5
Reflections and Looking Forward
Reflections Session Objective: To see whether participants plan to apply implementation science in health professions education (HPE) after the workshop.
In this final session of the workshop, participants answered a poll to find out whether they were less comfortable, more comfortable, or at the same level of comfort with implementation science, compared to the beginning of the workshop. From this informal tally, Brooks mused that no one said less comfortable, which led him to acknowledge the difficulty of the task the small groups were asked to undertake. One of the goals of the workshop, he said, was to have participants “struggle through” the process of implementation science in order to make them more comfortable using implementation science in their own settings. He asked participants to comment on what aspects of implementation science they would be likely to use, where they need more clarification or training, and where they see opportunities for action.
PARTICIPANT REFLECTIONS ON USING IMPLEMENTATION SCIENCE IN HPE
One participant said the workshop gave her more confidence about using implementation science in her work. Specifically, her association is charged with building resource guides for schools of pharmacy, and implementation science could be useful in helping schools identify and share best practices. She noted there are many good practices, but “they never seem
to translate” into use by other schools. Brooks concurred and added that, at his institution, six colleges operate individually rather than communicating and using successes; he said implementation science helps to create a dialogue between stakeholders who are all pursuing similar outcomes. Mary Antonelli, assistant professor, University of Massachusetts Graduate School of Nursing, shared that she is starting a new master’s program at her university, and this workshop has sparked ideas of how she can study the effect of the program and what models and framework to use to track student progress. A number of the factors described in the checklist are relevant for the program, she said, and will be useful in guiding an evaluation plan. Brooks added that evaluation is critical any time an institution invests resources in a new program. “We are in an age of accountability,” he said, and we need to demonstrate value and return on investment.
Valuing an Evidence Base for Using Implementation Science in HPE
One thing the workshop brought to the surface, said Soicher, is the value of evidence that is collected in a variety of ways. She joked that randomized controlled trials “really aren’t the gold standard of anything.” For example, it is not necessary to randomize students to one type of simulation or another in order to gain insight into their experiences in the classroom or to assess their abilities to communicate empathetically. “We don’t need to rely on only quantitative methods” to make decisions, she said, adding that implementation science has made clear that there are “other ways of knowing.” Toby Brooks remarked on the need to collect more evidence specific to HPE. The evidence that is relied upon for teaching interventions in HPE, he said, often comes from secondary or even primary education. He further emphasized that “fifth graders aren’t the same as med students.” The existing literature base is “woefully ineffective” at describing HPE institutions and their needs.
Identifying Challenges to Using Implementation Science in HPE
Another challenge, said Patrick Palmieri, regional director for Evidence-Based Health Care South America, is a lack of consistent definitions and terminology in HPE. “We have a real problem” with defining the words we use in our nomenclature, he said. Phrases like implementation science, improvement science, and translation research get used both interchangeably and differently, and it makes it challenging to work together. Palmieri joked that it would be a very big problem if chemistry had 10 different names for every compound. He said it is incumbent upon people within HPE to recognize that other disciplines have “gotten their act together” and that HPE needs to start defining terms clearly and concisely so everyone can
work in the “same sandbox.” Palmieri further commented on the issue of inconsistent terminology saying it is due in part to incentives in academia for researchers to “stake their claim.” Jessani agreed and said this is an issue across many disciplines, including social sciences. Brooks followed up the comment saying, “The more disparate we become, the less momentum we can build upon.” One way to address this issue, said Jeffries, is to develop and publish standardized glossaries, such as the International Nursing Association of Clinical and Simulation Learning (INACSL) glossary of standard terms in the area of SBE.1
USING IMPLEMENTATION SCIENCE IN THE FUTURE OF HEALTH PROFESSIONS EDUCATION
Soicher emphasized that it is clear there is a need to share and disseminate information about innovations so others can implement them. However, she added, much of this work is not eligible for some journals, either because it is not quantitative enough or it is too focused on a specific field. There is a need to build a space where information can be easily stored and accessed; further, the information should be synthesized so each individual is not responsible for “synthesizing an entire database worth of information.” D’Agostino added that during the pandemic, educators were looking for ways to meet educational outcomes when their usual approaches were no longer feasible. Having a database of standardized, detailed, and synthesized information about implementing pedagogical innovations may make it easier and smoother for educators to navigate future disasters and emergencies.
Different disciplines within HPE are starting from different places with implementation science, said Brooks. Some disciplines have a fair amount of experience while others are in the “embryonic” stage. Implementation science has the opportunity to dramatically change the face of HPE over the next decade, he noted, but “we have to do the lifting now.” Promoting implementation science in HPE will require work, but we are not “blazing new paths.” There are models from colleagues in other disciplines that can be followed and adapted for the unique needs of HPE. In addition, D’Agostino suggested that HPE could look to the business world for strategies being used there to improve processes. “We have to be creative … and get out of our own way,” he said, so these tools can be used to help make change for students and their patients. Instead of letting it take 17 years for an innovation to reach practice, D’Agostino pointed out, implementation science can be used to help jumpstart the process. With that, the workshop was adjourned.
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1https://www.nursingsimulation.org/article/S1876-1399(16)30133-5/pdf (accessed September 27, 2022).
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