Implementation Science What Does it Mean to Educators

Implementation Science: What Does it Mean to Educators? Presenters: Patricia O’Sullivan, Ed. D, UC San Francisco Summers Kalishman, Ph. D, University of New Mexico SOM

What we will do today �Objectives �Overview �Small for today’s session and background 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/History �Implementation 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

Assumption �Hard-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 IS �collaboration, �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 IS � Systematically-integrated achievement � Comprehensive health care approach to outcomes understanding of the complexities of � 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 models--yes ◦ ◦ and Quality Improvement Plan-Do-Study-Act Six Sigma Diffusion of Innovation Root cause analysis �Interprofessional �Patient teams—yes medical centered homes--yes

IS Constructs Applicable to Med. Ed �Planned behavior/reasoned action �Trans-theoretical model �PRECEED/PROCEED model �Pathman model �Learning transfer model �Force 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, 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

Vision � Medical education is the bridge between research and practice � Inter-professional � Environments learning collaboration is a must need be conducive to continued � 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

Medical Education as a Bridge between Medical Research and Practice Critical Success Factor 1: Collaboration & Integration Medical Research Critical Success Factor 2: Culture of Learning & Development Critical Success Factor 3: Alternative Research Designs Implementation Science Principles (collaboration, improved capacity, rigor & relevance, efficiency & speed, cumulative knowledge) Medical Practice

Educational research characteristics align with IS � Conducted in social context (classroom, healthcare office) � Low to no control over multiple variables � Need for progressive refinement of the study design with each iteration � Large amounts of data about climate, learning and system variables � Large undertakings in need of excellent coordination � Results reporting must include: rich descriptions (environments, participants and variables) study design and refinement

Potential for the future: IS integration with education 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. 1.

Small group exercise

Reports from Small Groups