Principles-Focused Evaluation: A Promising Practice in the Evaluation of Continuing Professional Development.

ABSTRACT: Outcome-based evaluations still dominate in continuing professional development (CPD) despite the availability of evaluation approaches that address program processes and contexts. Our continued reliance on outcomes-based evaluation fails to respect the importance of complexity and the human element of program planning and implementation. Therefore, it is time that the field of CPD embrace complementary approaches to program evaluation that consider the complexity and maturity of programs and their contexts, while providing credible and relevant information to inform strategic decisions regarding the future of a program. Principles-focused evaluation provides a complement to traditional evaluation approaches through the articulation of a program's values that can be actioned. These "actionable values," known as principles, become the focus of the evaluation for the purposes of program decision-making. This paper describes how one CPD program, designed as a response to growing opioid-related harms, adopted a principles-focused evaluation to inform ongoing iteration of the program. The process used to design the principles, how the principles are informing the transportability of the program, and implications for CPD evaluation are discussed.

Delivery and evaluation of simulations to promote authentic and meaningful engagement in childhood disability research.

BACKGROUND: In 2019, our interdisciplinary team of researchers, family members, and youth co-designed four simulation training videos and accompanying facilitation resources to prepare youth, family members, trainees, and researchers to build the knowledge and skills to engage in patient-oriented research (POR) authentically and meaningfully. Videos covered challenges in aspects of the research process including (1) forming a project team; (2) identifying project objectives and priorities; (3) agreeing on results; and (4) carrying out knowledge translation. METHODS: The purpose of the study was to deliver four simulation training videos across 2 two-hour facilitated workshops with researchers, trainees, and family partners. We evaluated whether the training videos and facilitated discussion of the simulations helped to improve knowledge and attitudes about authentic and meaningful partnership in research and self-perceived ability to engage in POR. An explanatory sequential two-phase mixed methods design was used. Phase 1 (quantitative) included two training workshops and a pre/post-training survey. Phase 2 (qualitative) included two qualitative focus groups. Results of each phase were analyzed separately and then combined during interpretation. RESULTS: Sixteen individuals (including researchers/research staff, trainees, family members, clinicians) took part in this research study. Overall, participants were highly receptive to the training, providing high scores on measures of acceptability, appropriateness, and feasibility. While the training videos and facilitated discussion of the simulations were found to increase participants' knowledge and ability to engage in authentic and meaningful POR, we found no significant change in attitude or intent. Recommendations about the simulation content and delivery were provided to inform for future use. CONCLUSIONS: The simulations were found to be a positive and impactful way for collaborative research teams to build knowledge and ability to engage in authentic and meaningful POR. Recommendations for future work include covering different content areas with varying levels of nuance; and offering the training to stakeholders in a variety of roles, such as those higher-ranked academic positions.

In 2019, our team of researchers, family members, and youth worked together to design and develop four digitally recorded simulation videos that can be used to train youth, caregivers/families, trainees, and researchers to engage with each other in research so that all parties feel supported and valued. This paper describes how the four simulation videos were packaged in the training and then delivered to 16 participants (researchers, trainees, and caregivers/families). We used multiple ways to evaluate the videos and training, including a survey before and after the training, focus groups with participants after the training, and written reflections shared by the training facilitators after the training was finished. We found that the simulation videos increased participants' knowledge on engagement and their self-reported ability to engage in authentic and meaningful patient-oriented research. Participants rated their belief in engagement and their intent to engage in collaborative research highly at the pre-test and this remained consistent at the post-test. Participants liked that the simulations focused on challenges in research engagement and that the training was offered to researchers and family partners together. They provided valuable feedback on what we should change about the simulations, including the content, which should have less exaggerated lessons and to add more topics. They also suggested it would be helpful if stakeholders other than just the research team complete the training in the future, especially those who are in higher positions of academic power.

Abortion care in the time of COVID-19: an illustration of how to adapt medical care during a pandemic.

Shortly after the first lockdown was announced in March 2020, a comprehensive guideline was released by the Royal College of Obstetrics and Gynaecologists documenting the changes that were acceptable to enable this essential service to continue to provide care to women. Abortion care providers had to act quickly to adapt their services; increasing the use of telemedicine and reducing the number of visits to hospitals and clinics in order to reduce risk to women requesting termination of pregnancy and making safe abortion accessible. Important changes to legislation were paramount in making this possible, as were changes to the tests done prior to an early medical abortion including omission of routine ultrasound scan and blood tests in low risk women. Medication to induce abortion along with analgesia and contraception were sent by post to eligible women to enable early medical abortion at home. Despite some initial concerns, studies have shown these changes to be safe and there is hope amongst abortion care providers that these changes could be here to stay.

Developmental Evaluation: six ways to get a grip on the potential of education scholarship to serve innovation.

In March 2020, COVID-19 challenged health and educational systems across the country. The rapid reallocation of resources to ensure public safety had taken priority over educational obligations. Healthcare students were removed from clinical environments as their learning came to a grinding halt. While academic institutions were pivoting and transforming teaching and learning experiences, students responded to the pandemic with innovation, attending to gaps in patient care. As educators, we must understand how we can further support students and faculty to unleash innovative thinking during a crisis. To begin to address this educational need, academic institutions now have an opportunity to broaden the practice of education scholarship in accordance with best practices to nurture innovation and innovative thinking. What framework can aid us in this endeavor? In times of instability, Developmental Evaluation is an approach that can support the implementation of innovations within medical education. Using an example of an innovation in medical education, we offer six practical tips to begin to use Developmental Evaluation to support and enable learners and faculty in the creation of innovations and contribute to a broader definition of education scholarship.

En mars 2020, la COVID-19 a bouleversé les systèmes de santé et d'éducation de tout le pays. La réaffectation rapide des ressources pour assurer la sécurité du public avait pris le pas sur les obligations éducatives. Les étudiants en santé ont été retirés des environnements cliniques et leur apprentissage a connu un arrêt net. Les établissements universitaires ont introduit des ajustements qui ont transformé les expériences d'enseignement et d'apprentissage. De leur côté, réagissant à la pandémie de manière innovante, les étudiants sont intervenus pour combler les besoins en soins aux patients. Il serait pertinent pour nous, éducateurs, de trouver les façons de mieux aider les étudiants et le corps enseignant à laisser libre cours à leur originalité dans les situations de crise. En vue de répondre à ce besoin éducatif, les établissements universitaires ont l'occasion d'aligner la recherche en éducation sur les meilleures pratiques pour favoriser l'innovation et la pensée novatrice. Quel cadre adopter pour nous aider dans cette entreprise? L'évaluation évolutive fait partie des approches qui peuvent soutenir la mise en œuvre d'innovations dans l'éducation médicale en période d'instabilité. À l'aide d'un exemple d'innovation dans le domaine, nous proposons six conseils pratiques pour faire de l'évaluation évolutive un facilitateur de l'innovation par les apprenants et les enseignants et un levier pour élargir la portée de la recherche en éducation.

Building and Sustaining a Culture of Innovation in an Academic Health Centre.

Although innovative organizations have the advantage of superior performance, the idea of adopting innovative practices and embracing risk taking at work can be intimidating, especially for those working in healthcare. When responsible for the health and safety of others, healthcare workers tend to gravitate away from ideas that could result in failure. The challenge of promoting innovation in a healthcare context can be addressed by creating an organizational culture of innovation - where innovative thinking is normalized, rewarded and even expected of employees. In this article, we share our journey and outline lessons learned in creating a culture of innovation at Holland Bloorview, Canada's largest pediatric rehabilitation hospital. It is our hope that those seeking to create a culture of innovation within their organization can learn from and apply these lessons in their own contexts.

From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting.

Purpose: Ensuring evidence-informed care happens systematically and consistently is not easy in complex health facilities. This paper describes the evolution of knowledge translation infrastructure (Evidence to Care) within a pediatric rehabilitation hospital to address barriers to evidence-informed decision-making and accelerate research uptake to influence clinical care.Methods: Development of Evidence to Care involved a series of steps integrating knowledge translation principles, best evidence and stakeholder needs. Key aspects included: recognizing health system drivers and organizational enablers; establishing organizational structures and processes; building and operationalizing a strategic vision through activities and demonstration projects; and evaluating impact.Results: By way of a fully realized working model, two large-scale demonstration projects aligned with the Knowledge-to-Action Cycle have been completed. Audit findings demonstrate tangible examples of improving healthcare quality through investment in knowledge translation resources, processes and tailored evidence products. Critical enablers of this infrastructure include strong leadership commitment and ongoing direction, a dedicated expert team, alignment with strategic priorities and situated within organizational structures to link research, clinical care and education.Conclusions: With a replicable model, Evidence to Care addresses established health system barriers related to time, resources, skill and knowledge through dedicated knowledge translation specialists and knowledge brokers to facilitate knowledge translation practice.Implications for rehabilitationDeveloping dedicated knowledge translation infrastructure is both novel and relatively new in healthcare.Sharing step by step processes helps other organizations learn from field-tested experiences of what works and what doesn't in a particular setting.Involving stakeholders at all levels of an organization is key to valuing knowledge translation and fostering an evidence-friendly culture.Co-creating tailored knowledge products and planning for dissemination and uptake fosters inter-disciplinary collaboration and joint problem-solving among clients, families and providers.

The tyrosine transporter of Toxoplasma gondii is a member of the newly defined apicomplexan amino acid transporter (ApiAT) family.

Apicomplexan parasites are auxotrophic for a range of amino acids which must be salvaged from their host cells, either through direct uptake or degradation of host proteins. Here, we describe a family of plasma membrane-localized amino acid transporters, termed the Apicomplexan Amino acid Transporters (ApiATs), that are ubiquitous in apicomplexan parasites. Functional characterization of the ApiATs of Toxoplasma gondii indicate that several of these transporters are important for intracellular growth of the tachyzoite stage of the parasite, which is responsible for acute infections. We demonstrate that the ApiAT protein TgApiAT5-3 is an exchanger for aromatic and large neutral amino acids, with particular importance for L-tyrosine scavenging and amino acid homeostasis, and that TgApiAT5-3 is critical for parasite virulence. Our data indicate that T. gondii expresses additional proteins involved in the uptake of aromatic amino acids, and we present a model for the uptake and homeostasis of these amino acids. Our findings identify a family of amino acid transporters in apicomplexans, and highlight the importance of amino acid scavenging for the biology of this important phylum of intracellular parasites.

Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation.

INTRODUCTION: We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection. METHODS: Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration. RESULTS: The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles. DISCUSSION: A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.

Centres for Leadership: a strategy for academic integration.

Purpose The purpose of this paper is to describe how an Academic Health Science Centre, providing pediatric rehabilitation services, research, and education, developed a Centres for Leadership (CfL) initiative to integrate its academic functions and embrace the goal of being a learning organization. Design/methodology/approach Historical documents, tracked output information, and staff members' insights were used to describe the ten-year evolution of the initiative, its benefits, and transformational learnings for the organization. Findings The evolutions concerned development of a series of CfLs, and changes over time in leadership and management structure, as well as in operations and targeted activities. Benefits included enhanced clinician engagement in research, practice-based research, and impacts on clinical practice. Transformational learnings concerned the importance of supporting stakeholder engagement, fostering a spirit of inquiry, and fostering leaderful practice. These learnings contributed to three related emergent outcomes reflecting "way stations" on the journey to enhanced evidence-informed decision making and clinical excellence: enhancements in authentic partnerships, greater innovation capacity, and greater understanding and actualization of leadership values. Practical implications Practical information is provided for other organizations interested in understanding how this initiative evolved, its tangible value, and its wider benefits for organizational collaboration, innovation, and leadership values. Challenges encountered and main messages for other organizations are also considered. Originality/value A strategy map is used to present the structures, processes, and outcomes arising from the initiative, with the goal of informing the operations of other organizations desiring to be learning organizations.

Staged Repair of an Aortic Pseudoaneurysm Secondary to Delayed Methylmethacrylate Plate Migration.

Methylmethacrylate is a prosthetic material commonly used for the reconstruction of large chest wall defects. We present the first reported case of delayed methylmethacrylate plate migration, which resulted in an aortic pseudoaneurysm with aortopulmonary fistula. Treatment management, including staged repair combining endovascular and open approaches, is also discussed.

A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study.

OBJECTIVE: To prepare for an RCT by examining the effects of an educational intervention on the listening skills of pediatric rehabilitation clinicians, piloting study procedures, and investigating participants' learning experiences. METHODS: Six experienced clinicians received the intervention, consisting of video simulations and solution-focused coaching regarding personal listening goals. Self- and observer-rated measures of listening skill were completed and qualitative information was gathered in interviews and a member checking session. RESULTS: Significant change on self-reported listening skills was found from pre- to post-test and/or follow-up. The pilot provided useful information to improve the study protocol, including the addition of an initial orientation to listening skills. Participants found the intervention to be a highly valuable and intense learning experience, and reported immediate changes to their clinical and interprofessional practice. CONCLUSION: The educational intervention has the potential to be an effective means to enhance the listening skills of practicing pediatric rehabilitation clinicians.

Integrating research, clinical care, and education in academic health science centers.

Purpose One of the major issues faced by academic health science centers (AHSCs) is the need for mechanisms to foster the integration of research, clinical, and educational activities to achieve the vision of evidence-informed decision making (EIDM) and optimal client care. The paper aims to discuss this issue. Design/methodology/approach This paper synthesizes literature on organizational learning and collaboration, evidence-informed organizational decision making, and learning-based organizations to derive insights concerning the nature of effective workplace learning in AHSCs. Findings An evidence-informed model of collaborative workplace learning is proposed to aid the alignment of research, clinical, and educational functions in AHSCs. The model articulates relationships among AHSC academic functions and sub-functions, cross-functional activities, and collaborative learning processes, emphasizing the importance of cross-functional activities in enhancing collaborative learning processes and optimizing EIDM and client care. Cross-functional activities involving clinicians, researchers, and educators are hypothesized to be a primary vehicle for integration, supported by a learning-oriented workplace culture. These activities are distinct from interprofessional teams, which are clinical in nature. Four collaborative learning processes are specified that are enhanced in cross-functional activities or teamwork: co-constructing meaning, co-learning, co-producing knowledge, and co-using knowledge. Practical implications The model provides an aspirational vision and insight into the importance of cross-functional activities in enhancing workplace learning. The paper discusses the conceptual and empirical basis to the model, its contributions and limitations, and implications for AHSCs. Originality/value The model's potential utility for health care is discussed, with implications for organizational culture and the promotion of cross-functional activities.

Building and Participating in a Simulation: Exploring a Continuing Education Intervention Designed to Foster Reflective Practice Among Experienced Clinicians.

INTRODUCTION: Engaging health professionals in the processes of first building and then participating in simulations has not yet been explored. This qualitative study explored the experience of building and participating in a simulation as an educational intervention with experienced clinicians. METHODS: Pediatric rehabilitation clinicians, along with a patient facilitator and standardized patients, created simulations and subsequently participated in a live simulation. The educational content of the simulation was culturally sensitive communication. We collected participants' perspectives about the process from individual journal entries and focus groups. A thematic analysis of these data sources was conducted. RESULTS: Participants described a process of building and participating in a simulation that provided: 1) a unique opportunity for clinicians to reflect on their current practice; 2) a venue to identify different perspectives through discussion and action in a group; and 3) a safe environment for learning. DISCUSSION: The combined process of building and participating in a simulation stimulated reflection about the clinicians' own abilities in culturally sensitive communication through discussion, practice, and feedback. It provided a safe environment for participants to share their multiple perspectives and to develop new ways of communicating. This type of educational intervention may contribute to the continuing education of experienced clinicians in both academic and community settings.

A design thinking approach to evaluating interprofessional education.

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners' attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery.

PURPOSE: To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. METHODS AND FINDINGS: The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. CONCLUSIONS: The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.