D.M. Hamza is an implementation scientist and the research and evaluation lead for postgraduate medical education, University of Alberta, Edmonton, Canada; ORCID: https://orcid.org/0000-0001-8943-2165 .
G. Regehr is professor, Department of Surgery, and scientist, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X .
Acad Med. 2021 Nov 1;96(11S):S48-S53. doi: 10.1097/ACM.0000000000004318.
When initiating an educational innovation, successful implementation and meaningful, lasting change can be elusive. This elusiveness stems from the difficulty of introducing changes into complex ecosystems. Program evaluation models that focus on implementation fidelity examine the inner workings of an innovation in the real-world context. However, the methods by which fidelity is typically examined may inadvertently limit thinking about the trajectory of an innovation over time. Thus, a new approach is needed, one that focuses on whether the conditions observed during the implementation phase of an educational innovation represent a foundation for meaningful, long-lasting change.
Through a critical review, authors examined relevant models from implementation science and developed a comprehensive framework that shifts the focus of program evaluation from exploring snapshots in time to assessing the trajectory of an innovation beyond the implementation phase.
Durable and meaningful "normalization" of an innovation is rooted in how the local aspirations and practices of the institutional system and the people doing the work interact with the grand aspirations and features of the innovation. Borrowing from Normalization Process Theory, the Consolidated Framework for Implementation Research, and Reflexive Monitoring in Action, the authors developed a framework, called Eco-Normalization, that highlights 6 critical questions to be considered when evaluating the potential longevity of an innovation.
When evaluating an educational innovation, the Eco-Normalization model focuses our attention on the ecosystem of change and the features of the ecosystem that may contribute to (or hinder) the longevity of innovations in context.
在启动教育创新时，成功实施和有意义、持久的变革可能难以实现。这种难以捉摸源于将变革引入复杂生态系统的困难。关注实施保真度的计划评估模型检查创新在真实环境中的内部运作。然而，通常检查保真度的方法可能会无意中限制对创新随时间推移的轨迹的思考。因此，需要一种新的方法，该方法侧重于观察到的教育创新实施阶段的条件是否代表有意义、持久变革的基础。
通过批判性审查，作者审查了实施科学中的相关模型，并开发了一个综合框架，将计划评估的重点从探索时间点转移到评估创新在实施阶段之外的轨迹。
创新的持久和有意义的“正常化”根植于机构系统的当地愿望和实践以及从事工作的人的愿望和实践与创新的宏大愿望和特征之间的相互作用。借鉴规范化过程理论、综合实施研究框架和行动中的反思性监测，作者开发了一个框架，称为生态正常化，该框架强调了在评估创新的潜在寿命时需要考虑的 6 个关键问题。
在评估教育创新时，生态正常化模型将我们的注意力集中在变革的生态系统及其可能有助于（或阻碍）创新在背景下持久存在的特征上。
