Department of Educational Development and Research FHML, Maastricht University, POB 616, NL-6200 MD Maastricht, The Netherlands.
Med Teach. 2013 Aug;35(8):661-70. doi: 10.3109/0142159X.2013.785629. Epub 2013 Apr 30.
Earlier studies suggested national culture to be a potential barrier to curriculum reform in medical schools. In particular, Hofstede's cultural dimension 'uncertainty avoidance' had a significant negative relationship with the implementation rate of integrated curricula.
However, some schools succeeded to adopt curriculum changes despite their country's strong uncertainty avoidance. This raised the question: 'How did those schools overcome the barrier of uncertainty avoidance?'
Austria offered the combination of a high uncertainty avoidance score and integrated curricula in all its medical schools. Twenty-seven key change agents in four medical universities were interviewed and transcripts analysed using thematic cross-case analysis.
Initially, strict national laws and limited autonomy of schools inhibited innovation and fostered an 'excuse culture': 'It's not our fault. It is the ministry's'. A new law increasing university autonomy stimulated reforms. However, just this law would have been insufficient as many faculty still sought to avoid change. A strong need for change, supportive and continuous leadership, and visionary change agents were also deemed essential.
In societies with strong uncertainty avoidance strict legislation may enforce resistance to curriculum change. In those countries opposition by faculty can be overcome if national legislation encourages change, provided additional internal factors support the change process.
早期的研究表明，民族文化可能是医学院校课程改革的潜在障碍。特别是霍夫斯泰德的文化维度“不确定性规避”与综合课程的实施率呈显著负相关。
然而，尽管一些国家的不确定性规避程度较高，但仍有一些学校成功地进行了课程改革。这就提出了一个问题：“这些学校是如何克服不确定性规避障碍的？”
奥地利在所有医学院校都采用了高度不确定性规避和综合课程的组合。对四所医科大学的 27 名关键变革推动者进行了访谈，并使用主题跨案例分析对访谈记录进行了分析。
最初，严格的国家法律和学校有限的自主权阻碍了创新，并助长了一种“借口文化”：“这不是我们的错。这是教育部的错。”一项增加大学自主权的新法律刺激了改革。然而，仅仅这项法律是不够的，因为许多教师仍然试图避免变革。强烈的变革需求、支持性和持续的领导力以及有远见的变革推动者也被认为是至关重要的。
在不确定性规避程度较强的社会中，严格的立法可能会强制抵制课程改革。在这些国家，如果国家立法鼓励变革，并且有其他内部因素支持变革过程，那么教师的反对是可以克服的。
