Peer-assisted learning in medical school: tutees' perspective

PURPOSE

Peer tutoring offers a valuable method of enhancing students' learning experience in medical school. Junior students learn from senior peers to reinforce curriculum content in an engaging community environment. The aim of our study was to assess tutees' perceptions of a formal peer tutoring program at the Central Clinical School of Sydney Medical School. We used the learning theory of the community of practice in order to understand tutees' perspectives.

PATIENTS AND METHODS

All Year 1 and Year 2 students within the Central Clinical School were invited to be tutored by Year 3 and Year 4 students, respectively. Tutor pairs taught a group of three to four tutees fortnightly, and the tutorials were largely clinically based. A questionnaire containing 13 closed items and four open-ended questions regarding their experiences in the program was distributed to the tutees. Descriptive statistics were used to analyze the data.

RESULTS

A total of 66 of 101 (65%) Year 1 and Year 2 students took part as tutees and 42 of 106 (40%) students as tutors. The tutees' response rate was 53% (35/66). Results were largely positive, with 97% of the tutees enjoying the program, 90% showing interest in tutorial topics, 91% feeling a sense of community, 100% wanting to take part next year, 97% finding small groups effective, and 97% and 91% feeling an improved understanding of medical concepts and clinical skills, respectively. Tutees perceived the most useful aspects to be learning and revision and advice from experienced peers. The most frequent suggestion for improvement was to resolve scheduling conflicts.

CONCLUSION

Tutees found the peer tutoring program to be valuable in learning and revision, establishing a community, and gaining practical skills and advice through a small-group format. The community of practice framework was useful in identifying these areas of benefit, demonstrating that a peer tutoring program such as this can provide an enhanced learning environment for tutees.

Participants' perception of a unique community of practice for substance abuse education in the Caribbean

BACKGROUND

Substance abuse is a significant public health challenge in the Caribbean. It is important that health and allied professionals be adequately trained in this field. The Caribbean Institute on Alcoholism and other Drug Problems (CARIAD) was established to provide new knowledge and share successful best practices in substance abuse in the Caribbean. CARIAD brings together diverse participants from throughout the region in a structured community of practice and emphasizes local knowledge formation. This paper evaluates the acceptability and perceived impact of CARIAD to/on participants.

METHODS

The authors analyzed anonymous written evaluations of 458 CARIAD participants completed immediately after the program in 2003-2012. Questionnaires collected quantitative data on the acceptability of the program in meeting the learning needs of participants. Perception of program acceptability and impact on the participant were also obtained from descriptive content analysis of qualitative data obtained through open-ended questions. A 2013 online follow-up survey collected data about the utilization and dissemination of knowledge acquired at CARIAD from 141 graduates of the same period. Data analysis employed basic descriptive statistics and qualitative content analysis.

RESULTS

Participant evaluation immediately following CARIAD showed a high level of satisfaction with the organization, structure, content, and usefulness of the program. Participants valued the program's cultural relevance and the opportunity for networking and collaboration. They expressed a collective solidarity, and empowerment to address substance abuse problems. Participants reported that CARIAD had impacted positively on their professional practice and facilitated knowledge transfer to colleagues and communities.

CONCLUSION

CARIAD is perceived as an effective community of practice, producing a network of graduates who use the acquired knowledge, skills, and motivation to lead in the field of substance abuse in the Caribbean. This process of learning can be recommended to countries where research is not prioritized and evidence-driven interventions are not always available.

"Men's health--a little in the shadow": a formative evaluation of medical curriculum enhancement with men's health teaching and learning

BACKGROUND

Enhancing a medical school curriculum with new men's health teaching and learning requires an understanding of the local capacity and the facilitators and barriers to implementing new content, and an approach that accommodates the systemic and cultural differences between medical schools.

METHODS

A formative evaluation was undertaken to determine the perspectives of key informants (academics, curriculum developers) from four Australian medical schools about the strategies needed to enhance their curriculum with men's health teaching and learning. Through semi-structured questioning with 17 key informants, interviewees also described the contextual barriers and facilitators to incorporating new topic areas into existing curriculum. Interviews were recorded with consent, transcribed verbatim, and analysed by two researchers to identify key themes.

RESULTS

Interviewees were enthusiastic about incorporating men's health content through a men's health curriculum framework but highlighted the need for systems to assist in identifying gaps in their current curriculum where the men's health topics could be integrated. The student experience was identified as a key driver for men's health teaching and learning. Furthermore, core men's health clinical outcomes needed to be defined and topic areas vertically integrated across the curricula. This would ensure that students were appropriately equipped with the skills and knowledge for subsequent clinical practice in a range of geographical settings. Interviewees consistently suggested that the best implementation strategy is to have someone 'on the ground' to work directly with medical school staff and champion the men's health discipline. Providing mechanisms for sharing knowledge and resources across medical schools was highlighted to facilitate implementation, particularly for those medical schools with limited men's health teaching resources.

CONCLUSIONS

Despite the unanimous support for men's health teaching and learning, the evaluation highlighted that the student experience must be recognised as paramount when integrating new topic areas into an already packed curriculum. A community of practice, where medical schools share relevant resources and knowledge, could help to ensure a commonality of student experience with respect to men's health learning in medical schools across different geographical settings and with different levels of resourcing. Such an approach could also be adapted to other areas of curriculum enhancement.

Facilitating the development of professional identity through peer assisted learning in medical education

Peer assisted learning (PAL) is well documented in the medical education literature. In this paper, the authors explored the role of PAL in a graduate entry medical program with respect to the development of professional identity. The paper draws on several publications of PAL from one medical school, but here uses the theoretical notion of legitimate peripheral participation in a medical school community of practice to shed light on learning through participation. As medical educators, the authors were particularly interested in the development of educational expertise in medical students, and the social constructs that facilitate this academic development.

The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya

PURPOSE

In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya.

METHOD

The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention--a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention.

RESULTS

In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice.

CONCLUSIONS

Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments. Implications for Rehabilitation The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life. Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments. Providing access to assistive technology early and consistently throughout students' schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

Blended learning in situated contexts: 3-year evaluation of an online peer review project

BACKGROUND

Situated and sociocultural perspectives on learning indicate that the design of complex tasks supported by educational technologies holds potential for dental education in moving novices towards closer approximation of the clinical outcomes of their expert mentors. A cross-faculty-, student-centred, web-based project in operative dentistry was established within the Universitas 21 (U21) network of higher education institutions to support university goals for internationalisation in clinical learning by enabling distributed interactions across sites and institutions. This paper aims to present evaluation of one dental faculty's project experience of curriculum redesign for deeper student learning.

METHODS

A mixed-method case study approach was utilised. Three cohorts of second-year students from a 5-year bachelor of dental surgery (BDS) programme were invited to participate in annual surveys and focus group interviews on project completion. Survey data were analysed for differences between years using multivariate logistical regression analysis. Thematic analysis of questionnaire open responses and interview transcripts was conducted.

RESULTS

Multivariate logistic regression analysis noted significant differences across items over time indicating learning improvements, attainment of university aims and the positive influence of redesign. Students perceived the enquiry-based project as stimulating and motivating, and building confidence in operative techniques. Institutional goals for greater understanding of others and lifelong learning showed improvement over time. Despite positive scores, students indicated global citizenship and intercultural understanding were conceptually challenging.

CONCLUSIONS

Establishment of online student learning communities through a blended approach to learning stimulated motivation and intellectual engagement, thereby supporting a situated approach to cognition. Sociocultural perspectives indicate that novice-expert interactions supported student development of professional identities.

Surgical journal club as a community of practice: a case study

BACKGROUND

Journal club has become a signature pedagogy in postgraduate medical education. In this article, social learning theory, through the lens of "communities of practice" (CoP), is applied to elucidate the process of learning in journal club.

MATERIALS AND METHODS

The study is a case study of a surgical journal club. Video recordings of 2 journal club sessions were followed by semistructured audio-recorded interviews with a sample of journal club participants. Thematic content analysis was performed, mapping data to themes arising based on the key tenets of CoP.

RESULTS

Features of the 4 tenets of CoP learning (community, meaning, identity, and practice) were identified in both the video recordings of journal club and the participant interviews. A shared enterprise and common sense of purpose (community) was seen throughout the video recordings, but feelings of belonging to the community were much stronger for senior members (consultants/attending staff and senior trainees) compared with junior members (junior trainees and students). Experiences and perspectives were more commonly exchanged between senior trainees and consultants, with junior trainees not partaking in discussions, an example of newcomers beginning at the periphery. The main impediment to learning was found with low senior member attendance at journal club, thus limiting access to narratives of senior experience of practice and feedback.

CONCLUSIONS

In attempting to improve journal club design for learning, ensuring the participation of senior community members and thus access to narratives of experience along with active engagement of junior members to allow them develop their own meaning should be incorporated into the journal club design.

Implementing a virtual community of practice for family physician training: a mixed-methods case study

Background

GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation.

Objective

The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation.

Methods

The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation.

Results

Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%).

Conclusions

The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.

Improving integrated care: modelling the performance of an online community of practice

INTRODUCTION

THIS ARTICLE AIMS TO CONFIRM THE FOLLOWING CORE HYPOTHESIS: a Community of Practice's use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated.

METHODS

An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses.

RESULTS

It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use.

CONCLUSIONS

The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.

Co-researching with people who have intellectual disabilities: insights from a national survey

BACKGROUND

Inclusive research with people with intellectual disabilities is growing internationally but with few studies examining its feasibility.

METHODS

In undertaking a national study exploring what life was like in Ireland for people with intellectual disabilities, a community of practice was developed involving a core group of co-researchers: five people with intellectual disabilities, four university researchers and three service support staff. An additional cadre of 15 co-researchers with intellectual disabilities was recruited to undertake data gathering and analysis with 23 focus groups involving 168 participants. The research experience was documented through oral feedback, progress reports, minutes and a project review.

RESULTS AND CONCLUSIONS

The key learning is documented arising from the setting up of an inclusive advisory group and implementation of each of six research steps. The study demonstrates feasibility and the added value of university co-researchers recruiting and developing skills together with co-researchers with intellectual disabilities. Topics for further research and development are identified. This paper tells you about how people with intellectual disabilities worked with a group of university researchers. Both groups were called co-researchers and together they ran 23 focus groups across Ireland. People with intellectual disabilities talked about their lives and what could make them better. They said they needed to have a good place to live; a job; enough money; relationships; and acceptance as respected citizens. The university co-researchers wrote about what it was like doing research together and how people with intellectual disabilities joined the advisory group; decided on the questions; ran focus groups; and presented findings. Together they grew into a community of researchers where the university co-researchers shared their research skills and people with intellectual disabilities shared what it was like living with a disability. They both saw great value in working together and plan to work more to make this type of research happen.

The influence of a professional physician network on clinical decision making

OBJECTIVE

The aim of this study was to examine the role of physicians' professional networks in decision-making processes.

METHODS

A professional network was examined in three stages: content analysis and categorization of discussions concerning decision-making processes, in-depth interviews, and a questionnaire.

RESULTS

The RAMBAM network has professional as well as social roles. On a professional level, physicians seek approval of their initial line of reasoning regarding their clinical cases, but will consider other approaches if such are suggested by persons of professional repute or if answers are based on evidence-based medicine and include referral to a relevant source. On a social level, physicians want to be part of their professional community and share information and experiences.

CONCLUSION

Physicians' professional networks have a social role that is expressed by a feeling of belonging to a community, as well as a professional role of capturing and disseminating medical knowledge during physicians' decision-making processes. Professional networks constitute a unique source of tacit knowledge that extends existing formal knowledge resources.

PRACTICE IMPLICATIONS

The study can increase physicians' awareness of professional networks as a unique source of tacit knowledge and can assist in the future design of medical professional networks as knowledge resources for medical decision making.

Adapting a community of practice model to design an innovative ethics curriculum in healthcare

The focus of healthcare ethics within the framework of ethical principles and philosophical foundations has always, in recent times, been the community, namely, the healthcare provider, the patient or, in research, the study participant. An initiative is thus described whereby a community of practice (CoP) model was developed around health ethics in health research, education and clinical care. The ethics curriculum was redesigned to include several components that are integrated and all embracing, namely, health research ethics, healthcare ethics, health personnel education in ethics and global and public health ethics. A CoP is a group who share a common interest and a desire to learn from and contribute to the community with their variety of experiences. The CoP is dynamic and organic, generating knowledge that can be translated into effective healthcare delivery and ethical research. It requires the collaboration and social presence of active participants such as community members, healthcare professionals and educators, ethicists and policy makers to benefit the community by developing approaches that adapt to and resonate with the community and its healthcare needs. Philosophical principles constitute the foundation or underpinning of this innovative curriculum. Recommendations are presented that will continue to guide the consolidation and sustainability of the CoP.

Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice

Background

Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training.

Objective

This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable.

Methods

A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia’s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4).

Results

Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network.

Conclusions

General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.

Poison Center Data for Public Health Surveillance: Poison Center and Public Health Perspectives

Objective

To describe the use of poison center data for public health surveillance from the poison center, local, state, and federal public health perspectives and to generate meaningful discussion on how to address the challenges to collaboration.

Introduction

Since 2008, poisoning has become the leading cause of injury-related death in the United States (US); since 1980, the poisoning-related fatality rate in the US has almost tripled.1 Many poison-related injuries and deaths are reported to regional poison centers (PCs) which receive about 2.4 million reports of human chemical and poison exposures annually.2 Federal, state, and local public health (PH) agencies often collaborate with poison centers and use PC data for public health surveillance of poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, CDC conducts public health surveillance for exposures and illnesses of public health significance using the National Poison Data System (NPDS), the national PC reporting database.

Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs has been hindered by numerous challenges. To address these challenges and bolster collaboration, the Poison Center and Public Health Collaborations Community of Practice (CoP) was created in 2010 by CDC as a means to share experiences, identify best practices, and facilitate relationships among federal, state and local public health agencies and PCs. To date, the Poison Center and Public Health Collaborations CoP includes over 200 members from state and local public health, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the Environmental Protection Agency (EPA). A leadership team was created with representatives of the many stakeholders of the community to drive its direction and oversee activities.

Methods

The panel will consist of 4 presenters and 1 moderator, who are members of the Poison Center and Public Health Collaborations CoP leadership team. Each presenter will bring a unique perspective of the use of PC data for PH practice and surveillance: CDC, state department of health, a local department of health, and a PC. Royal Law from the CDC National Center for Environmental Health will present on using PC data for identification of exposures and illnesses of public health significance identified from NPDS data collected from all 57 PCs. Dr. Jay Schauben from the Florida/USVI Poison Information Center - Jacksonville will discuss PC participation in surveillance and use of PC data for tracking and mitigation of PH events in Florida. Dr. Prakash Mulay from the Florida Department of Health will discuss utilization of PC data to enhance ESSENCE-based chemical-associated exposure and illness surveillance in Florida. Katherine Wheeler from the New York City (NYC) Department of Health and Mental Hygiene will discuss NYC’s use of PC data in surveillance of potential emerging issues, from energy drinks to synthetic marijuana. Each presenter will discuss the use of PC data for PH practice and surveillance in his or her organization and jurisdiction, the successes of using PC data, and their challenges.

Results

The moderator will engage the audience by facilitating discussion of the successes and challenges to using PC data for PH practice and surveillance with the audience.

Sample questions:

What are your current capacities and collaborative activities between your state/local health department and your poison center?

What non-funding related barriers hinder the collaboration between your state/local health department and poison center?

If more funding were available, how would you use this funding to increase the level of interactivity with the poison center and state/local health department?

Accelerating adaptation of natural resource management to address climate change

Natural resource managers are seeking tools to help them address current and future effects of climate change. We present a model for collaborative planning aimed at identifying ways to adapt management actions to address the effects of climate change in landscapes that cross public and private jurisdictional boundaries. The Southwest Climate Change Initiative (SWCCI) piloted the Adaptation for Conservation Targets (ACT) planning approach at workshops in 4 southwestern U.S. landscapes. This planning approach successfully increased participants' self-reported capacity to address climate change by providing them with a better understanding of potential effects and guiding the identification of solutions. The workshops fostered cross-jurisdictional and multidisciplinary dialogue on climate change through active participation of scientists and managers in assessing climate change effects, discussing the implications of those effects for determining management goals and activities, and cultivating opportunities for regional coordination on adaptation of management plans. Facilitated application of the ACT framework advanced group discussions beyond assessing effects to devising options to mitigate the effects of climate change on specific species, ecological functions, and ecosystems. Participants addressed uncertainty about future conditions by considering more than one climate-change scenario. They outlined opportunities and identified next steps for implementing several actions, and local partnerships have begun implementing actions and conducting additional planning. Continued investment in adaptation of management plans and actions to address the effects of climate change in the southwestern United States and extension of the approaches used in this project to additional landscapes are needed if biological diversity and ecosystem services are to be maintained in a rapidly changing world.

A community of practice for knowledge translation trainees: an innovative approach for learning and collaboration

A growing number of researchers and trainees identify knowledge translation (KT) as their field of study or practice. Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. The Knowledge Translation Trainee Collaborative is a trainee-initiated and trainee-led community of practice established by junior knowledge translation researchers and practitioners to: examine the diversity of knowledge translation research and practice, build networks with other knowledge translation trainees, and advance the field through knowledge generation activities. In this article, we describe how the collaborative serves as an innovative community of practice for continuing education and professional development in knowledge translation and present a logic model that provides a framework for designing an evaluation of its impact as a community of practice. The expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members' competencies (eg, combination of skills, abilities, and knowledge) in knowledge translation research and practice and contribute to the development and advancement of the knowledge translation field.

Mapping the informal science education landscape: An exploratory study

This study investigated the informal science education (ISE) field to determine whether it currently functions as an effective community of practice. Research questions included: How do professionals describe and self-identify their practice, including what missions, goals and motivating factors influence their professional work? What challenges do they face and how are these resolved? Is participation in ISE activities perceived as core or peripheral to their work? Open-ended interviews were conducted with high-level representatives of 17 different ISE sub-communities; results were analyzed qualitatively. Findings showed this broad assortment of ISE sub-communities as not currently functioning as a cohesive community of practice. Although examples of shared practice and ways of talking were found, evidence of widespread, active relationship-building over time and coalescence around issues of common concern were absent. A current "map" of the ISE community is proposed and thoughts about how this map could alter in the future are suggested.

Building a multi-institutional community of practice to foster assessment

This paper discusses the development of a multi-institutional community of practice that formed over 5 years. This community of practice was intentionally designed to support the evolution of student learning and programmatic assessment within member colleges and schools. Critical phases to the community's development are outlined, as well as its mission and goals. In addition, the community's contributions to faculty development and the scholarship of assessment are detailed. Success factors are discussed to assist others who may wish to initiate assessment-related collaborations across institutional borders. The community's vision for the future is also outlined.

Knowledge translation in audiology: promoting the clinical application of best evidence

The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced.

Partnered evaluation of a community engagement intervention: use of a kickoff conference in a randomized trial for depression care improvement in underserved communities

Community partnered research and engagement strategies are gaining recognition as innovative approaches to improving health care systems and reducing health disparities in underserved communities. These strategies may have particular relevance for mental health interventions in low income, minority communities in which there often is stigma and silence surrounding conditions such as depression and difficulty in implementing improved access and quality of care. At the same time, there is a relative dearth of evidence on the effectiveness of specific community engagement interventions and on the design, process, and context of these interventions necessary for understanding their implementation and generalizability. This article evaluates one of a number of community engagement strategies employed in the Community Partners in Care (CPIC) study, the first randomized controlled trial of the role of community engagement in adapting and implementing evidence-based depression care. We specifically describe the unique goals and features of a community engagement kickoff conference as used in CPIC and provide evidence on the effectiveness of this type of intervention by analyzing its impact on: 1) stimulating a dialog sense of collective efficacy, and opportunities for learning and networking to address depression and depression care in the community; 2) activating interest and participation in CPIC's randomized trial of two different ways to implement evidence-based quality improvement programs for depression across diverse community agencies; and 3) introducing evidence-based toolkits and collaborative care models to potential participants in both intervention conditions and other community members. We evaluated the effectiveness of the conference through a community-partnered process in which both community and academic project members were involved in study design, data collection and analysis. Data sources include participant conference evaluation forms (n = 187 over two conferences; response rate 59%) and qualitative observation field notes of each conference session. Mixed methods for the analysis consist of descriptive statistics of conference evaluation form ratings, as well as thematic analysis of evaluation form write-in comments and qualitative observation notes. Results indicate the effectiveness of this type of event for each of the three main goals, and provide insights into intervention implementation and use of similar community engagement strategies for other studies.

Learning and caring in communities of practice: using relationships and collective learning to improve primary care for patients with multimorbidity

We introduce a primary care practice model for caring for patients with multimorbidity. Primary care for these patients requires flexibility and ongoing coordination, and it often must be tailored to individual circumstances. Such complex and flexible care could be accomplished within communities of practice, whose participants are willing to learn from their shared practice, further each other's goals, share their stories of success and failure, and promote the continued evolution of collective learning. Primary care in these communities would be conceived as a complex adaptive process in which the participants use an iterative approach to care improvement that integrates what they learn and do collectively over time. Clinicians in these communities would define common goals, cocreate care plans, and engage in reflective case-based learning. As community members manage their knowledge, gain insights, and develop new care strategies, they can improve care for patients with multiple conditions. Using a mix of methods, future research should explore the conditions that are necessary for collective learning within communities of clinicians who care for patients with multimorbidity and who develop new knowledge in practice. By understanding these conditions, we can foster the development of collective learning and improve primary care for these patients.

Getting to uptake: do communities of practice support the implementation of evidence-based practice?

INTRODUCTION

Practitioners are increasingly encouraged to adopt evidence-based practices (EBP) leading to a need for new knowledge translation strategies to support implementation and practice change. This study examined the benefits of a community of practice in the context of Ontario's children's mental health sector where organizations are mandated to adopt a standardized outcome measure to monitor client response to treatment.

METHOD

Readiness for change, practice change, content knowledge, and satisfaction with and use of implementation supports were examined among practitioners newly trained on the measure who were randomly assigned to a community of practice (CoP) or a practice as usual (PaU) group. CoP practitioners attended 6 sessions over 12 months; PaU practitioners had access to usual implementation supports.

RESULTS

Groups did not differ on readiness for change or reported practice change, although CoP participants demonstrated greater use of the tool in practice, better content knowledge and were more satisfied with implementation supports than PaU participants.

CONCLUSION

CoPs present a promising model for translating EBP knowledge and promoting practice change in children's mental health that requires further study.