“Like, we can't keep adding”: a mixed methods study to explore the feasibility of implementing co-produced 24-Hour Movement Guideline content

Tamara L Morgan; Theresa Nowlan Suart; Michelle S Fortier; Isaac Kelman McFadyen; Jennifer Tomasone

doi:10.36834/cmej.78603

Authors

Tamara L Morgan Queen's University
Theresa Nowlan Suart Queen's University
Michelle S Fortier University of Ottawa
Isaac Kelman McFadyen Queen’s University
Jennifer Tomasone Queen’s University

DOI:

https://doi.org/10.36834/cmej.78603

Abstract

Background: Medical students must demonstrate competency in health promotion and illness prevention; however, movement behaviour promotion content is lacking in medical curricula. Canada’s 24-Hour Movement Guidelines (24HMG) present an opportunity to transform medical curricula to promote movement behaviours within a 24-hour paradigm. We previously co-produced a 24HMG curriculum map and 14 curriculum objectives at one Canadian medical school. The aim of this study was to gain consensus on the curriculum map and objectives among faculty and medical students and explore implementation determinants.

Methods: This study followed a concurrent nested mixed methods design using a modified Delphi method to assess the level of (dis)agreement with map components followed by interviews to explore the implementability of the map. A preliminary survey was distributed to collect demographic and movement behaviour data, followed by three online modified Delphi surveys. Suggested improvements to the map were solicited through open-text boxes. Interviews were semi-structured and conducted online. Interview data were analyzed using content analysis guided by the Consolidated Framework for Implementation Research (CFIR) 2.0.

Results: Consensus was reached on 156/180 items (86.7%) in Survey 1 (faculty, n = 6; students, n = 8), 49/51 items (96.1%) in Survey 2 (faculty, n = 4; students, n = 7), and 8/8 items (100%) in Survey 3 (faculty, n = 3; students, n = 7). Implementation determinants encompassed all five CFIR 2.0 domains, mostly the inner setting (e.g., culture, structural barriers).

Conclusions: Reciprocity and open communication between medical schools and external change agents should be prioritized when co-producing curriculum change in the present landscape of inflation and medical professional burnout.

References

Polak R, Pojednic RM, Phillips EM. Lifestyle medicine education. Am J Lifestyle Med. 2015;9(5):361-367. https://doi.org/10.1177/1559827615580307 DOI: https://doi.org/10.1177/1559827615580307

Warburton DER, Bredin SSD. Health benefits of physical activity: A systematic review of current systematic reviews. Curr Opin Cardiol. 2017;32(5):541-556. https://doi.org/10.1097/HCO.0000000000000437 DOI: https://doi.org/10.1097/HCO.0000000000000437

Medical Council of Canada. Examination objectives overview. 2022. Available from https://www.mcc.ca/objectives/ [Accessed Sept 20, 2022].

Canadian Medical Association [CMA]. Resolution 16-22. In: CMA 2016 Vancouver, Proceedings of the 149th Annual Meeting Including Transactions of General Council, August 21-24, 2016. Ottawa: The Association; 2016:16.

Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32(8):638-645. https://doi.org/10.3109/0142159X.2010.501190 DOI: https://doi.org/10.3109/0142159X.2010.501190

Capozzi LC, Lun V, Shellington EM, et al. Physical activity RX: Development and implementation of physical activity counselling and prescription learning objectives for Canadian medical school curriculum. Can Med Educ J. 2022;13(3). https://doi.org/10.36834/cmej.73767 DOI: https://doi.org/10.36834/cmej.73767

Solmundson K. Is current medical training preparing physicians to prescribe exercise to their patients? BC Med J. 2018;(April):170-171. https://doi.org/10.1139/apnm-2017-0763.cme

D’Urzo KA, Flood SM, Baillie C. Evaluating the implementation and impact of a motivational interviewing workshop on medical student knowledge and social cognitions towards counseling patients on lifestyle behaviors. Teach Learn Med. 2020;32(2):218-230. https://doi.org/10.1080/10401334.2019.1681273 DOI: https://doi.org/10.1080/10401334.2019.1681273

Trilk JL, Worthman S, Shetty P, et al. Undergraduate Medical Education: lifestyle medicine curriculum implementation standards. Am J Lifestyle Med. 2021;15(5):526-530. https://doi.org/10.1177/15598276211008142 DOI: https://doi.org/10.1177/15598276211008142

Morgan TL, Nowlan Suart T, Fortier MS, Tomasone JR. Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education. Can Med Educ J. 2022;13(5):87-100. https://doi.org/10.36834/cmej.74083 DOI: https://doi.org/10.36834/cmej.74083

Janssen I, Clarke AE, Carson V, et al. A systematic review of compositional data analysis studies examining associations between sleep, sedentary behaviour, and physical activity with health outcomes in adults. Appl Physiol Nutr Metab Physiol Appl Nutr Metab. 2020;45(10):S248-S257. https://doi.org/10.1139/apnm-2020-0160 DOI: https://doi.org/10.1139/apnm-2020-0160

Ross R, Chaput JP, Giangregorio LM, et al. Canadian 24-Hour Movement Guidelines for adults aged 18-64 years and adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45:S57-S102. https://doi.org/dx.doi.org/10.1139/apnm-2020-0467 DOI: https://doi.org/10.1139/apnm-2020-0843

Cusano R, Busche K, Coderre S, Woloschuk W, Chadbolt K, McLaughlin K. Weighing the cost of educational inflation in undergraduate medical education. Adv Health Sci Educ. 2017;22(3):789-796. https://doi.org/10.1007/s10459-016-9708-3 DOI: https://doi.org/10.1007/s10459-016-9708-3

Ing EB. Equity, diversity and inclusion and the CanMEDS framework. Can Med Educ J. 2021;78(4):202015. https://doi.org/10.1016/j.jsurg.2020.11.013. DOI: https://doi.org/10.36834/cmej.72988

Downer MB, Duffley LW, Hillier PB, et al. The Opioid Awareness and Support Team: an innovative example of medical education and community partnership. Can Med Educ J. 2021;12(6):112-113. https://doi.org/10.36834/cmej.71309 DOI: https://doi.org/10.36834/cmej.71309

Slavin S, D’Eon FM. Overcrowded curriculum is an impediment to change (Part B). Can Med Educ J. 2021;12(5):1-5. https://doi.org/10.36834/cmej.73813 DOI: https://doi.org/10.36834/cmej.73813

Roberts M. Producing tomorrow’s doctor: the new challenge for today’s undergraduate medical curriculum. J Vocat Educ Train. 2004;56(4):467-484. https://doi.org/10.1080/13636820400200265 DOI: https://doi.org/10.1080/13636820400200265

Nguyen T, Graham ID, Mrklas KJ, et al. How does integrated knowledge translation (IKT) compare to other collaborative research approaches to generating and translating knowledge? Learning from experts in the field. Health Res Policy Syst. 2020;18(1):1-20. https://doi.org/10.1186/s12961-020-0539-6 DOI: https://doi.org/10.1186/s12961-020-0539-6

Gagliardi AR, Kothari A, Graham ID. Research agenda for integrated knowledge translation (IKT) in healthcare: What we know and do not yet know. J Epidemiol Community Health. 2017;71(2):105-106. https://doi.org/10.1136/jech-2016-207743 DOI: https://doi.org/10.1136/jech-2016-207743

Castro FG, Kellison JG, Boyd SJ, Kopak A. A methodology for conducting integrative mixed methods. J Mix Methods Res. 2010;4(4):342-360. https://doi.org/10.1177/1558689810382916.A DOI: https://doi.org/10.1177/1558689810382916

Ryba TV, Wiltshire G, North J, Ronkainen NJ. Developing mixed methods research in sport and exercise psychology: potential contributions of a critical realist perspective. Int J Sport Exerc Psychol. 2022;20(1):147-167. https://doi.org/10.1080/1612197X.2020.1827002 DOI: https://doi.org/10.1080/1612197X.2020.1827002

Poucher ZA, Tamminen KA, Caron JG, Sweet SN. Thinking through and designing qualitative research studies: A focused mapping review of 30 years of qualitative research in sport psychology. Int Rev Sport Exerc Psychol. 2019;9858. https://doi.org/10.1080/1750984X.2019.1656276 DOI: https://doi.org/10.1080/1750984X.2019.1656276

Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684-706. https://doi.org/10.1177/0269216317690685 DOI: https://doi.org/10.1177/0269216317690685

Damschroder LJ, Reardon CM, Opra Widerquist MA, Lowery JC. The updated Consolidated Framework for Implementation Research: CFIR 2.0. Implement Sci. 2022;17(75). https://doi.org/10.1186/s13012-022-01245-0 DOI: https://doi.org/10.21203/rs.3.rs-1581880/v1

QSR International. NVivo [Windows]. Published online 2020.

IBM Corp. IBM SPSS Statistics for Windows. Published online 2021.

Shah S, McCann M, Yu C. Developing a national competency-based diabetes curriculum in undergraduate medical education: a Delphi study. Can J Diabetes. 2020;44(1):30-36.e2. https://doi.org/10.1016/j.jcjd.2019.04.019 DOI: https://doi.org/10.1016/j.jcjd.2019.04.019

Kastner M, Makarski J, Hayden L, et al. Improving KT tools and products: development and evaluation of a framework for creating optimized, knowledge-activated Tools (KaT). Implement Sci Commun. 2020;1(1):1-15. https://doi.org/10.1186/s43058-020-00031-7 DOI: https://doi.org/10.1186/s43058-020-00031-7

Humphrey-Murto S, Varpio L, Wood TJ, et al. The use of the Delphi and other consensus group methods in medical education research: a review. Acad Med. 2017;92(10):1491-1498. https://doi.org/10.1097/ACM.0000000000001812 DOI: https://doi.org/10.1097/ACM.0000000000001812

Morgan TL, Fortier MS, Jain R, et al. Development of the whole day matters toolkit for primary care: a consensus-building study to mobilize national public health guidelines in practice. Health Promot Chronic Dis Prev. Accepted.

Field AP. Kendall’s Coefficient of Concordance. In: Everitt BS, Howell DC, eds. Encyclopedia of statistics in behavioral science. John Wiley & Sons, Ltd.; 2005:1010-1011.

Braun V, Clarke V. Thematic analysis. In: Cooper H, ed. APA Handbook of Research Methods in Psychology. Vol 2. ; 2012:57-71. https://doi.org/10.1037/13620-004 DOI: https://doi.org/10.1037/13620-004

Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci. 2016;11(1). https://doi.org/10.1186/s13012-016-0437-z DOI: https://doi.org/10.1186/s13012-016-0437-z

Tracy SJ. Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qual Inq. 2010;16(10):837-851. https://doi.org/10.1177/1077800410383121 DOI: https://doi.org/10.1177/1077800410383121

Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021;11(4):116-129. https://doi.org/10.5662/wjm.v11.i4.116 DOI: https://doi.org/10.5662/wjm.v11.i4.116

Lee IR, Kim HW, Lee Y, et al. Changes in undergraduate medical education due to COVID-19: a systematic review. Eur Rev Med Pharmacol Sci. 2021;25:4426-4434. https://doi.org/10.26355/eurrev_202106_26155

Kelly K, Hwei LRY, Octavius GS. Coronavirus outbreaks including COVID-19 and impacts on medical education: a systematic review. J Community Empower Health. 2020;3(2):130-140. https://doi.org/10.22146/jcoemph.57082 DOI: https://doi.org/10.22146/jcoemph.57082

Rasmussen S, Sperling P, Poulsen MS, Emmersen J, Andersen S. Medical students for health-care staff shortages during the COVID-19 pandemic. The Lancet. 2020;395(10234):e79-e80. https://doi.org/10.1016/S0140-6736(20)30923-5 DOI: https://doi.org/10.1016/S0140-6736(20)30923-5

Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: Time for a map? J Contin Educ Health Prof. 2006;26(1):13-24. https://doi.org/10.1002/chp.47 DOI: https://doi.org/10.1002/chp.47

Shrier I. Consensus statements that fail to recognise dissent are flawed by design: A narrative review with 10 suggested improvements. Br J Sports Med. 2021;55(10):545-549. https://doi.org/10.1136/bjsports-2020-102545 DOI: https://doi.org/10.1136/bjsports-2020-102545

Monforte J, Davis C, Saleem S, Smith B. Moving on from the Delphi study: The development of a physical activity training programme prototype through co-produced qualitative research. Qual Health Res. 2022;32(13):1952-1964. https://doi.org/10.1177/10497323221126535 DOI: https://doi.org/10.1177/10497323221126535

Englander R, Frank JR, Carraccio C, Sherbino J, Ross S, Snell L. Toward a shared language for competency-based medical education. Med Teach. 2017;39(6):582-587. https://doi.org/10.1080/0142159X.2017.1315066 DOI: https://doi.org/10.1080/0142159X.2017.1315066

Shah AP, Walker KA, Walker KG, Cleland J. Context matters in curriculum reform: an analysis of change in surgical training. Med Educ. 2023;57:741-752. https://doi.org/10.1111/medu.15071 DOI: https://doi.org/10.1111/medu.15071

Bush SH, Gratton V, Kabir M, et al. Building a medical undergraduate palliative care curriculum: lessons learned. J Palliat Care. 2020;36(1):1-9. https://doi.org/10.1177/0825859720916565 DOI: https://doi.org/10.1177/0825859720916565

Dore K, Bogie BJM, Saperson K, Finlay K, Wasi P. Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework. Can Med Educ J. Mar 19, 2021. https://doi.org/10.36834/cmej.70434 DOI: https://doi.org/10.36834/cmej.70434

Dacey ML, Kennedy MA, Polak R, Phillips EM. Physical activity counseling in medical school education: a systematic review. Med Educ Online. 2014;19:24325. https://doi.org/10.1136/jech.2003.018085 DOI: https://doi.org/10.3402/meo.v19.24325

Salas RME, Gamaldo A, Collop NA, et al. A step out of the dark: Improving the sleep medicine knowledge of trainees. Sleep Med. 2013;14(1):105-108. https://doi.org/10.1016/j.sleep.2012.09.013 DOI: https://doi.org/10.1016/j.sleep.2012.09.013

Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Acad Med. 2011;86(7):901-906. https://doi.org/10.1038/jid.2014.371 DOI: https://doi.org/10.1097/ACM.0b013e31821da193

Moser EM, Stagnaro-Green A. Teaching behavior change concepts and skills during the third-year medicine clerkship. Acad Med. 2009;84(7):851-858. https://doi.org/10.1097/ACM.0b013e3181a856f8 DOI: https://doi.org/10.1097/ACM.0b013e3181a856f8

Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012;46(9):625-631. https://doi.org/10.1136/bjsports-2011-090734 DOI: https://doi.org/10.1136/bjsports-2011-090734