title: Patience, persistence and pragmatism: experiences and lessons learnt from the implementation of clinically integrated teaching and learning of evidence-based health care - a qualitative study.
abstract: BACKGROUND
  Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes.
  
  
  RESULTS
  We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling.
  
  
  CONCLUSIONS
  Implementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers.
authors.affiliation: Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa; Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Taryn
authors.initials: T
authors.lastname: Young
authors.affiliation: Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Anke
authors.initials: A
authors.lastname: Rohwer
authors.affiliation: Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Susan
authors.initials: S
authors.lastname: van Schalkwyk
authors.affiliation: Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Volmink
authors.affiliation: All Ireland Hub for Trials Methodology Research, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Mike
authors.initials: M
authors.lastname: Clarke
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D055317:Evidence-Based Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D036301:Qualitative Research; D013337:Students, Medical