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Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice "is," how it "develops" and how it is "operationalized" in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

BackgroundNational strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada.AimsThis study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context.MethodsA modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators.ResultsRepresentatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being "very satisfied" with the process.ConclusionsThis process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions.

Professional identity is believed to foster self-confidence and resilience in health care professionals. While literature exists describing professional identity in medicine, the relevance of this evidence to rehabilitation professionals (occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP)) is limited due to differences between professions in decision-making authority (patient care), professional autonomy and understanding of their scope of practice. The objective was to determine the extent, range and nature of the literature on professional identity/professional identity formation in rehabilitation professionals. Findings from the scoping review based on Arksey and O'Malley's methodological framework are presented. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, and ProQuest Dissertations and Theses from 1996 to October 2020 for empirical and conceptual studies on OT, PT, and S-LP clinicians or students. Of 4983 retrieved records, 53 papers were selected for data extraction. Data were organised into themes for professional identity/professional identity formation: conceptual descriptors (dynamic state, multiple identities); influences (person, professional education/environments, profession-at-large). Findings are consistent with the professional identity literature in medicine. However, they point to gaps for further empirical inquiry in the role of symbols and rituals in the professional identity/professional identity formation of rehabilitation professionals, profession-specific differences between OT, PT and S-LP, and influences related to the profession-at-large on the professional identity/professional identity formation of rehabilitation professionals. These findings may help to inform professional education programs and health care and professional systems in developing resources to support professional identity formation of rehabilitation professionals.

Background: The widespread implementation of longitudinal assessment (LA) to document trainees' progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders' knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. Methods: We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. Results: Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial resources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. Conclusion: Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, resources to support LA implementation need to be addressed to facilitate its uptake.

Evidence based medicine (EBM) has been synonymous to delivery of quality care for almost thirty years. Since the movement's inception, the assumption has been that decisions based on high quality evidence would translate to better care for patients. Despite EBM's many attractive features and the substantive attention it has received in the contemporary clinical and medical education literature, how it is defined and operationalized as a component of training is often unclear and problematic. How to practice EBM is not well articulated in the literature; therefore, it becomes difficult to teach and equally challenging to assess. In this paper, we put forward a call for deeper consideration of how EBM is taught, and for clarification on how it is defined and operationalized in medical education. In preparing this paper, we considered questions such as what it means to practice EBM, the role that medical education plays in helping realize EBM, how the teaching of EBM can change to reflect recent developments in clinical practice and education, and whether transformations in the practice of medicine necessitate a change in how we teach EBM. We end with four avenues that may be pursued to advance the teaching of EBM in medical education: (1) consensus on what we mean by EBM; (2) clear articulation of EBM-associated competencies; (3) empirically and theoretically supported means of promoting EBM competencies; (4) ways to assess both skill acquisition and use of EBM. We discuss implications for educators of EBM.

Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.

Children with Attention Deficit Hyperactivity Disorder (ADHD), a neurobehavioral disorder prevalent in childhood, demonstrate a persistent pattern of inattention and hyperactive and/or impulsive behavior that is more severe than their typically developing peers. Much of this challenging behavior is observed in the classroom. However, current literature on ADHD for school-aged children largely examines issues of clinical diagnosis and pharmacological management. Consequently, the associated challenges in functional limitations and participation restrictions that these children demonstrate have not been well examined. Fortunately, as members of the school-based team, occupational therapists are uniquely suited to address this important perspective. Therefore, the purpose of this study was to: (1) identify the scope of occupational therapy (OT) practices in assessment, intervention and service delivery with children/youth with ADHD across Canada; (2) indicate potential research and practice gaps; and (3) discuss future implications with respect to OT intervention for children with ADHD. A bilingual national survey was created based on a comprehensive literature review and consultation with experts in pediatrics and knowledge translation. The survey link was sent to pediatric occupational therapists across Canada through mailing lists obtained from national and provincial organizations. A total of 172 surveys were completed (response rate = 10%). The majority of respondents reported that children with ADHD comprised 26-75% of their caseloads. More than 90% of respondents reported using OT interventions to address skills related to impairments (sensory processing), activity (fine motor function), and participation (school functioning) in their treatment of children with attentional disorders. OTs frequently reported using sensory-based principles to address the behavioral symptoms of children with ADHD. The most common form of service delivery was individualized sessions, followed by consultation. Potential gaps and implications at the research, practice and organizational levels are discussed to further support the role of OT with school-aged children with ADHD.

BACKGROUND: Health human resources are scarce worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. OBJECTIVE: To investigate the phenomena of attrition and retention with OTs, PTs and S-LPs who stayed in, or left their profession. METHODS: Cultural-historical activity theory provided the theoretical scaffolding for this interpretive description study. We used purposeful sampling (maximum variation approach) to recruit OTs, PTs, and S-LPs from Quebec, Canada. Individual interviews were conducted with 51 OTs, PTs, and S-LPs from Quebec, Canada, in English or French (2019–2020). Inductive and deductive approaches, and constant comparative techniques were used for data analysis. RESULTS: Six themes were developed: 1) characteristics of work that made it meaningful; 2) aspects of work that practitioners appreciate; 3) factors of daily work that weigh on a practitioner; 4) factors that contribute to managing work; 5) relationships with different stakeholders that shape daily work; and 6) perceptions of the profession. Meaningfulness was tied to participants' sense that their values were reflected in their work. Factors outside work shaped participants' work experiences. Recurrent negative experiences led some to leave their profession. CONCLUSION: Findings underscore a critical need to address contributing factors to attrition and retention which are essential to ensuring the availability of OTs, PTs and SLPs for present and future rehabilitation needs. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives Method Results Conclusion The integration of evidence‐based practice (EBP) into rehabilitation education programs has been widespread, but little is known about how graduates' EBP competencies evolve over time.To explore how and why the use of EBP by occupational therapists (OTs) and physical therapists (PTs) evolves during the first 3 years of clinical practice.We used an interpretive description methodology. We conducted semi‐structured interviews with OTs and PTs who participated in a minimum of three out of four time points in a previous longitudinal pan‐Canadian mixed methods study. Data analysis was guided by Braun and Clarke's approach to thematic analysis.Seventeen clinicians (13 OTs and 4 PTs) participated in the study. Our analysis identified six overarching themes: (1) evolution of “what EBP is and what it means”; (2) over time, evidence takes a back seat; (3) patients and colleagues have a vital and perennial role in clinical decision making; (4) continuing professional development plays a vital role in EBP; (5) personal attitudes and attributes influence EBP; and (6) organizational factors influence EBP.Our study highlights the dynamic nature of EBP use among OTs and PTs in the first 3 years of clinical practice, emphasizing the need for contextualized approaches and ongoing support to promote evidence‐informed healthcare in rehabilitation. [ABSTRACT FROM AUTHOR]

Scoping reviews are increasingly used in health professions education to synthesize research and scholarship, and to report on the depth and breadth of the literature on a given topic. In this Perspective, we argue that the philosophical stance scholars adopt during the execution of a scoping review, including the meaning they attribute to fundamental concepts such as "knowledge" and "evidence," influences how they gather, analyze, and interpret information obtained from a heterogeneous body of literature. We highlight the principles informing scoping reviews and outline how "epistemology"--the aspect of philosophy that "deals with questions involving the nature of knowledge, the justification of beliefs, and rationality"--should guide methodological considerations, toward the aim of ensuring the production of a high-quality review with defensible and appropriate conclusions. To contextualize our claims, we illustrate some of the methodological challenges we have personally encountered while executing a scoping review on clinical reasoning and reflect on how these challenges could have been reconciled through a broader understanding of the methodology's philosophical foundation. We conclude with a description of lessons we have learned that might usefully inform other scholars who are considering undertaking a scoping review in their own domains of inquiry.

Spaced education (SE) is a learning strategy that can improve long-term knowledge retention. Inspired by the concept of SE, we conducted a mixed methods study of a smartphone application (app) as a platform of SE. Objectives were to: (phase 1 quantitative) estimate the extent to which weekly alerts on the app can stimulate medical residents to visit the app, (connection of phases) identify participants for a second qualitative phase, and (phase 2 qualitative) describe factors, from the resident perspective, which influence sustainable participation in SE, and describe strategies for improvement of the app. Methodology and methods: phase-1 design was pre-experimental, phase-2 design was qualitative descriptive (deductive-inductive thematic analysis). Results: We observed a stimulating effect of weekly alerts for the first two months of the one-year study. Per participant, alert visits varied from 0 to 34 (mean = 1.7, SD = 4.5) and total page visits varied from 1 to 442 (mean = 28.3, SD = 61.4). Barriers and facilitators to sustainable participation in SE fell into five dimensions: user-related factors, information content factors, mobile app design factors, alert system factors, and service factors. Four strategies for app improvement were described. In conclusion, we propose five dimensions pertaining to potential predictors of sustainable participation in SE to deliver clinical information.

Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP). Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8). The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings. Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies. Rehabilitation professions including occupational therapy, physical therapy and speech-language pathology acknowledge the importance of evidence-based practice (EBP). Current challenges in the teaching of EBP among rehabilitation students include educators' different conceptualizations of EBP, the perceived complexity of EBP, and the boundaries between the academic and the clinical setting. This study shows that increasing interactions between faculty and preceptors, for instance through an online community of practice, constitutes a stakeholder-endorsed priority to advance EBP education in rehabilitation. [ABSTRACT FROM AUTHOR]

Integrating multiple perspectives is key to successful co-design, yet often hampered by communication gaps arising from different epistemological backgrounds and lived experiences. This challenge is amplified when the design problem centres around experiences that are difficult articulate in words, such as those in Parkinson’s disease (PD). To explore alternative strategies for communication between diverse PD stakeholders, Piece of Mind brought together neuroscientists, performing artists and individuals with lived experience to co-create an interdisciplinary performance grounded in scientific and experiential knowledge. Participants met on Zoom over nine months, in which creative, embodied approaches were used to share scientific concepts, facilitate discussion, and identify key issues for the performance. We built on emergent themes through virtual and in-studio collaborations, culminating in a 45-min filmed and live performance. We conducted semi-structured interviews with a subset of participants regarding their co-design experience and take-aways, to identify elements of process, space and materials contributing to its success. We found that an embodied approach, in virtual space and incorporating multiple artistic media, enabled participants to leave their comfort zones and disciplinary boundaries to engage with one another through curiosity and generosity – and consider how these conditions facilitated disparate starting points to converge towards a common goal. [ABSTRACT FROM AUTHOR]

Following a longitudinal study to understand how evidence-based practice evolves during the initial years of occupational therapy (OT) and physiotherapy (PT) practice, we held an end-of-grant symposium with representatives from education, practice, research, and policy. The objectives were to: (1) elicit feedback on the implications of the study results; and (2) co-develop a list of actionable recommendations for each sector. Qualitative participatory approach. The symposium was held over two half days and consisted of a presentation of study findings, a discussion on the implications of the research for each sector and future recommendations. Discussions were audio recorded, transcribed verbatim and analyzed using qualitative thematic analysis. The themes related to implications of the longitudinal study included: (1) A need to rethink what evidence-based practice (EBP) really is; (2) How to practice EBP; and (3) The continuing challenge of measuring EBP. The co-development of actionable recommendations resulted in nine strategies. This study highlighted how we may collectively promote EBP competencies in future OTs and PTs. We generated sector-specific avenues that may be pursued to promote EBP and argued for the importance of pooling efforts from the four sectors so that we may achieve the intended ethos of EBP. There is a need to revisit the definition of evidence-based practice (EBP) and the traditional 3-circle model in rehabilitation to include a broader conceptualization of what constitutes evidence. We recommend using EBP measures as tools for self-reflection and professional development that can support practitioners to be reflective and accountable evidence-based practitioners. Optimal promotion of EBP competencies in occupational therapists and physiotherapists should rest upon collaborative efforts from the education, practice, research, and policy sectors. [ABSTRACT FROM AUTHOR]

Rationale: Only half of newly implemented evidence‐based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown. Aims and Objectives: We aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome). Methodology: Informed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo‐Portland Adaptability Inventory ‐ version 4 (MPAI‐4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI‐4. Results: We linked context, mechanisms and outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI‐4 scoring: 77.7%) to low level (e.g., rate of MPAI‐4 application to clinical decision‐making: 3.7%)] and (4) the work of sustaining the MPAI‐4 is shared amongst different stakeholders. Conclusion: Implementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: Contextual factors can influence healthcare professionals' (HCPs) competencies, yet there is a scarcity of research on how to optimally measure these factors. The aim of this study was to develop and validate a comprehensive tool for HCPs to document the contextual factors likely to influence the maintenance, development, and deployment of professional competencies. Methods: We used DeVellis' 8-step process for scale development and Messick's unified theory of validity to inform the development and validation of the context tool. Building on results from a scoping review, we generated an item pool of contextual factors articulated around five themes: Leadership and Agency, Values, Policies, Supports, and Demands. A first version of the tool was pilot tested with 127 HCPs and analyzed using the classical test theory. A second version was tested on a larger sample (n = 581) and analyzed using the Rasch rating scale model. Results: First version of the tool: we piloted 117 items that were grouped as per the themes related to contextual factors and rated on a 5-point Likert scale. Cronbach alpha for the set of 12 retained items per scale ranged from 0.75 to 0.94. Second version of the tool included 60 items: Rasch analysis showed that four of the five scales (ie, Leadership and Agency, Values, Policies, Supports) can be used as unidimensional scales, whereas the fifth scale (Demands) had to be split into two unidimensional scales (Demands and Overdemands). Discussion: Validity evidence documented for content and internal structure is encouraging and supports the use of the McGill context tool. Future research will provide additional validity evidence and cross-cultural translation. [ABSTRACT FROM AUTHOR]

Introduction: Community-based spinal cord injury (SCI) organizations deliver peer mentorship programs in rehabilitation settings. Little is known on how these programs are delivered through the collaboration between community-based SCI organizations and rehabilitation institutions. This study aimed to identify barriers, facilitators, and collaboration processes within a SCI peer mentorship program provided by a community-based organization at a rehabilitation center. Methods: A qualitative case study design was applied. Seven participants were recruited, including two mentees, two mentors, one program director of the community-based SCI organization, and two healthcare professionals of the rehabilitation center. Each participant completed a one-on-one interview. Data were analyzed inductively and deductively based on the Consolidated Framework for Implementation Research (CFIR). Results: Ten factors were identified to influence the delivery of the peer mentorship program, including nine CFIR constructs. Successful delivery of the program required strong, collaborative inter-professional relationships between health professionals and community organizational staff (e.g., peer mentors) as facilitators; whereas potential cost, minimal patient needs, and limited mentor resources were found to be barriers. Engaging health professionals by initiating communications, reflecting and evaluating the program collectively with health professionals were important collaboration processes for the community-based organization to maintain effective partnership with the rehabilitation center. Discussion: The collaboration processes and strategies to addressing/leveraging the barriers and facilitators may inform evidence-based practice to establish and optimize the delivery of SCI peer mentorship programs in various rehabilitation settings. [ABSTRACT FROM AUTHOR]

Rationale: Engagement in scholarly practice has been associated with professional empowerment, role satisfaction and improvements in care delivery and patient outcomes across many healthcare professions. However, in evolving professions like respiratory therapy, scholarly practice is excluded from competency frameworks, resulting in a gap in education and subsequent application of this competency in practice. An exploration of scholarly practice in respiratory therapy may provide insights into evolving professions that face tensions between meeting competency requirements as outlined in frameworks and providing quality healthcare to the populations they serve. Aims and Objectives: The aim of the study was to explore what scholarly practice means, and how it manifests in practice from respiratory therapists' (RTs) perspectives. Methods: We used interpretive description methodology. We purposively sampled participants to obtain varied perspectives of scholarly practice in respiratory therapy. We conducted 26 semistructured interviews with RTs in different roles (clinicians, educators, researchers, leaders and managers) across Canada and analysed the data using inductive analysis. Data collection and analysis proceeded concurrently. Results: We developed five main themes: (i) the identity of a scholarly practitioner in RTs; (ii) factors influencing scholarly practice; (iii) one's impression of their professional self‐image; (iv) scholarly practice as a vehicle for changing practice and (v) the complex interconnections between knowledges and practices. Conclusion: Scholarly practice appears to be a multifaceted phenomenon encompassing a wide range of activities and skills including conducting research, reflective practice, application of research to practice, and contributing to the advancement of the profession and healthcare. Scholarly practice is influenced by organisational context and culture, available resources, intrinsic motivation and external political context. We identified similarities between professional identity and the description of the scholarly practitioner, suggesting that these two phenomena may be interconnected. Furthermore, participants believed that scholarly practice could enhance the image, credibility, legitimacy and professionalisation of the profession. [ABSTRACT FROM AUTHOR]