Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Med Educ. 2014 Oct;48(10):998-1007. doi: 10.1111/medu.12529.
Curriculum renewal is an essential and continual process for undergraduate medical education programmes. Although there is substantial literature on the critical role of leadership in successful curricular change, the voices of frontline faculty teachers implementing such change have not been explored. We aimed not only to examine and understand the perceptions of faculty members as they face curriculum change, but also to explore the influences on their engagement with change.
We used a constructivist grounded approach in this exploratory study. Sixteen faculty members teaching in the pre-clinical years were interviewed on their perspectives on a recent curricular change in the undergraduate medical programme at a single Canadian medical school. Constant comparative analysis was conducted to identify recurring themes.
Faculty teachers' engagement with curriculum change was influenced by three critical tensions during three phases of the change: (i) tension between individual and institutional values, which was prominent as change was being introduced; (ii) tension between drivers of change and restrainers of change, which was prominent as change was being enacted, and (iii) tension between perceived gains and perceived losses, which was prominent as teachers reflected on change once implemented.
We propose a model of faculty engagement with curricular change that elucidates the need to consider individual experiences and motivations within the broader context of the institutional culture of medical schools. Importantly, if individual and institutional values are misaligned, barriers to change outweigh facilitators, or perceived losses prevail; subsequently faculty teachers' engagement may be threatened, exposing the medical education programme to risk.
课程更新对于本科医学教育项目来说是一个必不可少且持续的过程。尽管有大量文献探讨领导力在成功的课程变革中的关键作用，但在实施此类变革的一线教师的声音尚未得到探索。我们的目的不仅是考察和理解教师在面对课程变革时的看法，还要探讨影响他们参与变革的因素。
我们在这项探索性研究中采用了建构主义扎根方法。在加拿大一所医学院的本科医学项目中，我们对 16 名教授基础医学课程的教师进行了采访，了解他们对最近课程变革的看法。采用持续比较分析来确定反复出现的主题。
教师参与课程变革受到三个关键张力的影响，这三个张力存在于变革的三个阶段：（i）个人价值与机构价值之间的紧张关系，在变革引入时尤为突出；（ii）变革驱动力与变革抑制因素之间的紧张关系，在变革实施时尤为突出；（iii）感知收益与感知损失之间的紧张关系，在教师反思实施后的变革时尤为突出。
我们提出了一个教师参与课程变革的模型，阐明了需要在医学院机构文化的更广泛背景下考虑个人经验和动机。重要的是，如果个人和机构价值不一致，变革的障碍大于促进因素，或者感知损失占主导地位，那么教师的参与可能会受到威胁，使医学教育项目面临风险。
