Simon Kitto1,2,3; Jennifer Peller 2; Carol-Anne Moulton1,2,4; Steven Gallinger1,4

1 Department of Surgery, University of Toronto, Toronto, Canada. 2 Wilson Centre, University of Toronto, Toronto, Canada. 3 Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Canada. 4 Division of General Surgery, University Health Network, Toronto, Canada.

Short Synopsis

Although the term CoP was first conceptualized as an educational concept, CoPs have been adopted in healthcare as quality improvement initiatives orientated towards a governing structure. The Cancer Care Ontario Hepatobiliary/pancreatic Community of Practice (CCO HPB CoP) is a surgical service quality improvement initiative formed along shared priorities, research agenda and the dissemination of clinical guidelines. This qualitative study explores the member engagement with the CCO HPB CoP to examine the interplay between the educational and governing aspects of the CoP and explore the intended and unintended effects.

Purpose

The CCO HPB CoP was formally created in 2007 to provide organizational support to surgeons and institutions involved in HPB surgery. In surgical education, CoPs are more than a rationalizing governance structure; they are conceptualised as formal or informal groups of people who share an interest, craft, and/or profession with a shared goal of sharing and gaining knowledge related to their field. This study examines the relationship between the governing and educational aspects of the CCO HPB COP to gain insight into the effectiveness of the CCO HPB CoP as a quality improvement and continuing education intervention in HPB surgery.

Methods

This qualitative study employs an interpretivist framework to gather in-depth interview accounts of participants’ perspectives and experiences of their early and current involvement in the CCO HPB CoP. The study also triangulates the data by using a discourse analysis framework to conduct a document analysis.

Results

Three key inter-related themes were found 1) Variation in the understanding and intent of the CCO HPB CoP amongst its members; 2) Variation in the strength of commitment of the CCO HPB CoP by its members; 3) An operational tension between the twin purposes of the CCO HPB CoP as a regionalisation/rationalisation activity based on volume/outcome principles, and as an educationally focused CoP to enhance and maintain competence in HPB surgery.

Conclusion

Active participation in and understanding of the CCO HPB CoP by its members is important to the functionality and sustainability of the governance structure, and professional growth and development of the CCO HPB community members. Greater emphasis on the development and maintenance of the continuing education component of the CCO HPB CoP is required.

Declaration

We have no conflicts of interest to disclose.