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Translation of Research Into Practice: Why We Can’t "Just Do It"

From the University of Michigan, LS&A Psychology Department (CMS), and Department of Family Medicine (LAG), Ann Arbor, MI

Correspondence: Corresponding author: Lee Green, MD, MPH, Associate Professor, University of Michigan, Department of Family Medicine, 1018 Fuller, Ann Arbor, MI 48109-0708 (e-mail: greenla{at}umich.edu)

Translation of new knowledge into practice proceeds through 3 stages, from awareness through acceptance to adoption. Translational research focuses almost exclusively on the first 2 stages. We argue that improving the disappointing results of translation efforts will require a detailed understanding of how adoption takes place. We summarize research in cognitive science that illustrates how accepted "declarative" knowledge (acquired through lectures, reading, and discussion) differs (even down to its locus in the brain) from adopted "procedural" knowledge that is acted on in clinical practice. We suggest strategies that can capitalize on the cognitive processes by which declarative knowledge is proceduralized, as a means of making translation more effective, including (1) structured case-level feedback, automated or from human consultants, during the declarative stage; (2) practice in context early in the procedural stage; and (3) deliberative practice when procedural knowledge has been formed but is still being refined.