Rapid Knowledge Mobilization and Continuing Professional Development: Educational Responses to COVID-19.

INTRODUCTION: The field of Continuing Professional Development (CPD) has a role to play in supporting health care professionals as they respond to the COVID-19 pandemic. However, the evolving science of COVID-19, the need for quick action, and the disruption of conventional knowledge networks pose challenges to existing CPD practices. To meet these emergent and rapidly evolving needs, what is required is an approach to CPD that draws insights from the domain of knowledge mobilization (KMb). METHODS: This short report describes a research protocol for exploring rapid KMb responses to COVID-19 at one Canadian academic teaching hospital. The proposed research will proceed as a case study using a mixed methods design collecting quantitative (surveys and Web site use metrics) and qualitative data (interviews) from individuals involved in developing, using, and supporting the KMb resources. Analysis will proceed in two phases: descriptive analysis of data to share insights and integrative analysis of data to build theory. RESULTS: Results from this study will inform the immediate KMb and CPD contribution to the COVID-19 response. DISCUSSION: Findings from this study will also make a broader contribution to the field of CPD, theoretically informing intersections between KMb and CPD and therefore contributing to an integrated science of CPD.

An Education Framework for Effective Implementation of a Health Information System: Scoping Review.

BACKGROUND: To optimize their use of a new Health Information System (HIS), supporting health care providers require effective HIS education. Failure to provide this education can significantly hinder an organization's HIS implementation and sustainability efforts. OBJECTIVE: The aim of this review is to understand the most effective educational strategies and approaches to enable health care providers to optimally use an HIS. METHODS: Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to Nursing and Allied Health Literature, and EBSCO Education Resources Information Center were searched to identify relevant papers. Relevant studies were systematically reviewed and analyzed using a qualitative thematic analysis approach. RESULTS: Of the 3539 studies screened, 17 were included for data extraction. The literature on the most effective approaches to enable health care providers to optimally use an HIS emphasized the importance of investing in engaging and understanding learners in the clinical context, maximizing the transfer of learning to care, and designing continuous and agile evaluation to meet the emerging demands of the clinical environment. CONCLUSIONS: This review supports the advancement of a new HIS learning framework that organizational leaders and educators can use to guide HIS education design and development. Future research should examine how this framework can be translated into practice.

Widening the Lens on Needs Assessment: Identifying Profession-Specific and Interprofessional Learning Needs Across Professions in an Academic Health Sciences Institution.

Traditionally, education planning for the health professions is conducted in a reactive manner, with profession-specific learning opportunities being organized in response to educational issues arising or based upon speaker availability. Moreover, limited information exists to guide organizations on systematic approaches to planning and implementing large-scale interprofessional learning programs, despite clear evidence for benefits of team-based learning in the workplace. Our organizational approach to the learning needs assessment process was in need of updating to enhance pedagogical rigor and to proactively inform ongoing education planning with respect to both profession-specific and interprofessional learning needs. To address this, a novel mixed methods approach integrated within a quality improvement framework was developed to elicit participant engagement. The approach included use of a questionnaire, focus groups, and key stakeholder interviews. Ranking of learning priorities of respondents indicated that highest priority was placed on learning needs related to profession-specific clinical and technical skills. A number of distinct inter¬professional learning needs were identified through this novel needs assessment process, including a selection of clinical topics that were deemed to be well-suited for interprofessional learning forums. Utilization of a multi-method interprofessional approach to needs assessment thus enabled elicitation of more comprehensive results than could have been achieved through a traditional profession-specific needs assessment, and hence changing our ongoing approach to education planning at our organization.

Implementing a peer-learning approach for the clinical education of respiratory therapy students.

INTRODUCTION: With recent clinical placement demands exceeding supply, the University Health Network (UHN) Respiratory Therapy (RT) department implemented a 2:1 student-to-preceptor model where a focus on peer learning (PL) becomes a key component of program success. PL can be defined as students learning from and with each other in both formal and informal ways. The shift towards facilitative student-directed models in other health care professions can be seen globally with the literature suggesting that 2:1 models not only support increases in student capacity but also improve the student learning experience through PL strategies. The aim of this study was to explore the perceptions of RT preceptors and students regarding the 2:1 model as an educational strategy in the context of their clinical experience. The study further explored experiences of PL to understand how learning is enabled in RT practice-based education, particularly within 2:1 models. METHODS: A qualitative descriptive study using single-episode semi-structured interviews with RT preceptors (n = 10) and students (n = 10) was conducted during the 2015-2016 RT student clinical year. Twelve open-ended interview questions were designed to draw out study participants' PL experiences and exploration of issues using a 2:1 model in the context of their clinical experience. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: The content analysis resulted in two broad themes with respect to the RT 2:1 educational model: "enablers" and "barriers" to a PL approach. The 2:1 model was preferred by students and preceptors early on in the clinical training due to the benefits of PL, whereas opportunities to showcase independent practice was preferred towards the end of their clinical year. Furthermore, careful planning, resources, and supports need to be implemented to augment benefits and diminish potential disadvantages of using a 2:1 model structure. CONCLUSION: Participants felt that a 2:1 model strongly contributes to a supportive learning environment and can have a positive influence on the RT student clinical experience at UHN. Along with the improved critical thinking and student engagement opportunities that a 2:1 model offers, increased placement numbers are also supported.

Initiating communities of practice for teaching and education scholarship in hospital settings: a multi-site case study.

This article was migrated. The article was marked as recommended. Background and Rationale: Numerous calls have been made for faculty development programming to better address faculty members' ongoing needs, to situate training strategies within the workplace and to utilize social learning perspectives, communities of practice in particular. Reviews have pointed to a paucity of published qualitative research on faculty development communities of practice and, more generally, on the processes of change and the organizational contexts in which interventions are implemented. Intervention: An initiative was started to instigate education scholarship communities of practice in three highly distinct academic health care settings, to address faculty members' ongoing needs for community and, ultimately, to serve as a source of support for the application of new knowledge to routine education activities. A research project was launched jointly to describe the process and progress of attempting to develop communities of practice at the three sites and to identify common and unique influences on sites' progress. Data Collection: Phone interviews were conducted with group facilitators from each site following group meetings, for the duration of the initiative. Analysis: Multiple case study methodology was employed to describe and compare the processes and progress of attempting to initiate communities of practice at the three sites and to identify obstacles related to organizational context. Findings: All three sites made limited progress in developing a shared domain of interest and a shared history of regular interaction (i.e. regular meetings). Participants identified different professional backgrounds and different education practices as challenges to establishing shared interest. More prominently, they identified busy schedules, geographic barriers, and absence of protected time as obstacles to regular and consistent meetings. Discussion: Difficulty establishing shared interest and shared history are considered in light of the unclear meaning of "education scholarship", cognitive and ethical boundaries between professions, and time constraints within modern, highly complex academic healthcare settings. Conclusions: While CoPs may appeal as self-sustaining, low-cost alternatives to formal programming, limited progress is possible without institutional investment and allowance commensurate with the implied scope and challenges.

Flying blind: the experience of online interprofessional facilitation.

The role of the facilitator is known to be important in fostering productive interprofessional education (IPE) in the face-to-face (F2F) environment. Online learning can help surmount some of the logistical challenges in IPE by bringing together diverse professionals in multiple geographical locations. Best practices in F2F IPE facilitation are beginning to emerge, but there is scant literature examining IPE facilitation online. What little research exists has focused on the asynchronous environment and suggests that the skill sets of online and F2F facilitators have considerable overlap, but there are further demands in the online setting. This qualitative study sought to examine online synchronous IPE facilitation through the self-reported experiences of seven trained facilitators during a 12-week online course. Data collected through focus groups and targeted interviews were analyzed by the research team using constant comparison techniques. Four major themes were revealed: technology as a dynamic force, reduction in non-verbal cues, evolution of the online IPE group process over time and the importance of co-facilitation. The foundations of IPE facilitation were seen to carry over to the online setting. This study has implications for the training of IPE facilitators and for the design of online IPE learning experiences.

Conflicting messages: examining the dynamics of leadership on interprofessional teams.

PURPOSE: Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. METHOD: Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. RESULTS: Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors' observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. CONCLUSIONS: A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

Community re-engagement and interprofessional education: the impact on health care providers and persons living with stroke.

PURPOSE: This study evaluated the impact of an educational intervention that integrates concepts of a community re-engagement framework (CR) and interprofessional collaboration (IPC) on health care providers' (HCP) practice with persons living with stroke (PLS). METHOD: A mixed-methods design was used in which HCPs (n = 67) and PLS (n = 29) participated from 9 organizations across the care continuum. Pre- and postintervention surveys and interviews were conducted with the HCPs. One-on-one interviews with stroke clients were also conducted pre and post intervention. Quantitative responses were analyzed in SPSS (Chicago, Illinois, USA) for descriptive frequencies and differences between pre- and postintervention groups. Qualitative open-ended responses were thematically coded using NVivo7. RESULTS: Significant increases occurred in HCPs' knowledge of CR, confidence levels in working with PLS, enhanced understanding of the complex needs of PLS, and positive self-reported impacts on practice. PLS reported positive perceptions of care pre and post intervention. CONCLUSIONS: The intervention provided HCPs with a common language and framework to work collaboratively and holistically in delivering care consistent with stroke best practices.

The group priority sort: a participatory decision-making tool for healthcare leaders.

Healthcare leaders have long expressed the need to effectively engage all members of their organizations in the process of decision-making. The group priority sort is an innovation in healthcare leadership that supports both consensus building and effective consultation.

An exploratory investigation using appreciative inquiry to promote nursing oral care.

The purpose of this exploratory study was to determine the impact of an appreciative inquiry (AI) approach in a nursing knowledge translation initiative to facilitate oral care service delivery improvements. Comments made by nurse participants showed that they valued knowledge and strived for consistency in oral care provision. They felt that this could be obtained by implementing an oral health assessment tool, having access to an oral health expert, and enhancing interprofessional collaboration. Results also supported nurses' perceptions that organization-wide support and commitment is required in order to successfully implement and sustain improvements in oral care practice. AI was found to be a useful framework for generating dialogue regarding ways to improve oral care. This method generated positive momentum for practice change and empowered participants to become ambassadors for change, thereby effectively bridging the knowledge-to-action gap. Although AI is not a guaranteed solution for improving oral care in long-term care institutions, it should be considered as one part of a multi-interventional strategy.

Organizational model and process for clinical best practice in rehabilitation and complex continuing care.

Toronto Rehabilitation Institute developed its Clinical Best Practice Model and Process (TR-CBPMP) to facilitate a systematic and consistent approach to best practice with the goal of shortening the path between best knowledge and clinical care and linking this process to patient needs and outcomes. The TR-CBPMP guides clinicians, inter-professional teams, administrators and leaders in identifying patient needs, reviewing present practice, determining best practice priorities, analyzing gaps, preparing for and implementing best practice, evaluating patient-based outcomes and sustaining the best practice. The TR-CBPMP has been used successfully to develop program-specific, profession-specific and organization-wide best practices.

Facilitating best practice in aged care: exploring influential factors through critical incident technique.

Aim. The focus of this study is on the perspective of facilitators of evidence-based aged care in long-term care (LTC) homes about the factors that influence the outcome of their efforts to encourage nursing staff use of best practice knowledge. Design. Critical incident technique was used to examine facilitators' experiences. Methods. Thirty-four participants submitted critical incident stories about their facilitation experiences through face-to-face interviews, telephone interviews, and/or a web-based written questionnaire. The resultant 123 stories were analysed using an inductive qualitative approach. Results. Factors at individual and contextual levels impacted the success of facilitators' work. The approaches and traits of facilitators as well as the emotionality and intellectual capacity of nursing staff were the individual factors of influence. On a contextual level, the inherent leadership, culture, and workload demands within LTC homes, as well as externally imposed standards were influential. Conclusions. Primary factors influencing the facilitation of best aged care in LTC homes appear to be largely relational in nature and intimately connected to the emotionality of those who work within these settings. Enhancing the interactional patterns amongst staff and leaders as well as promoting a positive emotional climate may be particularly effective in promoting better aged care nursing practice.

The role of reflection in implementing learning from continuing education into practice.

INTRODUCTION: Although the use of reflection to facilitate learning and its application in practice has been widely advocated, there is little empirical research to establish whether or not health professionals use reflection to integrate learning into clinical practice. Particularly troublesome is the lack of empirically based theory underlying strategies to promote reflection and understand factors that influence its use in translating learning into practice. Occupational therapists participated in this case study, in which reflection and implementation of learning from a short course into practice were examined using a multimethod approach. METHODS: In phase one (n = 41), quantitative data were collected from a practice survey, the Self-Reflection and Insight Scale (SRIS) and Commitment to Change (CTC) statements. In phase two (n = 33), follow-up CTC data were collected to quantify the extent of achievement of CTCs. Data from phases one and two were analyzed descriptively to inform the selection of interview participants (n = 10) in phase three of data collection. RESULTS: Two models were generated. One model describes when reflection was used, and the second model explains factors influencing its use. Participants used reflection before, during, and after the course, and reflection was influenced by a range of factors associated with the course, practice context, and the individual. DISCUSSION: The theory and models depicting the use of reflection may guide educators' use of reflective learning before, during, and after short courses.