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| MEDICAL EDUCATION |
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| Year : 2019 | Volume
: 7
| Issue : 2 | Page : 273-276 |
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Translating research and evidence into practice: Understanding the influencing factors
Elizabeth M Wooster
Higher Education, Ontario Institute for Studies in Education, University of Toronto, Ontario, Canada
| Date of Submission | 06-Dec-2019 |
| Date of Decision | 09-Dec-2019 |
| Date of Acceptance | 10-Dec-2019 |
| Date of Web Publication | 16-Dec-2019 |
Correspondence Address:
Dr. Elizabeth M Wooster
Ontario Institute for Studies in Education, University of Toronto, Ontario
Canada
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/amhs.amhs_166_19
As the education continuum moves toward a competency-based format, there is also a movement toward the need to translate research and evidence into clinical and academic practice. While there has been much written about the theoretical basis of knowledge translation, significantly less exists about the practical aspects surrounding this. This article will examine the practical and theoretical basis for using research and evidence to inform clinical and academic practice. It will begin by developing a working definition of research, evidence, and practice. Theoretical basis and its role in translation will then be discussed. The article will finish by discussing practical tips for implementing research and evidence into practice.
Keywords: Evidence-based practice, influencing factors, knowledge translation
How to cite this article:
Wooster EM. Translating research and evidence into practice: Understanding the influencing factors. Arch Med Health Sci 2019;7:273-6 |
| Introduction | |  |
As the medical education continuum moves toward promotion and completion based on the achievement of skills rather than time spent on the task, there is a greater importance being placed on the role and implementation of research and evidence into clinical and academic practice.
To fully understand how to implement and put research into practice, there are certain terms that must be understood. The terms “research,” “evidence,” and “practice” are often used without stating the definitions or being clear about how the terms are being used. For the purpose of this article, the following definitions will be used. Research will be defined as “the detailed study of a subject, especially in order to discover information or reach a new understanding.”[1] The reason for using this definition is to emphasize the fact that research does not have to be limited to a specific methodology or theoretical construct. Evidence will be defined as “the available body of facts or information indicating whether a belief or proposition is true or valid.”[2] Practice will be defined as “the actual application or use of an idea, belief, or method, as opposed to theories relating to it.”[3]
Explicitly defining these terms prior to beginning the discussion surrounding their application is important for two main reasons. First, it removes any ambiguity that may be inherent in a discussion of this nature. Second, by using broader definitions of these terms, it allows the discussions to be expanded to include aspects that may not be included in discussions that involve more narrow definitions or lack of definitions. Removing the ambiguity and utilizing broader definitions provides the opportunity to thoroughly discuss all aspects of implementing research and evidence into practice.
Furthermore, in the past decade, there has been a push toward grounding medical education and medical education research in theory and using theoretical frameworks to support understanding and aid in implementation.[4],[5],[6] In their 2010 article, Bunniss and Kelly discuss the importance of understanding the assumptions related to specific research methodologies and how these assumptions influence the data collection and representation that follow their use.[5] They further elucidate four major paradigms that currently exist in medical education research. They define paradigms as “sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines.”[5] The four paradigms they describe are positivism, postpositivism, interpretivism, and critical theory. Bunniss and Kelly do not claim that one paradigm is superior to another; in fact, they state that “each research paradigm generates valuable informing information.”[5]
As with the exercise of defining the key terms at the beginning of this article, the definition and understanding of the paradigm on which the research (clinical or medical education) is based is essential. Each paradigm has specific assumptions related to it concerning ontology (the nature of reality), epistemology (the nature of knowledge), methodology (the nature of research), and the methods used.[5] In order to be able to apply the knowledge that is generated by the specific research and the evidence that is gained from this research, it is necessary to have a solid understanding of the underpinnings of each paradigm. When a specific paradigm is not explicitly stated in an article, report, or suggested a process, it is often possible to determine which is being used by examining the methodology and methods used. Terminology and phrasing used to describe discussions and conclusions can also be used to decide the underlying paradigm.
| Discussion | | |
In terms of applying research and evidence to clinical and medical education practice, there are several elements that are important to consider (in addition to understanding the definition of terms and understanding of paradigms). These include the role of context, matching approaches to context, developing a team approach, and gaining buy-in. These are not the only factors involved with the application of research and evidence to practice and are not necessarily undertaken in a linear fashion, and they are the factors that tend to be the most influential in successfully implementing evidence into practice.
Role of context
The concept of context is one that can be examined at a micro-, meso-, or macrolevel. It is important to understand the levels that will impact the evidence that is attempting to be implemented in each specific case. The implementation of the same set of research or evidence may vary greatly when considering the context from a micro-, meso-, or macrolevel. In terms of context, the microlevel would involve understanding the needs and applications of the individual health care practitioner or trainee, the meso involves understanding the needs and applications of the system or team, and macro involves understanding the large or national players.[7] In their 2019 article, Wooster and Maniate describe these levels as they relate to managing uncertainty and change.[8] Some of the concepts that are described in that article also apply to the idea of context.
Micro context relates to those factors that involve or influence the individual practitioner or trainee. These may be related to work-based factors, individual factors, or preexisting factors.[7] Each plays a different degree of influence on the individual and should be understood to be able to reach a greater understanding of the impact and uptake of evidence and research. While this may appear to be time consuming, often there are micro context factors that occur for more than one individual.
Meso context refers to those factors that influence the understanding of the system or team.[7] Systems and teams can vary in size and complexity and understanding how these are defined is important to the success of the uptake of the evidence or research in question. For example, if the meso context is defined as the team or department within a hospital or university that may have significantly different implications, then the meso context is defined at a system level and concerns factors that influence the hospital or university.
Macro context refers to the understanding of the large, national, or transnational players and constructs.[7] This level of contextual factors is usually easier to define as it is often defined by external constructs. Some types of factors or players are national specialty and accrediting societies, national governments, and governmental agencies. It is important to understand the factors influencing and defining the context for these players as their reach is extensive and while the constructs may not be the same as those influencing the meso- or microlevel, the decisions made at this level will have an impact on the other two levels.
To understand the context at each of these levels, care must be taken to choose the correct method to gain the necessary information. For example, when considering the microlevel, one-on-one discussions and interviews with multiple stakeholders may be appropriate, whereas at the macro level, it may be difficult or time constrained to use this same approach. In that case, information can be gained by reviewing strategic plans and other high-level documents. While these will not provide as rich and detailed information as the one-on-one discussions, it may be the best way to gain a wealth of knowledge. If more detailed information is necessary, key informant interviews may be the correct approach to take.
Matching approaches to context
As stated above, understanding context is essential when it comes to the application of evidence and research to practice. There are two main areas where the modification of findings may be important. The first is in the approach taken to deliver the information to those targeted to uptake the information. The second is the application of the findings themselves.
A 2010 report released by the Institute of Medicine states that the systematic and timely delivery of information, accompanied by supporting Continuing Professional Development (CPD), is essential in the application of practice guidelines to current practice.[9] A strong understanding of the context is essential to be able to achieve this systematic and timely delivery. By understanding the components that influence uptake, it is easier to gain a timely delivery of information to those who require it.
In addition, research has demonstrated that certain CPD activities have a higher probability of influencing practice change than others and that a combination of CPD strategies is most effective for the uptake of new information. In addition, these activities should address learning needs tailored to personal practice profiles. These needs should be based on the self-assessment/self-reflection and data collected from individual practice.[10],[11],[12] Understanding the context at all levels will aid medical education practitioners and researchers in choosing the best fit of CPD strategies for the uptake of specific evidence. This approach also holds true of educational interventions in undergraduate and postgraduate medical education.
Developing a team approach and gaining buy-in
Developing a team approach and gaining buy-in often operate in concert when approaching the implementation of new evidence and research. While the exact composition of the team needed to successfully implement an uptake of evidence into practice varies depending on the type of evidence in question, there are certain constructs that remain the same. These include the representation of targeted groups, equal say in the decision-making process, and the process to hear opposing views.
Representation of the targeted groups is important as it is essential that the groups that the new evidence is meant for be included from the beginning in the decision-making process surrounding the approaches to be undertaken. Not only this provides a sense of belonging for each of the target groups but also it assists in building buy-in. Specific health-care professions or trainees are more likely to take approaches that have been adopted seriously if they know that they had representation in the process. It also provides other members of each group with a person that they can approach if they have questions surrounding the decisions that have been made. Having this opportunity allows a trust to be built in both the team and the approach being taken. This trust is often then transferred to the evidence being adopted.
Equal say in the decision-making process is essential to building trust and gaining buy-in within the team and within the target groups outside of the team. The second important aspect of this process is that once a decision is made within the team, there needs to be support from all its members. The team meetings are the locations for discussions of divergent views, and once the decision is made, then it is to be supported. To continue the discussion outside of the team meetings and outside of team members will only serve to break down trust and undermine initiatives intended to assist in the uptake of new evidence and research.
Having a process in place to discuss opposing views both within the team and with external stakeholders is important to building trust and gaining buy-in with members outside of the team. If the approach being undertaken is to gain support, there needs to be a process by which people can provide feedback and comments. Each feedback and comment needs to have the opportunity to be heard and the response provided. Often, feedback from an outside source provides an opportunity for those involved in the decision-making process to reevaluate the approach they are taking. It is quite possible that those involved with the development of the approach are so familiar with the process that it is difficult for them to see items that may not be fully explained or the importance described. This may occur through either confirmation or selection bias. Confirmation bias occurs when the person performing the data analysis wants to prove a predetermined assumption. They then keep looking in the data until this assumption can be proven.[13] Selection bias occurs when data are not reflective of the population on the whole.[13]
| Conclusion | | |
There are many factors that influence the translation of evidence and research into practice. Key among these is understanding the definition of terms, understanding the underlying paradigms of the research conducted, understanding the role of context, matching approaches to context, adopting a team approach, and gaining buy-in. Ensuring that the elements have been addressed will increase the probability that the translation of evidence and research will be successful. Gaining an increase in the successful implementation and adoption of evidence and research are essential in the complex and changing health-care systems of today's practice.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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