RESUMEN
OBJECTIVES: There are only a few descriptive reports on the implementation of distributed medical education (DME) and these provide accounts of successful implementation from the senior leadership perspective. In Saskatchewan, over a period of 4 years (2010-2014), four family medicine residency sites were established and two additional sites could not be developed. The aim of this study was to identify challenges, success factors and pitfalls in DME implementation based upon experiences of multiple stakeholders with both successful and unsuccessful outcomes. METHODS: Data were obtained through document analysis (n = 64, spanning 2009-2016; perspectives of government, senior leadership, management and learners), focus groups of management and operations personnel (n = 10) and interviews of senior leaders (n = 4). Challenges and success factors were ascertained through categorisation. Iterative coding guided by three sensitising frameworks was used to determine themes in organisational dynamics. RESULTS: Both challenges and success factors included contextual variables, governance, inter- and intra-organisational relationships (most common success factor), resources (most common challenge), the learning environment and pedagogy. Management and operations were only a challenge. Organisational themes affecting the outcome and the pitfalls included the pace of development across multiple sites, collaborative governance, continuity in senior leadership, operations alignment and reconciliation of competing goals. CONCLUSIONS: Emerging opportunities for DME can be leveraged through collaborative governance, aligned operations and resolution of competing goals, even in constrained contexts, to translate political will into success; however, there are pitfalls that need to be avoided. Our findings based upon multi-stakeholder perspectives add to the body of knowledge on deployment, carefully considering the conditions for success and associated pitfalls.
