The case for knowledge translation: shortening the journey from evidence to effect

Abstract

A large gulf remains between what we know and what we practise.Eisenberg and Garzon point to widespread variation in the use of aspirin, calcium antagonists, blockers, and anti-ischaemic drugs in the United States, Europe, and Canada despite good evidence on their best use. 1 Such variation is common not only internationally but within countries.2 Large gaps also exist between best evidence and practice in the implementation of guidelines.Failure to follow best evidence highlights issues of underuse, overuse, and misuse of drugs 3 and has led to widespread interest in the safety of patients.4 Not surprisingly, many attempts have been made to reduce the gap between evidence and practice.These have included educational strategies to alter practitioners' behaviour 5 and organisational and administrative interventions.We explore three constructs: continuing medical education (CME), continuing professional development (CPD), and (the newest of the three) knowledge translation (box).Knowledge translation both subsumes and broadens the concepts of CME and CPD and has the potential to improve understanding of, and overcome the barriers to, implementing evidence based practice. Concepts of CME and CPDContinuing medical education CME refers to education after certification and licensure.It is arguably the most complex, and clearly the longest, phase of medical education.Most physicians think of continuing medical education in terms of the traditional medical conference, with rows of tables, pitchers of ice water, green table cloths, and a lecturer at the front of the room.7 Many accreditation systems in the United States, United Kingdom, and Canada value attendance at such activities.This reinforces the teacher driven nature of continuing medical education, which gives little attention to the concept of professional development.Continuing professional development CPD embodies both professional learning and personal growth.It incorporates much of the theory and practice of adult learning, 8 self directed learning, 9 reflective practice, 10 and other models.It also offers the possibility of embracing topics beyond those included in traditional medical education-for example, bioethics, business management, and communication skills-topics rarely included in continuing medical education programmes.11 Although the focus on subjective, learner centred curriculums is laudable, it means that continuing professional development can contribute only marginally to improving public health.