post‑training: Phase 1 Mdn = 2, 4; Phase 2 Mdn = 3, 4; and Phase 3 Mdn = 2, 4. Wilcoxon signed‑rank tests indicated that scores were significantly different before and after each phase of training; for each phase, W = − 22.5, p = .0039. The effect sizes for each phase were large, with r = .96, .91 and .91, respectively. Therefore, training had a statistically significant effect on self-reported knowledge. A Friedman test was conducted to compare scores across the three phases of training. The test did not reveal a statistically significant difference among the phases, χ²(8) = 1.03, p = .998. Qualitative Results Phase 1 Results: PCORI Online Modules Modules were valued for explanations of patient-centered CER through videos, quizzes, and slide presentations, although several participants noted redundancy and tedium. Patient participants valued learning about the many stakeholders in research but expressed confusion about the content and how it connected with their goals of learning about dry eye. One of 10 (10%) participants struggled to remember this phase, indicating recall bias, and one of 10 (10%) did not participate in this phase. Phase 2 Results: Mastering Dry Eye Nine out of ten participants found learning about eye anatomy, pathophysiology, symptoms, diagnosis, and treatment very valuable, even those who had read the textbook previously. (“I was mostly surprised about how much I did not know that I didn't pick up from reading the book on my own [Participant 9].) The researcher-participants emphasized that foundational knowledge of dry eye was essential for informing future studies. (“I learned about what research projects could be undertaken in this area, and I learned a lot about dry eye” [Participant 8].) Patient participants cited personal experience, preparation for the council, and advocacy work as motivators for participation. The participants highly rated the textbook for its content, clarity, organization, and depth. Quizzes were appreciated for reinforcing learning, despite occasional confusion. Discussion sessions were valued for peer engagement and reinforcing learning, although participants reported that discussion sessions sometimes veered off topic. One participant proposed that instructors review the chapter material in advance of small-group sessions to enhance discussion quality. Overall, training was considered professional, well organized, and very effective at increasing knowledge (“Because I actually learned a lot more than I had previously known as far as vocabulary words, the scientific field of it, different comorbidities… and overall, more knowledge and experience than I had prior” [Participant 5]). Phase 3 Results: Dry Eye Patient Council Practicum Patient-participant perceptions varied, although they valued learning about the research process and gaining experience. (“I felt better equipped to be talking to researchers about a research project” [Participant 7].) Some participants without prior experience reported experiencing stress and emotional distress, particularly when not all team members contributed equally and the burden of completing the project shifted. (“I did not expect it to be this challenging. Had I known, I would have not participated” [Participant 2]). Others were confused about assignments. (“We were confused at times, like, what were we supposed to do” [Participant 9].) The length of time between Phase 1 and Phase 2 contributed to the confusion of purpose. (“It was like…18 months before we actually did the study… design. So, at that time, I really didn't understand really the whole setup of the thing... it was just confusing for me to understand what we were doing” [Participant 1]). Several patient participants had positive experiences even while being challenged. (“I just thought overall, it was a good experience. It pushed me out of my comfort zone, and I really liked working with my group, and they had completely different backgrounds than us” [Participant 1]). Study feasibility, a metric in the judge’s scoring rubric, influenced some groups’ topic selection, as did ethics and confounding variables. Research participants enjoyed working with patients recognizing their value in study design. (“They were wonderful, and we had very good discussions. We came up with a good research problem, so it was very useful” [Participant 8]). While training patients to become researchers was not a goal of Phase 3, some felt unprepared for membership on the patient council (“I still don’t feel like I’m a researcher” [Participant 5]) or expressed a lack of interest in participating on the patient council. Others found the experience rewarding and collaborative. (“I just learned so much, and this is the first study, actually from the beginning to the end, we designed ourselves” [Participant 4]). Results Overall Patient participants were motivated by the opportunity to learn about dry eye. Compensation was not a primary factor. Mastering Dry Eye was viewed as essential preparation for the practicum. Patient participants improved their understanding of dry eye, but improved understanding did not influence disease management by patients, who cited either years of experience managing the disease or reliance on physician guidance. The participants valued peer connections (“It was an awesome experience. I met a lot of good people, made a lot of good bonds and friendships” [Participant 9] and expressed interest in future research involvement (“It's certainly made me want to do more research and push for more research on dry eye” [Participant 10]). Discussion This mixed methods study evaluated the feasibility and effectiveness of a multiphase training program designed to prepare patients and researchers for meaningful collaboration in dry eye patient-centered CER. The quantitative and qualitative findings converged to support the program’s success and highlight areas for refinement. Given the small sample size, we applied the nonparametric Wilcoxon signed-rank test across all phases to ensure consistent analysis. Statistical analyses revealed consistently large gains in self-reported knowledge across all phases, with effect sizes exceeding conventional thresholds, W = -22.5, P < .01, r ≥ .91. These results suggest that participants internalized content in ways that enhanced confidence and readiness for research engagement. Notably, Phase 1 produced the largest effect size despite receiving the lowest subjective ratings, suggesting the importance of foundational content, specifically exposure to the novel concepts of patient-centered CER. However, although structured prompts were used, the Phase 1 results may have been affected by recall bias, with two of the nine participants who completed the training needing one prompt and one requiring two prompts. The Friedman test did not reveal significant differences in self-reported knowledge gains across the three phases of training, suggesting that each module contributed equally to learning. These findings support the inclusion of all three phases of training—1) research methods and patient-centered comparative effectiveness research, 2) in-depth knowledge of disease, and 3) collaboration on the design of a mock research study to simulate the actual experience—are important for preparing patients to become members of a research advisory council, although further research is needed to assess their distinct contributions. Phase 2 emerged as the most effective and well-received component. The participants consistently rated the materials and methods highly. The textbook and small-group discussions were noted for their depth and accessibility. Assessments (quizzes and final exam) reinforced learning. Disease-specific education empowered patients as patient advocates and as partners in research but did not influence patients’ disease management strategies because of the duration of illness and their reliance on physician guidance. The researcher participants emphasized the importance of foundational knowledge of dry eye. Phase 3 offered a simulated experience in study design and team-based collaboration. While the participants reported knowledge gains, the qualitative responses revealed emotional complexity. However, discomfort may reflect productive disequilibrium that contributes to deep learning.(D'Mello & Graesser, 2012 ) Furthermore, the practicum was designed to surface these tensions in a simulated environment, allowing participants to develop confidence before engaging with research teams on real, not mock, research studies. Nevertheless, findings suggest that while experiential learning is effective, additional scaffolding may be needed to support novice participants. Importantly, the practicum fostered mutual respect and insight among patient and researcher participants, reinforcing the value of colearning environments. Across all phases, the participants expressed strong motivation to engage, driven by personal experience and a desire to contribute meaningfully to research. Compensation was not a primary motivator. While not all participants felt fully prepared for council membership, the training was widely viewed as a critical step toward meaningful patient‒researcher partnerships. These findings affirm the feasibility of a structured, multiphase training model for preparing diverse stakeholders to engage as partners in dry eye-related CER. Future adaptations should consider differentiated support for participants with varying research backgrounds and emphasize research-specific relevance. This study has several limitations. First, the small sample size and single-disease focus limit generalizability to broader populations or other disease contexts. Second, interviews were conducted approximately four months after the conclusion of a 2-year training program, introducing potential recall bias. Third, the instructional systems designer who conducted the interviews was known to the participants, which may have influenced their responses due to social desirability bias. Fourth, the project lead—who was also involved in program design and delivery—coded and synthesized the qualitative data, raising the possibility of interpretive bias despite efforts to ensure transparency and rigor. Fifth, while the training was designed to simulate real-world research collaboration, participants’ experiences may not fully reflect the dynamics of actual research partnerships. Finally, the absence of a control or comparison group limits the ability to attribute observed outcomes solely to the training intervention. Conclusion The formation of the Dry Eye Patient Council marks a significant advancement in embedding patients’ lived experiences and expertise into the research process. This initiative addresses a critical gap in dry eye research—the absence of structured, meaningful patient engagement, not just as subjects but as partners in the research process—and demonstrates the feasibility and impact of comprehensive training grounded in scientific literacy and methodological rigor. The participants emerged with a shared vocabulary, expanded confidence, and the ability to contribute meaningfully to patient-centered CER. The council’s development model—anchored in sustained engagement, bidirectional learning, and cocreation—potentially offers a replicable blueprint for other disease communities seeking to amplify patient voice in research. Integrating such councils at the earliest stages of study design has the potential to redirect research priorities, improve the relevance of studies, and enhance patient outcomes. Sustainability and scalability will depend on continued investment, institutional partnerships, and a cultural shift that positions patients not solely as subjects but also as indispensable collaborators in the pursuit of better science and better care. Abbreviations • CER comparative effectiveness research • PCORI Patient-Centered Outcomes Research Institute • LMS Learning management system • IRB Institutional review board Declarations Ethics Approval and Consent to Participate All participants provided written agreement to participate in the training activities and verbal consent to respond to interview questions. The study received an exemption determination from the Institutional Review Board at the University of Central Florida, Office of Research, Orlando, Florida, USA. Consent for Publication Both authors approved the final manuscript and consented to its publication in Research Involvement and Engagement. Availability of data and materials The quantitative dataset supporting the conclusions of this article is included within the article. To protect participant anonymity given the small sample size, a qualitative dataset is not available. Competing Interests NAW is co-founder and chair of the Not A Dry Eye Foundation. JBA reports no competing interests. Funding This project was funded through a Patient-Centered Outcomes Research Institute ® (PCORI ® ) (1333 New Hampshire Ave NW, Washington, DC 20036) Eugene Washington PCORI Engagement Award [EASO-29000]. The views, statements, and opinions presented in this work are solely the responsibility of the authors and do not necessarily represent the views of PCORI ® . The funding organization participated in funding the project and publication of this study. Authors' Contributions NAW and JBA jointly conceptualized the study and developed the methodology. JBA conducted the investigation and data collection. NAW carried out the formal analysis. Both authors contributed to writing the original draft and participated in reviewing and editing the manuscript. Project administration and funding acquisition were undertaken by NAW. Both authors read and approved the final manuscript. Acknowledgments The authors extend their gratitude to Roger Azevedo, PhD, for his valuable guidance and contributions to the refinement of the manuscript. References Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. https://doi.org/10.1191/1478088706qp063oa D'Mello, S., & Graesser, A. (2012). Dynamics of affective states during complex learning. Learning and instruction , 22 , 145–157. https://doi.org/10.1016/j.learninstruc.2011.10.001 Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, Phone, Mail, and MixMode Surveys: The Tailored Design Method, 4th ed . John Wiley & Sons Inc. Ehlers, A. P., Davidson, G. H., Deeney, K., Talan, D. A., Flum, D. R., & Lavallee, D. C. (2017). Methods for incorporating stakeholder engagement into clinical trial design. EGEMS (Wash DC) , 5 (1), 4. https://doi.org/10.13063/2327-9214.1274 Guo, O. L., & Akpek, E. (2020). The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci , 50 (Si-2), 1611–1615. https://doi.org/10.3906/sag-2002-143 Khan, C. P., Parver, S., Kennedy Lesch, J., DiGioia, K., Gaglio, B., Daugherty, S., Clauser, S. B., & Arora, N. K. (2019). Comparative clinical effectiveness research focused on community-based delivery of palliative care: overview of the patient-centered outcomes research institute's funding initiative. J Palliat Med , 22 (S1), 2–6. https://doi.org/10.1089/jpm.2019.0370 Maskin, S. L., & Warren, N. A. (2022). Your Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope [Book]. Yale University Press. PCORI. Building effective multi-stakeholder research teams . Retrieved March 29, 2022 from https://research-teams.pcori.org/ PCORI. (2024a). Research fundamentals: preparing you to successfully contribute to research . [PCORI]. Retrieved March 23 from https://www.pcori.org/engagement-research/engagement-resources/research-fundamentals-preparing-you-successfully-contribute-research#ResearchFundamentals PCORI. (2024b). The value of engagement in research . [PCORI]. Retrieved April 16, 2025 from https://www.pcori.org/engagement-research/value-engagement-research Research Involvement and Engagement. (2025). Retrieved June 16, 2025 from https://researchinvolvement.biomedcentral.com/ Saldanha, I. J., Dickersin, K., Hutfless, S. T., & Akpek, E. K. (2017). Gaps in current knowledge and priorities for future research in ery eye. Cornea , 36 (12), 1584–1591. https://doi.org/10.1097/ico.0000000000001350 Saldanha, I. J., Le, J. T., Solomon, S. D., Repka, M. X., Akpek, E. K., & Li, T. (2019). Choosing core outcomes for use in clinical trials in ophthalmology: perspectives from three ophthalmology outcomes working groups. Ophthalmology , 126 (1), 6–9. https://doi.org/10.1016/j.ophtha.2018.09.008 Saldanha, I. J., Petris, R., Han, G., Dickersin, K., & Akpek, E. K. (2018). Research questions and outcomes prioritized by patients with dry eye. JAMA Ophthalmol , 136 (10), 1170–1179. https://doi.org/10.1001/jamaophthalmol.2018.3352 Sandelowski, M. (1986). The problem of rigor in qualitative research. ANS Adv Nurs Sci , 8 (3), 27–37. https://doi.org/10.1097/00012272-198604000-00005 Warren, N. A. (2023). Engaging partners and patients to build capacity for PCOR in dry dye and MGD [EASO-29000] (EASO-29000) [Grant]. Warren, N. A., Maskin, S. L., Gurupur, V., Rector, D. A., Adelman, D., Howell, S., McAree, J., Dibble, R., Carlisano, C., Maconi, D. P., Schrotenboer, D., Jaimes, M., Marte, N., Carlisano, T., Toland, C., Chung, J., Cremers, S. L., & Corbin, G. S. (2024). Engaging stakeholders to develop a roadmap for dry eye and MGD PCORI-funded research. Patient Related Outcome Measures . https://doi.org/10.2147/PROM.S438290 Wennerstrom, A., Springgate, B. F., Jones, F., Meyers, D., Henderson, N., Brown, A., Niyogi, A., Martin, D., Smith, J., 3rd, Kirkland, A. L., Jones, L., & Norris, K. C. (2018). Lessons on patient and stakeholder engagement strategies for pipeline to proposal awards. Ethn Dis , 28 (Suppl 2), 303–310. https://doi.org/10.18865/ed.28.S2.303 Additional Declarations Competing interest reported. Natalia A. Warren chairs the Not A Dry Eye Foundation, the first patient-founded non-profit organization dedicated to raising awareness of dry eye. Supplementary Files SupplementalMaterial.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Mar, 2026 Reviews received at journal 17 Feb, 2026 Reviews received at journal 02 Feb, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviews received at journal 12 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Submission checks completed at journal 05 Jan, 2026 First submitted to journal 30 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8484290","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":572611742,"identity":"bfce7cc4-a49b-4de1-9a0f-f65c2b193f9d","order_by":0,"name":"Natalia A. Warren","email":"data:image/png;base64,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","orcid":"","institution":"Not A Dry Eye Foundation","correspondingAuthor":true,"prefix":"","firstName":"Natalia","middleName":"A.","lastName":"Warren","suffix":""},{"id":572611743,"identity":"148d876d-a6eb-4863-a884-d7b312aa1cd2","order_by":1,"name":"JB Adams","email":"","orcid":"","institution":"Adams Learning","correspondingAuthor":false,"prefix":"","firstName":"JB","middleName":"","lastName":"Adams","suffix":""}],"badges":[],"createdAt":"2025-12-30 21:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8484290/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8484290/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100016366,"identity":"a141655e-0e01-4e83-bd79-8e5f30e899f0","added_by":"auto","created_at":"2026-01-12 06:54:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73951,"visible":true,"origin":"","legend":"","description":"","filename":"FromPatienttoAdvisor.docx","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/5e0046007c848cb9f34a832a.docx"},{"id":100016353,"identity":"fcd89d42-3131-43b3-b569-585c475ccceb","added_by":"auto","created_at":"2026-01-12 06:53:55","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3615,"visible":true,"origin":"","legend":"","description":"","filename":"36832648eb7046018898c615bd0d6660.json","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/820cfe05e89d85e7fccb4524.json"},{"id":100361877,"identity":"3f8fe15f-c016-4587-bcdb-cb2758758f93","added_by":"auto","created_at":"2026-01-16 07:45:52","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":938209,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalMaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/1b152206ef8fc1b838bbb48f.pdf"},{"id":100016367,"identity":"55ff7a2c-13bc-4fc7-9a98-a737022f5685","added_by":"auto","created_at":"2026-01-12 06:54:05","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108665,"visible":true,"origin":"","legend":"","description":"","filename":"36832648eb7046018898c615bd0d66601enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/d461e0bf2fe7f8f3289cac3b.xml"},{"id":100016361,"identity":"961c5d65-c370-475d-ab07-e1e10882e8b4","added_by":"auto","created_at":"2026-01-12 06:53:58","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103874,"visible":true,"origin":"","legend":"","description":"","filename":"36832648eb7046018898c615bd0d66601structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/e40879a06c40b3b1846d4379.xml"},{"id":100016370,"identity":"90a0369a-f8f4-4621-9ae6-af7c0ac84da6","added_by":"auto","created_at":"2026-01-12 06:54:06","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116650,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/3f1778b875f3cb018d39a34c.html"},{"id":100380931,"identity":"dc317c22-5475-48d3-afa9-5f6f0b3546f1","added_by":"auto","created_at":"2026-01-16 10:36:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1017585,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/07a9b1f0-9262-4931-9b57-d5b457d8608e.pdf"},{"id":100016371,"identity":"cdc84970-c195-4b60-a5bc-7be1da6e0b05","added_by":"auto","created_at":"2026-01-12 06:54:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":938209,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalMaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8484290/v1/81e5389cfb13eb4330ab3ecd.pdf"}],"financialInterests":"Competing interest reported. Natalia A. Warren chairs the Not A Dry Eye Foundation, the first patient-founded non-profit organization dedicated to raising awareness of dry eye.","formattedTitle":"From Patient to Advisor: Establishing a Patient Council for Dry Eye Research","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eThis study examined whether a three‑part training program could help dry eye patients learn to work with researchers on patient‑centered research.\u003c/p\u003e\n\u003cp\u003eThe participants were adults with dry eye disease (or caregivers) and researchers who were 18-75 years old, lived in the U.S., spoke English, and had access to a computer and the internet. Ten completed the program.\u003c/p\u003e\n\u003cp\u003eThe training ran from July 2023 to June 2025 and included three phases:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePhase 1: Research Basics\u003cbr\u003e\u0026nbsp;Participants completed online modules on the fundamentals of patient‑centered research, including how studies are designed and conducted.\u003c/li\u003e\n \u003cli\u003ePhase 2: Mastering Dry Eye\u003cbr\u003e\u0026nbsp;The participants read a book about dry eye disease, took quizzes, and joined virtual discussions to deepen their understanding of the condition.\u003c/li\u003e\n \u003cli\u003ePhase 3: Research Simulation\u003cbr\u003e\u0026nbsp;The participants worked in teams to design mock research studies, gaining hands‑on experience.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study assessed knowledge gains using before‑and‑after surveys and participant experiences through interviews.\u003c/p\u003e\n\u003cp\u003eThe results revealed significant increases in knowledge across all three phases. Feedback about the training experience included the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePhase 1 was informative but sometimes tedious.\u003c/li\u003e\n \u003cli\u003ePhase 2 was valued for its depth and small‑group discussions.\u003c/li\u003e\n \u003cli\u003ePhase 3 was useful, but some participants felt frustrated or less engaged.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOverall, the program effectively prepared dry eye patients to collaborate with researchers. The participants especially benefited from disease‑specific education and interactive learning. Future versions may need added support for those with limited research experience.\u003c/p\u003e\n\u003cp\u003eThese findings supported the creation of a new patient advisory group for dry eye research, the Dry Eye Patient Council.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eDry eye-related research has largely ignored the patient perspective despite the profound impact that the disease and related comorbidities can have on quality of life (Guo \u0026amp; Akpek, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Among hundreds of published dry eye studies, only one (Warren et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) meaningfully incorporated the patient perspective across its design, implementation, and analysis. In contrast, three studies (Saldanha et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Saldanha et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Saldanha et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) that appeared patient-centered treated patients as subjects rather than as collaborators in the research process.\u003c/p\u003e \u003cp\u003eThe absence of patient cocreation renders most dry eye research incomplete. This limitation is not solely the fault of researchers. For over 15 years, including patients as partners rather than just subjects has been a hallmark of disease-specific and community-based research initiatives (PCORI, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024b\u003c/span\u003e; Research Involvement and Engagement, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, dry eye researchers have lacked access to a trained, disease-specific patient advisory body. Without such a structure, there has been no mechanism to support authentic, sustained patient engagement.\u003c/p\u003e \u003cp\u003eIn response to this deficiency, and modeled on other advisory groups, (Ehlers et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Khan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wennerstrom et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) the Not A Dry Eye Foundation established the Dry Eye Patient Council to give patients a voice in research and researchers access to the lived experiences and priorities of patients.\u003c/p\u003e \u003cp\u003eThis initiative brought together patients, caregivers, and researchers to participate in a two-year training program addressing both dry eye complexity and the foundational principles of patient-centered CER.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe effort to establish the Dry Eye Patient Council began in mid-2023 through the Not A Dry Eye Foundation (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.notadryeye.org\u003c/span\u003e\u003cspan address=\"http://www.notadryeye.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), a nonprofit organization led by patients, funded through a two-year Patient-Centered Outcomes Research Institute (PCORI) Engagement Award (Warren, EASO-29000/2023). The project\u0026rsquo;s purpose was to equip patients and caregivers with the skills to participate meaningfully in patient-centered research. Candidates for membership in the patient council were selected through purposive and snowball sampling on the basis of lived experience. Researchers were also selected through purposive and snowball sampling on the basis of their research focus.\u003c/p\u003e \u003cp\u003eThe initial cohort included eight patients/caregivers and three researchers aged 18\u0026ndash;75 years, with high school-to-postgraduate education, residing in two time zones (Eastern and Central), 8 (83%) of whom were female and 3 (27%) of whom were male. One female dropped out after Phase 2, leaving 7 (70%) females and 3 (30%) males in the final cohort; ages\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026ndash;75 years. All the participants were fluent in English and had access to computers, the internet, and Zoom. An Engagement Agreement outlined an estimated time commitment of approximately 40 hours of participation per grant year.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTraining\u003c/h2\u003e \u003cp\u003eThe training emphasized three domains: (1) foundational patient-centered CER literacy, (2) an in-depth understanding of dry eye, and (3) practical experience in developing a dry eye-related research study. Training was delivered in three progressive phases:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePhase 1: PCORI Research Fundamentals (Fall 2023). Self-paced modules introducing key research(PCORI, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e) and multistakeholder team(PCORI) concepts.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePhase 2: Mastering Dry Eye (spring 2024). Seven-module education series focused on the science of dry eye.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePhase 3: Dry Eye Patient Council Practicum (spring 2025). Simulated team-based experience preparing mock dry eye-related research studies.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhase 1: PCORI Research Fundamentals Training\u003c/h3\u003e\n\u003cp\u003eIn September 2023, participants started PCORI\u0026rsquo;s online course, \u003cem\u003eResearch Fundamentals\u003c/em\u003e(PCORI, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e) and \u003cem\u003eBuilding Effective Multi-Stakeholder Research Teams\u003c/em\u003e.(PCORI) The self-paced courses introduced participants to core patient-centered CER concepts (see Supplemental Material 1).\u003c/p\u003e\n\u003ch3\u003ePhase 2: Mastering Dry Eye\u003c/h3\u003e\n\u003cp\u003eThe participants engaged in a structured seven-module experience based on the authoritative text \u003cem\u003eYour Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope.\u003c/em\u003e(Maskin \u0026amp; Warren, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) Quizzes were administered through TalentLMS (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.talentlms.com/\u003c/span\u003e\u003cspan address=\"https://www.talentlms.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), an online learning management system (LMS). Training materials included a 100-page study guide (see Supplemental Material 2), glossaries, videos, slide sets, and challenge questions for real-time, live, small group virtual (Zoom) discussions (see Supplemental Material 3). The instructional design and technical content were reviewed by experts.\u003c/p\u003e \u003cp\u003eThe modules were delivered every three weeks beginning in April 2024. The curriculum emphasized the progressive layering of concepts\u0026mdash;from basic eye anatomy to more complex topics such as pathophysiology, comorbidities, contributing factors, symptoms, diagnosis, treatment, and disease management. Each module followed a 4-step process.\u003c/p\u003e \u003cp\u003e1: LMS video overview\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e2: Assigned readings and glossary terms\u003c/p\u003e\u003cp\u003e3: Open-note quizzes\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e4: Live virtual session with review and discussions\u003c/p\u003e \u003cp\u003eQuizzes measured knowledge acquisition, with a passing criterion of 80% accuracy. Unlimited retakes were allowed until the criterion was met. Challenge questions required oral articulation of key concepts and terminology. The course concluded with an online oral examination conducted in front of the entire group, during which participants were required to pronounce medical terms aloud and provide their definitions. All the participants passed and advanced to the research practicum.\u003c/p\u003e \u003cp\u003eThe pedagogical approach balanced structure with adaptability. Learners progressed at their own pace within each module window while benefiting from scheduled discussions. This blend of self-guided study and interactive facilitation prepared participants for collaborative engagement in the final phase.\u003c/p\u003e\n\u003ch3\u003ePhase 3: Research Practicum\u003c/h3\u003e\n\u003cp\u003eBeginning in January 2025, the six-session practicum simulated a professional collaborative experience. The participants were assigned to one of three teams to codesign mock research study proposals. Each team included one researcher and several patients or caregivers.\u003c/p\u003e \u003cp\u003eTeams prepared contracts to set team norms and expectations, identified research topics, conducted literature reviews, and selected one topic to pursue. A patient-centered CER-aligned template guided proposal development. Teams also prepared slide presentations.\u003c/p\u003e \u003cp\u003eBefore Session Five, proposals and slide presentations were submitted for review by PCORI Ambassador judges via a preestablished scoring rubric (see Supplemental Material 4). During their presentations, participants shared speaking responsibilities and responses to questions. Teams submitted addenda addressing judges\u0026rsquo; questions before the final session, where judges selected the strongest proposal.\u003c/p\u003e \u003cp\u003eAssignments promoted methodological rigor and inclusive engagement. Participation fostered confidence and the ability to address the technical, ethical, and strategic dimensions of collaborative research.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study received IRB exemption. Approximately 4 months after training concluded, one-on-one virtual semistructured interviews were conducted via Zoom with participants who completed the training (n\u0026thinsp;=\u0026thinsp;10). The participants provided verbal consent. The items were developed in accordance with the tailored design method (Dillman et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) guidelines for survey research, including procedures for conducting phone interviews. The participants were read questions aloud and shown PowerPoint slides to focus their responses (see Supplemental Materials 5 and 6). The interviews were audio recorded and transcribed via the Zoom transcription tool, deidentified except for patient or nonpatient status, and saved in Microsoft Word and Excel files. The responses to the quantitative questions used 5-point Likert scales (e.g., very effective \u0026ndash; not at all effective) (see Supplemental Materials 5 and 6). Statistical analysis was conducted via Microsoft Excel 2024 and SAS Release 3.82 Enterprise Edition. Significance was set at 0.05. Patient participants reported having dry eye for an average of 7.9 years (range 2\u0026ndash;40 years).\u003c/p\u003e \u003cp\u003eOpen-ended responses were analyzed using inductive thematic analysis, a method for identifying, analyzing, and reporting patterns or themes in qualitative data.(Braun \u0026amp; Clarke, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) The responses were reviewed to identify recurring patterns and justifications that elaborated on the participants\u0026rsquo; quantitative ratings. Themes were developed on the basis of participant language and aligned with corresponding survey items, allowing the integration of qualitative insights with quantitative findings.\u003c/p\u003e \u003cp\u003eThe second author conducted the interviews; the first author coded and synthesized the results, which were reviewed collaboratively. Disagreements were resolved by consensus. To ensure rigor, the authors followed Sandelowski (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1986\u003c/span\u003e) criteria for credibility, fittingness, auditability, and confirmability. To maintain credibility, the authors ensured that the findings accurately reflected the participants\u0026rsquo; perceptions. To ensure fittingness, only participants who completed phases of training were included. To maintain auditability, an audit trail was maintained throughout the research process. For confirmability, the findings were based only on participants' quotes from the research data source, and these quotes characterized the data as a whole.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Results\u003c/h2\u003e \u003cp\u003eThe participants rated Phase 2 highest in value, effectiveness, and quality (Phase 1 range: 3.38\u0026ndash;4.13; Phase 2: 4.2\u0026ndash;5; Phase 3: 3.6\u0026ndash;4.7). The textbook in Phase 2 received the highest individual score for effectiveness (5), whereas the team contract in Phase 3 scored lowest (2.7). Overall, the training met the participants\u0026rsquo; objectives (M\u0026thinsp;=\u0026thinsp;4.5), and Phase 2 was most likely to be recommended (M\u0026thinsp;=\u0026thinsp;4.7). The engagement levels in Phases 2 and 3 were high (M\u0026thinsp;=\u0026thinsp;4.4). One participant did not recall Phase 1 modules, and one struggled to answer questions about Phase 3 (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative Results: Number of Ranked Responses, Total Score, Mean\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eResponse Options\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMean/Median\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase 1. PCORI\u003csup\u003ec\u003c/sup\u003e Online Modules\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow valuable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVideo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizzes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPT\u003csup\u003ed\u003c/sup\u003e Slides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePretraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhase 2. Mastering Dry Eye\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow valuable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eText book\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Guide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizzes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscussion sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal Exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMastering Dry Eye training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuizzes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscussion sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Guide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eText book\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePretraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosttraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhase 3. Practicum\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow valuable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Guide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstruction sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam Contract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssignments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWritten\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPT slides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddendum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePracticum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContract Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepared for Council\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePretraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosttraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMet objectives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompensation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLikely to recommend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCORI modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMastering Dry Eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePracticum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: LMS, learning management system; PCORI, Patient-Centered Outcomes Research Institute; PPT, PowerPoint slides.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e Response options were on 5-point Likert scales (1\u0026thinsp;=\u0026thinsp;low, 5\u0026thinsp;=\u0026thinsp;high). The values represent the number of responses per item.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e All items are abbreviated. See Supplemental Material 5 for the full text of each item.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ec\u003c/sup\u003e PCORI online training modules are available on the Patient-Centered Outcomes Research Institute (PCORI) website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pcori.org\u003c/span\u003e\u003cspan address=\"https://www.pcori.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ed\u003c/sup\u003e PowerPoint (PPT) slides provided by PCORI were used in the training.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ee\u003c/sup\u003eMedian scores for knowledge items, pretraining and posttraining. Mean scores for all other items.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePlease place\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eEach phase was independently evaluated using the Wilcoxon signed-rank test to assess within-subject self-reported knowledge gains. Across phases 1, 2 and 3, the median scores for self-reported knowledge increased from pre‑training to post‑training: Phase 1 \u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2, 4; Phase 2 \u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3, 4; and Phase 3 \u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2, 4. Wilcoxon signed‑rank tests indicated that scores were significantly different before and after each phase of training; for each phase, W = \u0026minus;\u0026thinsp;22.5, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.0039. The effect sizes for each phase were large, with r\u0026thinsp;=\u0026thinsp;.96, .91 and .91, respectively. Therefore, training had a statistically significant effect on self-reported knowledge.\u003c/p\u003e \u003cp\u003eA Friedman test was conducted to compare scores across the three phases of training. The test did not reveal a statistically significant difference among the phases, χ\u0026sup2;(8)\u0026thinsp;=\u0026thinsp;1.03, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.998.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative Results\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePhase 1 Results: PCORI Online Modules\u003c/h2\u003e \u003cp\u003eModules were valued for explanations of patient-centered CER through videos, quizzes, and slide presentations, although several participants noted redundancy and tedium. Patient participants valued learning about the many stakeholders in research but expressed confusion about the content and how it connected with their goals of learning about dry eye. One of 10 (10%) participants struggled to remember this phase, indicating recall bias, and one of 10 (10%) did not participate in this phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePhase 2 Results: Mastering Dry Eye\u003c/h2\u003e \u003cp\u003eNine out of ten participants found learning about eye anatomy, pathophysiology, symptoms, diagnosis, and treatment very valuable, even those who had read the textbook previously. (\u0026ldquo;I was mostly surprised about how much I did not know that I didn't pick up from reading the book on my own [Participant 9].) The researcher-participants emphasized that foundational knowledge of dry eye was essential for informing future studies. (\u0026ldquo;I learned about what research projects could be undertaken in this area, and I learned a lot about dry eye\u0026rdquo; [Participant 8].) Patient participants cited personal experience, preparation for the council, and advocacy work as motivators for participation. The participants highly rated the textbook for its content, clarity, organization, and depth. Quizzes were appreciated for reinforcing learning, despite occasional confusion. Discussion sessions were valued for peer engagement and reinforcing learning, although participants reported that discussion sessions sometimes veered off topic. One participant proposed that instructors review the chapter material in advance of small-group sessions to enhance discussion quality. Overall, training was considered professional, well organized, and very effective at increasing knowledge (\u0026ldquo;Because I actually learned a lot more than I had previously known as far as vocabulary words, the scientific field of it, different comorbidities\u0026hellip; and overall, more knowledge and experience than I had prior\u0026rdquo; [Participant 5]).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePhase 3 Results: Dry Eye Patient Council Practicum\u003c/h2\u003e \u003cp\u003ePatient-participant perceptions varied, although they valued learning about the research process and gaining experience. (\u0026ldquo;I felt better equipped to be talking to researchers about a research project\u0026rdquo; [Participant 7].) Some participants without prior experience reported experiencing stress and emotional distress, particularly when not all team members contributed equally and the burden of completing the project shifted. (\u0026ldquo;I did not expect it to be this challenging. Had I known, I would have not participated\u0026rdquo; [Participant 2]). Others were confused about assignments. (\u0026ldquo;We were confused at times, like, what were we supposed to do\u0026rdquo; [Participant 9].) The length of time between Phase 1 and Phase 2 contributed to the confusion of purpose. (\u0026ldquo;It was like\u0026hellip;18 months before we actually did the study\u0026hellip; design. So, at that time, I really didn't understand really the whole setup of the thing... it was just confusing for me to understand what we were doing\u0026rdquo; [Participant 1]). Several patient participants had positive experiences even while being challenged. (\u0026ldquo;I just thought overall, it was a good experience. It pushed me out of my comfort zone, and I really liked working with my group, and they had completely different backgrounds than us\u0026rdquo; [Participant 1]).\u003c/p\u003e \u003cp\u003eStudy feasibility, a metric in the judge\u0026rsquo;s scoring rubric, influenced some groups\u0026rsquo; topic selection, as did ethics and confounding variables. Research participants enjoyed working with patients recognizing their value in study design. (\u0026ldquo;They were wonderful, and we had very good discussions. We came up with a good research problem, so it was very useful\u0026rdquo; [Participant 8]).\u003c/p\u003e \u003cp\u003eWhile training patients to become researchers was not a goal of Phase 3, some felt unprepared for membership on the patient council (\u0026ldquo;I still don\u0026rsquo;t feel like I\u0026rsquo;m a researcher\u0026rdquo; [Participant 5]) or expressed a lack of interest in participating on the patient council. Others found the experience rewarding and collaborative. (\u0026ldquo;I just learned so much, and this is the first study, actually from the beginning to the end, we designed ourselves\u0026rdquo; [Participant 4]).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResults Overall\u003c/h2\u003e \u003cp\u003ePatient participants were motivated by the opportunity to learn about dry eye. Compensation was not a primary factor. Mastering Dry Eye was viewed as essential preparation for the practicum. Patient participants improved their understanding of dry eye, but improved understanding did not influence disease management by patients, who cited either years of experience managing the disease or reliance on physician guidance. The participants valued peer connections (\u0026ldquo;It was an awesome experience. I met a lot of good people, made a lot of good bonds and friendships\u0026rdquo; [Participant 9] and expressed interest in future research involvement (\u0026ldquo;It's certainly made me want to do more research and push for more research on dry eye\u0026rdquo; [Participant 10]).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed methods study evaluated the feasibility and effectiveness of a multiphase training program designed to prepare patients and researchers for meaningful collaboration in dry eye patient-centered CER. The quantitative and qualitative findings converged to support the program\u0026rsquo;s success and highlight areas for refinement.\u003c/p\u003e \u003cp\u003eGiven the small sample size, we applied the nonparametric Wilcoxon signed-rank test across all phases to ensure consistent analysis. Statistical analyses revealed consistently large gains in self-reported knowledge across all phases, with effect sizes exceeding conventional thresholds, W = -22.5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01, r\u0026thinsp;\u0026ge;\u0026thinsp;.91. These results suggest that participants internalized content in ways that enhanced confidence and readiness for research engagement. Notably, Phase 1 produced the largest effect size despite receiving the lowest subjective ratings, suggesting the importance of foundational content, specifically exposure to the novel concepts of patient-centered CER. However, although structured prompts were used, the Phase 1 results may have been affected by recall bias, with two of the nine participants who completed the training needing one prompt and one requiring two prompts.\u003c/p\u003e \u003cp\u003eThe Friedman test did not reveal significant differences in self-reported knowledge gains across the three phases of training, suggesting that each module contributed equally to learning. These findings support the inclusion of all three phases of training\u0026mdash;1) research methods and patient-centered comparative effectiveness research, 2) in-depth knowledge of disease, and 3) collaboration on the design of a mock research study to simulate the actual experience\u0026mdash;are important for preparing patients to become members of a research advisory council, although further research is needed to assess their distinct contributions.\u003c/p\u003e \u003cp\u003ePhase 2 emerged as the most effective and well-received component. The participants consistently rated the materials and methods highly. The textbook and small-group discussions were noted for their depth and accessibility. Assessments (quizzes and final exam) reinforced learning. Disease-specific education empowered patients as patient advocates and as partners in research but did not influence patients\u0026rsquo; disease management strategies because of the duration of illness and their reliance on physician guidance. The researcher participants emphasized the importance of foundational knowledge of dry eye.\u003c/p\u003e \u003cp\u003ePhase 3 offered a simulated experience in study design and team-based collaboration. While the participants reported knowledge gains, the qualitative responses revealed emotional complexity. However, discomfort may reflect productive disequilibrium that contributes to deep learning.(D'Mello \u0026amp; Graesser, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) Furthermore, the practicum was designed to surface these tensions in a simulated environment, allowing participants to develop confidence before engaging with research teams on real, not mock, research studies. Nevertheless, findings suggest that while experiential learning is effective, additional scaffolding may be needed to support novice participants. Importantly, the practicum fostered mutual respect and insight among patient and researcher participants, reinforcing the value of colearning environments.\u003c/p\u003e \u003cp\u003eAcross all phases, the participants expressed strong motivation to engage, driven by personal experience and a desire to contribute meaningfully to research. Compensation was not a primary motivator. While not all participants felt fully prepared for council membership, the training was widely viewed as a critical step toward meaningful patient‒researcher partnerships.\u003c/p\u003e \u003cp\u003eThese findings affirm the feasibility of a structured, multiphase training model for preparing diverse stakeholders to engage as partners in dry eye-related CER. Future adaptations should consider differentiated support for participants with varying research backgrounds and emphasize research-specific relevance.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the small sample size and single-disease focus limit generalizability to broader populations or other disease contexts. Second, interviews were conducted approximately four months after the conclusion of a 2-year training program, introducing potential recall bias. Third, the instructional systems designer who conducted the interviews was known to the participants, which may have influenced their responses due to social desirability bias. Fourth, the project lead\u0026mdash;who was also involved in program design and delivery\u0026mdash;coded and synthesized the qualitative data, raising the possibility of interpretive bias despite efforts to ensure transparency and rigor. Fifth, while the training was designed to simulate real-world research collaboration, participants\u0026rsquo; experiences may not fully reflect the dynamics of actual research partnerships. Finally, the absence of a control or comparison group limits the ability to attribute observed outcomes solely to the training intervention.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe formation of the Dry Eye Patient Council marks a significant advancement in embedding patients\u0026rsquo; lived experiences and expertise into the research process. This initiative addresses a critical gap in dry eye research\u0026mdash;the absence of structured, meaningful patient engagement, not just as subjects but as partners in the research process\u0026mdash;and demonstrates the feasibility and impact of comprehensive training grounded in scientific literacy and methodological rigor. The participants emerged with a shared vocabulary, expanded confidence, and the ability to contribute meaningfully to patient-centered CER. The council\u0026rsquo;s development model\u0026mdash;anchored in sustained engagement, bidirectional learning, and cocreation\u0026mdash;potentially offers a replicable blueprint for other disease communities seeking to amplify patient voice in research.\u003c/p\u003e \u003cp\u003eIntegrating such councils at the earliest stages of study design has the potential to redirect research priorities, improve the relevance of studies, and enhance patient outcomes. Sustainability and scalability will depend on continued investment, institutional partnerships, and a cultural shift that positions patients not solely as subjects but also as indispensable collaborators in the pursuit of better science and better care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CER\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomparative effectiveness research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; PCORI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient-Centered Outcomes Research Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; LMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLearning management system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; IRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional review board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written agreement to participate in the training activities and verbal consent to respond to interview questions. The study received an exemption determination from the Institutional Review Board at the University of Central Florida, Office of Research, Orlando, Florida, USA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors approved the final manuscript and consented to its publication in \u003cem\u003eResearch Involvement and Engagement.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative dataset supporting the conclusions of this article is included within the article. To protect participant anonymity given the small sample size, a qualitative dataset is not available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNAW is co-founder and chair of the Not A Dry Eye Foundation. JBA reports no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was funded through a Patient-Centered Outcomes Research Institute\u003csup\u003e\u0026reg;\u003c/sup\u003e (PCORI\u003csup\u003e\u0026reg;\u003c/sup\u003e) (1333 New Hampshire Ave NW, Washington, DC 20036) Eugene Washington PCORI Engagement Award [EASO-29000]. The views, statements, and opinions presented in this work are solely the responsibility of the authors and do not necessarily represent the views of PCORI\u003csup\u003e\u0026reg;\u003c/sup\u003e. The funding organization participated in funding the project and publication of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNAW and JBA jointly conceptualized the study and developed the methodology. JBA conducted the investigation and data collection. NAW carried out the formal analysis. Both authors contributed to writing the original draft and participated in reviewing and editing the manuscript. Project administration and funding acquisition were undertaken by NAW. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their gratitude to Roger Azevedo, PhD, for his valuable guidance and contributions to the refinement of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eBraun, V., \u0026amp; Clarke, V. (2006). Using thematic analysis in psychology. \u003cem\u003eQualitative Research in Psychology\u003c/em\u003e,\u003cem\u003e 3\u003c/em\u003e(2), 77–101. https://doi.org/10.1191/1478088706qp063oa \u003c/p\u003e\n\u003cp\u003eD'Mello, S., \u0026amp; Graesser, A. (2012). Dynamics of affective states during complex learning. \u003cem\u003eLearning and instruction\u003c/em\u003e,\u003cem\u003e 22\u003c/em\u003e, 145–157. https://doi.org/10.1016/j.learninstruc.2011.10.001 \u003c/p\u003e\n\u003cp\u003eDillman, D. A., Smyth, J. D., \u0026amp; Christian, L. M. (2014). \u003cem\u003eInternet, Phone, Mail, and MixMode Surveys: The Tailored Design Method, 4th ed\u003c/em\u003e. John Wiley \u0026amp; Sons Inc. \u003c/p\u003e\n\u003cp\u003eEhlers, A. P., Davidson, G. H., Deeney, K., Talan, D. A., Flum, D. R., \u0026amp; Lavallee, D. C. (2017). Methods for incorporating stakeholder engagement into clinical trial design. \u003cem\u003eEGEMS (Wash DC)\u003c/em\u003e,\u003cem\u003e 5\u003c/em\u003e(1), 4. https://doi.org/10.13063/2327-9214.1274 \u003c/p\u003e\n\u003cp\u003eGuo, O. L., \u0026amp; Akpek, E. (2020). The negative effects of dry eye disease on quality of life and visual function. \u003cem\u003eTurk J Med Sci\u003c/em\u003e,\u003cem\u003e 50\u003c/em\u003e(Si-2), 1611–1615. https://doi.org/10.3906/sag-2002-143 \u003c/p\u003e\n\u003cp\u003eKhan, C. P., Parver, S., Kennedy Lesch, J., DiGioia, K., Gaglio, B., Daugherty, S., Clauser, S. B., \u0026amp; Arora, N. K. (2019). Comparative clinical effectiveness research focused on community-based delivery of palliative care: overview of the patient-centered outcomes research institute's funding initiative. \u003cem\u003eJ Palliat Med\u003c/em\u003e,\u003cem\u003e 22\u003c/em\u003e(S1), 2–6. https://doi.org/10.1089/jpm.2019.0370 \u003c/p\u003e\n\u003cp\u003eMaskin, S. L., \u0026amp; Warren, N. A. (2022). \u003cem\u003eYour Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope\u003c/em\u003e [Book]. Yale University Press. \u003c/p\u003e\n\u003cp\u003ePCORI. \u003cem\u003eBuilding effective multi-stakeholder research teams\u003c/em\u003e. Retrieved March 29, 2022 from https://research-teams.pcori.org/\u003c/p\u003e\n\u003cp\u003ePCORI. (2024a). \u003cem\u003eResearch fundamentals: preparing you to successfully contribute to research\u003c/em\u003e. [PCORI]. Retrieved March 23 from https://www.pcori.org/engagement-research/engagement-resources/research-fundamentals-preparing-you-successfully-contribute-research#ResearchFundamentals\u003c/p\u003e\n\u003cp\u003ePCORI. (2024b). \u003cem\u003eThe value of engagement in research\u003c/em\u003e. [PCORI]. Retrieved April 16, 2025 from https://www.pcori.org/engagement-research/value-engagement-research\u003c/p\u003e\n\u003cp\u003eResearch Involvement and Engagement. (2025). Retrieved June 16, 2025 from https://researchinvolvement.biomedcentral.com/\u003c/p\u003e\n\u003cp\u003eSaldanha, I. J., Dickersin, K., Hutfless, S. T., \u0026amp; Akpek, E. K. (2017). Gaps in current knowledge and priorities for future research in ery eye. \u003cem\u003eCornea\u003c/em\u003e,\u003cem\u003e 36\u003c/em\u003e(12), 1584–1591. https://doi.org/10.1097/ico.0000000000001350 \u003c/p\u003e\n\u003cp\u003eSaldanha, I. J., Le, J. T., Solomon, S. D., Repka, M. X., Akpek, E. K., \u0026amp; Li, T. (2019). Choosing core outcomes for use in clinical trials in ophthalmology: perspectives from three ophthalmology outcomes working groups. \u003cem\u003eOphthalmology\u003c/em\u003e,\u003cem\u003e 126\u003c/em\u003e(1), 6–9. https://doi.org/10.1016/j.ophtha.2018.09.008 \u003c/p\u003e\n\u003cp\u003eSaldanha, I. J., Petris, R., Han, G., Dickersin, K., \u0026amp; Akpek, E. K. (2018). Research questions and outcomes prioritized by patients with dry eye. \u003cem\u003eJAMA Ophthalmol\u003c/em\u003e,\u003cem\u003e 136\u003c/em\u003e(10), 1170–1179. https://doi.org/10.1001/jamaophthalmol.2018.3352 \u003c/p\u003e\n\u003cp\u003eSandelowski, M. (1986). The problem of rigor in qualitative research. \u003cem\u003eANS Adv Nurs Sci\u003c/em\u003e,\u003cem\u003e 8\u003c/em\u003e(3), 27–37. https://doi.org/10.1097/00012272-198604000-00005 \u003c/p\u003e\n\u003cp\u003eWarren, N. A. (2023). \u003cem\u003eEngaging partners and patients to build capacity for PCOR in dry dye and MGD [EASO-29000]\u003c/em\u003e (EASO-29000) [Grant]. \u003c/p\u003e\n\u003cp\u003eWarren, N. A., Maskin, S. L., Gurupur, V., Rector, D. A., Adelman, D., Howell, S., McAree, J., Dibble, R., Carlisano, C., Maconi, D. P., Schrotenboer, D., Jaimes, M., Marte, N., Carlisano, T., Toland, C., Chung, J., Cremers, S. L., \u0026amp; Corbin, G. S. (2024). Engaging stakeholders to develop a roadmap for dry eye and MGD PCORI-funded research. \u003cem\u003ePatient Related Outcome Measures\u003c/em\u003e. https://doi.org/10.2147/PROM.S438290 \u003c/p\u003e\n\u003cp\u003eWennerstrom, A., Springgate, B. F., Jones, F., Meyers, D., Henderson, N., Brown, A., Niyogi, A., Martin, D., Smith, J., 3rd, Kirkland, A. L., Jones, L., \u0026amp; Norris, K. C. (2018). Lessons on patient and stakeholder engagement strategies for pipeline to proposal awards. \u003cem\u003eEthn Dis\u003c/em\u003e,\u003cem\u003e 28\u003c/em\u003e(Suppl 2), 303–310. https://doi.org/10.18865/ed.28.S2.303 \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient-centered research, patient involvement, patient engagement, patient advisory council, dry eye, ocular surface disease","lastPublishedDoi":"10.21203/rs.3.rs-8484290/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8484290/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess the effectiveness of a multiphase training program that jointly prepares patients and researchers for collaboration in dry-eye patient-centered research.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e \u003cp\u003eCross-sectional, mixed methods study. August\u0026ndash;September 2025.\u003c/p\u003e\u003ch2\u003eSubjects:\u003c/h2\u003e \u003cp\u003eInitial cohort: Dry eye patients/caregivers (8) and researchers (3). Age 18\u0026ndash;75. High school to postgraduate education. Eastern and Central time zones. English fluency. Access to computer, internet. The participants were selected through purposive, snowball sampling. Eight (83%) females and 3 (27%) males were included. One female dropped out during Phase 1 and was replaced. One female dropped out after Phase 2 and was not replaced. The final cohort included 7 (70%) females and 3 (30%) males. Age\u0026thinsp;\u0026gt;\u0026thinsp;30\u0026ndash;75 years.\u003c/p\u003e\u003ch2\u003eIntervention:\u003c/h2\u003e \u003cp\u003e Participants completed a structured three‑phase training program beginning with online informational modules on patient-centered research literacy, including study design and research methods; progressed to book studies with quizzes and live virtual discussions to develop in‑depth disease knowledge; and culminated in group simulations, designing a mock research study, and replicating real‑world teamwork. July 2023\u0026ndash;June 2025.\u003c/p\u003e\u003ch2\u003eMain outcome measures:\u003c/h2\u003e \u003cp\u003eQuantitative: effectiveness/value of training, self-reported pre- and post-training knowledge gains, using 5-point Likert scales. Qualitative: responses to semistructured interviews.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eQuantitative: Statistically significant gains in self-reported knowledge were observed across all three phases of training; Wilcoxon signed-rank tests, W = -22.5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; effect sizes for each phase were large, r\u0026thinsp;=\u0026thinsp;.96, .91 and .91, respectively. Qualitative: Phase 1 (Research Fundamentals), informative but occasionally tedious; Phase 2 (Mastering Dry Eye), valued for in-depth content and small-group discussions; and Phase 3 (Research Practicum), valuable, although some participants expressed frustration/low interest.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis structured, multiphase training program effectively prepared patients and researchers for collaborative engagement in dry eye patient-centered comparative effectiveness research (CER). Statistically significant gains in self-reported knowledge were observed across all three phases, with large effect sizes. The emphasis on disease-specific education and interactive learning was valued. Future adaptations may be needed to better support participants with limited research experience. The results support the decision to establish a dry eye patient research advisory group, the Dry Eye Patient Council.\u003c/p\u003e","manuscriptTitle":"From Patient to Advisor: Establishing a Patient Council for Dry Eye Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:53:14","doi":"10.21203/rs.3.rs-8484290/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-06T18:19:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T10:18:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-02T13:29:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35587932707603735862377399503416587144","date":"2026-01-16T07:14:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T10:27:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191970063832230301288318338944463428449","date":"2026-01-09T18:08:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80159862005771437927825673155125663582","date":"2026-01-09T17:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267774384465949831821055484769178222430","date":"2026-01-09T17:45:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237770130787382844748891813292113232992","date":"2026-01-07T17:40:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T17:33:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T13:11:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-05T09:41:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Research Involvement and Engagement","date":"2025-12-30T21:13:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cd4105e-44f0-46d7-98b2-eaf9b9e9238c","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-25T20:08:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:53:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8484290","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8484290","identity":"rs-8484290","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}