This educational dissemination project includes the following aims: 1) develop the multi-pronged practice immersion educational model to improve colorectal cancer (CRC) screening rates and prepare sites for implementation activities;2) implement the educational model at four sites;3) evaluate the educational model's impact on CRC screening rates;and 4) disseminate the educational model to other primary care residency educators and interested groups. The intervention is based on the Dissemination of Innovation theory. Family medicine residents (n = 96) from four rural Arkansas family medicine residency programs will receive training on how to optimize their patients'CRC screening rates. The educational approach involves residency clinic redesign, seminars on effective communications, augmentation of patient education and navigation, and adoption of advanced electronic medical record (EMR) software that includes prompts and reminders and quality improvement reports. Each residency's clinic management team will receive guidance from the grant educational support team on how to improve adherence with the American Cancer Society CRC screening guidelines, and will attend a training workshop in Little Rock to assist them in implementing the intervention. There will be a post-intervention dissemination effort that will use a social marketing approach aimed primarily at primary care residency program faculty, and will be delivered via an annual workshop, electronic-based communications (knowledge repositories and Web-CT conferences), publications, seminars at primary care education meetings, and consultation with the educational team via Internet and phone. Hierarchical analysis will be used to shed light on the influence of different factors that may impact on resident learning and performance. These factors will include organizational parameters such as organizational capacity and management's readiness to adopt the educational intervention;resident factors such as years of residency training and readiness to adopt innovations, and patient factors (demographics, insurance status, and readiness to change). We will evaluate the value of the educational strategy through multiple program evaluations using surveys of trainees and staff focusing on each element of the educational program, and changes in residents'attitudes, knowledge, and skills related to improving CRC screening (pre/post intervention). The dissemination will be evaluated using the RE-AIM strategy, which assesses the reach of the program through presentations and publications, as well as its long-term adoption.
