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Introduction: There is global recognition that low back pain (LBP) should be managed with a biopsychosocial approach. Previous implementation of this approach resulted in low uptake and highlighted the need for ongoing support. This study aims to explore the feasibility of (i) training and using a champion to support implementation, (ii) using a cluster randomised controlled trial (RCT), (iii) collecting patient reported outcome measures in a Canadian public healthcare setting and to identify contextual barriers to implementation., Methods: A pragmatic cluster RCT with embedded qualitative study with physiotherapists treating LBP in publicly funded physiotherapy departments in Newfoundland and Labrador, Canada. Participants will complete a previously developed online training course to equip them to deliver a biopsychosocial intervention for LBP. Clusters randomised to the intervention arm will receive additional support from a champion. A minimum champion training package has been developed based on known barriers in the literature. This includes strategies to target barriers relating to group-based scheduling issues, lack of managerial support, perceived patient factors such as addressing patient expectations for other types of treatments or selecting which patients might be best suited for this intervention, and anxiety about delivering something new. This package will be further codeveloped with study champions based on identified implementation barriers using the Behaviour Change Wheel. Clusters will be monitored for 6 months to assess champion and physiotherapist recruitment and retention, acceptability and implementation of the champion training, and the viability of conducting a cluster RCT in this setting. A purposive sample of physiotherapists will be interviewed from both arms., Ethics and Dissemination: This study was approved by Newfoundland and Labrador Health Research Ethics Authority in December 2018. Results will be disseminated to academic audiences through conferences and peer reviewed publications; to all study participants, their clinical leads, and patients with LBP., Trial Registration Number: ClinicalTrials.gov Identifier: NCT04377529; Memorial University of Newfoundland Protocol Record 20190025; Pre-results., Competing Interests: Competing interests: ZH provides private training to healthcare professionals in cognitive behavioural therapy., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue., Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score., Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis., Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice., Competing Interests: None

Purpose: Little is known about knowledge translation processes within medical education. Specifically, there is scant research on how and whether faculty incorporate empirical medical education knowledge into their educational practices. The authors use the conceptual framework of affordances to examine factors within the medical education practice environment that influence faculty utilization of empirical knowledge., Method: In 2012, the authors, using a purposive sampling strategy, recruited medical education leaders in undergraduate medical education from a Canadian university. Recruits all had direct teaching and curricular development roles in either preclinical or clinical courses across the four years of the undergraduate curriculum. Data were collected through individual semistructured interviews on participants' use of empirical evidence, as well as the factors that influence integration of empirical knowledge into practice. Data were analyzed using thematic analysis., Results: Fifteen medical educators participated. The authors identified both constraining and facilitating affordances of empirical medical education knowledge use. Constraining affordances included poor quality and availability of evidence, inadequate knowledge delivery approaches, work and role overload, faculty and student change resistance, and resource limitations. Facilitating affordances included faculty development, peer recommendations, and local involvement in medical education knowledge creation., Conclusions: Affordances of the medical education practice environment influence empirical knowledge use. Developing strategies for effective knowledge translation thus requires careful assessment of contextual factors that can enable, constrain, or inhibit evidence use. Empirical knowledge use is most likely to occur among medical educators who are afforded rich, facilitative opportunities for participation in creating, seeking, and implementing knowledge.

Rationale, Aims and Objectives: While the science of knowledge translation (KT) has been growing steadily for the past decade in relation to understanding processes and actions which are embedded within clinical practice settings, little is known about how empirical knowledge is used within the medical education system. Despite an increase of research in this domain, we know very little about the contribution of this evidence in the development of medical students into effective physicians. This pilot study aims to: provide a synthesis of the evidence for educational strategies within medical education; explore the perceptions and experiences of faculty in undergraduate (UG) medical education in relation to their use of evidence in their educational practices; and illuminate how medical education evidence is formally integrated into a UG medical curriculum., Method: The study will involve three phases. First, a scoping review of the medical education research literature will be undertaken to generate insight into the evidence available for curriculum development, teaching and assessment activities within this domain. Second, a content analysis of undergraduate courses at the University of Toronto will be undertaken to generate an additional insight into the extent that medical education research has been formally integrated into the UG curriculum for medical students at the University. Finally, a purposeful sample of 30-40 medical education leaders from a single large university, selected as it aims to deliver a rigorous research-oriented medical curriculum, will be interviewed to understand how they use the available evidence in their education practices., Discussion: This study will lay the grounds to generate initial data into the determinants of knowledge use in a medical education context. In doing so, the findings will also inform the development of a larger, pan-Canadian study at medical schools that will generate a comprehensive account of the processes and challenges related to KT within an educational context. This larger study will also begin to explore the relevance of the Knowledge-to-Action model to a medical education context., (© 2012 John Wiley & Sons Ltd.)

Introduction: Interest in collaborative care approaches and in interprofessional education (IPE) to prepare providers for interprofessional collaboration is increasing and particularly so in the field of primary health care. Although evidence for the effectiveness of IPE is mixed, Barr et al. (2005) have proposed a useful framework for evaluating six levels of IPE outcomes. The Building a Better Tomorrow Initiative (BBTI) was a continuing professional development (CPD) program established to enhance the collaborative competencies of primary health care providers and foster interprofessional collaboration in primary health care settings. This article describes the evaluation design, specific measures, and educational outcomes of the BBTI program using Barr and colleagues' evaluation framework., Methods: We used a mixed method approach. The evaluation research design was a one-group, pre- to poststudy utilizing a combination of quantitative and qualitative evaluation instruments and methods to collect data for the six levels of the Barr et al. evaluation framework. Evaluation focused especially on the following levels: participant satisfaction (reaction), confidence change (attitudes), performance change, and organizational impact., Results: Participants were very satisfied with the BBTI modules and reported significant increases in their confidence and interprofessional collaborative competencies upon return to their primary health care practice sites. Interviews and focus groups with participants and administrators suggest that the BBTI modules were also effective in promoting and fostering interprofessional collaboration within primary health care settings., Discussion: Results suggest that interprofessional CPD is effective in enhancing understanding of the roles of other professions, fostering respect and positive attitudes toward interprofessional collaboration, developing collaborative competencies, and promoting organizational change.

This study examines the experiences of nine medical teachers who transitioned from face-to-face teaching to facilitating a course in an online environment. The authors examined the reasons why the teachers agreed to facilitate an online course, the challenges they encountered and their practical solutions, and the advantages and disadvantages they perceived to this teaching environment. Thirty-minute phone interviews were conducted. An iterative process was used to develop the themes and sub-themes for coding. Teachers reported being attracted to the novelty of the new instructional format and saw online learning as an opportunity to reach different learners. They described two facets to the transition associated with the technical and facilitation aspects of online facilitation. They had to adapt their usual teaching materials and determine how they could make the 'classroom' user friendly. They had to determine ways to encourage interaction and facilitate learning. Lack of participation was frustrating for most. This study has implications for those intending to develop online courses. Teacher selection is important as teachers must invest time in course development and teaching and encourage participation. Teacher support is critical for course design, site navigation and mentoring to ensure teachers facilitate online discussion.