Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review

Is There a Problem With Evidence in Health Professions Education?

ABSTRACT

What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume this knowledge might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris' learning loops framework.From a single-loop perspective ("How are we doing?"), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective ("Could we do better?") suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more system-wide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective ("Are we asking the right questions?") highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations and influencing decisions.

Clinical supervision in medical education: A citation analysis

PURPOSE

Medical education relies on clinical supervision for critical functions, including trainee assessment and ensuring patient safety. Yet, there is substantial variance in supervision, which has led to calls for a shared definition of the concept and guidelines to inform practice. AMEE Guide No. 27 provided these desired elements and is highly cited, suggesting that translation and utilization of the Guide's knowledge is suboptimal. This study investigates utilization by systematically characterizing citations to the Guide and by describing translation of its recommendations in relation to supervision.

MATERIALS AND METHODS

Citations were identified using Web of Science, Scopus, and Google Scholar. The authors coded all citations and conducted a subanalysis of studies specific to supervision.

RESULTS

583 studies were identified; 268 met inclusion criteria for general analysis of which 167 studies were further analyzed. Most studies reiterated the Guide's characterization of effective supervision, but few demonstrate how these recommendations inform innovations in supervisory practice.

CONCLUSION

Translation of the Guide's recommendations regarding clinical supervision appears limited. Future research should consider the extent of knowledge translation occurring in clinical supervision literature as well as AMEE Guides. Increased attention to knowledge translation in medical education may benefit the distribution of similar knowledge products.

Harnessing a knowledge translation framework to implement an undergraduate medical education intervention: A longitudinal study

INTRODUCTION

Implementation of evidence-informed educational interventions (EEI) involves applying and adapting theoretical and scientific knowledge to a specific context. Knowledge translation (KT) approaches can both facilitate and structure the process. The purpose of this paper is to describe lessons learned from applying a KT approach to help implement an EEI for clinical reasoning in medical students.

METHODS

Using the Knowledge to Action framework, we designed and implemented an EEI intended to support the development of students' clinical reasoning skills in a renewed medical curriculum. Using mixed-methods design, we monitored students' engagement with the EEI longitudinally through a platform log; we conducted focus groups with students and stakeholders, and observed the unfolding of the implementation and its continuation. Data are reported according to six implementation outcomes: Fidelity, Feasibility, Appropriateness, Acceptability, Adoption, and Penetration.

RESULTS

Students spent a mean of 24 min on the activity (fidelity outcome) with a high completion rate (between 75% and 95%; feasibility outcome) of the entire activity each time it was done. Focus group data from students and stakeholders suggest that the activity was acceptable, appropriate, feasible, adopted and well-integrated into the curriculum.

DISCUSSION

Through the process we observed the importance of having a structuring framework, of working closely and deliberatively with stakeholders and students, of building upon concurrent evaluations in order to adapt iteratively the EEI to the local context and, while taking students' needs into consideration, of upholding the EEI's core educational principles.

Leveraging knowledge translation and implementation science in the pursuit of evidence informed health professions education

Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.

Degrees of freedom analysis in educational research and decision-making: leveraging qualitative data to promote excellence in bioinformatics training and education

Qualitative data are commonly collected in higher, graduate and postgraduate education; however, perhaps especially in the quantitative sciences, utilization of these qualitative data for decision-making can be challenging. A method for the analysis of qualitative data is the degrees of freedom analysis (DoFA), published in 1975. Given its origins in political science and its application in mainly business contexts, the DoFA method is unlikely to be discoverable or used to understand survey or other educational data obtained from teaching, training or evaluation. This article therefore introduces and demonstrates the DoFA with modifications specifically to support educational research and decision-making with examples in bioinformatics. DoFA identifies and aligns theoretical or applied principles with qualitative evidence. The demonstrations include two hypothetical examples, and a case study of the role of scaffolding in an independent project ('capstone') of a graduate course in biostatistics. Included to promote inquiry, inquiry-based learning and the development of research skills, the capstone is often scaffolded (instructor-supported and therefore, formative), although it is intended to be summative. The case analysis addresses the question of whether the scaffolding provided for a capstone assignment affects its utility for formative or summative assessment. The DoFA is also used to evaluate the relative efficacies of other models for scaffolding the capstone project. These examples are intended to both explain this method and to demonstrate how it can be used to make decisions within a curriculum or for bioinformatics training.

[Development of a risk map in an oral and maxillofacial surgical unit]

INTRODUCTION

the main aim of this study was to develop and implement a risk map in the Oral and Maxillofacial Surgery Service of the University Hospital «Virgen de las Nieves» of Granada to minimize the incidence of adverse effects (AE).

MATERIALS AND METHODS

Longitudinal, prospective study carried out in the Oral and Maxillofacial Surgery Service of the Hospital Universitario Virgen de las Nieves of Granada, from June 2017 to May 2018, through the methodology of «Analysis and Failure Mode Effect». Management of the different AE was addressed. The following phases were considered as it follows: identification of the problem, identification of AE for within the practice of the oral and maxillofacial surgery that represents a problem in the assistive safety, creation of an interdisciplinary working group, analysis of the current situation in patient safety and risk management using 2analysis tools, SWOT and PITELO, preparation of the patient care process, development of a catalog of AE and preparation of a risk map.

RESULTS

A total of 33 AE were identified. The risk map showed a higher incidence of AE in the Surgical Area (22) compared to the areas of Outpatient Clinic and Hospital Discharge (6). A total of 10 critical AE were identified.

CONCLUSIONS

The elaboration of a risk map allowed to determine the process of the oral and maxillofacial surgical patient, and to elaborate a catalog of AE.

Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis

BACKGROUND

To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators.

METHODS

A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES).

RESULTS

Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable.

DISCUSSION

For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.

Experiences of Patients with Mental Illness' Interactions with Medical Students: A Systematic Review

OBJECTIVES

Mental health is a key area for learning within undergraduate medical education. Given the nature of mental illness, interactions may have the potential to uniquely affect patients. This study set out to systematically review studies reporting experiences and perceptions of patients with mental illness' clinical interactions with medical students. This includes which factors encourage patients to interact with medical students and if patients perceive negative and positive effects from these interactions.

METHOD

Studies reporting patient experiences of involvement in undergraduate medicine were included. A standardised search of online databases was carried out independently by 2 authors and consensus reached on the inclusion of studies. Data extraction and quality assessment were also completed independently, after which a content analysis of interventions was conducted and key themes extracted. Studies were included from peer-reviewed journals, in any language.

RESULTS

Eight studies from 5 countries were included, totaling 1088 patients. Most patients regarded interacting with medical students as a positive experience. Patients described feeling comfortable with medical students, and the majority believed it is important for students to 'see real patients'. Patients described benefits to them as enjoyment, being involved in student education, and developing an illness narrative.

CONCLUSIONS

Results suggest that most patients with mental illness want to interact with medical students, and this should be encouraged during student placements. Further research, however, is required to understand in more depth what else can be done to improve the comfort and willingness for patients to interact with students, including barriers to this.