医学教育中知识转化的可供性：对医学教育工作者实证知识运用的质性探索
Affordances of knowledge translation in medical education: a qualitative exploration of empirical knowledge use among medical educators.
作者信息
Onyura Betty, Légaré France, Baker Lindsay, Reeves Scott, Rosenfield Jay, Kitto Simon, Hodges Brian, Silver Ivan, Curran Vernon, Armson Heather, Leslie Karen
机构信息
Dr. Onyura is research and evaluation consultant, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Le´gare´ is Canada Research Chair in Implementation of Shared Decision Making in Primary Care and professor, Department of Family Medicine and Emergency Medicine, Laval University, Québec, Québec, Canada. Ms. Baker is research and education consultant, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Reeves is professor of interprofessional research, Faculty of Health, Social Care and Education, Kingston University and St. Georges, University of London, London, United Kingdom. Dr. Rosenfield is professor, Faculty of Medicine, and vice dean of undergraduate medical education, University of Toronto, Toronto, Ontario, Canada. Dr. Kitto is a medical sociologist and assistant professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Dr. Hodges is professor, Faculty of Medicine and Faculty of Education, University of Toronto, and vice president of education, University Health Network, Toronto, Ontario, Canada. Dr. Silver is professor, Faculty of Medicine, University of Toronto, and vice president of education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Curran is professor, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. Dr. Armson is director of research, Foundation of Medical Practice Education, and professor, University of Calgary, Calgary, Alberta, Canada. Dr. Leslie is director, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, and associate professor, Department of Pediatrics, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
出版信息
Acad Med. 2015 Apr;90(4):518-24. doi: 10.1097/ACM.0000000000000590.
PURPOSE
Little is known about knowledge translation processes within medical education. Specifically, there is scant research on how and whether faculty incorporate empirical medical education knowledge into their educational practices. The authors use the conceptual framework of affordances to examine factors within the medical education practice environment that influence faculty utilization of empirical knowledge.
METHOD
In 2012, the authors, using a purposive sampling strategy, recruited medical education leaders in undergraduate medical education from a Canadian university. Recruits all had direct teaching and curricular development roles in either preclinical or clinical courses across the four years of the undergraduate curriculum. Data were collected through individual semistructured interviews on participants' use of empirical evidence, as well as the factors that influence integration of empirical knowledge into practice. Data were analyzed using thematic analysis.
RESULTS
Fifteen medical educators participated. The authors identified both constraining and facilitating affordances of empirical medical education knowledge use. Constraining affordances included poor quality and availability of evidence, inadequate knowledge delivery approaches, work and role overload, faculty and student change resistance, and resource limitations. Facilitating affordances included faculty development, peer recommendations, and local involvement in medical education knowledge creation.
CONCLUSIONS
Affordances of the medical education practice environment influence empirical knowledge use. Developing strategies for effective knowledge translation thus requires careful assessment of contextual factors that can enable, constrain, or inhibit evidence use. Empirical knowledge use is most likely to occur among medical educators who are afforded rich, facilitative opportunities for participation in creating, seeking, and implementing knowledge.
目的
关于医学教育中的知识转化过程，我们所知甚少。具体而言，关于教师如何以及是否将实证医学教育知识融入其教育实践的研究极少。作者运用可供性的概念框架来审视医学教育实践环境中影响教师对实证知识利用的因素。
方法
2012年，作者采用目的抽样策略，从一所加拿大大学招募了本科医学教育领域的医学教育领导者。所有被招募者在本科课程的四年中，在临床前或临床课程中都担任直接教学和课程开发的角色。通过对参与者使用实证证据的情况以及影响实证知识融入实践的因素进行个人半结构化访谈来收集数据。使用主题分析法对数据进行分析。
结果
15位医学教育工作者参与了研究。作者确定了实证医学教育知识使用的制约性和促进性可供性。制约性可供性包括证据质量差和可获取性不足、知识传递方法不当、工作和角色负担过重、教师和学生对变革的抵触以及资源限制。促进性可供性包括教师发展、同行推荐以及当地参与医学教育知识创造。
结论
医学教育实践环境的可供性影响实证知识的使用。因此，制定有效的知识转化策略需要仔细评估能够促进、制约或抑制证据使用的背景因素。实证知识的使用最有可能发生在那些有丰富、便利机会参与知识创造、寻求和实施的医学教育工作者当中。
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