A Case Study Using the PIES Implementation Framework to Implement a Vertically Integrated Multisite Team-Based Learning Curriculum.

Scaling curricular innovations require an understanding of contextual barriers and facilitators. Implementation science offers theory-based methods to systematically assess contextual factors influencing implementation. We present a case report employing the PIES (Prescribed, teacher-Intended, Enacted, and Sustainable curriculum) framework to evaluate local contextual enablers and barriers to the implementation of a multisite, vertically integrated Team-Based Learning (TBL) curriculum embedded in the core clerkship year at a single institution with a multisite longitudinal integrated clerkship (LIC). We used a convergent mixed-methods case study design to evaluate the TBL implementation. Data collection was informed by the PIES framework and pragmatically selected based on feasibility and potential for actionable change. Data sources included: 1) surveys of faculty, 2) interviews with faculty, 3) narrative feedback from student surveys, and 4) direct observations of TBL sessions. We assessed the Prescribed curriculum by measuring perceptions of faculty development: 91% (30/33) of TBL facilitators participated in training sessions, and 25/29 (86%) felt faculty development was helpful for understanding the prescribed curriculum. In qualitative analysis, the subtheme "adapting faculty development to site needs" captured barriers to disseminating faculty development materials equally across sites. Conversely, the subtheme "longitudinal team-building" described how the prescribed TBL implementation was facilitated through stable year-long relationships between students and faculty. Within the teacher-Intended curriculum, 85% (28/33) of faculty responded that they agree/strongly agree with TBL's acceptability for teaching the learning objectives. The subthemes within the theme "supporting faculty transition from lecturer to TBL facilitator" elaborated on factors enabling and inhibiting this transition. In the Enacted curriculum, 39.4% (13/33) of faculty reported never/rarely deviating from the facilitator guides. Direct observations of TBL indicated divergent results, with deviations occurring in 56% of observed sessions. Within the Sustainable curriculum, 20/33 (62.5%) agreed or strongly agreed that the amount of time to recruit faculty was feasible, while the qualitative subtheme "challenges sustaining volunteer faculty engagement" explored barriers and strategies across diverse sites sustaining volunteer faculty. We describe an illustrative example of how an implementation science approach guided by the proposed PIES framework was applied to scaling a multisite and multispecialty TBL curriculum. Locally, results will be used to improve faculty development, student orientation, and continuous quality improvement processes essential to ensuring quality and comparability. We present our methods and findings as a case study for educators seeking to pragmatically and systematically evaluate and scale their curricular innovation.