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Maintaining fidelity to an evidence-based curriculum is important, yet educators may need to adapt to unexpected situations or particular contexts. The purpose of this study is to identify the reasons for unplanned adaptations during implementation of an evidence-based sexual health education program in California. Evaluators reviewed fidelity checklists from the implementation of 571 cohorts for activities with reported unplanned adaptations. Reasons were qualitatively coded and compared across two phases of implementation and by setting. Educators reported 319 unplanned adaptations, affecting 21.5% of the 571 cohorts and 2.9% of 13,782 activities. The most common reasons for unplanned adaptations were due to time management issues, site logistic issues, and to increase participant engagement. Over time, health educators reported fewer unplanned adaptations, particularly those due to time management, resulting in a decrease in the cohorts and activities affected. Adaptations to evidence-based curricula are necessary and often occur during implementation to fit local conditions and populations. Ongoing review of adaptation data provides an opportunity to refine training and technical assistance efforts. Guidance about the types of permitted adaptations and how to anticipate and plan for adaptations for future implementation can ensure fidelity to the core curriculum components and responsiveness to youth participants., Competing Interests: Declarations of interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to evaluate the impact of Woman- to-Woman, a lay health advisor (LHA)-led educational intervention on cervical cancer and human papillomavirus (HPV) knowledge in a cohort of at-risk Grenadian women., Methods: LHAs from high-risk parishes were trained in the administration of the intervention and administered the program to 78 local women. Participants completed a pre- and post-knowledge test and a session evaluation. LHAs participated in a process evaluation focus group., Results: Sixty-eight percent (68%) of participants obtained higher knowledge scores following the educational intervention. The difference between the pre- and post-test scores was statistically significant ( p = 0.05). Almost 94% agreed that they were taught new and useful information by credible, community informed and responsive LHAs. Ninety percent (90%) indicated great satisfaction and high motivation to recommend to others. LHAs reported on the intervention and their community interactions., Conclusions: Results demonstrate that a LHA-led educational intervention significantly improved participants' knowledge of cervical cancer, HPV, Papanicolaou test and vaccination against HPV. Innovations: Researchers trancreated an evidenced based intervention originally designed for Latina women for Grenadian women. There is no evidence in the literature of previous LHA- cervical cancer education studies conducted in Grenada nor the Caribbean., Competing Interests: The Author(s) declare that there is no conflict of interest., (© 2022 The Authors.)

Introduction: Medical information is expanding at exponential rates. Practicing physicians must acquire skills to efficiently navigate large bodies of evidence to answer clinical questions daily. How best to prepare medical students to meet this challenge remains unknown. The authors sought to design, implement, and assess a pragmatic evidence-based medicine (EBM) course engaging students at the transition from undergraduate to graduate medical education., Materials and Methods: An elective course was offered during the required 1-month Capstone medical school curriculum. Participants included one hundred sixty-eight graduating fourth-year medical students at Emory University School of Medicine who completed the course from 2012 to 2018. Through interactive didactics, small groups, and independent work, students actively employed various electronic tools to navigate medical literature and engaged in structured critical appraisal of guidelines and meta-analyses to answer clinical questions., Results: Assessment data was available for 161 of the 168 participants (95.8%). Pre- and post-assessments demonstrated students' significant improvement in perceived and demonstrated EBM knowledge and skills ( p  < 0.001), consistent across gender and specialty subgroups., Discussion: The Capstone EBM course empowered graduating medical students to comfortably navigate electronic medical resources and accurately appraise summary literature. The objective improvement in knowledge, the perceived improvement in skill, and the subjective comments support this curricular approach to effectively prepare graduating students for pragmatic practice-based learning as resident physicians., Competing Interests: Conflict of InterestThe following authors have no conflicts of interest to disclose: Caitlin Anderson MD MPH, John Haydek MD, Lucas Golub MD, Traci Leong PhD, Dustin T. Smith MD, Jason Liebzeit MD. Daniel D. Dressler MD MSc discloses royalties from McGraw-Hill Education., (© International Association of Medical Science Educators 2020.)