Agius Steven J, Willis Sarah C, McArdle Patricia J, O'Neill Paul A
University of Manchester Medical Education Unit, UK.
Med Teach. 2008;30(4):e87-94. doi: 10.1080/01421590801929976.
Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors.
To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change.
We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change.
12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'.
At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.
“医学职业现代化”（MMC）是一项旨在改变英国医生培训方式的宏伟计划。其成功实施的关键在于担任当地教育领导者和监督者的资深医生对MMC的认知方式和实施方式。
运用Schein的扩展模型来解释医院顾问对现代化进程的看法及其对他们作为高级住院医师（SHO）主要教育者角色的影响，以此确定他们在变革过程中所处的阶段。
我们采访了6家信托机构的医学主任、学院导师、临床导师和教育监督员。使用Schein的变革模型对访谈记录进行分析，以探究资深医务人员的看法和假设，并确定他们在变革过程中所处的阶段。
12名导师、12名监督员以及6名医学主任中有4名同意参与（共30人，28人参与）。访谈记录分析得出了9个主题。这些主题与变革的三阶段模型相关。大多数参与者处于“解冻”阶段，表达了对期望未得到确认、内疚、焦虑以及某种心理安全感的看法。少数人处于“转向新立场”阶段。“再冻结”的例子有限。
在地方实施层面，大多数资深医生意识到有必要审视他们目前的立场，并改变他们对研究生医学教育的方法和假设。然而只有少数人在向前推进。要成功实施MMC仍有大量工作要做。
