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A Voice for Children's Injury Prevention: Q&A With Flaura Winston, MD, PhD
Editor's Note: The 2021 Distinguished Investigator Award for Translation into Public Benefit and Policy recognizes Flaura Winston, MD, PhD, the founder and scientific director of the Center for Injury Research and Prevention (CIRP) at Children's Hospital of Philadelphia, for her "signature research-action-to-impact approach" that brought together stakeholders in academia, industry, and policy to create change and save the lives of children.
The Association for Clinical and Translational Science (ACTS) held its annual meeting — Breaking Barriers and Building Bridges — virtually March 30 to April 2, 2021. Amid the scientific programming featuring insights of key scholars and leaders in the field of translational science, ACTS bestowed its Distinguished Investigator Awards. View a video honoring Dr. Winston as an ACTS award winner.
J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine at the University of Pennsylvania, who nominated Dr. Winston noted that in 1988, more than 30,819 youth and young adults died in motor vehicle accidents; in 2018, the number had decreased to 7,381 per year, due in no small part to Dr. Winston's tireless work. She investigated preventable deaths from airbag deployments, ensured children are properly restrained with appropriate use of booster seats, and now strives to equip new drivers with the skills they need to drive safely.
Cornerstone spoke with Dr. Winston, and she reflected on her ongoing work in injury prevention, her unique career trajectory, and strength in coordinating teams to solve defined problems.
What does the ACTS Distinguished Investigator Award represent to you?
I am so grateful to Dean Jameson for this nomination and honored that ACTS, which represents the best of the best of translational research in medicine, recognize a pediatrician doing injury work as being their distinguished investigator. This award is not only important for me but also for the field. I am happy to accept this award on behalf of many people who have been supportive of my work — including the hundreds of thousands of youth and their families who generously participated in our studies — but also for the field of injury prevention.
How did you come by your unique, multidisciplinary background that includes medicine, engineering, and public health? Was this path by design?
My interdisciplinary background began early, as a University Scholar undergraduate at the University of Pennsylvania. In this program, I was expected to stretch into other disciplines and pursue interdisciplinary graduate studies. I knew as a freshman that I would be pursuing an MD/PhD in Bioengineering. So, during my formative years, I was trained to cross and transcend discipline boundaries.
I am a curious person by nature, and this background shaped me into seeing problems from multiple viewpoints. I was inspired to tackle challenging problems that could not be solved with one discipline's approach. I focused on injury because it remains the leading cause of death through adolescence and because the complex questions and solutions sit at the boundary of behavior, engineering, medicine, and policy.
What I learned from my academic background is how much I don't know and that when tackling challenging problems, I need to work with the best minds. So, my role naturally evolved into one in which I was the boundary spanner and vision leader, translating across disciplines and bringing the viewpoints together to create solutions that have impact — sometimes feeling like a conductor of virtuoso soloists.
My success was built on a foundation of being given opportunities to think outside the box, the freedom to explore, and great mentorship.
Your nomination noted your belief that "publishing rigorous research was necessary but insufficient to address the health crisis of child injury" and you wanted to put research into action. How did you first bridge that gap to bring these stakeholders into your research and convince them to look at the change you could make together?
As I started to talk with people about child injury, I realized that across audiences, we share a common goal of protecting children. I also realized that when I combine this shared experience with what I have to offer — rigorous, unbiased research and compelling solutions — people want to talk to me. This gave me the confidence to talk to anyone about my work. Whether it is asking a parent or adolescent to participate in a study, funding from a CEO of a major insurance company, or willingness to pass to legislation by a senator, I found that my calls were welcome.
Often, they were "cold calls," invitations for "20 minutes of someone's time." It's important to keep the initial request for time short and the conversation focused. With my interdisciplinary background, I was able to reframe the problem in a way that resonated with the person with whom I was talking. The conversation is never the same twice – I'm always learning how to best convey the importance of the science and the need to act. Another framing that helped me was that I was not asking for anything for myself, rather, I was just a messenger for the children and what their safety required.
My career got off the ground when I had a surveillance system in the CHOP Emergency Department identifying children suffering traffic injuries, in order to understand the mechanism of injury. One of the first children in the system was a child, dead on arrival after seated in a rear-facing child safety seat in the front seat of a vehicle in a crash. This was the first child who died of an airbag injury. As an engineer and a pediatrician, I recognized that this was an unusual injury, and I called the National Transportation Safety Board and the National Highway Traffic Safety Administration. They sent representatives to Philadelphia, and from there, I was introduced through friends to people in the insurance industry.
State Farm Insurance and I worked together and created the first and only child-focused crash surveillance system. It was a massive undertaking begun in 1997 before the Internet was big. We created a real-time, child-focused crash surveillance system where all the claims representatives were the data collectors, and we did crash investigation, telephone interviews, and collected data for more than 500,000 children in crashes. State Farm leaders (the vice presidents of Claims and Strategic Resources) recognized that we shared a problem — avoidable injuries to children in crashes, and we shared the passion to solve it together.
Our data and results fueled innovations in child passenger safety that saved thousands of children's lives through improved products, laws, regulations, and training. That's just one story. It's really all about having the humility to recognize that you can't solve a problem yourself, knowing how to work with partners, and the passion to get through the hard work.
What aspect of your work or particular project are you most proud of?
I'm most proud of how much the field has grown from when I started. So many other young people are taking this work on to solve these important problems. This next generation of injury researchers are passionate, rigorous beyond belief, and committed to making a difference. This is sort of in our DNA, and I'm really proud of that.
I see my current role as less visible, behind the scenes and helping guide others who are passionate about their work, like supporting CIRP faculty, faculty across CHOP and Penn, and international colleagues. I am delighted with the new Center for Violence Prevention. I'm so proud of what the leaders there have done, and I enjoy supporting my colleagues rather than being the one in the front; it's really wonderful.
When I was training, the kind of work I did, changing laws and regulations to prevent injury, was not valued as an academic pursuit and not well funded by the National Institutes of Health. What I'm most proud of is seeing the shift in that thinking, which I hope I had something to do with. Policy-relevant, translational research has gained credibility, in part due to the real-world impact in reach like ours.
Where do you anticipate the future is heading in injury prevention and driving safety?
So many things are going on! I am co-founder of a company called Diagnostic Driving Inc. where we aim to make safer drivers by ensuring they have the skills they need to drive safely. That is going quite well, We collaborated with the Ohio Department of Public Safety and the Ohio Bureau of Motor Vehicles to adapt and pilot a previously validated virtual driving test, Ready-Assess™, to identify underprepared new license applicants, as part of the licensing process and before the state's on-road exam. One of the fascinating things that is happening right now is a proposed rule change to require the virtual driving test in the state, which would be amazing.
And, of course, a large portion of my effort focuses on turning CHOP into an Innovation Ecosystem. Most people get started in research for children because they have a passion for problem solving. Advancing knowledge is important, and so is making a measurable a difference with the work we're doing. The Innovation Ecosystem aims to enable and accelerate that ability. I am inspired by the scientific developments that came from COVID-19; we need to build on that "new normal" that allows us to move quickly and safely in solving major problems for children, their families, and communities.