Teaching strategies for evidence-based health care: filling the gap between traditional academic curricula and health service prioritization.

Abstract

To provide safe and effective clinical care, both healthcare organizations and practicing health professionals rely on tertiary education at undergraduate and postgraduate levels for the development of skills and knowledge. The 1980s focus on the ‘research practice gap’ was a significant challenge. Firstly to the research community on improving research quality, impact and accessibility, and secondly to healthcare organizations as best practice became an industry standard and expectation. In 1981, it was noted that Research in the practice setting brings forth two major conflicts: the differing requirements of scientific enquiry and clinical decision making, and the differing goals for research held by clinicians, administrators, and researchers.1(p.33) The transition toward evidence-based health care (EBHC) as the dominant paradigm was in part driven by increased attention to the gap between research and practice.2 Early developments in EBHC within the academic community included significant self-critique in terms of transparency of methods for reporting the quality and rigor of research, and a focus on active dissemination as a precursor to today's focus on implementation and impact. Research awareness training became the new norm in the tertiary education sector, particularly in nursing and midwifery. The number of postgraduate programs and research degrees, and demonstration projects that integrate research language and methods with healthcare education, continues to increase. Forty years of progress has delivered innovation in education across undergraduate and postgraduate teaching and research. Education for the practicing professions today includes established positions such as Clinical Chairs, enabling linkage between universities and clinical practice. It is the new norm for academics and hospital/health service leadership to work together, delivering focused research training in short programmatic courses suited to clinicians. A benefit of this approach was that nursing and health science research increasingly focused on local healthcare priorities. However, it remains unclear whether the scale and quality of research has improved. It is worthwhile asking, what is the result? The result in terms of nursing and health science research has been a preponderance of low-quality underpowered research that is not aligned to healthcare quality or organizational priorities and imperatives. In addition, few staff have the in-depth knowledge and skills to do influential research. The impact of current undergraduate or postgraduate EBHC education is also uncertain, with measures of confidence dominating the literature. Examination of the sustainable impact on practice and patient outcomes is urgently needed. These issues are underpinned by findings that undergraduate students question the relevance and applicability of research training. They find it difficult to link (or connect) the relevance of research to practice.3 Important questions remain about effective partnership supplementation between healthcare organizations and education providers to enable integration of EBHC at the point of care. The need for focus on implementation work to facilitate uptake of research findings should guide development of new academic clinician pathways within the health ecosystem. Arguably this asks too much of the tertiary education sector, which has a primary focus on the development of competent practitioners and the provision of advanced practice and research training through postgraduate programs. The addition of EBHC to already full curriculum has been tried and tested and found to be deeply complex and predominantly supported by subjective outcome measures.4,5 To strengthen existing clinical academic partnerships, EBHC programs should be designed with the health service and clinician as the primary stakeholder. Clarity on the foundational questions is critical to a future roadmap: (1) Education for what? (2) Education of who, and how many? (3) What forms and levels of education? A purpose-built approach to EBHC education and training, founded on EBHC principals and processes promotes skill transfer and reinforcement. It is more likely to deliver sustainable improvements in care delivery and patient outcomes. Training should include facilitated evidence implementation and clinical leadership development, with implementation topics aligned to immediate organizational and clinical priorities based on low-cost sustainable methods such as audit and feedback. Instead of the traditional clinical/tertiary partnerships, we suggest a third option be integrated that focuses on competencies for EBHC that address both the needs of the individual clinician and their patients. The JBI Model of EBHC conceptualizes and illustrates the integration of organizational needs for sustainable strategies to measurably increase impact and improve quality of care.6 Thinking and planning for the future of education and practice informed by real world models can support the integration of EBHC in such a way that the majority of clinicians routinely use core EBHC skills. Progressive research training and leadership can then be recognized as the highly complex, skilled work process congruent with international reporting standards to generate adequately powered, meaningful findings for practice. Uptake of evidence in our health systems will remain inadequate in the absence of updated approaches to education.7 We hope this editorial stimulates the continuation of this important discourse between the needs of clinical services and the academy with EBHC providers as a critical link in the service chain. This is a call for a fresh approach. One that integrates EBHC specialist organizations so that practicing health professionals are given the best possible opportunity to deliver high quality care with less research waste. Acknowledgements With grateful acknowledgement to Alex Mignone and Dr Dimi Hoppe for technical editing. Conflicts of interest We, the named authors confirm this is original work that has not been submitted in part, or in full elsewhere. The work was conceptualized by C.L., K.B.d.S. and V.A.d.A.P., with significant input from H.K. from draft one onwards. There was equal contribution in terms of concept development for the article, revisions and obtaining consensus on the version being submitted.