Table 2 Adapting CFIR and UTAUT Frameworks for Medical Education Implementation of virtual patient simulation tools
Study sub-themes/adapted construct | Short description | Related CFIR Construct(s) | Related UTAUT Construct(s) | Examples of evidence in this study | Facilitator or Barrier in the context of this study |
|---|---|---|---|---|---|
Theme I: External context: influences of adoption (CFIR “Outer setting”) | |||||
Limited opportunities for learning CR through interactions with real patients | The extent to which student needs, as well as barriers and facilitators to meet those needs influence need for adoption | External Policy & Incentives Patient needs & resources | None | Tutors reported that increasing numbers of students led to limited placements available, constraining opportunities for face-to-face interactions with real patients | Facilitator |
Knowledge of students’ needs and resources: previous experience with online learning | The extent to which students’ previous experience with online learning influence their future acceptability | Patient needs & resources | Experience, Social Influence | Tutors reported that student’s diverse familiarity with online teaching can impact their readiness to accept | Facilitator if previous experience is positive |
Theme II: The features of the innovation | |||||
Perceived benefits and challenges of using virtual patients as educational tools – providing the evidence | Stakeholders’ perception of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes | Evidence Strength & Quality, Knowledge and Beliefs about the Intervention | Evidence strength/quality | Tutors reported that often lack of evidence on available resources constitutes a barrier to adoption | Facilitator if evidence can be provided |
Perceived benefits and challenges of using virtual patients as educational tools – providing the evidence | Stakeholders’ beliefs about the intervention | Relative Advantage, Knowledge & Beliefs about the Intervention (follows from themes I-II) | Knowledge and beliefs about the resource, Performance Expectancy, Effort Expectancy, Other personal attributes (motivation), Other personal attributes (values), Relative advantage | Tutor beliefs about advantages and disadvantages of virtual patients | Facilitator if the advantages outweigh the disadvantages |
Perceived benefits and challenges of using virtual patients as educational tools – providing the evidence | Experience with online teaching: The extent to which the stakeholders’ previous experience with online learning influence their adaptation | Individual Stage of Change | Experience, Self-efficacy, Other personal attributes (motivation) | We found that tutors’ own diverse familiarity with online teaching can impact their readiness to adopt | Facilitator if the experience is positive |
Beliefs about using virtual patients as educational tools—distinction between reality and simulation | Distinction between reality and simulation: The degree that the intervention is realistic in terms of the online patient simulations | Knowledge & Beliefs about the Intervention | Knowledge and beliefs about the resource, Other personal attributes (motivation), Other personal attributes (values), Relative advantage | Tutors reported that virtual patients should mirror how students should consult with patients in real life | Facilitator if the resource is realistic |
Beliefs about using virtual patients as educational tools—distinction between reality and simulation | Distinction between linearity and complexity: The degree that the intervention is realistic in terms of the patient scenarios | Knowledge & Beliefs about the Intervention | Knowledge and beliefs about the resource, Other personal attributes (motivation), Other personal attributes (values), Relative advantage | Tutors reported that virtual patients should mirror the complexity of real-life consultations with patients (including question-orientation) | Facilitator if the resource is realistic |
Theme III: Institutional context: opportunities and barriers for adoption (CFIR “inner setting”) | |||||
Explicit positioning of CR in curricula | Receptiveness of change (materials): The extent to which the nature and communication of teaching material enable curricula change | Implementation Climate, Readiness for Implementation | None | Tutors reported that the diversity of teaching CR with different terms constitutes a barrier to adoption and reinforces uncertainty | Barrier |
Explicit positioning of CR in curricula | Receptiveness of change (CR as a subject): The extent to which CR current teaching enables curricula change | Implementation Climate, Readiness for Implementation | None | Tutors reported that the lack of explicit positioning of CR in curricula constitutes a barrier to adoption (CR not explicit) | Barrier |
Explicit positioning of CR in curricula | Feasibility of change: Stakeholders’ perception of how feasible is to introduce a change in medical school curriculum | Structural Characteristics, Implementation Climate, Relative Advantage | None | Tutor reported that medical school curricula are inflexible to changes that makes introducing a new resource challenging | Barrier |
Decision-making for adoption | Norms, processes and basic assumptions of a medical school | Structural Characteristics, Culture, Implementation Climate | None | Tutors reported that decision-making process and integration in medical schools depends on scale | Facilitator if introduced on a small scale first |
Decision-making for adoption | Dispersed faculty: The positioning of internal networking requirements for adoption | Networks & Communications, Access to Knowledge and Information, Individual Identification with Organization | Social Influence, Facilitator Conditions | Tutors reported that other adopters can help facilitating adoption | Facilitator |
Decision-making for adoption | Positioning of intervention: The degree that additional interventions fit with existing teaching practices and how these can be combined | Implementation Climate, Knowledge & Beliefs about the Intervention, Relative Advantage, Compatibility | None | Tutors reported that positioning of virtual patients as additional instead of replacement can bend resistances to adoption | Facilitator |
Decision-making for adoption | Identification with institution: The extent to which individuals identify themselves with the medical school, and their relationship and degree of commitment with the school | Individual Identification with Organization | Individual identification with organization, Other personal attributes (motivation) | Tutors reported that the institutional model of using NHS doctors to deliver teaching means they don’t have institutional levers to enforce changes | Barrier |