Centre for Medical Education, University of Dundee, Dundee, UK.
Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Med Educ. 2021 Jan;55(1):55-64. doi: 10.1111/medu.14297. Epub 2020 Aug 28.
Medical education is neither simple nor stable, and is highly contextualised. Hence, ways of perceiving multiple connections and complexity are fundamental when seeking to describe, understand and address concerns and questions related to change.
In response to calls in the literature, we introduce three examples of contemporary organisational theory which can be used to understand and operationalise change within medical education. These theories, institutional logics, paradox theory and complexity leadership theory, respectively, are relatively unknown in medical education. However, they provide a way of making sense of the complexity of change creatively. Specifically, they cross-cut different levels of analysis and allow us to 'zoom in' to micro levels, as well as to 'zoom out' and connect what is happening at the individual level (the micro level) to what happens at a wider institutional and even national or international level (the macro level), thereby providing a means of understanding the interactions among individuals, teams, organisations and systems. We highlight the potential value of these theories, provide a brief discussion of the few studies that have used them in medical education, and then briefly critique each theory.
We hope that by drawing the attention of readers to the potential of these management theories, we can unlock some of the complexity of change in medical education, support new ways of thinking and open new avenues for research.
医学教育既不简单也不稳定，具有高度的情境性。因此，当寻求描述、理解和解决与变革相关的问题和疑虑时，感知多种联系和复杂性的方法是至关重要的。
针对文献中的呼吁，我们引入了三种当代组织理论的例子，可以用于理解和实施医学教育中的变革。这些理论，即制度逻辑、悖论理论和复杂性领导理论，在医学教育中相对不为人知。然而，它们为创造性地理解变革的复杂性提供了一种方法。具体来说，它们跨越了不同的分析层次，使我们能够“深入微观层次”，以及“跳出微观层次”，将个体层面（微观层次）发生的事情与更广泛的机构层面（甚至国家或国际层面）发生的事情联系起来，从而提供了一种理解个体、团队、组织和系统之间相互作用的方法。我们强调了这些理论的潜在价值，简要讨论了少数在医学教育中使用这些理论的研究，然后对每个理论进行了简要的批评。
我们希望通过引起读者对这些管理理论潜力的关注，我们能够解开医学教育变革的一些复杂性，支持新的思维方式，并为研究开辟新途径。
