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Paeds Vivasprofessional-practice-and-evidence

Paeds Vivas · professional-practice-and-evidence

Implementation science and translating evidence into practice — branching viva

Viva on diagnosing the evidence-practice gap, choosing and applying frameworks (CFIR, Cabana, RE-AIM, knowledge-to-action), selecting ERIC strategies, measuring Proctor implementation outcomes, and defending evidence and equity.

branching clinical structured oral4 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A paediatric emergency department has a college-endorsed sepsis guideline, yet only 52% of eligible children receive the first antibiotic within one hour; the guideline has been emailed and posted on the intranet for a year with no change; the examiner wants to know how you would actually close the gap.

Opening (candidate)

My first move is to reframe this from a dissemination problem into an implementation problem. Emailing and posting a guideline is dissemination — the passive spread of information — and it changes behaviour almost nothing. The gap is one of implementation: only 52% of eligible children receive the first antibiotic within an hour, and closing that needs active, tailored strategy. I would define implementation science as the scientific study of methods to promote the systematic uptake of research findings into routine care, then apply the knowledge-to-action cycle: identify the gap, adapt the bundle to context, assess the barriers with Cabana and CFIR, map each barrier to a strategy from the ERIC compilation, deploy with fidelity monitoring, measure the implementation outcomes with Proctor and the impact with RE-AIM, and plan sustainability from the outset — disaggregating reach by subgroup so an equity gap cannot hide. [1] [9]

Paediatrics Fellowship Pro

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

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References8ShowHide
  1. [1]Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM An introduction to implementation science for the non-specialist. BMC Psychology, 2015.PMID 26376626
  2. [2]Morris ZS, Wooding S, Grant J The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine, 2011.PMID 22179294
  3. [3]Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA, 1999.PMID 10535437
  4. [4]Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 2009.PMID 19664226
  5. [5]Glasgow RE, Vogt TM, Boles SM Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health, 1999.PMID 10474547
  6. [7]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. Administration and Policy in Mental Health, 2011.PMID 20957426
  7. [8]Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 2015.PMID 25889199
  8. [9]Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE Knowledge translation of research findings. Implementation Science, 2012.PMID 22651257
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