Pettersson Fanny L M
Department of Education, Umeå University, Mediagrand, Umea, Sweden.
Rural Remote Health. 2013 Apr-Jun;13(2):2173. Epub 2013 Apr 10.
In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally.
To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes.
The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized.
This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.
2011年，瑞典于默奥大学首次尝试将现有的医学课程转变为区域化医学课程（RMP），并借助数字技术的支持。瑞典的区域化医学课程意味着学生在进行五个临床实习学期时会被分配到地理上分散的小组中。为了让医学专业学生在地理上分散的情况下也能进行理论学习，数字技术被用于教育和管理目的。在本文中，将对瑞典的区域化医学课程进行描述，并与之前关于在农村地区培养医学生的国际研究相关联。本文的目的是从管理角度了解在数字技术支持下，瑞典区域化医学课程实施过程中是否以及如何出现矛盾。基于这一分析，进一步的目的是从管理角度讨论改进这种医学教育实践的可能性和挑战，并为国际上医学课程的其他类似变革提供启示。
为了识别实施过程中可能存在的矛盾，在管理工作会议期间以及第一个区域化学期之前和期间进行了受民族志启发的观察。此外，在2011年5月和6月对瑞典区域化医学课程的六位管理人员进行了深入的跟进访谈，了解他们对实施过程的期望和经验。定性和受活动理论（AT）启发的分析产生了两个主要主题和七个子主题。
分析表明，在瑞典区域化医学课程的实施过程中出现了一些矛盾。例如，大学管理层与一些教师之间在如何以及应该如何在医学生教育中使用数字技术和技术增强学习（TEL）方面存在冲突，这构成了一种矛盾。此外，由于数字技术的使用，实施过程有助于揭示教育实践中现有的问题和紧张关系，而这些问题管理层之前并未察觉。这些矛盾包括课程目标、教学实践和考试应如何开展方面缺乏一致性等。此外，还发现了过时的课程内容以及课程和学科之间的重叠，这导致了对所有学期进行全面改革，不仅是那些区域化的学期。
本研究表明，在数字技术支持下实施瑞典区域化医学课程时，教育实践中出现了矛盾。这些矛盾对管理层改进瑞典区域化医学课程的实施方式和质量而言，既带来了可能性，也带来了挑战。管理层面临的一个挑战是找到最有效的方法来促进更多互动性和创新性的技术增强学习解决方案的采用和使用。然而，一种可能性是区域化过程和实施的改进也可能影响非区域化学期，最终有可能提高整个课程的质量。
