By Jack Kues, PhD, FACEHP, CHCP
As medical educators, one of our more important responsibilities is to disseminate new knowledge and practices across a wide range of health care providers who practice in very diverse delivery environments. Research has identified education strategies that are both innovative and highly effective. Simulation and team-based learning are among the recent techniques that are becoming very popular for mastery learning of specific skill sets. A critical question that we have to address is the role that we, as educators, play in how these new techniques are used to optimize their ability to change and improve practice.
In the article: “Dissemination of an Innovative Mastery Learning Curriculum Grounded in Implementation Science Principles: A Case Study,” William McGaghie and colleagues describe their role in disseminating a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for residents in two different practice environments: an academic medical center and a community hospital. Their description, published in the November 2015 issue of Academic Medicine, is interesting not so much because of the intervention but because it provides a good overview of implementation science and how it impacts the role of medical educators. They point out that implementation science is a relatively new field (developed a little over a decade ago), but it helps us understand the context in which we, as educators, operate as we introduce education and practice innovations into an existing organization and system.
Their experience implementing the SBML curriculum in two very different environments reflects many of the frustrations and barriers that we have experienced when trying to introduce new programs under similar circumstances. If you are hoping for a magic bullet or clever trick to solve these problems, this article will leave you disappointed. However, after recognizing that adapting an education intervention to the idiosyncrasies of an organization is very hard work, they offer a number of valuable lessons learned.
The authors note that the establishment of the SBML curriculum was successful at both institutions but it was “neither easy nor perfect.” Their lessons learned include the importance of local champions, defined as educationally influential physicians. These individuals were critical allies in getting the organization to accept the importance of the new curriculum for achieving educational and patient care goals. Both organizations had typical distributions of innovation adoption among the medical staff. This is a normal curve that includes faculty innovators (2.5 percent), early adopters (13.5 percent), early majority (34 percent), late majority (34 percent) and laggards (16 percent). The educators in this study focused on moving the upper half of the curve with the recognition that only after these individuals had adopted the educational changes would they be able to get the lower half of the curve to move. We often become frustrated by trying to move everyone at once. This typically results in expending a great deal of energy and resources on the tail end of the curve instead of supporting the innovators and early adopters.
Another lesson learned is the importance of understanding how an innovation is received by the organization as a whole. Specifically, successful dissemination is linked to praise, reinforcement, resources and security from the organization for both the innovation and the innovators. Organizational change is inherently slow and requires a high level of trust among organizational members. Organizational trust is generally low when an intervention is introduced from outside. Taking the time to establish strong internal relationships was important for the educational team in this study. As educators, this is not something that we typically consider when we are planning an education intervention.
The authors summarize their experience by stating that knowledge about an innovation is insufficient for successful implementation in educational practice. It requires active educational leadership, personal contacts, hard work and attention to implementation science principles. The history of CEhp has only recently included a responsibility for successfully changing practice and patient outcomes. Many of us are in positions where we cannot easily measure this level of impact. However, increasingly, our value to learners and health care organizations is dependent on our ability to affect change. This article provides some direct insight into the knowledge and skills that are necessary to overcome implementation roadblocks. Whether you are facing these challenges yourself or are engaging learners who will face these issues when they attempt to implement what they have learned at your activity; this article provides some useful tips.
The article is a relatively quick and easy read. It provides a good introduction and overview to implementation science, and the case study material is generalizable to the introduction of virtually any innovative educational strategy. Readers can use this information to expand their role as educator and to achieve more effective outcomes for their educational programs.