Scratching beneath the surface: How organisational culture influences curricular reform

We read, with great interest, the article by Shah et al. on scratching beneath the surface of major curriculum reform. 1 We concur with the authors that curriculum reform is about more than simply putting recommendations into practice. It is a complex undertaking that involves mastering a dual challenge, changing both the curriculum and the delivering organisation 2 both of which are closely related to a change in organisational culture. Using Gerry Johnson's cultural web theory as a lens, Shah et al. offer valuable insights into how organisational culture influences curriculum reform. 1

“…

…”

supporting

confidence: 68%

Diving beneath the surface of major curriculum reform using Bourdieu's field theory

Franz,

Peters

2023

“…It is awareness of that background that made us pleased to see two research articles that are included in the present issue. Both demonstrate, yet again, that evidence pertaining to the impact of faculty development activities is largely restricted to the individual teachers involved 4,5 . However, both studies give a glimpse of insight into the interface of individual academics and their organisational context.…”

mentioning

confidence: 88%

“…A common theme appears to be the limited opportunity to implement educational change beyond one's own individual teaching practice 5 . Not surprisingly, evaluation of the roll‐out of a common educational intervention showed between‐hospital variation in implementation, which was reflected in both trainees' and trainers' perception of success 4 . To what extent such observations should be used to guide ongoing efforts at performance improvement, however, must be considered with caution.…”

mentioning

confidence: 99%

“…Though the encouragement to include learners and patients in efforts to study the impact of faculty development may render some research projects more demanding, much of it would require only moderate changes in methodology. For example, in the research article on how organisational culture influenced the implementation of Improving Surgical Training in Scotland, 4 questions on the number of operations performed by residents before and after the intervention could have been added as part of the interviews performed (or through more objective means as a way of stimulating further discussion during the interviews). The resulting data on whether or not the intended improvement actually resulted in more opportunities for residents to operate and whether or not between‐hospital differences in such residents' opportunities correlated with the differences in organisational culture noted would significantly contribute to a broader understanding of change (and whether it was enabled) given the complexity of healthcare environments.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Faculty development in the complex academic culture

Sellmann

Marsch

2023

Faculty development refers to all activities health professionals pursue to improve their knowledge, skills and behaviours as educators, leaders and scholars. 1 These academics work in complex environments with many stakeholders and conflicting goals. Medical leaders have to constantly navigate their units between service requirements, financial constraints, research activities and variable teaching obligations that include medical students, residents and continuing education for advanced professionals. Substantial differences in requirements, regulations and stakeholders across each of these activities further increases workplace complexity and may even result in conflicting goals. Such differences are to be expected given that medical departments, hospitals, and medical schools each have distinct histories during which they, by adapting to their environment, develop unique organisational cultures that can have profound impacts on faculty development. For example, in a hierarchical culture, there may be resistance to bottom-up initiatives while in a culture that values innovation and continuous improvement, changes may be embraced as an opportunity to improve processes. With

“…The research team continually reviewed and discussed the patterns that emerged during the inductive data analysis. Credibility was ensured through triangulation of data sources (stakeholder interview data, document data and comparison with data from the wider case study involving trainees and trainers 40,58 in which the current work was nested). 29 The study protocol was adhered to throughout with regards to participant recruitment and data collection and data management.…”

Section: Reflexivity and Rigourmentioning

confidence: 99%

Context matters in curriculum reform: An analysis of change in surgical training

Shah

Walker

et al. 2023

Self Cite

Introduction: Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change.Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries.Methods: Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. Results:The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted.Conclusions: Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.