Department of healthcare education, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
Faculty of Science, Athena Institute for Transdisciplinary research, VU University, Amsterdam, the Netherlands.
BMC Med Educ. 2019 Oct 17;19(1):377. doi: 10.1186/s12909-019-1815-4.
In postgraduate medical education, program directors are in the lead of educational change within clinical teaching teams. As change is part of a social process, it is important to not only focus on the program director but take their other team members into account. The purpose of this study is to provide an in-depth insight into how clinical teaching teams manage and organize curriculum change processes, and implement curriculum change in daily practice.
An explorative qualitative semi-structured interview study was conducted between October 2016 and March 2017. A total of six clinical teaching teams (n = 6) participated in this study, i.e. one program director, one clinical staff member, and one trainee from each clinical teaching team (n = 18). Data were analysed and structured by means of thematic analysis.
The analysis yielded to five factors that positively impact change: shared commitment, reinvention, ownership, supportive structure and open culture. Factors that negatively impact change were: resistance, behaviour change, balance between different tasks, lack of involvement, lack of consensus, and unsafe culture and hierarchy. Overall, no clear change strategy could be recognized.
Insight was gathered in factors facilitating and hindering the implementation of change. It seems particularly important for clinical teaching teams to be able to create a sense of ownership among all team members by making a proposed change valuable for their local context as well as to be capable of working together as a team. Cultural factors seem to be particularly relevant in a team's ability to accomplish this.
在研究生医学教育中，项目主任在临床教学团队中处于教育变革的领导地位。由于变革是社会进程的一部分，因此不仅要关注项目主任，还要考虑其团队成员。本研究的目的是深入了解临床教学团队如何管理和组织课程变革过程，并在日常实践中实施课程变革。
本研究采用探索性定性半结构式访谈方法，于 2016 年 10 月至 2017 年 3 月进行。共有 6 个临床教学团队（n=6）参与了本研究，即每个临床教学团队的 1 名项目主任、1 名临床工作人员和 1 名学员（n=18）。数据分析和结构采用主题分析。
分析得出了五个积极影响变革的因素：共同承诺、重新发明、所有权、支持性结构和开放文化。消极影响变革的因素包括：阻力、行为改变、不同任务之间的平衡、缺乏参与、缺乏共识、不安全的文化和等级制度。总体而言，没有明确的变革策略。
深入了解了促进和阻碍变革实施的因素。临床教学团队似乎特别需要通过使提议的变革对其当地背景具有价值，并能够作为一个团队共同协作，从而使所有团队成员都能感受到所有权。文化因素在团队实现这一目标的能力方面似乎尤为重要。
