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“I Wish I Knew This Before…”: An Implementation Science Primer and Model to Guide Implementation of Simulation Programs in Medical Education

  • Raluca Dubrowski
  • Melanie Barwick
  • Adam Dubrowski
Chapter

Abstract

The present chapter addresses an implementation gap identified in the area of simulation-based medical education, where Programs Directors are struggling with how to successfully implement simulation programs in the absence of best practices to guide their efforts (Kurashima and Hirano 2016). Given the increasing complexity of simulation-based education over the past few decades (Roussin and Weinstock 2017) and the recognized need for best practices for implementation (Kurashima and Hirano 2016), we proposed an Adapted Implementation Model for Simulation (AIM-SIM) to guide institutions in their efforts to implement new simulation programs. AIM-SIM is entirely derived from the existing implementation literature by blending three complementary implementation models (process, determinant and outcome models) and applying them to the simulation context. AIM-SIM includes three main implementation phases: (a) stakeholder engagement and context exploration, (b) pre-implementation planning, and (c) program implementation with monitoring and ongoing evaluation. Our overall goal is to increase implementation capacity in simulation-based medical education by offering a systematic approach to program implementation. As such, AIM-SIM is based on evidence from the emerging field of implementation science, which is increasingly used to optimize program implementation and maximize the desired outcomes.

Keywords

Implementation Simulation programs Simulation Medical education Process evaluation Outcome evaluation Implementation science Consolidated framework for implementation research Quality implementation framework Implementation outcomes framework 

References

  1. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Admin Pol Ment Health. 2011;38(1):4–23.  https://doi.org/10.1007/s10488-010-0327-7.CrossRefGoogle Scholar
  2. Alkin MC, Christie CA. The evaluation theory tree. In: Alkin MC, editor. Evaluation roots: tracing theorists’ views and influences. Thousand Oaks: Sage Publications; 2004.CrossRefGoogle Scholar
  3. Allen JD, Linnan LA, Emmons KM. Fidelity and its relationship to implementation effectiveness, adaptation, and dissemination. In: Dissemination and implementation research in health: translating science to practice. New York: Oxford University Press; 2012. p. 281–305.  https://doi.org/10.1093/acprof:oso/9780199751877.003.0014.CrossRefGoogle Scholar
  4. Barwick M, Barac R, Zlotkin S. Evaluation of effective implementation of exclusive breastfeeding in Ethiopia and Mali using the Consolidated Framework for Implementation Research. 2015. http://www.can-mnch.ca/wp-content/uploads/2015/05/EBF-Research-Report-FINAL-July-29-2015.pdf. Accessed 1 June 2017.
  5. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32.  https://doi.org/10.1186/s40359-015-0089-9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Bernstein SL, Stoney CM, Rothman RE. Dissemination and implementation research in emergency medicine. Acad Emerg Med. 2015;22(2):229–36.  https://doi.org/10.1111/acem.12588.CrossRefPubMedGoogle Scholar
  7. Birken SA, Powell BJ, Shea CM, Haines ER, Kirk MA, Leeman J, Rohweder C, Damschroder L, Presseau J. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci. 2017;12:124.  https://doi.org/10.1186/s13012-017-0656/y.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Blase K, Kiser L, Van Dyke M. The hexagon tool: exploring context. Chapel Hill: National Implementation Research Network, FPG Child Development Institute, University of North Carolina at Chapel Hill; 2013. http://implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/resources/NIRN-Education-TheHexagonTool.pdf. Accessed 7 June 2017.
  9. Brehaut JC, Eva KW. Building theories of knowledge translation interventions: use the entire menu of constructs. Implement Sci. 2012;7:114.  https://doi.org/10.1186/1748-5908-7-114.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Acad Med. 2010;85(5):806–12.  https://doi.org/10.1097/ACM.0b013e3181d7aabd.CrossRefPubMedGoogle Scholar
  11. Carpenter CR, Lo AX. Falling behind? Understanding implementation science in future emergency department management strategies for geriatric fall prevention. Acad Emerg Med. 2015;22(4):478–80.  https://doi.org/10.1111/acem.12628.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40.  https://doi.org/10.1186/1748-5908-2-40.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Century J, Cassata A. Implementation research: finding common ground on what, how, why, where, and who. Rev Res Educ. 2016;40:169–215.  https://doi.org/10.3102/0091732X16665332.CrossRefGoogle Scholar
  14. Chamberlain P, Brown CH, Saldana L. Observational measure of implementation progress: the stages of implementation completion (SIC). Implement Sci. 2011;6:116.  https://doi.org/10.1186/1748-5908-6-116.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM. Three collaborative models for scaling up evidence-based practices. Admin Pol Ment Health. 2012;39(4):278–90.  https://doi.org/10.1007/s10488-011-0349-9CrossRefGoogle Scholar
  16. Chinman M, Hunter S, Ebener P, Paddock SM, Stillman L, Imm P, Wandersman A. The getting to outcomes demonstration and evaluation: an illustration of the prevention support system. Am J Community Psychol. 2008;41(3-4):206–24.  https://doi.org/10.1007/s10464-008-9163-2.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Chiu M, Posner G, Humphrey-Murto S. Foundational elements of applied simulation theory: development and implementation of a longitudinal simulation educator curriculum. Cureus. 2017;9(1):e1002.  https://doi.org/10.7759/cureus.1002.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Colditz GA. The promise and challenges of dissemination and implementation research. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and implementation research in health: translating science to practice. New York: Oxford University Press pp; 2012. p. 3–23.CrossRefGoogle Scholar
  19. Cook DA, Bordage G, Schmidt HG. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Med Educ. 2008;42(2):128–33.  https://doi.org/10.1111/j.1365-2923.2007.02974.x.CrossRefPubMedGoogle Scholar
  20. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: new guidance. 2008. http://www.mrc.ac.uk/complexinterventionsguidance. Accessed 16 July 2004.
  21. Cristancho S, Hodgson A, Pachev G, Nagy A, Panton N, Qayumi K. Assessing cognitive & motor performance in minimally invasive surgery (MIS) for training & tool design. Stud Health Technol Inform. 2006;119:108–13. http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=0f21d238-1186-4b52-807d-7a420aed4e58%40sessionmgr4007&vid=1&hid=4201PubMedGoogle Scholar
  22. Damschroder JL, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implement Sci. 2013;8:51.  https://doi.org/10.1186/1748-5908-8-51.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.  https://doi.org/10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Dubrowski A, Morin MP. Evaluating pain education programs: an integrated approach. Pain Res Manag. 2011;16(6):407–10.  https://doi.org/10.1155/2011/320617.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Durlak J, DuPre E. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3-4):327–50.  https://doi.org/10.1007/s10464-008-9165-0.CrossRefPubMedGoogle Scholar
  26. Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci. 2006;1(1):1.  https://doi.org/10.1186/1748-5908-1-1.CrossRefPubMedCentralGoogle Scholar
  27. Fixsen DL, Blase K. Implementation: the missing link between research and practice. National Implementation Research Network Implementation Brief, 1. Chapel Hill: The University of North Carolina; 2009. http://files.eric.ed.gov/fulltext/ED507422.pdf. Accessed 10 June 2017.
  28. Fixsen DL, Blase KA, Timbers GD, Wolf MM. In search of program implementation: 792 replications of the teaching-family model. In: Bernfeld GA, Farrington DP, Leschied AW, editors. Offender rehabilitation in practice: implementing and evaluating effective programs. London: Wiley; 2001. p. 149–66.Google Scholar
  29. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: a synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute; 2005. http://ctndisseminationlibrary.org/PDF/nirnmonograph.pdf. Accessed 5 June 2017.
  30. Gendreau P, Goggin C, Smith P. The forgotten issue in effective correctional treatment: program implementation. Int J Offender Ther Comp Criminol. 1999;43(2):180–7.  https://doi.org/10.1177/0306624X99432005.CrossRefGoogle Scholar
  31. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.  https://doi.org/10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;31(7):50.  https://doi.org/10.1186/1748-5908-7-50.CrossRefGoogle Scholar
  33. Haji FA, Da Silva C, Daigle DT, Dubrowski A. From bricks to buildings: adapting the Medical Research Council framework to develop programs of research in simulation education and training for the health professions. Simul Healthc. 2014;9(4):249–59.  https://doi.org/10.1097/SIH.0000000000000039.CrossRefPubMedGoogle Scholar
  34. Halle T, Zaslow M, Martinez-Beck I, Metz A. Applications of implementation science to early care and education programs and systems: implications for research, policy, and practice. In: Halle TG, Metz AJ, Martinez-Beck I, editors. Applying implementation science in early childhood programs and systems. Baltimore: Brookes Publishing; 2013. p. 295–314.Google Scholar
  35. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11:e33.  https://doi.org/10.1186/s13012-016-0398-2.CrossRefGoogle Scholar
  36. Kirkpatrick DL. Evaluating training programs: the four levels. 2nd ed. San Francisco: Berrett-Koehler Publishers; 1998.Google Scholar
  37. Kurashima Y, Hirano S. Systematic review of the implementation of simulation training in surgical residency curriculum. Surg Today. 2016;47:777.  https://doi.org/10.1007/s00595-016-1455-9.CrossRefPubMedGoogle Scholar
  38. MacRae HM, Satterthwaite L, Reznick RK. Setting up a surgical skills center. World J Surg. 2008;32(2):189–95.  https://doi.org/10.1007/s00268-007-9326-6.CrossRefPubMedGoogle Scholar
  39. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.  https://doi.org/10.1056/NEJMsa022615.CrossRefPubMedGoogle Scholar
  40. McMillen JC. Dissemination and implementation in social service settings. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and implementation research in health: translating science to practice. New York: Oxford University Press; 2012. p. 384–99.CrossRefGoogle Scholar
  41. Meyers D, Durlak J, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3-4):462–80.  https://doi.org/10.1007/s10464-012-9522-x.CrossRefPubMedGoogle Scholar
  42. Mittman B. Partnering for improvement across research, practice, and policy: the case of implementation research in health, presentation. Los Angeles: VA Greater Los Angeles Healthcare System; 2011. http://www.sbm.org/meeting/2011/presentations/thursday/Master%20Lecture%20-%20Brian%20Mittman.pdfGoogle Scholar
  43. MRC Health Services and Public Health Research Board. A framework for development and evaluation of RCTs for complex interventions to improve health. 2000. https://www.mrc.ac.uk/documents/pdf/rcts-for-complex-interventions-to-improve-health/. Accessed 14 June 2017.
  44. Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes G, Griffiths C, Rycroft-Malone J, Meissner P, Murray E, Patel A, Sheikh A, Taylor S. Standards for reporting implementation studies (StaRI) explanation and elaboration document. BMJ Open. 2017a;7(4):e013318.  https://doi.org/10.1136/bmjopen-2016-013318.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes G, Griffiths C, Rycroft-Malone J, Meissner P, Murray E, Patel A, Sheikh A, Taylor S. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017b;356:i6795.  https://doi.org/10.1136/bmj.i6795.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Admin Pol Ment Health. 2009;36(1):24–34.  https://doi.org/10.1007/s10488–008–0197–4.CrossRefGoogle Scholar
  47. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38(2):65–76.  https://doi.org/10.1007/s10488-010-0319-7.CrossRefGoogle Scholar
  48. Rabin BA, Glasgow RE, Kerner JF, Klump MP, Brownson RC. Dissemination and implementation research on community-based cancer prevention: a systematic review. Am J Prev Med. 2010;38(4):443–56.CrossRefPubMedGoogle Scholar
  49. Ridde V. Need for more and better implementation science in global health. BMJ Glob Health. 2016;1:e000115.  https://doi.org/10.1136/bmjgh-2016-000115.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Roussin CJ, Weinstock P. SimZones: an organizational innovation for simulation programs and centers. Acad Med. 2017;92(8):1114–20.  https://doi.org/10.1097/ACM.0000000000001746. [Epub ahead of print].CrossRefPubMedGoogle Scholar
  51. Rycroft-Malone J. The PARIHS framework—a framework for guiding the implementation of evidence-based practice. J Nurs Care Qual. 2004;19(4):297–304.  https://doi.org/10.1097/00001786-200410000-00002.CrossRefPubMedGoogle Scholar
  52. Saldana L, Chamberlain P, Wang W, Brown CH. Predicting program start-up using the stages of implementation measure. Admin Pol Ment Health. 2012;39(6):419–25.  https://doi.org/10.1007/s10488-011-0363-yCrossRefGoogle Scholar
  53. Stufflebeam DL. CIPP evaluation model checklist. 2007. http://dmeforpeace.org/sites/default/files/Stufflebeam_CIPP%20Evaluation%20Model%20CheCheckl.pdf. Accessed 14 June 2017.
  54. Tabak RG, Khoong EC, Chambers D, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–50.  https://doi.org/10.1016/j.amepre.2012.05.024.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Van Achterberg T, Schoonhoven L, Grol R. Nursing implementation science: how evidence-based nursing requires evidence-based implementation. J Nurs Scholarsh. 2008;40(4):302–10.  https://doi.org/10.1111/j.1547-5069.2008.00243.CrossRefPubMedGoogle Scholar
  56. Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res. 2015;17(11):e262.  https://doi.org/10.2196/jmir.5091.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery. 2007;141(4):442–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Raluca Dubrowski
    • 1
    • 2
  • Melanie Barwick
    • 1
    • 3
  • Adam Dubrowski
    • 4
  1. 1.Research Institute, Hospital for Sick ChildrenTorontoCanada
  2. 2.Faculty of ScienceMemorial University of NewfoundlandSt. John’sCanada
  3. 3.Department of Psychiatry and the Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  4. 4.Faculty of MedicineMemorial University of NewfoundlandSt. John’sCanada

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