Table 1
Facilitators and barriers to engagement with the EPA app
|
CFIR domain |
Facilitators |
Barriers |
|---|---|---|
|
Intervention characteristics |
– Sufficient training prior to use – Few, if any, technical challenges – EPA app intuitive and easy to use, especially compared with paper-based assessment tools – Feedback timely and frequent – Feedback quality high—behaviorally specific and salient – User interface forced succinct feedback with a single take home message for the resident |
– Residents and faculty see the value of assessment tools (such as the paper-based form also used in the clinic) which generate more comments that are more detailed, nuanced, and comprehensive – The absence of a checklist, while making the app easier to use, led to less systematic observation and feedback – No reinforcing comments – Most faculty did not understand the entrustment scale and/or the EPA framework – Faculty prefer paper-forms for discretely jotting down feedback points while observing |
|
Characteristics of individuals |
– Excitement about the use of app-based technology – High confidence in use of the app – Faculty appreciated how the interface forced synthesis and distillation of their observations into a single, concise feedback point |
– Faculty worry that use of the EPA app during patient encounters may convey lack of respect and attention – Residents reviewed emailed feedback briefly, then rarely referred to it again – Faculty prioritized verbal feedback over app completion when short on time |
|
Inner setting |
– Faculty time protected for the sole purpose of directly observing the resident and giving feedback – Monitoring of app utilization by the program |
– Clinical demands, especially from the residents’ panels of patients, often resulted in the EPA app assessment not being completed |
|
Outer setting |
– The app aligned with the organization’s emphasis on innovation—especially regarding the use of measurement and technology—in clinical and educational practice |