Implementation Science: What Does it Mean to Educators?

Presenters:Patricia O’Sullivan, EdD, UC San FranciscoSummers Kalishman, PhD, University of New Mexico SOM

What we will do todayObjectives for today’s session

Overview and background

Small group work and discussion ◦vignette transformation

Objectives for today’s session

Describe the intersection between implementation science and medical education.

Apply the principles of implementation science to medical education to advance the way educators engage in medical education that addresses patient-centered care.

Background/HistoryImplementation science is considered

key to developing optimal healthcare delivery and is often unclear to educators outside of continuing education

AAMC’s Group on Educational Affairs convened a writing group in 2012 to develop manuscripts and provide guidance on Implementation Science in Medical Education.

What is Implementation Science?Implementation science involves

the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice to improve the quality and effectiveness of health services

AssumptionHard-working, intelligent health

care workers and/or medical educators will intuitively implement the best evidence into practice without any need of a skill set for implementation

True or False?

Principles of IScollaboration, improved capacity, rigor and relevance, efficiency and speed, and cumulative knowledge

Glasgow RE, Vinson C, Chambers D, Khoury MJ, Kaplan RM, Hunter C. National institutes of health approaches to dissemination and implementation science: Current and future directions. Am J Public Health. 2012;102(7):1274-1281

Advantages of ISSystematically-integrated approach to outcomes

achievement

Comprehensive understanding of the complexities of health care

Streamlined access to patient data to enhance the meaningfulness of clinical, educational and research initiatives

Eliminating waste and redundancies = cost effectiveness

Improved individual and population health outcomes

Tools in Implementation Science

Individual change behavior models—yes

Implementation and Quality Improvement models--yes◦ Plan-Do-Study-Act◦ Six Sigma◦ Diffusion of Innovation◦ Root cause analysis

Interprofessional teams—yes

Patient medical centered homes--yes

IS Constructs Applicable to MedEd

Planned behavior/reasoned actionTrans-theoretical modelPRECEED/PROCEED modelPathman modelLearning transfer modelForce field analysis

These models must compliment and work with educational models

Need for evidence is changing

Accreditation requirements focus on implementation of evidence-based approaches ◦UGME, GME, CPD/CME, MOC

CLER “clinical learning environment review” ◦sponsoring institutions need to

demonstrate leadership in quality improvement, patient safety and reduction of health care disparities

Focus: Desirable Patient Outcomes

reconsider educational activities when performance gaps exist at

individual, community or patient population levels

VisionMedical education is the bridge between research and

practice

Inter-professional collaboration is a must

Environments need be conducive to continued learning

Value-added by medical education need to be proven via alternative research designs

Medical education needs to re-imagine new possibilities for engaging medical professionals in learning

Critical Success Factor 1:

Collaboration & Integration

Medical ResearchMedical

ResearchMedical PracticeMedical Practice

Implementation Science Principles(collaboration, improved capacity, rigor & relevance,

efficiency & speed, cumulative knowledge)

Critical Success Factor 2:

Culture of Learning &

Development

Critical Success Factor 3:

Alternative Research Designs

Medical Education as a Bridge between

Medical Research and Practice

Educational research characteristics

align with ISConducted in social context (classroom, healthcare

office)Low to no control over multiple variablesNeed for progressive refinement of the study design

with each iterationLarge amounts of data about climate, learning and

system variablesLarge undertakings in need of excellent

coordinationResults reporting must include:

rich descriptions (environments, participants and variables)study design and refinementlessons learned

Potential for the future: IS integration with education1. Strengthen interprofessional

collaboration and systems-level integration,

2. Foster an environment conducive to on-going learning and build educator capacity,

3. Identify and apply alternative research designs to demonstrate the value added by medical education.

Small group exercise

Reports from Small Groups