Assessing change in medical education: A case study

Abstract

Despite a 70-year long call for reform of the structure of medical education, the process by which one becomes a physician has remained remarkedly unchanged since the early 1900s. This case study was undertaken to identify the factors the facilitated and inhibited attempts at curricular reform in a state College of Medicine at a Research I institution in the southwest. The theoretical lenses of resource dependency, academic capitalism, professionalism/jurisdiction, power, and leadership were used to identify and understand the interrelatedness of the internal and external factors influencing change in medical education. Based on the theoretical constructs underlying the study, several propositions were outlined a priori. The findings indicated support for the propositions: the dean's support of reform initiatives was a key factor in the success of the initiatives; and conversely, those initiatives that were not actively and verbally supported by the dean did not tend to be approved; the dean influenced the agenda by taking key proposals for reform off the agenda; faculty were most resistant to those proposals that would have required them to relinquish their curricular jurisdiction to a central curriculum authority; faculty further maintained jurisdiction over their courses by simply choosing not to use materials made available to them through educational grants; the tenuous financial situation of the institution at the time affected the dean's and the faculty members' willingness to be involved in and support curricular reform efforts as they were under increasing pressure to increase their income-generating activities; and furthermore, the resource allocation patterns of the institution did not support reform initiatives. The findings highlighted two themes that were not accounted for in the propositions. The first indicated that the quality of the working relationship transcended jurisdictional boundaries that would have been expected from the professionalism/jurisdiction framework underlying the study. The second indicated that the efforts of a single individual could transcend all of the theoretical constructs underlying the study. Lastly, based on the findings of the study, several strategies were developed that may be useful to consider when attempting curricular reform.