By Ginny Jacobs, MEd, MLS, CHCP, director, Strategy & Performance, AXDEV Global; Julie White, MS, CHCP, director, Continuing Medical Education, Boston University School of Medicine; and Patrice Lazure, MSc, director of Research, AXDEV Group
How often have you or someone in your organization said, “I wish we had taken time to submit an abstract and/or manuscript for publication to highlight our experience and share our story?”
Work groups often take on challenging projects and, when completed, they have much to be proud of. Even with projects that fall short of expectations with elements that veer off track, there are typically insights gained that could serve to advance the field and help inform and/or accelerate subsequent efforts. Unfortunately, in both cases, only a small fraction of those experiences or stories are formally shared and even fewer are featured in the peer-reviewed literature.
Improvement science is a problem-solving approach centered on continuous inquiry and learning. The generation of scholarly papers and presentations is certainly one way to promote learning.
Most work groups support the value of formally documenting project results and lessons learned as a means to help advance the field of medical education, but it is easy to imagine numerous factors that may interfere with those objectives.
To better understand the situation, what is it that prevents pursuit of scholarly activity in the form of generating abstracts and/or manuscripts for submission? When asked to examine the barriers educators face in designing and publishing education research, participants in an AAMC consensus workshop (11/2013) listed barriers in the following domains:
- Misperceptions of what scholarly work entails.
The following case will highlight how two organizations have used a collaborative model to overcome the barrier to deliberately engage in scholarly work over a project funded under a risk evaluation and mitigation strategy (REMS) to promote safe extended-release/long-acting (ER/LA) opioid prescribing education.
The approach taken has highlighted the power of leveraging the strength of two respected organizations to pursue scholarly work. Academic leaders from Boston University’s School of Medicine (BUSM) joined forces with AXDEV Global, a performance improvement company noted for its ability to conduct rigorous mixed-methods research. Through a disciplined planning process, the team partnered to design and develop scholarly presentations and manuscripts related to the BUSM’s Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program.
As the first grantee funded by the REMS Program Companies (RPC) to address the FDA blueprint specific to ER/LA opioid analgesics, SCOPE of Pain launched in February of 2013. Over the span of nearly seven years, the program’s complexity has evolved and has resulted in an impressive collection of valuable data to support a meaningful assessment plan.
Since its inception, the SCOPE of Pain activities have included:
- An online training program
- 180 live meetings held in 27 states
- The development of a trainers’ toolkit offering a wide array of educational tools (case study, role plays, video trigger tapes)
- Six live and archived webinars
- The 2019 launch of an updated program, in compliance with the September 2018 FDA Opioid Analgesics Blueprint
The Scope of Pain program has been successful on multiple levels.
- Participant reach and impact: More than 160,000 healthcare practitioners from multiple disciplines have completed a comprehensive pain management curriculum from across a wide variety of professions. The volume of learners engaged in SCOPE of Pain and the span of time during which BUSM has been providing this education has resulted in much data to examine related to a number of issues. Our program outcomes indicate that participating in SCOPE of Pain improves clinician knowledge, attitude, confidence and self-reported clinical practice in safer opioid prescribing. Of particular interest is the data specific to commitments to change and barriers to implementing changes. For example, the top reported barriers to making changes are consistently “patient resistance to change” and “lack of support staff to help make these changes.”
- Rigorous design: Early brainstorming sessions occurred as part of the planning process and resulted in BUSM and AXDEV adopting an innovative view of evaluative research that went well beyond the basics. The enhanced study design and extensive data collection plan facilitated a rigorous assessment of the program’s impact. A decision was made on the onset to capture information beyond basic demographic and evaluation requirements to include measurements of metrics, such as attitudes and clinical behaviors assessments, that went beyond what was required by the funder (RPC). BUSM and AXDEV were able to build upon well-defined objectives in the program development phase to align the program assessment plan and develop new instruments for a more in-depth assessment.
- Scholarly reach: Scholarly activity is important for this program, and it required significant preplanning. As data were getting collected and analyzed over the years, BUSM and AXDEV not only reported on the program’s impact, but they also studied — and are still studying — research questions of importance to the field, such as the impact of voluntary versus mandatory education on learning outcomes.
To date, three articles have been published in peer-reviewed journals and eight conference abstracts have been presented at both clinical and educational conferences in the United States and internationally. A mixed-methods study aiming at understanding the long-term impact of the Scope of Pain Program and how reasons for participating may influence this impact was recently deployed and will be submitted for publication.
There are abundant obstacles to an institution’s ability to produce scholarly work. The key is to identify and address what hinders faculty and/or medical education specialists from producing scholarship within their institutions and find a way to harness the resources needed.
The work that was demonstrated through the BUSM and AXDEV partnership highlights the value of a collaborative approach where each institution’s strengths are leveraged to help navigate the barriers that exist so the project team is able to share their story and disseminate their lessons learned. Core to the success of this joint venture, which has emphasized the importance of publishing findings, has been our shared commitment to deliberate planning.