The Impact of Varying Levels of Implementation Fidelity on Resident Perceptions of an Assessment Innovation

Abstract

Background/Objectives: Medical education researchers regularly develop excellent, evidence-based innovations. Often, these innovations are implemented, yet fail. In our program, we witnessed varying levels of success with an assessment innovation. In this study we explored the reasons for varying levels of success with an innovation that was solidly grounded in evidence and theory. Methods: A multiple methods design was used. Using a grounded theory approach, we conducted focus groups with family medicine residents. Thirty-two first-year and second-year residents across 5 different teaching sites responded to a set of semistructured questions. An “implementation fidelity” (the degree to which the innovation in action resembles the innovation in theory) inventory was also conducted, with data collected through quantitative analysis of use of the innovation at individual teaching sites. Results: Many residents who participated in our focus groups perceived substantial problems with the assessment innovation, which stem predominantly from (1) technical issues with the web-based portfolio and (2) varying levels of preceptor involvement. In some instances, where preceptors sounded highly involved, residents voiced satisfaction with the innovation. Value was seen for learning and for guided self-assessment in sites where implementation fidelity was highest. Sites where champions of the innovation could be identified showed highest implementation fidelity and highest degree of resident perception of learning benefits from the innovation. Frustration with technical clumsiness of the web-based interface was seen for all sites. Conclusions: The results demonstrate the need for active preceptor involvement in any medical education innovation in order for the innovation to be effective. Learner-driven innovations will falter when preceptors do not take an active role in effective practice of innovations. Implementation fidelity was a constant factor in the success of the innovation.