“…Yet effecting and documenting Level 3 uptake of improvements into clinical practice is a perennial challenge (Davis et al, 1999;Kulier et al, 2010;Oxman, Thomson, Davis, & Haynes, 1995;Takayesu, Nadel, Bhatia, & Walls, 2010). Past research has indicated that using multifaceted educational approaches, such as practice-based tools, quality improvement data, and using opinion leaders to influence practice behaviors, have the most success in effecting practice changes (Bradley et al, 2004;Gifford et al, 1999;Grol & Grimshaw, 2003;Vickrey, 2005). The DEW used continual learner feedback, formal and informal, to ensure that the 5D assessment guides were practice based and had supplementary learning modalities to assist educators and learners in the use of this tool.…”