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42 Thus questions remain about transference and sustainability of knowledge over time and this has been a relatively neglected area of simulation research.
We speculate that in settings where traditional didactic methods of teaching are practiced exposure to participatory methods will be acceptable and may lead to acquisition and sustainability of knowledge.
Finally, this finding may suggest that a single training program may not be sufficient to manage sustainability of knowledge gains in the long term without additional changes in practice or repetition of training.
Also, we assessed the impact of the educational intervention immediately following the discussion, so we cannot comment as to whether the improvement in knowledge was durable, though other studies of brief educational interventions have shown sustainability of knowledge from 1 to 18 months later [ 39, 40].
Secondary outcome measures comprise 1) sustainability of knowledge; 2) achievement of individual treatment goals regarding the use of statins, levels of blood pressure and glucose control, and smoking; 3) achievement of treatment goals prioritised by the individual patients; 4) medication uptake from T1 to T2.
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The week starts with a permaculture intensive that teaches the practices of living in concert with nature and harnessing natural systems for maximum food production which allows patrons to come home with a sustainability toolbox of knowledge.
Another main strength of this study was that results were sustained at 12 months, and engagement in experiential learning may importantly contribute to such sustainability of QI knowledge (as shown by the statistically significant increase in QIKAT scores comparing post-curriculum assessment and post-project assessment).
This research highlights the importance for sustainability of both preserving knowledge transfer systems resulting in TEK and in developing hands-on educational systems that rely upon the natural world as the primary classroom.
A two-month period is not considered long enough to determine the level of sustainability of the obtained knowledge for the two different instructional procedures as some instructional procedures especially those which use implicit techniques require a long time for the actual outcomes to appear.
We compared the sustainability of the acquired knowledge through the completion of an MCQ 2 weeks following the teaching session.
The evaluation design could not be a randomized control trial due to the nature of the roll-out of the learning modules across the province, but the participants were surveyed before training, at the end of training, and at 3-6 months following completion of training to assess the retention or sustainability of the new knowledge and skills (see Fig. 1).
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