Course curriculum
The course is based on a few key principles. There is an emphasis on the theories, models and frameworks of implementation science to provide a structure and promote an understanding of the mechanisms of implementation for the students. The course does not advocate the use of any specific theoretical approach, instead allowing the students to choose from the existing “smorgasbord” of approaches and reflect on the choices they make. The course applies a systems perspective on implementation, which means that implementation problems and “solutions” are sought at different levels, from individual practitioners to teams, departments, professions, organizations and society. The course advocates interprofessional and interdisciplinary collaboration to facilitate different perspectives on implementation challenges.
The pedagogical method problem-based learning (PBL), widely used at Linköping University, informed the development of the course curriculum [
13]. The teachers hold lectures on key topics within implementation science, but consistent with the PBL approach, there are also seminars supervised by a teacher where the focus is on the students’ own discussions of specific themes, such as the meaning of context, the history of the evidence-based movement and implementation outcomes. Further, a great deal of self-study of the literature is expected from the students, in accordance with the PBL approach. Suggestions for literature are provided and further reading is encouraged, but no literature is compulsory. This student-centred approach is sometimes referred to as active learning, characteristics of which includes involvement and engagement in activities, emphasis on developing student skills and exploration of attitudes and values and involvement in higher order thinking in terms of analysis, synthesis and evaluation [
14].
The course language is English. The main learning objective of the course is to achieve improved understanding of implementation challenges in health care and increased knowledge concerning relevant theoretical approaches (theories, models, frameworks) used in implementation science.
The course involves three on-site sessions from September to December, over 6 days, including the final 1-day seminar. Few on-site sessions make the course feasible for students from other parts of the country and from abroad. The number of participants has ranged from 20 to 25 over the years. At the start, 25 students were accepted, but this number was lowered to 20 students for practical reasons (availability of rooms, work load for teachers, group sizes). The number of students is considered appropriate to engage the students in discussions as part of the lectures, to avoid teacher-centred approaches and achieve more active, student-centred learning [
14,
15]. The class is divided into two groups for the seminars to facilitate active participation by all students. A web-based version of the course was given in spring 2014. It included two on-site occasions, one at the outset of the course and the other being the final seminar. All other lectures, seminars and group discussions were held on-line.
The examination consists of a written assignment, an essay that focuses on the application of a suitable theory, model or framework to a chosen case, e.g. the doctoral student’s own research project. The case consists of either a planned implementation endeavour, which is analysed in terms of potential or actual barriers and facilitators of the process, or the analysis of an already accomplished implementation endeavour. The purpose is to select, motivate and apply a relevant theoretical approach for improved understanding of what might affect implementation success. The final seminar focuses on discussions of the essays, with the authors presenting and defending their essays and other students acting as discussants.
The course has been given each autumn from 2011 to 2016. Some modifications have been made over the years for practical reasons and on the basis of suggestions from the students. An important development is that the course today has less focus on the emergence of implementation science and more focus on modern theories and frameworks used to study implementation. The scope has also been slightly narrowed over time, focusing more on implementation of evidence-based practices in health care settings. The course rendered 7.5 credits in 2011–2012, but this was changed to 5.0 credits from 2013, which was an adaptation to the Linköping University standard for courses at doctoral level. Credits are based on the European Credit Transfer and Accumulation System (ECTS). Approximately eight lecturers, from PhDs to professors, are teaching in the course. The course consists of approximately 25 h of lectures, 10 h of group discussions and seminars and 50 h are expected to be used for literature study and writing of the assignment. The lectures and the themes for the group discussions/seminars in the current curriculum are displayed in Tables
1 and
2.
Table 1
Lectures in current curriculum
– Introduction to Implementation Science | |
– Theoretical approaches to implementation | |
– Strategies to facilitate implementation | |
– Research use in clinical practice | |
– Individual and contextual influences on implementation | |
– Implementation outcomes | |
– The role of habit in implementation | |
– Innovation research | |
– Guidelines in theory and practice | |
Table 2
Themes for supervised group discussions/seminars in the current curriculum
– Defining the implementation object | |
– Evidence-based medicine | |
– Contextual factors in implementation research | |
– Discussion of the short drafts preceding the written assignments | |
– Discussion of the written assignments (examination seminar) | |
Data collection
The first data collection was carried out immediately after completion of the course each year, using an evaluation form distributed face-to-face by one of the teachers and answered and returned anonymously in connection with the final seminar. Students judged the quality of the course on a 5-point Likert-type scale: the extent to which they found the contents useful, the extent to which course objectives were achieved and their overall perception of the course. There were also open-ended questions regarding what was perceived as positive, what was perceived as negative and suggestions for improvement (see Additional file
1). The development of the four questions in the questionnaire was based on discussions among the teachers and was informed by regularly collected information in course assessments at Linköping University. Data are available from all six courses.
The second data collection, which was conducted in autumn 2016, consisted of a questionnaire developed specifically for the present study. Questions were formulated to address the levels 2–4 of the Kirkpatrick model. The questions were discussed among the three authors (who also teach the course) to obtain satisfactory face validity. The questionnaire was pilot-tested with former doctoral students (
n = 3) interested in implementation, but who had not participated in the course. Minor changes, primarily clarifications, were made based on their suggestions. The eight multiple-choice questions included in the final questionnaire are provided in the “
Results” section. There was also one open-ended question regarding what the students believed were the most valuable insights from course participation (see Additional file
2).
The questionnaire was distributed by e-mail to all course participants who had completed the course, using the web-based tool Publech® Survey. Mailing addresses were sought in the course archives. If the e-mail address was not working, an individual search was made to identify the student in order to have an accurate mailing list for the survey. A reminder was sent after 2 weeks, followed by a second reminder a week later.
Data analysis
Descriptive data from the Likert-type questions in data collection 1 are presented. The five-point Likert scales were transformed into numbers 1–5 and a mean for each of the three questions each year was calculated by hand.
The open-ended questions in data collection 1 concerned factors (i.e. aspects of the course) perceived as positive, factors perceived as negative and suggestions for improvement and were analysed using the basic components of qualitative content analysis described by Graneheim and Lundman [
21]. The analysis was initially performed by SC and then discussed among all the authors. Factors perceived as positive are presented separately, whereas factors perceived as negative are incorporated in suggestions for improvement. Data from data collection 2 were handled using Statistical Package for the Social Sciences (SPSS) version 23.0. and are presented descriptively.