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      Building and executing a research agenda toward conducting implementation science in medical education

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          Abstract

          Background

          Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education.

          Approach

          We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care.

          Perspectives

          IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings.

          Conclusions

          IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely.

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          Most cited references20

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          What’s in a mechanism? Development of a key concept in realist evaluation

          Background The idea that underlying, generative mechanisms give rise to causal regularities has become a guiding principle across many social and natural science disciplines. A specific form of this enquiry, realist evaluation is gaining momentum in the evaluation of complex social interventions. It focuses on ‘what works, how, in which conditions and for whom’ using context, mechanism and outcome configurations as opposed to asking whether an intervention ‘works’. Realist evaluation can be difficult to codify and requires considerable researcher reflection and creativity. As such there is often confusion when operationalising the method in practice. This article aims to clarify and further develop the concept of mechanism in realist evaluation and in doing so aid the learning of those operationalising the methodology. Discussion Using a social science illustration, we argue that disaggregating the concept of mechanism into its constituent parts helps to understand the difference between the resources offered by the intervention and the ways in which this changes the reasoning of participants. This in turn helps to distinguish between a context and mechanism. The notion of mechanisms ‘firing’ in social science research is explored, with discussions surrounding how this may stifle researchers’ realist thinking. We underline the importance of conceptualising mechanisms as operating on a continuum, rather than as an ‘on/off’ switch. Summary The discussions in this article will hopefully progress and operationalise realist methods. This development is likely to occur due to the infancy of the methodology and its recent increased profile and use in social science research. The arguments we present have been tested and are explained throughout the article using a social science illustration, evidencing their usability and value.
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              Theoretical perspectives in medical education: past experience and future possibilities.

              Pedagogical practices reflect theoretical perspectives and beliefs that people hold about learning. Perspectives on learning are important because they influence almost all decisions about curriculum, teaching and assessment. Since Flexner's 1910 report on medical education, significant changes in perspective have been evident. Yet calls for major reform of medical education may require a broader conceptualisation of the educational process. Medical education has emerged as a complex transformative process of socialisation into the culture and profession of medicine. Theory and research, in medical education and other fields, have contributed important understanding. Learning theories arising from behaviourist, cognitivist, humanist and social learning traditions have guided improvements in curriculum design and instruction, understanding of memory, expertise and clinical decision making, and self-directed learning approaches. Although these remain useful, additional perspectives which recognise the complexity of education that effectively fosters the development of knowledge, skills and professional identity are needed. Socio-cultural learning theories, particularly situated learning, and communities of practice offer a useful theoretical perspective. They view learning as intimately tied to context and occurring through participation and active engagement in the activities of the community. Legitimate peripheral participation describes learners' entry into the community. As learners gain skill, they assume more responsibility and move more centrally. The community, and the people and artefacts within it, are all resources for learning. Learning is both collective and individual. Social cognitive theory offers a complementary perspective on individual learning. Situated learning allows the incorporation of other learning perspectives and includes workplace learning and experiential learning. Viewing medical education through the lens of situated learning suggests teaching and learning approaches that maximise participation and build on community processes to enhance both collective and individual learning. © Blackwell Publishing Ltd 2010.

                Author and article information

                Journal
                Med Educ Online
                Med Educ Online
                MEO
                Medical Education Online
                Co-Action Publishing
                1087-2981
                25 August 2016
                2016
                : 21
                : 10.3402/meo.v21.32405
                Affiliations
                [1 ]Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
                [2 ]Department of Public Health & Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
                [3 ]Department of Medicine, Augusta University/University of Georgia Medical Partnership, Athens, GA, USA
                [4 ]School of Medicine, University of Louisville, Louisville, KY, USA
                [5 ]Department of Pediatrics, Oregon Health & Science University School of Medicine, Portland, OR, USA
                [6 ]Department of Surgery, Carolinas Healthcare System, Charlotte, NC, USA
                [7 ]Department of Family Medicine, College of Medicine, University of Vermont, Burlington, VT, USA
                [8 ]American Board of Medical Specialties Research and Education Foundation, Chicago, IL, USA
                [9 ]Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA
                [10 ]Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
                [11 ]Department of Psychology, University of North Carolina, Charlotte, NC, USA
                [12 ]Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
                Author notes
                [* ]Correspondence to: Patricia A. Carney, Department of Family Medicine, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA, Email: carneyp@ 123456ohsu.edu
                Article
                32405
                10.3402/meo.v21.32405
                5002033
                27565131
                2aa488ba-beb7-4463-a048-46465b8609d2
                © 2016 Patricia A. Carney et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

                History
                : 26 May 2016
                : 25 July 2016
                : 25 July 2016
                Categories
                Research Article

                Education
                best educational practices,curriculum development,team-based care,educational research,undergraduate/graduate medical education

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