Applications of Implementation Science in Graduate Surgical Education: A Scoping Review

Implementation Science (IS) is the study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use. The use of IS in graduate surgical education has not been well characterized. This scoping review aims to identify key barriers, facilitators, and best practices for integrating IS into surgical education.

Embase, PubMed, Scopus, Cochrane Library, and ERIC were searched in accordance with PRISMA guidelines. Included studies utilized a validated IS strategy to implement an educational or curricular intervention for surgical residents. Qualitative analysis was used to map the IS theories, models, and frameworks used in the included studies to existing IS frameworks, as well as characterize barriers and facilitators to implementation via the Theoretical Domains Framework (TDF).

Six studies were identified with surgical residents from general surgery, urology, obstetrics-gynecology, vascular surgery, and cardiothoracic surgery programs. Each study used a different approach informed by IS to successfully implement an educational intervention (e.g., quality improvement research curriculum, faculty-resident coaching program, or surgical skills simulation course). IS theories, models, and frameworks included: the Replicating Effectiveness Programs Framework, Fixsen's 6-stage Implementation Framework, Expert Recommendations for Implementing Change, RE-AIM Framework, Normalization Process Theory, and Theory of Change Methodology. Barriers to implementation included variability in resident schedules and competing demands of clinical responsibilities. Facilitators to implementation included protected didactic time, endorsement from program leadership, and incorporation into established educational programming.

The studies identified in this review utilized a variety of IS theories, models, and frameworks to successfully implement new educational practices. The majority of barriers and facilitators identified fit into the "Environmental Context and Resources" and "Social Influences" domains of the TDF. Key facilitators to implementation shared across the six studies included protected didactic time, buy-in from leadership, and integration into established resident education time. IS represents a promising field for enhancing graduate surgical education.