Foundations
A Community of Practice for Knowledge Translation Trainees: An Innovative Approach for Learning and Collaboration ROBIN URQUHART,1 PHD; EVELYN CORNELISSEN,2 RD, PHD; SHALINI LAL,3 PHD; HEATHER COLQUHOUN,4 PHD; GAIL KLEIN,5 MSC; SARAH RICHMOND,6 PHD; HOLLY O. WITTEMAN,7,8,9 PHD A growing number of researchers and trainees identify knowledge translation (KT) as their field of study or practice. Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. The Knowledge Translation Trainee Collaborative is a trainee-initiated and trainee-led community of practice established by junior knowledge translation researchers and practitioners to: examine the diversity of knowledge translation research and practice, build networks with other knowledge translation trainees, and advance the field through knowledge generation activities. In this article, we describe how the collaborative serves as an innovative community of practice for continuing education and professional development in knowledge translation and present a logic model that provides a framework for designing an evaluation of its impact as a community of practice. The expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members’ competencies (eg, combination of skills, abilities, and knowledge) in knowledge translation research and practice and contribute to the development and advancement of the knowledge translation field. Key Words: community of practice, knowledge translation, collaboration, trainees, continuing education
Introduction Disclosures: The authors report none. Affiliations: 1 Cancer Outcomes Research Program, Dalhousie University/Capital Health, Halifax, Nova Scotia, Canada; 2 Department of Family Practice, University of British Columbia, Kelowna, British Columbia, Canada; 3 Department of Psychiatry, McGill University, Montreal, Quebec, Canada; 4 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa, Ontario, Canada; 5 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; 6 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada; 7 Office of Education and Continuing Professional Development, Faculty of Medicine, Universit´e Laval, Quebec City, Quebec, Canada; 8 Department of Family and Emergency Medicine, Faculty of Medicine, Universit´e Laval, Quebec City, Quebec, Canada; 9 Research Centre of the Centre Hospitalier Universitaire de Qu´ebec, Quebec City, Quebec, Canada. Correspondence: Robin Urquhart, Cancer Outcomes Research Program, Dalhousie University/Capital Health, Room 804, Victoria Building, QEII Health Sciences Centre, 1276 South Park Street, Halifax, NS B3H 2Y9; e-mail: [email protected]. © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education. • Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/chp.21190
Knowledge translation (KT) has been defined as the “iterative, timely, and effective process of integrating best evidence into the routine practice of patients, practitioners, health care teams, and systems.”1 Simply put, it refers to the process of moving knowledge into healthcare practice from clinical “frontline” care to policy making. KT practice is about helping knowledge “users” (eg, clinicians, patients, and health system managers and administrators) become aware of knowledge and facilitating their use of it in their day-to-day work and decision making. KT research is about studying the determinants of knowledge use and investigating methods to support the adoption, implementation, and sustained use of knowledge in practice. KT researchers have consistently demonstrated that the movement of knowledge (largely defined as scientific evidence) into practice is a slow and often indiscriminate process.2,3 The past decade of KT research has highlighted limitations in traditional methods of knowledge transfer and application (eg, dissemination through didactic presentations and lectures),4,5 resulting in tremendous growth in both KT research and practice. Consequently, many researchers and trainees now identify KT as their field of study or practice.6
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Leaders in the field have argued that advancing KT research and practice will require new research collaborations and partnerships,7 and exploration and application of multiple modes of inquiry and perspectives.8 Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. In Canada, one group, KT Canada, provides a training initiative to enhance capacity in KT research and practice, specifically at eight affiliated universities.9 Although KT Canada’s support and mentorship of KT trainees have been significant, the current funding for this group ends in 2015, potentially limiting opportunities for trainees to advance their learning and skill development in KT. The KT Trainee Collaborative (KTTC) is a unique trainee-initiated and trainee-led national community of practice (CoP). It was established by junior KT researchers and KT practitioners (eg, graduate students, postdoctoral fellows, junior faculty, clinicians, and knowledge brokers) to examine the diversity of KT research and practice, build networks with other KT trainees, and advance the field through knowledge generation activities. At its core, it is focused on continuing education and professional development in KT. Membership is diverse, with members crossing geographical, methodological, and disciplinary boundaries.6 This article has 2 purposes: (1) to describe how the KTTC serves as an innovative CoP approach to continuing education/professional development in KT, and (2) to present a logic model that provides a framework for designing an evaluation of its impact as a CoP. The KTTC as a Community of Practice The KTTC was established in 2010 by trainees as a sustainable social collaborative structure that provides accessible, ongoing opportunities for learning and collaboration in an environment that is primarily virtual, that respects and represents diversity in KT theory, methods, and tools. The KTTC defines trainees as “students, graduate students, postdoctoral fellows, faculty, community learners, scientists/researchers from a wide spectrum of academia, healthcare professionals, health care administrators, and/or others who are new to KT and are interested in actively exploring and developing KT research and practice.”10 This definition is deliberately broad and relates to one’s experience within the field of KT versus age or career stage per se. Given this membership focus, senior or expert KT researchers and practitioners have not been core KTTC members, as the CoP was established as a supplement or complement to existing groups led and populated by experts, such as KT Canada. Through its vision and mission statements, the KTTC identifies as a CoP. Wenger11 defines CoPs as “groups of
people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in the area by interacting on an ongoing basis” (p. 4). The notion that learning occurs in social environments11,12 and that trainees could (and would) acquire valuable KT knowledge and skills through social relationships with their peers was a fundamental driver to developing the KTTC as a CoP. Though conceptualizations and structures of CoPs vary,13 members perceived this group would develop beyond a KT network, or a set of informal relationships, to a collaborative-type entity wherein junior researchers and practitioners would engage in collaborative learning and in the establishment of collaborative programs of research. Wenger11 has described CoPs as having 3 common elements: domain, community, and practice. Domain refers to the concern or topic around which members organize, or the common ground that differentiates members from nonmembers. Community refers to the social structure that facilitates learning through relationships and members’ mutual engagement. Practice refers to the body of knowledge or set of resources that a CoP shares, develops, and maintains. EXHIBIT 1 provides a detailed description of the KTTC in relation to these elements. In a systematic review of CoPs in the business and healthcare sectors, Li and colleagues13 identified 4 characteristics present in CoP groups: members interact with one another in formal and informal settings; members share knowledge with one another; members collaborate with one another to create new knowledge; and groups promote the development of a shared, professional identity among members. At the beginning of the KTTC’s development, members identified and agreed on 4 collective goals, around which the group’s functions and activities would be centered: collaborative learning, collaborative work, networking, and career/professional development.6 The characteristics articulated by Li et al.13 are present in the KTTC’s collective goals and subsequent or planned activities. TABLE 1 presents these activities, which include annual face-to-face meetings, a quarterly newsletter, a virtual seminar series, and a peer mentorship program. Though membership of CoPs is typically fluid with members more or less active at different times,12 fostering a “critical mass” of engaged and committed members14 has been a predominant focus of the group’s efforts over the past 2 years. Since its inception, the KTTC has assembled 123 members (from March 2010 to December 2012). An analysis of member engagement indicates that 43 (35%) members are presently engaged in core activities (ie, steering and executive committees, working groups, research collaborations). An additional 10 (8%) members are minimally engaged (eg, posting on the blog) or were engaged in the first 2 years of KTTC activity but are no longer. In addition to this critical mass, 70 (57%) members have never actively engaged in any KTTC event or activity.
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Domain • Interest in knowledge translation research and practice, specifically in engaging in interdisciplinary dialogue and learning more about, and expanding, the existing knowledge base in this field.
Community • KTTC members include graduate students, post-doctoral fellows, junior faculty, clinicians, and KT specialists. • KTTC structures are composed of a vision, mission, and governance structure outlined in a Terms of Reference document. • Members interact via virtual (blog, video chat, collaboratively created Google Docs), teleconference, e-mail, and in-person means.
Practice • • • • • • • • •
Blog: http://ktclearinghouse.ca/kttc/ Virtual seminar series, with archived summaries of discussions Peer-mentorship program (within membership of KTTC) Quarterly newsletter (updates, successes, challenges, on-going projects, member profiles) Annotated bibliography repository Publications (peer-reviewed journals, professional journals/newsletters) and conference presentations Grant applications (successful and unsuccessful) Research protocols and related resources Special interest groups (eg, mental health/arts-based KT, economics of KT)
EXHIBIT 1. The Knowledge Translation Trainee Collaborative (KTTC) in relation to Wenger’s11 Community of Practice Elements; KT = knowledge translation
Benefits and Opportunities One of the benefits of learning within a CoP is learning from peers. Early on, KTTC members identified the need for a space where junior researchers and practitioners could come together to learn from each other, cultivate connections and relationships with other trainees, and develop collaborative opportunities to meaningfully develop and contribute knowledge to this new field. In this way, the KTTC attends to Patton’s15 “degrees of working together continuum.” That is, development and maintenance of the KTTC’s practice provide members opportunities for “low-level working together as distinct entities” (eg, networking to share information and ideas, cooperating to help one another achieve individual goals) and for “high-level, fully integrated working together” (eg, partnering on shared goals, collaborating on common goals) (p. 245).15 CoPs are conceptualized as places of open exploration and reflection where members can safely pose difficult questions and consult each other for assistance and cooperation.11 Such spaces have been deemed critical to continuing medical education and professional development.16–18 Indeed, CoPs often challenge members’ current ideas and ways of thinking/working and foster rich learning environments, specifically in relation to engaging in double-loop learning19 (ie, learning that occurs when one 276
challenges the underlying assumptions about how things are normally done) and processes of unlearning.20 In addition, members frequently deepen their understanding and expertise on a particular topic by learning from each other. Often, this learning is achieved by way of tacit knowledge shared through interaction, storytelling, and working together.16,17 This type of situated learning, occurring during social interaction and collaboration, is believed to be critical to acquiring, developing, and using the knowledge required in authentic contexts—that is, the real-world settings and situations that would normally involve that knowledge.21 Interactions with colleagues facing similar problems and tasks are key sources of learning and skills updating for many clinicians.16,22,23 Gaining such knowledge is also critical to early career investigators and KT practitioners, helping them acquire new perspectives, knowledge, and skills to enhance their research and enable competent KT practice. Another benefit of participating in a CoP, particularly for trainees who are beginning their careers, is building a community wherein members are supported in generating new knowledge and contributing to their chosen field. The varied methodological and clinical expertise that exists within the KTTC is shared through informal (eg, interaction and discussion with peers) and formal (eg, peer mentorship
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—33(4), 2013 DOI: 10.1002/chp
Community of Practice for Knowledge Translation TABLE 1. Characteristics of Communities of Practice in Relation to the Knowledge Translation Trainee Collaborative’s (KTTC) Collective Goals and Activities
Characteristica
KTTC Goal
KTTC Activities
• Annual face-to-face and other meetings, with formal and informal networking time • Teleconference meetings, with time dedicated to unstructured communication (ie, socialization) • Virtual seminar seriesb • Peer-mentorship programc
Social interaction
Networking
Knowledge sharing
Collaborative learning
• Virtual seminar series • Peer-mentorship program • Formal and informal encouragement for reflection, both on specific KT topics and relational aspects of KTTC functioning • KT leader presentations at annual meetings, shared virtually via webinar at 2012 meeting • Quarterly newsletter • Annotated bibliography
Knowledge creation
Collaborative work
• Develop and conduct collaborative research projects • Multi-authored publications (peer-reviewed and other), and university and conference presentations
Identity building
Professional development
• Career and Curriculum Vitae-building activities (eg, multiauthored publications, research protocols, grant applications, plan and conduct annual meetings) • Presentation of academic work to other members (eg, practice PhD defenses, oral presentations at annual meetings) • Development of leadership skills (eg, chairing committees and meetings)
a
Characteristics based on Li et al.13 systematic review. The virtual seminar series is an ongoing series created to explore one topic in-depth through a series of teleconference sessions. c The peer mentorship program includes a visiting exchange program for post-doctoral fellows and ongoing events for more senior members to share training- and career-related experiences with junior members. KT = knowledge translation. b
program) mechanisms. Much of the collaborative work to date has centered on research activities, including development of grant proposals and research protocols, and creating and writing multi-authored publications. For the most part, these activities are performed virtually through the use of online tools that facilitate team input and collaborative writing. By collaborating as peers in early career, the KTTC has enabled members to engage in peer mentorship about the ins and outs of doing research, bringing practiced techniques and norms from their own disciplines and institutions to the table, and also collectively developing new approaches as a community. Importantly, mentors are often more readily accessible in CoPs than in other learning environments (eg, traditional continuing medical education).16
Through facilitating collaboration, the KTTC strives to enable situated learning, cultivate good working relationships among junior researchers and practitioners from various disciplinary backgrounds, and cocreate community knowledge that is greater than what any one individual can create on his/her own. An opportunity, therefore, resides in what Huxham and MacDonald24 describe as collaborative advantage, wherein something unusually creative is produced synergistically or an objective is met that no person could have produced him/herself. The notion of synergy provides one of collaboration’s most important outcomes: the capacity for a group’s collective output to be greater and/or different than if the individuals were working alone, a notion paralleled in definitions of interdisciplinarity and
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transdisciplinarity where the whole is more than the sum of its parts25 and different forms of knowledge are combined to produce “new forms of knowledge.”26 Indeed, the concepts of interdisciplinarity and transdisciplinarity were purposefully integrated into the community’s formal structures (eg, identity and vision statements) and the current membership reflects the group’s diversity in terms of disciplines, perspectives and ways of knowing. For example, members have backgrounds in a wide range of disciplines, including health services and policy research, epidemiology, population health, engineering, exercise physiology, library/information sciences, sociology, medicine, nursing, occupational therapy, physiotherapy, psychology, dietetics, and social work. Interdisciplinary collaboration in the KTTC serves to capitalize on individuals’ prior education and skill development, and offers the potential to advance KT thought and discourse by enabling members to collectively integrate and build on different disciplines’ theoretical and methodological insights to generate new forms of knowledge about moving knowledge into healthcare practice.27 The integration of multiple disciplines also helps to address the limitations of members’ respective disciplines in terms of understanding and studying KT. In this way, the KTTC is endeavoring to facilitate transdisciplinary participation wherein multiple disciplinary perspectives harmonize to produce academic and other outputs that transcend traditional disciplinary boundaries.25 Knowledge generation activities within the KTTC focus on research areas that often require the assimilation of diverse perspectives and research approaches, such as the impact of collaboration and collaborative advantage, sustainability of knowledge use, competencies in KT, and arts-based KT. Challenges Engaging in collaborative learning and work brings challenges, particularly for a group of junior researchers with constrained resources. These range from practical (eg, acquiring and maintaining resources for teleconferencing) to more academic issues. For example, multi-authored work in the KTTC has raised a number of important issues: (1) how to effectively and efficiently produce new knowledge (including managing and negotiating issues of lead authors, primary investigators, etc) when authors have limited or no prior working relationships and have to work entirely through virtual mechanisms; and (2) how to navigate and leverage authors’ varied worldviews and ways of knowing to create knowledge that contributes new and meaningful insight into KT discourse, research, and practice. These issues have been managed through incorporating authorship principles in the KTTC’s formal terms of reference,10 early and explicit discussion of and agreement on authorship roles (eg, primary and secondary authors) and availability (eg, anticipated 278
timing and depth of commitment), and attempts to balance the diverse theoretical and methodological expertise through use of mixed methods studies and projects. Additionally, members are encouraged to focus on shared goals such as professional development, social support in a nonhierarchical structure, and producing outputs relevant to career advancement. Finally, the growth and sustainment of the KTTC are, at least partially, dependent on the appeal and impact of its practice (ie, the resources it develops and maintains, the projects it pursues), and on its added value. Meeting members’ needs and expectations with respect to these elements, in a volunteer-led group without dedicated resources and few funding opportunities, represents considerable challenges to growing and establishing this CoP in the broader KT community. Indeed, the KTTC must meet members’ needs if they are going to volunteer their time and participate in an active and ongoing way. As a consequence, evaluating the KTTC’s appeal and perceived impact will be integral to planning activities that support its growth and sustainability. Evaluating the KTTC as a Community of Practice How does a CoP such as the KTTC assess its value for its members and its contribution to the broader field of KT? Periodic assessment and evaluation is imperative to ensuring that the community achieves its collective goals, meets members’ individual and collective needs and expectations, and contributes meaningfully to the growing KT field. Most of the literature on CoPs in health care is comprised of qualitative studies describing the structure and operation of CoPs rather than assessing its value and impact.13 Several researchers have explored various aspects of value, such as the acquisition of expertise and resources28 and the number and intensity of new connections.29 However, there have been limited efforts to collect and integrate different sources of data to gain a broader understanding of a CoP’s value. Recently, a number of researchers have emphasized the need for thoughtful and systematic evaluation of CoPs13,30,31 and frameworks to support their evaluation.30 Toward this end, the KTTC has developed a logic model, using a template adapted from one developed by the University of Wisconsin-Extension,32 that illustrates the theoretical rationale for the existence of the CoP and provides a framework for evaluating its impact (FIGURE 1). The logic model describes the inputs (what is invested to implement the CoP), outputs (what the CoP does and whom it reaches), and outcomes (what the CoP is to achieve). The framework also includes a number of outcome measures wherein the aim is to integrate these measures into a meaningful account of the KTTC’s value and impact. The need for an evaluation framework and its initial conception emerged at an inperson meeting of KTTC members (including authors of this
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Community of Practice for Knowledge Translation
FIGURE 1. A Logic Model to Evaluate the Impact of the Knowledge Translation Trainee Collaborative (KTTC); KT = knowledge translation
article). Development continued through electronic discussion, with 1 author (S.L.) using the discussion material to draft the logic model, which was subsequently refined by all authors. In terms of inputs and outputs, the model highlights the importance of members’ in-kind, volunteer investments to the sustainability of the KTTC, the various activities that occur, and the diversity of KTTC membership. In terms of outcomes, the KTTC was created to provide a mechanism to link trainees from diverse geographical areas and disciplines.6 The primary recipients of the KTTC’s value are the members themselves and thus outcomes converge around members’ experiences and perspectives. As depicted in FIGURE 1, the outcomes may be short, medium, or long term. In the short term, members may acquire a large number of connections with varied KT expertise and perceive value from the “knowledge capital”33 being created within the community. For instance, an increase in social connections and relationships may provide members with an enhanced ability to ask questions and seek assistance related to KT issues because they know who to ask and trust. In the medium and long term, members may have a more diverse knowledge base in KT and an enhanced skill set re-
lated to KT. Indeed, the expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members’ competencies (eg, combination of skills, abilities, and knowledge.34 ) in KT research and practice. In this way, the KTTC may complement the formal learning mechanisms by which members acquire KT knowledge and skills. New knowledge and skills can be applied, and new connections leveraged, in members’ own work as they build their professional careers. In the long-term, improved competencies and increased collaborations may lead to an increased capacity in KT research and practice at both individual and collective levels. The evaluation framework depicted in FIGURE 1 leverages the skills and expertise of a diverse membership in conceptualizing and implementing evaluation activities. The KTTC is currently adopting a mixed-methods approach that applies social network analysis, surveys, and qualitative research methods to understand how the KTTC functions, the degree to which members are connected, and how collaborative advantage24 manifests itself in this CoP. Outcomes are assessed at the individual and collective levels through consideration of process (eg, level of participation) and outcome
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(eg, publication and funding) metrics, and self-reported measures related to building networks and engaging in collaborative activities among members. Using this framework, the KTTC is better positioned to evaluate the extent to which the networking and relationships fostered through the CoP lead to the improvement of individual members’ competencies in KT research and practice. The integration of multiple types of data should also offer insight into specific aspects of the KTTC that contribute (or not) to members’ learning and skill development. For instance, the evaluation might shed light on whether limiting senior researcher/practitioner involvement and maintaining relatively similar levels of experience and expertise was a wise and valuable decision, and, if not, how we might shift the CoP’s structure to encompass varying levels of experience and expertise. The framework also provides a foundation for the evaluation of specific KTTC activities: for example, we are currently evaluating the impact of peer mentorship on members’ career development. We anticipate that this framework might also prove useful for evaluation activities within other CoPs and similar types of collaboratives. The long-term vision of the KTTC is that the traineeinitiated and -led CoP will also contribute to the development and advancement of the KT field. The cultivation of professional relationships among junior KT researchers and practitioners, with diverse epistemological perspectives, methodological backgrounds, and health care interests, is anticipated to enhance the next generation of KT researchers’ and practitioners’ awareness and understanding of the multiple dimensions of KT (educational, behavioral, social, embedded, organizational, and system components) and provide them with a broad range of tools (ie, methodologies, methods, and competencies) to study and practice KT. Relationships established through communities often continue long after the formal organizing entity ceases35 or member affiliations with the formal community structure weaken. Although the KTTC deliberately adopted a definition of trainee that covers a range of career stages, ultimately, members will move on from official trainee status and may therefore move on from the KTTC as an organization. However, through the KTTC, members may develop professional relationships and research collaborations that endure throughout their careers and beyond formal relationships with the KTTC. Importantly, the uniqueness of this community will be intricately linked to its focus on trainees, providing them with informal and formal peer mentoring opportunities, enabling them to develop relationships early in their career with others who share similar interests, and facilitating their involvement in collaborative projects (eg, grant applications, research studies, papers for academic and professional journals) that directly and indirectly benefit their continuing education and professional development. For many trainees,
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such KT-focused opportunities are limited in their formal training and work environments. Conclusions KT trainees self-identified a need to develop a social structure, and harness technological infrastructure, to cultivate sustainable collaborative efforts to promote diverse KT thought and discourse and to advance KT science and practice. To this end, trainees initiated a national CoP to provide a positive peer environment for junior KT researchers and practitioners to network and build relationships, develop skills, and create and share knowledge. The contributions this CoP makes to the KT field may be tangible or intangible. Certainly, KTTC members can visibly contribute to KT discourse, research, and practice through traditional academic products (eg, research grants/protocols, peer-reviewed publications, conference presentations). Importantly, through the CoP activities, these contributions can occur before trainees begin their academic or professional careers. The intangible contributions to professional learning, professional collaboration, and knowledge development may also prove valuable consequences of the KTTC. The learning that occurs through the recounting of stories and experiences and the sharing of formal and informal resources can appreciably contribute to members’ current and future academic and career pursuits, and thereby contribute to the KT field as a whole.
Lessons for Practice •
Communities of practice enable learning, facilitate collaboration, and provide a mechanism to achieve collaborative advantage, wherein members co-create knowledge that is greater than what any one individual can create on his/her own.
•
Trainees (or persons early in their careers) can benefit from communities of practice, specifically in terms of sharing knowledge and developing networks and relationships, in a positive peer environment, which contribute to their academic and career pursuits.
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Communities of practice require periodic evaluation to ensure they achieve their collective goals, meet members’ individual and collective needs and expectations, and support their growth and sustainability.
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A Community of Practice for Knowledge Translation Trainees: An Innovative Approach for Learning and Collaboration ROBIN URQUHART,1 PHD; EVELYN CORNELISSEN,2 RD, PHD; SHALINI LAL,3 PHD; HEATHER COLQUHOUN,4 PHD; GAIL KLEIN,5 MSC; SARAH RICHMOND,6 PHD; HOLLY O. WITTEMAN,7,8,9 PHD A growing number of researchers and trainees identify knowledge translation (KT) as their field of study or practice. Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. The Knowledge Translation Trainee Collaborative is a trainee-initiated and trainee-led community of practice established by junior knowledge translation researchers and practitioners to: examine the diversity of knowledge translation research and practice, build networks with other knowledge translation trainees, and advance the field through knowledge generation activities. In this article, we describe how the collaborative serves as an innovative community of practice for continuing education and professional development in knowledge translation and present a logic model that provides a framework for designing an evaluation of its impact as a community of practice. The expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members’ competencies (eg, combination of skills, abilities, and knowledge) in knowledge translation research and practice and contribute to the development and advancement of the knowledge translation field. Key Words: community of practice, knowledge translation, collaboration, trainees, continuing education
Introduction Disclosures: The authors report none. Affiliations: 1 Cancer Outcomes Research Program, Dalhousie University/Capital Health, Halifax, Nova Scotia, Canada; 2 Department of Family Practice, University of British Columbia, Kelowna, British Columbia, Canada; 3 Department of Psychiatry, McGill University, Montreal, Quebec, Canada; 4 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa, Ontario, Canada; 5 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; 6 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada; 7 Office of Education and Continuing Professional Development, Faculty of Medicine, Universit´e Laval, Quebec City, Quebec, Canada; 8 Department of Family and Emergency Medicine, Faculty of Medicine, Universit´e Laval, Quebec City, Quebec, Canada; 9 Research Centre of the Centre Hospitalier Universitaire de Qu´ebec, Quebec City, Quebec, Canada. Correspondence: Robin Urquhart, Cancer Outcomes Research Program, Dalhousie University/Capital Health, Room 804, Victoria Building, QEII Health Sciences Centre, 1276 South Park Street, Halifax, NS B3H 2Y9; e-mail: [email protected]. © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education. • Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/chp.21190
Knowledge translation (KT) has been defined as the “iterative, timely, and effective process of integrating best evidence into the routine practice of patients, practitioners, health care teams, and systems.”1 Simply put, it refers to the process of moving knowledge into healthcare practice from clinical “frontline” care to policy making. KT practice is about helping knowledge “users” (eg, clinicians, patients, and health system managers and administrators) become aware of knowledge and facilitating their use of it in their day-to-day work and decision making. KT research is about studying the determinants of knowledge use and investigating methods to support the adoption, implementation, and sustained use of knowledge in practice. KT researchers have consistently demonstrated that the movement of knowledge (largely defined as scientific evidence) into practice is a slow and often indiscriminate process.2,3 The past decade of KT research has highlighted limitations in traditional methods of knowledge transfer and application (eg, dissemination through didactic presentations and lectures),4,5 resulting in tremendous growth in both KT research and practice. Consequently, many researchers and trainees now identify KT as their field of study or practice.6
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Community of Practice for Knowledge Translation
Leaders in the field have argued that advancing KT research and practice will require new research collaborations and partnerships,7 and exploration and application of multiple modes of inquiry and perspectives.8 Yet, KT educational and professional development opportunities and established KT networks remain relatively uncommon, making it challenging for trainees to develop the necessary skills, networks, and collaborations to optimally work in this area. In Canada, one group, KT Canada, provides a training initiative to enhance capacity in KT research and practice, specifically at eight affiliated universities.9 Although KT Canada’s support and mentorship of KT trainees have been significant, the current funding for this group ends in 2015, potentially limiting opportunities for trainees to advance their learning and skill development in KT. The KT Trainee Collaborative (KTTC) is a unique trainee-initiated and trainee-led national community of practice (CoP). It was established by junior KT researchers and KT practitioners (eg, graduate students, postdoctoral fellows, junior faculty, clinicians, and knowledge brokers) to examine the diversity of KT research and practice, build networks with other KT trainees, and advance the field through knowledge generation activities. At its core, it is focused on continuing education and professional development in KT. Membership is diverse, with members crossing geographical, methodological, and disciplinary boundaries.6 This article has 2 purposes: (1) to describe how the KTTC serves as an innovative CoP approach to continuing education/professional development in KT, and (2) to present a logic model that provides a framework for designing an evaluation of its impact as a CoP. The KTTC as a Community of Practice The KTTC was established in 2010 by trainees as a sustainable social collaborative structure that provides accessible, ongoing opportunities for learning and collaboration in an environment that is primarily virtual, that respects and represents diversity in KT theory, methods, and tools. The KTTC defines trainees as “students, graduate students, postdoctoral fellows, faculty, community learners, scientists/researchers from a wide spectrum of academia, healthcare professionals, health care administrators, and/or others who are new to KT and are interested in actively exploring and developing KT research and practice.”10 This definition is deliberately broad and relates to one’s experience within the field of KT versus age or career stage per se. Given this membership focus, senior or expert KT researchers and practitioners have not been core KTTC members, as the CoP was established as a supplement or complement to existing groups led and populated by experts, such as KT Canada. Through its vision and mission statements, the KTTC identifies as a CoP. Wenger11 defines CoPs as “groups of
people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in the area by interacting on an ongoing basis” (p. 4). The notion that learning occurs in social environments11,12 and that trainees could (and would) acquire valuable KT knowledge and skills through social relationships with their peers was a fundamental driver to developing the KTTC as a CoP. Though conceptualizations and structures of CoPs vary,13 members perceived this group would develop beyond a KT network, or a set of informal relationships, to a collaborative-type entity wherein junior researchers and practitioners would engage in collaborative learning and in the establishment of collaborative programs of research. Wenger11 has described CoPs as having 3 common elements: domain, community, and practice. Domain refers to the concern or topic around which members organize, or the common ground that differentiates members from nonmembers. Community refers to the social structure that facilitates learning through relationships and members’ mutual engagement. Practice refers to the body of knowledge or set of resources that a CoP shares, develops, and maintains. EXHIBIT 1 provides a detailed description of the KTTC in relation to these elements. In a systematic review of CoPs in the business and healthcare sectors, Li and colleagues13 identified 4 characteristics present in CoP groups: members interact with one another in formal and informal settings; members share knowledge with one another; members collaborate with one another to create new knowledge; and groups promote the development of a shared, professional identity among members. At the beginning of the KTTC’s development, members identified and agreed on 4 collective goals, around which the group’s functions and activities would be centered: collaborative learning, collaborative work, networking, and career/professional development.6 The characteristics articulated by Li et al.13 are present in the KTTC’s collective goals and subsequent or planned activities. TABLE 1 presents these activities, which include annual face-to-face meetings, a quarterly newsletter, a virtual seminar series, and a peer mentorship program. Though membership of CoPs is typically fluid with members more or less active at different times,12 fostering a “critical mass” of engaged and committed members14 has been a predominant focus of the group’s efforts over the past 2 years. Since its inception, the KTTC has assembled 123 members (from March 2010 to December 2012). An analysis of member engagement indicates that 43 (35%) members are presently engaged in core activities (ie, steering and executive committees, working groups, research collaborations). An additional 10 (8%) members are minimally engaged (eg, posting on the blog) or were engaged in the first 2 years of KTTC activity but are no longer. In addition to this critical mass, 70 (57%) members have never actively engaged in any KTTC event or activity.
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Domain • Interest in knowledge translation research and practice, specifically in engaging in interdisciplinary dialogue and learning more about, and expanding, the existing knowledge base in this field.
Community • KTTC members include graduate students, post-doctoral fellows, junior faculty, clinicians, and KT specialists. • KTTC structures are composed of a vision, mission, and governance structure outlined in a Terms of Reference document. • Members interact via virtual (blog, video chat, collaboratively created Google Docs), teleconference, e-mail, and in-person means.
Practice • • • • • • • • •
Blog: http://ktclearinghouse.ca/kttc/ Virtual seminar series, with archived summaries of discussions Peer-mentorship program (within membership of KTTC) Quarterly newsletter (updates, successes, challenges, on-going projects, member profiles) Annotated bibliography repository Publications (peer-reviewed journals, professional journals/newsletters) and conference presentations Grant applications (successful and unsuccessful) Research protocols and related resources Special interest groups (eg, mental health/arts-based KT, economics of KT)
EXHIBIT 1. The Knowledge Translation Trainee Collaborative (KTTC) in relation to Wenger’s11 Community of Practice Elements; KT = knowledge translation
Benefits and Opportunities One of the benefits of learning within a CoP is learning from peers. Early on, KTTC members identified the need for a space where junior researchers and practitioners could come together to learn from each other, cultivate connections and relationships with other trainees, and develop collaborative opportunities to meaningfully develop and contribute knowledge to this new field. In this way, the KTTC attends to Patton’s15 “degrees of working together continuum.” That is, development and maintenance of the KTTC’s practice provide members opportunities for “low-level working together as distinct entities” (eg, networking to share information and ideas, cooperating to help one another achieve individual goals) and for “high-level, fully integrated working together” (eg, partnering on shared goals, collaborating on common goals) (p. 245).15 CoPs are conceptualized as places of open exploration and reflection where members can safely pose difficult questions and consult each other for assistance and cooperation.11 Such spaces have been deemed critical to continuing medical education and professional development.16–18 Indeed, CoPs often challenge members’ current ideas and ways of thinking/working and foster rich learning environments, specifically in relation to engaging in double-loop learning19 (ie, learning that occurs when one 276
challenges the underlying assumptions about how things are normally done) and processes of unlearning.20 In addition, members frequently deepen their understanding and expertise on a particular topic by learning from each other. Often, this learning is achieved by way of tacit knowledge shared through interaction, storytelling, and working together.16,17 This type of situated learning, occurring during social interaction and collaboration, is believed to be critical to acquiring, developing, and using the knowledge required in authentic contexts—that is, the real-world settings and situations that would normally involve that knowledge.21 Interactions with colleagues facing similar problems and tasks are key sources of learning and skills updating for many clinicians.16,22,23 Gaining such knowledge is also critical to early career investigators and KT practitioners, helping them acquire new perspectives, knowledge, and skills to enhance their research and enable competent KT practice. Another benefit of participating in a CoP, particularly for trainees who are beginning their careers, is building a community wherein members are supported in generating new knowledge and contributing to their chosen field. The varied methodological and clinical expertise that exists within the KTTC is shared through informal (eg, interaction and discussion with peers) and formal (eg, peer mentorship
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—33(4), 2013 DOI: 10.1002/chp
Community of Practice for Knowledge Translation TABLE 1. Characteristics of Communities of Practice in Relation to the Knowledge Translation Trainee Collaborative’s (KTTC) Collective Goals and Activities
Characteristica
KTTC Goal
KTTC Activities
• Annual face-to-face and other meetings, with formal and informal networking time • Teleconference meetings, with time dedicated to unstructured communication (ie, socialization) • Virtual seminar seriesb • Peer-mentorship programc
Social interaction
Networking
Knowledge sharing
Collaborative learning
• Virtual seminar series • Peer-mentorship program • Formal and informal encouragement for reflection, both on specific KT topics and relational aspects of KTTC functioning • KT leader presentations at annual meetings, shared virtually via webinar at 2012 meeting • Quarterly newsletter • Annotated bibliography
Knowledge creation
Collaborative work
• Develop and conduct collaborative research projects • Multi-authored publications (peer-reviewed and other), and university and conference presentations
Identity building
Professional development
• Career and Curriculum Vitae-building activities (eg, multiauthored publications, research protocols, grant applications, plan and conduct annual meetings) • Presentation of academic work to other members (eg, practice PhD defenses, oral presentations at annual meetings) • Development of leadership skills (eg, chairing committees and meetings)
a
Characteristics based on Li et al.13 systematic review. The virtual seminar series is an ongoing series created to explore one topic in-depth through a series of teleconference sessions. c The peer mentorship program includes a visiting exchange program for post-doctoral fellows and ongoing events for more senior members to share training- and career-related experiences with junior members. KT = knowledge translation. b
program) mechanisms. Much of the collaborative work to date has centered on research activities, including development of grant proposals and research protocols, and creating and writing multi-authored publications. For the most part, these activities are performed virtually through the use of online tools that facilitate team input and collaborative writing. By collaborating as peers in early career, the KTTC has enabled members to engage in peer mentorship about the ins and outs of doing research, bringing practiced techniques and norms from their own disciplines and institutions to the table, and also collectively developing new approaches as a community. Importantly, mentors are often more readily accessible in CoPs than in other learning environments (eg, traditional continuing medical education).16
Through facilitating collaboration, the KTTC strives to enable situated learning, cultivate good working relationships among junior researchers and practitioners from various disciplinary backgrounds, and cocreate community knowledge that is greater than what any one individual can create on his/her own. An opportunity, therefore, resides in what Huxham and MacDonald24 describe as collaborative advantage, wherein something unusually creative is produced synergistically or an objective is met that no person could have produced him/herself. The notion of synergy provides one of collaboration’s most important outcomes: the capacity for a group’s collective output to be greater and/or different than if the individuals were working alone, a notion paralleled in definitions of interdisciplinarity and
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transdisciplinarity where the whole is more than the sum of its parts25 and different forms of knowledge are combined to produce “new forms of knowledge.”26 Indeed, the concepts of interdisciplinarity and transdisciplinarity were purposefully integrated into the community’s formal structures (eg, identity and vision statements) and the current membership reflects the group’s diversity in terms of disciplines, perspectives and ways of knowing. For example, members have backgrounds in a wide range of disciplines, including health services and policy research, epidemiology, population health, engineering, exercise physiology, library/information sciences, sociology, medicine, nursing, occupational therapy, physiotherapy, psychology, dietetics, and social work. Interdisciplinary collaboration in the KTTC serves to capitalize on individuals’ prior education and skill development, and offers the potential to advance KT thought and discourse by enabling members to collectively integrate and build on different disciplines’ theoretical and methodological insights to generate new forms of knowledge about moving knowledge into healthcare practice.27 The integration of multiple disciplines also helps to address the limitations of members’ respective disciplines in terms of understanding and studying KT. In this way, the KTTC is endeavoring to facilitate transdisciplinary participation wherein multiple disciplinary perspectives harmonize to produce academic and other outputs that transcend traditional disciplinary boundaries.25 Knowledge generation activities within the KTTC focus on research areas that often require the assimilation of diverse perspectives and research approaches, such as the impact of collaboration and collaborative advantage, sustainability of knowledge use, competencies in KT, and arts-based KT. Challenges Engaging in collaborative learning and work brings challenges, particularly for a group of junior researchers with constrained resources. These range from practical (eg, acquiring and maintaining resources for teleconferencing) to more academic issues. For example, multi-authored work in the KTTC has raised a number of important issues: (1) how to effectively and efficiently produce new knowledge (including managing and negotiating issues of lead authors, primary investigators, etc) when authors have limited or no prior working relationships and have to work entirely through virtual mechanisms; and (2) how to navigate and leverage authors’ varied worldviews and ways of knowing to create knowledge that contributes new and meaningful insight into KT discourse, research, and practice. These issues have been managed through incorporating authorship principles in the KTTC’s formal terms of reference,10 early and explicit discussion of and agreement on authorship roles (eg, primary and secondary authors) and availability (eg, anticipated 278
timing and depth of commitment), and attempts to balance the diverse theoretical and methodological expertise through use of mixed methods studies and projects. Additionally, members are encouraged to focus on shared goals such as professional development, social support in a nonhierarchical structure, and producing outputs relevant to career advancement. Finally, the growth and sustainment of the KTTC are, at least partially, dependent on the appeal and impact of its practice (ie, the resources it develops and maintains, the projects it pursues), and on its added value. Meeting members’ needs and expectations with respect to these elements, in a volunteer-led group without dedicated resources and few funding opportunities, represents considerable challenges to growing and establishing this CoP in the broader KT community. Indeed, the KTTC must meet members’ needs if they are going to volunteer their time and participate in an active and ongoing way. As a consequence, evaluating the KTTC’s appeal and perceived impact will be integral to planning activities that support its growth and sustainability. Evaluating the KTTC as a Community of Practice How does a CoP such as the KTTC assess its value for its members and its contribution to the broader field of KT? Periodic assessment and evaluation is imperative to ensuring that the community achieves its collective goals, meets members’ individual and collective needs and expectations, and contributes meaningfully to the growing KT field. Most of the literature on CoPs in health care is comprised of qualitative studies describing the structure and operation of CoPs rather than assessing its value and impact.13 Several researchers have explored various aspects of value, such as the acquisition of expertise and resources28 and the number and intensity of new connections.29 However, there have been limited efforts to collect and integrate different sources of data to gain a broader understanding of a CoP’s value. Recently, a number of researchers have emphasized the need for thoughtful and systematic evaluation of CoPs13,30,31 and frameworks to support their evaluation.30 Toward this end, the KTTC has developed a logic model, using a template adapted from one developed by the University of Wisconsin-Extension,32 that illustrates the theoretical rationale for the existence of the CoP and provides a framework for evaluating its impact (FIGURE 1). The logic model describes the inputs (what is invested to implement the CoP), outputs (what the CoP does and whom it reaches), and outcomes (what the CoP is to achieve). The framework also includes a number of outcome measures wherein the aim is to integrate these measures into a meaningful account of the KTTC’s value and impact. The need for an evaluation framework and its initial conception emerged at an inperson meeting of KTTC members (including authors of this
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Community of Practice for Knowledge Translation
FIGURE 1. A Logic Model to Evaluate the Impact of the Knowledge Translation Trainee Collaborative (KTTC); KT = knowledge translation
article). Development continued through electronic discussion, with 1 author (S.L.) using the discussion material to draft the logic model, which was subsequently refined by all authors. In terms of inputs and outputs, the model highlights the importance of members’ in-kind, volunteer investments to the sustainability of the KTTC, the various activities that occur, and the diversity of KTTC membership. In terms of outcomes, the KTTC was created to provide a mechanism to link trainees from diverse geographical areas and disciplines.6 The primary recipients of the KTTC’s value are the members themselves and thus outcomes converge around members’ experiences and perspectives. As depicted in FIGURE 1, the outcomes may be short, medium, or long term. In the short term, members may acquire a large number of connections with varied KT expertise and perceive value from the “knowledge capital”33 being created within the community. For instance, an increase in social connections and relationships may provide members with an enhanced ability to ask questions and seek assistance related to KT issues because they know who to ask and trust. In the medium and long term, members may have a more diverse knowledge base in KT and an enhanced skill set re-
lated to KT. Indeed, the expectation is that formal and informal networking will lead to knowledge sharing and knowledge generation opportunities that improve individual members’ competencies (eg, combination of skills, abilities, and knowledge.34 ) in KT research and practice. In this way, the KTTC may complement the formal learning mechanisms by which members acquire KT knowledge and skills. New knowledge and skills can be applied, and new connections leveraged, in members’ own work as they build their professional careers. In the long-term, improved competencies and increased collaborations may lead to an increased capacity in KT research and practice at both individual and collective levels. The evaluation framework depicted in FIGURE 1 leverages the skills and expertise of a diverse membership in conceptualizing and implementing evaluation activities. The KTTC is currently adopting a mixed-methods approach that applies social network analysis, surveys, and qualitative research methods to understand how the KTTC functions, the degree to which members are connected, and how collaborative advantage24 manifests itself in this CoP. Outcomes are assessed at the individual and collective levels through consideration of process (eg, level of participation) and outcome
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(eg, publication and funding) metrics, and self-reported measures related to building networks and engaging in collaborative activities among members. Using this framework, the KTTC is better positioned to evaluate the extent to which the networking and relationships fostered through the CoP lead to the improvement of individual members’ competencies in KT research and practice. The integration of multiple types of data should also offer insight into specific aspects of the KTTC that contribute (or not) to members’ learning and skill development. For instance, the evaluation might shed light on whether limiting senior researcher/practitioner involvement and maintaining relatively similar levels of experience and expertise was a wise and valuable decision, and, if not, how we might shift the CoP’s structure to encompass varying levels of experience and expertise. The framework also provides a foundation for the evaluation of specific KTTC activities: for example, we are currently evaluating the impact of peer mentorship on members’ career development. We anticipate that this framework might also prove useful for evaluation activities within other CoPs and similar types of collaboratives. The long-term vision of the KTTC is that the traineeinitiated and -led CoP will also contribute to the development and advancement of the KT field. The cultivation of professional relationships among junior KT researchers and practitioners, with diverse epistemological perspectives, methodological backgrounds, and health care interests, is anticipated to enhance the next generation of KT researchers’ and practitioners’ awareness and understanding of the multiple dimensions of KT (educational, behavioral, social, embedded, organizational, and system components) and provide them with a broad range of tools (ie, methodologies, methods, and competencies) to study and practice KT. Relationships established through communities often continue long after the formal organizing entity ceases35 or member affiliations with the formal community structure weaken. Although the KTTC deliberately adopted a definition of trainee that covers a range of career stages, ultimately, members will move on from official trainee status and may therefore move on from the KTTC as an organization. However, through the KTTC, members may develop professional relationships and research collaborations that endure throughout their careers and beyond formal relationships with the KTTC. Importantly, the uniqueness of this community will be intricately linked to its focus on trainees, providing them with informal and formal peer mentoring opportunities, enabling them to develop relationships early in their career with others who share similar interests, and facilitating their involvement in collaborative projects (eg, grant applications, research studies, papers for academic and professional journals) that directly and indirectly benefit their continuing education and professional development. For many trainees,
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such KT-focused opportunities are limited in their formal training and work environments. Conclusions KT trainees self-identified a need to develop a social structure, and harness technological infrastructure, to cultivate sustainable collaborative efforts to promote diverse KT thought and discourse and to advance KT science and practice. To this end, trainees initiated a national CoP to provide a positive peer environment for junior KT researchers and practitioners to network and build relationships, develop skills, and create and share knowledge. The contributions this CoP makes to the KT field may be tangible or intangible. Certainly, KTTC members can visibly contribute to KT discourse, research, and practice through traditional academic products (eg, research grants/protocols, peer-reviewed publications, conference presentations). Importantly, through the CoP activities, these contributions can occur before trainees begin their academic or professional careers. The intangible contributions to professional learning, professional collaboration, and knowledge development may also prove valuable consequences of the KTTC. The learning that occurs through the recounting of stories and experiences and the sharing of formal and informal resources can appreciably contribute to members’ current and future academic and career pursuits, and thereby contribute to the KT field as a whole.
Lessons for Practice •
Communities of practice enable learning, facilitate collaboration, and provide a mechanism to achieve collaborative advantage, wherein members co-create knowledge that is greater than what any one individual can create on his/her own.
•
Trainees (or persons early in their careers) can benefit from communities of practice, specifically in terms of sharing knowledge and developing networks and relationships, in a positive peer environment, which contribute to their academic and career pursuits.
•
Communities of practice require periodic evaluation to ensure they achieve their collective goals, meet members’ individual and collective needs and expectations, and support their growth and sustainability.
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