Intended for healthcare professionals

Learning In Practice

The case for knowledge translation: shortening the journey from evidence to effect

BMJ 2003; 327 doi: (Published 03 July 2003) Cite this as: BMJ 2003;327:33
  1. Dave Davis, associate dean, continuing education (,
  2. Mike Evans Davis, >principal investigator, knowledge translation programme1,
  3. Alex Jadad, director, centre for global eHealth innovation1,
  4. Laure Perrier, information specialist, continuing education1,
  5. Darlyne Rath, member, knowledge translation programme1,
  6. David Ryan, member, knowledge translation programme1,
  7. Gary Sibbald, director, continuing education (department of medicine)1,
  8. Sharon Straus, principal investigator, knowledge translation programme1,
  9. Susan Rappolt, member, knowledge translation programme1,
  10. Maria Wowk, research officer, knowledge translation programme1,
  11. Merrick Zwarenstein, principal investigator, knowledge translation programme1
  1. 1Faculty of Medicine, University of Toronto, Toronto ON, Canada M5G 1VJ
  1. Correspondence to: D Davis
  • Accepted 29 April 2003

A large gulf remains between what we know and what we practise. Eisenberg and Garzon point to widespread variation in the use of aspirin, calcium antagonists, βblockers, and anti-ischaemic drugs in the United States, Europe, and Canada despite good evidence on their best use.1 Such variation is common not only internationally but within countries.2 Large gaps also exist between best evidence and practice in the implementation of guidelines. Failure to follow best evidence highlights issues of underuse, overuse, and misuse of drugs3 and has led to widespread interest in the safety of patients.4

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Not surprisingly, many attempts have been made to reduce the gap between evidence and practice. These have included educational strategies to alter practitioners' behaviour5 and organisational and administrative interventions. We explore three constructs: continuing medical education (CME), continuing professional development (CPD), and (the newest of the three) knowledge translation (box). Knowledge translation both subsumes and broadens the concepts of CME and CPD and has the potential to improve understanding of, and overcome the barriers to, implementing evidence based practice.

Concepts of CME and CPD

Continuing medical education

CME refers to education after certification and licensure. It is arguably the most complex, and clearly the longest, phase of medical education. Most physicians think of continuing medical education in terms of the traditional medical conference, with rows of tables, pitchers of ice water, green table cloths, and a lecturer at the front of the room.7 Many accreditation systems in the United States, United Kingdom, and Canada value attendance at such activities. This reinforces the teacher driven nature of continuing medical education, which gives little attention to the concept of professional development.

“Knowledge translation is defined as the exchange, synthesis and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of …

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