Aliki Thomas

Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review

BackgroundUse of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals.MethodsSearches were conducted in six databases: Ovid MEDLINE (1948 – May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings.ResultsOf the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions.ConclusionsThis scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.

Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions

Health care professionals are expected to use a systematic approach based on evidence, professional reasoning and client preferences in order to improve client outcomes. In other words, they are expected to work within an evidence-based practice (EBP) context. This expectation has had an impact on occupational therapy academic programs’ mandates to prepare entry-level clinicians who demonstrate competence in the knowledge, skills and behaviors for the practice of evidence-based occupational therapy. If the EBP approach is to be entrenched in the day to day practice of future clinicians, a pedagogically sound approach would be to incorporate EBP in every aspect of the curriculum. This, however, would require a comprehensive understanding of EBP: its basis, the principles that underpin it and its effectiveness in promoting core professional competencies. The existing literature does not elucidate these details nor does it shed light on how requisite competencies for EBP are acquired in professional education in general and in occupational therapy education in particular. Drawing from educational psychology and EBP in the health professions, this paper provides a critical review of the evidence that supports EBP and the effectiveness of EBP teaching and assessment interventions in professional heath sciences programs and offers suggestions for the design of EBP instruction, grounding recommendations in educational theory for the health professions.

Knowledge translation in physical therapy: from theory to practice

Abstract Purpose: Knowledge translation (KT) has emerged as a concept that can lead to a greater utilization of evidence-based research in systems of care. Despite a rise in KT research, the literature on KT in relation to physical therapy practice is scarce. This article provides physical therapists (PTs) with recommendations that can support the effective implementation of new knowledge and scientific evidence in clinical practice. Method: Recommendations are grounded in the Ottawa Model of Research Use and in the literature in KT in the health professions. Results: A well-established KT process, which is supported by a planning model, is essential to guide the implementation of scientific evidence. Consensus among all stakeholders about what evidence will be implemented must be reached. Context-related barriers and facilitators should be assessed and tailored active and multi-component interventions should be considered. Participation from individuals in intermediary positions (e.g. opinion leaders) supports implementation of KT interventions. Monitoring of the process and assessment of intended outcomes should be performed in order to assess the success of the implementation. Conclusion: Five major recommendations grounded in the Ottawa model are provided that can assist PTs with the complex task of implementing new knowledge in their clinical practice. Implications for Rehabilitation In order to support EBP, knowledge translation interventions can be used to support best practice. Implementation of new knowledge should be guided by a framework or a conceptual model. Consensus on the evidence must be reached and assessment of context-related factors should be done prior to the implementation of any KT intervention. Intervention strategies should be active, multi-component and include individuals with intermediary positions that can facilitate the KT process.

Engaging stakeholders in rehabilitation research: a scoping review of strategies used in partnerships and evaluation of impacts

Abstract Purpose: To describe how stakeholder engagement has been undertaken and evaluated in rehabilitation research. Methods: A scoping review of the scientific literature using five search strategies. Quantitative and qualitative analyses using extracted data. Interpretation of results was iteratively discussed within the team, which included a parent stakeholder. Results: Searches identified 101 candidate papers; 28 were read in full to assess eligibility and 19 were included in the review. People with disabilities and their families were more frequently involved compared to other stakeholders. Stakeholders were often involved in planning and evaluating service delivery. A key issue was identifying stakeholders; strategies used to support their involvement included creating committees, organizing meetings, clarifying roles and offering training. Communication, power sharing and resources influenced how stakeholders could be engaged in the research. Perceived outcomes of stakeholder engagement included the creation of partnerships, facilitating the research process and the application of the results, and empowering stakeholders. Stakeholder engagement outcomes were rarely formally evaluated. Conclusions: There is a great interest in rehabilitation to engage stakeholders in the research process. However, further evidence is needed to identify effective strategies for meaningful stakeholder engagement that leads to more useful research that positively impacts practice. Implications for Rehabilitation Using several strategies to engage various stakeholders throughout the research process is thought to increase the quality of the research and the rehabilitation process by developing proposals and programs responding better to their needs. Engagement strategies need to be better reported and evaluated in the literature. Engagement facilitate uptake of research findings by increasing stakeholders’ awareness of the evidence, the resources available and their own ability to act upon a situation. Factors influencing opportunities for stakeholder engagement need to be better understood.

Changing clinicians' habits: Is this the hidden challenge to increasing best practices?

Purpose. The purpose of this article is to reflect on the concept of habit as an under-explored, but critically important factor that might help explain the lack of uptake of new, scientifically sound practices by rehabilitation clinicians. Method. The complexity relating to being a scholarly practitioner is first presented. The transtheoretical model of behaviour change, developed to better understand behaviour change such as stopping a ‘bad’ habit or implementing a ‘good’ one for health improvement purposes, is used to foster reflection on factors involved in uptake of best practices in rehabilitation. To illustrate simply the different scenarios relating to uptake of best practices, such as the use of a standardised tool over a home-grown one, two well known approaches to assessment (use of thermometer versus hand on forehead) that could be used to assess the same construct (body temperature) are contrasted. Results. As rehabilitation clinicians, we are potentially blocked in our uptake of best practices by our habits. Although habits are often comfortable, and change is less so, we need to move away from our comfort zone if we are to adopt best practices. Conclusions. Given the extensive literature suggesting that there are major gaps between best practice and actual practices, it behoves us to explore the impact of habits to a greater extent.

Teaching professionalism to first year medical students using video clips

Abstract Background: Medical schools are confronted with the challenge of teaching professionalism during medical training. The aim of this study was to examine medical students’ perceptions of using video clips as a beneficial teaching tool to learn professionalism and other aspects of physicianship. Methods: As part of the longitudinal Physician Apprenticeship course at McGill University, first year medical students viewed video clips from the television series ER. The study used qualitative description and thematic analysis to interpret responses to questionnaires, which explored the educational merits of this exercise. Results: Completed questionnaires were submitted by 112 students from 21 small groups. A major theme concerned the students’ perceptions of the utility of video clips as a teaching tool, and consisted of comments organized into 10 categories: “authenticity and believability”, “thought provoking”, “skills and approaches”, “setting”, “medium”, “level of training”, “mentorship”, “experiential learning”, “effectiveness” and “relevance to practice”. Another major theme reflected the qualities of physicianship portrayed in video clips, and included seven categories: “patient-centeredness”, “communication”, “physician-patient relationship”, “professionalism”, “ethical behavior”, “interprofessional practice” and “mentorship”. Conclusions: This study demonstrated that students perceived the value of using video clips from a television series as a means of teaching professionalism and other aspects of physicianship.

Evidence-based practice supports among Canadian occupational therapists

Background. Supports for evidence-based practice (EBP) and research utilization are needed for moving evidence into practice. Purpose. The purpose of this study was to identify the presence of individual and organizational EBP supports (based on a previous scoping review) and the attitudes toward the supports in a convenience sample of Canadian occupational therapists. Method. A cross-sectional survey was used to collect data from members of the Canadian Association of Occupational Therapists. Findings. Data from 368 clinicians (21%) indicated that although factors that have been shown to support EBP, such as student supervision and participation in research and mentoring, were not common practice, attitudes toward these EBP supports were positive. Implications. EBP supports, although viewed favourably by clinicians, have yet to be integrated fully into clinical practice. These findings provide researchers with an opportunity to design studies to support clinicians who view EBP in a positive light in integrating evidence into their practice. Description. Des mécanismes de soutien de la pratique fondée sur les données probantes (PFDP) et l’utilisation de la recherche sont requis pour appliquer ces faits dans la pratique. But. Le but de cette étude était d’identifier la présence de mécanismes de soutien individuels et organisationnels (à partir d’une recension précédente des écrits) et les attitudes face à ces mécanismes dans un échantillon de commodité composé d’ergothérapeutes canadiens. Méthologie. Une enquête transversale a été menée pour recueillir des données auprès d’ergothérapeutes membres de l’Association canadienne des ergothérapeutes. Résultats. Des données recueillies auprès de 368 cliniciens (21%) ont indiqué que bien que l’on considère que certains facteurs favorisant la PFDP—supervision des étudiants, et participation à des activités de recherche et de mentorat—n’étaient pas courants dans la pratique, les attitudes étaient positives face à ces mécanismes de soutien. Conséquences. Bien que les mécanismes de soutien de la PFDP soient accueillis favorablement par les cliniciens, ils ne sont pas encore intégrés pleinement dans la pratique clinique. Ces résultats offrent aux chercheurs la possibilité de concevoir des études pour appuyer les cliniciens qui ont une attitude positive face à la PFDP, afin qu’ils puissent intégrer des preuves scientifiques dans leur pratique.

Fast Tracking the Design of Theory-Based KT Interventions Through a Consensus Process

BackgroundDespite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.MethodsIndividual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.ResultsNine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients’ treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.ConclusionsA multifaceted KT educational intervention targeting chiropractors’ management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.

Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Purpose: This study attempted to capture the evidence-based practice (EBP) behaviours of expert occupational therapy (OT) clinicians in order to develop a reference model of EBP in falls prevention. Methods: Expert clinicians participated in the creation of a clinical vignette through focus group discussions. Using the vignette as the stimulus case, the same clinicians answered questions that reflected the EBP process. Validation of original responses and data synthesis occurred through a second focus group. This validation process resulted in the elaboration of a tree structure EBP decision model. Results: Findings show that clinicians are not expert evidence-based practitioners. Although some of the experts’ clinical decisions were based on a combination of professional experience and research evidence, clinicians relied primarily on clinical experience for more complex aspects of decision-making. When explicitly instructed to answer questions corresponding to the five EBP steps, experts were compelled to think about the use of evidence and could proceed through the EBP process. Conclusions: The model represents the expert clinical decisions in each of the EBP steps and illustrates what aspects of the decision-making process are in line with EBP versus aspects that are driven primarily by experience. This research has the potential to assist clinicians working in prevention of falls in geriatric rehabilitation who can use the model as a practice framework to guide them through the EBP process. Implications for Rehabilitation Experienced clinicians can proceed through the steps of the evidence-based practice process with guidance and scaffolding. Clinical experience is a major factor in decision-making in falls prevention. Models of expert performance provide useful insights into decision-making outcomes and evidence-based practise behaviours of experienced clinicians in falls prevention.

Candidates’ and Interviewers’ Perceptions of Multiple-Mini Interviews for Admission to an Occupational Therapy Professional Program

ABSTRACT Multiple-Mini Interviews (MMIs) were used to assess professional attributes of candidates seeking admission to an occupational therapy professional entry-level masters program. Candidates and interviewers were invited to complete a questionnaire comprised of quantitative and open-ended questions following the MMIs. The MMIs were perceived to be fair, enjoyable, and capable of capturing professional attributes. Descriptive analysis of candidates’ data revealed perceptions regarding logistics, interview station content, process, and interviewers. Interviewers commented on the positive and challenging aspects of the scenarios and the MMI process. Admissions committees need to consider several logistical, content, and process issues when designing and implementing MMIs as a selection tool.