Scholarly clinical practice: what is it and how can we support it? (July 2021 – No 05)

July 2021 Edition (05)

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Scholarly clinical practice: what is it and how can we support it?

AN INTERVIEW SUMMARY WITH Aliki Thomas

 

Aliki Thomas

Associate Professor, School of Physical and Occupational Therapy, McGill University

Associate Member, Institute of Health Sciences Education Researcher, Axis 2, Thematic Unit Leader 2, and Site Director of Research, CRIR–Jewish Rehabilitation Hospital, CISSS de Laval

Knowledge Exchange and Education in the Health Professions (K.E.E.P.) Lab

 

 

How would you describe what you do in one sentence?

 

My research program aims to enhance clinical practice by supporting current and future clinicians in embracing and using evidence-based practices in their day-to-day clinical activities.

Amazing! Let’s break it down now, how do you do that? Can you give me some of the meat around the bones?

I can tell you about two recent projects that highlight this very well. The first is a CIHR-funded project that started in 2016 with Annie Rochette, Ph.D. co-principal investigator and CRIR researcher. We have been following graduates from all occupational therapy (OT) and physiotherapy (PT) programs across Canada (our initial pool was with 1700 graduates from 15 universities) to understand how their knowledge of and skills in evidence-based practice (EBP) evolve as they transition from their professional program into clinical practice. For example, do the competencies associated with EBP change over time? If so, how and why? So, for three years after they graduated, we sent them questionnaires and conducted interviews to better understand the evolution of these important competencies. As we complete our analyses, we are seeing that both individual characteristics, such as, knowledge of EBP and confidence in navigating certain challenges in practice, and organizational factors, such as, dedicated time to read scientific articles and have discussions with peers, and access to continuing professional development, are both extremely important and empowering for clinicians as they engage in an EBP approach. About midway through this project, we realized the work context had a major role to play in one’s inclination and ability to enact the competencies associated with EBP, which led me to the second project I want to share with you.

For the second project I received funding from SSHRC to study the influence of context in particular. We are two years into this four-year project, and I am very proud of this initiative! The goal is to understand how the work context influences our abilities as clinicians to deploy, to maintain, and to refine our professional competencies, including those of the scholarly practitioner (i.e., individuals who are up to date on the scientific evidence and are able to make judicious decisions in their practice). We developed two measures that will allow us to see how, according to the clinician, the context influences their professional competencies. With this data we can begin to explore how we may intervene on those contextual factors through continuing professional development programs and knowledge translation (KT) activities.

Can you give me some examples of environmental or organizational factors you’ve come across so far?

Certainly! Some are related to resources and others are related to the characteristics of the organization. For example, the values of the organization regarding EBP, the support from one’s peers and collaborators, access to the literature, work schedules and access to continuing professional development. It can be sometimes challenging for organizations to put in place processes to support clinicians in their roles as scholarly practitioners and to make time for activities that are key to professional development. Participating in research, mentoring, teaching, and contributing to KT for example are instrumental for clinicians as they strive to be more scholarly in their practice; however, when some of these are added to a clinician’s busy workday, they may face challenges in balancing these with their direct patient care responsibilities.

Tell me more about integrated knowledge translation…

Integrated Knowledge Translation (IKT) is an approach whereby stakeholders are engaged in all phases of the project so that ultimately, they can benefit fully from the results. When stakeholders are involved in a project they find relevant and meaningful from the onset, they are more likely to apply the knowledge they are co-creating. The two projects I’ve shared with you are both using IKT approaches. From day one we got Canada-wide partners from education and clinical practice to sit around the table with us to collaboratively identify what questions matter most to them, how to go about answering them, and how to improve our current systems based on the answers we get. Our teams include educators, OT and PT university program representatives, national professional associations, the College of Family Physicians, the Royal College of Physicians and Surgeons, the National Association of Regulators, researchers, and clinicians. It’s a big team which of course has some challenges. We don’t always have the same priorities or the same timelines, but it’s an incredibly rich and rewarding process! I’m confident that together we can make a greater impact in education and clinical practice.

I’ve also been fortunate to have the opportunity to develop some expertise in the scientific study of KT; a growing field called Implementation Science. This means that I also delve into questions like, what are the best methods to address important KT questions? Did this strategy work? Why and how? Using robust methods and theories in KT increases our likelihood of success!

It seems these projects follow a logical suite. If we imagine the continued trajectory, what is your dream down the line?

The ultimate goal is to establish a dynamic tripartite program where each of the three sectors (education and research, practice, and policy) are represented, understand their individual roles as well as the value of a unified system, and remain collectively accountable for supporting clinicians in being scholarly practitioners. For example, going through formal education in an occupational therapy program is only one piece of the scholarly practice puzzle. Teaching students about what evidence-based practice is and how it helps inform practice is key but is only the beginning. We need to prepare graduates for what they will encounter on the ground, in the clinical context and within complex and evolving health care systems. More support for strengthening our clinicians’ competencies and helping them to remain a scholarly practitioner over time is what I would like to see.

A rehabilitation trifecta! And what would achieving this dream mean for the general public?

I would love to tell my family and friends… “when you need to see an occupational therapist, or a physical therapist you will be in great hands! You can be confident the therapist has received state of the art training, they are working within a supportive environment that helps them maintain their professional competencies, and is offering the best possible services based on up-to-date research”.

Best of luck for the future! The CRIR is rooting for you!