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Van Houtven CH, Drake C, Malo TL, Decosimo K, Tucker M, Sullivan C, D'Adolf J, Hughes JM, Christensen L, Grubber JM, Coffman CJ, Sperber NR, Wang V, Allen KD, Hastings SN, Shea CM, Zullig LL. Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory. Implement Sci Commun 2023; 4:69. [PMID: 37337208 DOI: 10.1186/s43058-023-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST. METHODS In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters." RESULTS Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption. CONCLUSIONS To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption. TRIAL REGISTRATION ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.
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Affiliation(s)
- Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Teri L Malo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Josh D'Adolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Janet M Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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Shah AP, Walker KA, Hawick L, Walker KG, Cleland J. Scratching beneath the surface: How organisational culture influences curricular reform. MEDICAL EDUCATION 2022. [PMID: 36458943 DOI: 10.1111/medu.14994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early-years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? METHODS This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020-2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. RESULTS The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements-Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)-and how these interact. However, it did not shed light on the influence of exogenous events on change. CONCLUSION Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Barak LC, Kuijpers G, Hoeijmakers L, Scheele F. Learning from the implementation of clinical empathy training: an explorative qualitative study in search of the barriers and facilitators. BMC MEDICAL EDUCATION 2022; 22:806. [PMID: 36419055 PMCID: PMC9685956 DOI: 10.1186/s12909-022-03877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Amid concerns about the decline of empathy during the clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to identify the barriers and facilitators of the implementation of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as a 'MedGezel' or 'medical coach'. METHOD We conducted an explorative qualitative study based on interview data collected and analyzed using reflexive thematic analysis and the readiness for change theory. We conducted semi-structured interviews with relevant stakeholders in this particular qualitative study. Thematic analysis was based on open and axial coding using ATLAS.ti 9, which facilitated the emergence of common themes of interest and meaning for the study. RESULTS A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The following themes emerged: the case for change: why change?; practical necessity; leadership; management and resources; staff culture; and alignment with the corporate strategy. DISCUSSION The implementation failure can be partially explained as resulting from the personal attitudes and choices of participants, who struggled to reconcile a vision that they liked with side effects that they feared. While participants repeatedly mentioned management and leadership issues, these organizational issues seemed less important as they could be easily resolved in practice. What was more important and fatal for the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy. CONCLUSION This investigation into the barriers and facilitators influencing the implementation of the MedGezel program identified 6 explanatory themes, the most impactful one being staff culture.
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Affiliation(s)
| | - Giliam Kuijpers
- Social enterprise MedGezel, and OLVG hospital, Amsterdam, the Netherlands
| | | | - Fedde Scheele
- Athena Institute, VU University Amsterdam, and Amsterdam UMC, Amsterdam, the Netherlands
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Karimi E, Sohrabi Z, Aalaa M. Change Management in Medical Contexts, especially in Medical Education: A Systematized Review. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2022; 10:219-227. [PMID: 36310665 PMCID: PMC9589067 DOI: 10.30476/jamp.2022.96519.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Change is a multifaceted and challenging process. Due to the growing and increasing volume of technologies and organizational processes, there is a need to adapt to these changes because adaptation to changes is essential for the organization survival. The purpose of this study was to investigate change management in medical education in order to identify and categorize the strategies, barriers, and other important issues related to change management. METHODS A systematized review of the related studies was carried out according to the Khan et al.'s guideline. Five bibliographic databases and search engines including Cochrane Library, Eric, PubMed, SCOPUS, and Web of Sciences were searched. The following keywords were used with a period constraint of 2017 to March 2021 to search various online data sources: change management and medical issues. Advanced search options and Boolean operator (AND) were also used to find out more relevant records. RESULTS Overall, 498 records were identified. After removing duplicate records and those with irrelevant titles, abstracts, or full texts, we selected 40 articles for data extraction. The Kotter model is frequently used to manage change. Also, consideration of resistance to change and having a plan for it have been important elements of change management. CONCLUSION In most cases, resistance to change was observed, and several ways for resolution merged. Resistance to change and coping strategies are considered as one of the most important factors that must be considered in change situations. Awareness of change management principles and utilization of available models can pave the way for management of the change.
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Affiliation(s)
- Elham Karimi
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zohreh Sohrabi
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
In light of readiness to change, organizational readiness has received little attention with the extensive assessment of individual readiness to change. (1) Background: Therefore, this conceptual paper aims to address the need for change at the organizational level through the lenses of Lewin theory, organizational change theory, and social exchange theory. It will identify issues and implications in readiness to change at the organizational level; (2) Methods: The primary method used in the study was mainly a literature review to add neglected factors driving change such as contextual factors and technology. (3) Results: The paper shows how various players and other determinants of successful change implementation can derail the organization’s readiness to embrace change. (4) Conclusions: The paper adds to the available knowledge on how technology is likely to affect organizational willingness to change. The study suggests various solutions that seek to address the issues on organizational readiness to change. Hence, this study may provide organizational managers with takeaway implications on change management for policymakers and practitioners to improve an organization’s preparedness towards change implementation.
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Wijk H, Heikkilä K, Ponzer S, Kihlström L, Nordquist J. Successful implementation of change in postgraduate medical education - a qualitative study of programme directors. BMC MEDICAL EDUCATION 2021; 21:213. [PMID: 33853598 PMCID: PMC8048047 DOI: 10.1186/s12909-021-02606-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Leaders in postgraduate medical education are responsible for implementing educational change. Although difficulties in implementing change are described both in the general leadership literature as well as in the field of medical education, knowledge of what characterises successful change leadership in postgraduate medical education is limited. The aim of this study is to explore the process used by educational leaders in successful change implementation in postgraduate medical education. METHODS Semi-structured interviews were conducted with 16 programme directors to explore how they had implemented successful change projects. The sample consisted of programme directors who had reported in a previous survey having high educational impact at their workplace. Interviews were analysed using Ödman's qualitative interpretative method. RESULTS The interviews identified similarities in how participating programme directors had implemented changes. Five interconnected themes crystallised from the data: (1) belonging to a group, (2) having a vision and meaning, (3) having a mandate for change, (4) involving colleagues and superiors, and (5) having a long-term perspective. CONCLUSIONS Our findings illuminate important aspects of successful change management in postgraduate medical education. Change is ideally based on a clear vision and is implemented in coalition with others. A long-term strategy should be planned, including involvement and anchoring of key persons in several discrete steps as change is implemented. While some of these findings are congruent with the general literature on change management, this study emphasises the importance of a mandate, with successful change leadership dependent on coalition and the facilitation provided by the next level of leadership.
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Affiliation(s)
- Hanna Wijk
- Department of Medicine (Huddinge), Karolinska Institutet, 141 86 Stockholm, Stockholm, Sweden
| | - Kristiina Heikkilä
- Department of Health and Care Sciences, Linnaeus University, Kalmar, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Lars Kihlström
- Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Nordquist
- Department of Medicine (Huddinge), Karolinska Institutet, 141 86 Stockholm, Stockholm, Sweden
- Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
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Mishra S, Chung A, Rogoza C, Islam O, Mussari B, Wang X, Dagnone D, Cofie N, Dalgarno N, Kwan BYM. Creating a Competency-Based Medical Education Curriculum for Canadian Diagnostic Radiology Residency (Queen's Fundamental Innovations in Residency Education)-Part 2: Core of Discipline Stage. Can Assoc Radiol J 2021; 72:678-685. [PMID: 33656945 DOI: 10.1177/0846537121993058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE All postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) model divided into 4 stages of training. Queen's University has been the first Canadian institution to mandate transitioning to CBME across all residency programs, including Diagnostic Radiology. This study describes the implementation of CBME with a focus on the third developmental stage, Core of Discipline, in the Diagnostic Radiology residency program at Queen's University. We describe strategies applied and challenges encountered during the adoption and implementation process in order to inform the development of other CBME residency programs in Diagnostic Radiology. METHODS At Queen's University, the Core of Discipline stage was developed using the Royal College of Physicians and Surgeons of Canada's (RCPSC) competence continuum guidelines and the CanMEDS framework to create radiology-specific entrustable professional activities (EPAs) and milestones for assessment. New committees, administrative positions, and assessment strategies were created to develop these assessment guidelines. Currently, 2 cohorts of residents (n = 6) are enrolled in the Core of Discipline stage. RESULTS EPAs, milestones, and methods of evaluation for the Core of Discipline stage are described. Opportunities during implementation included tracking progress toward educational objectives and increased mentorship. Challenges included difficulty meeting procedural volume requirements, inconsistent procedural tracking, improving feedback mechanisms, and administrative burden. CONCLUSION The transition to a competency-based curriculum in an academic Diagnostic Radiology residency program is significantly resource and time intensive. This report describes challenges faced in developing the Core of Discipline stage and potential solutions to facilitate this process.
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Affiliation(s)
- Siddharth Mishra
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Andrew Chung
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Christina Rogoza
- 12363Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Omar Islam
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Benedetto Mussari
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Xi Wang
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Damon Dagnone
- Department of Emergency Medicine, 71459Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Nicholas Cofie
- 12363Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Nancy Dalgarno
- 12363Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Nousiainen M, Scheele F, Hamstra SJ, Caverzagie K. What can regulatory bodies do to help implement competency-based medical education? MEDICAL TEACHER 2020; 42:1369-1373. [PMID: 32847447 DOI: 10.1080/0142159x.2020.1809640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In response to the numerous challenges resident trainees currently face in their ability to competently acquire the requisite skills, knowledge and attitudes upon graduation, medical educators have looked to a competency-based medical education (CBME) approach as a possible solution. As CBME has already been implemented in many jurisdictions around the world, certain challenges in implementation have been experienced. One important challenge identified relates to how regulatory bodies can either assist or unintentionally hinder implementation. By examining the varied experiences from Canada, the USA and the Netherlands in implementing CBME, this paper identifies how regulatory bodies can support and advance worldwide efforts of furthering its implementation. If regulatory bodies restructure accreditation and regulatory criteria to align with CBME principles, work together in a coordinated fashion to ensure alignment of vital regulatory meaures throughout the training and practice continuum of a physician, and allow for (if not incentivize) individuals and programs to be innovative in adapting CBME to meet their local environments, it is likely that the worldwide implementation of CBME will occur successfully.
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Affiliation(s)
- Markku Nousiainen
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Fedde Scheele
- Amsterdam University Medical Centre and Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Stanley J Hamstra
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly Caverzagie
- Department of Internal Medicine, University of Nebraska Medical Centre, Omaha, NE, USA
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Dagnone JD, Chan MK, Meschino D, Bandiera G, den Rooyen C, Matlow A, McEwen L, Scheele F, St Croix R. Living in a World of Change: Bridging the Gap From Competency-Based Medical Education Theory to Practice in Canada. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1643-1646. [PMID: 32079931 DOI: 10.1097/acm.0000000000003216] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.
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Affiliation(s)
- Jeffrey Damon Dagnone
- J.D. Dagnone is associate professor of emergency medicine and competency-based medical education faculty lead, Queen's University, Kingston, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6963-7948
| | - Ming-Ka Chan
- M.-K. Chan is associate professor and clinician educator of pediatrics and child health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Meschino
- D. Meschino is assistant professor, Department of Psychiatry, University of Toronto (Women's College Hospital), Toronto, Ontario, Canada
| | - Glen Bandiera
- G. Bandiera is professor of emergency medicine and associate dean of postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Corry den Rooyen
- C. den Rooyen is an educationalist and change manager, Utrecht, the Netherlands
| | - Anne Matlow
- A. Matlow is faculty lead, strategic initiatives, postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Laura McEwen
- L. McEwen is director of assessment and evaluation for postgraduate medical education, Queen's University, Kingston, Ontario, Canada
| | - Fedde Scheele
- F. Scheele is professor of health systems innovation and education, Athena Institute, VU University and Amsterdam UMC, and a practicing clinician, obstetrics and gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Rhonda St Croix
- R. St. Croix is change advisor, The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Integration of Maternity and Neonatal Care to Empower Parents. J Obstet Gynecol Neonatal Nurs 2019; 49:65-77. [PMID: 31809695 DOI: 10.1016/j.jogn.2019.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the transition from a traditional hospital design with separate maternity and neonatal departments to a design in which maternity and neonatal health care infrastructures are integrated to empower parents. DESIGN A descriptive, qualitative analysis. SETTING A mother and child center in a teaching hospital in Amsterdam. PARTICIPANTS Six staff members who were involved in the transition. METHODS We analyzed the content of all relevant policy reports and other related documents that were produced during the transition from April 2010 to October 2014. This content was supplemented with in-depth, semistructured interviews with the six participants. We used thematic analysis and Bravo et al.'s model of patient empowerment to analyze the documents and the qualitative interview data. RESULTS We identified eight themes. At the health care system level, the four themes were Joint Vision and Goal, Integration of Three Wards Into One With Single-Family Rooms, Reorganization of the Health Care Team, and New Equipment. At the health care provider level, the three themes were Training for Extension of Professional Goals, Intensified Coaching for Parents, and Implementing Patient Centeredness. The single theme at the patient level was Opinions and Experiences of Parents. CONCLUSION We found a good fit between the new design and Bravo et al.'s model of patient empowerment. Challenges that remain include the adaptation of staff training programs and further development of the infrastructure in collaboration with staff and parents. The experiences of parents and staff members will be evaluated in future studies.
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Bank L, Jippes M, Scherpbier AJJA, den Rooyen C, Scheele F. How To Get Your Clinical Teaching Team Ready For Curriculum Change: A Practical Guide. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:979-986. [PMID: 31819697 PMCID: PMC6875520 DOI: 10.2147/amep.s211958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Our health care system is constantly adapting to change at an increasingly rapid pace. Unavoidably, this also applies to the field of medical education. As a result, clinical teaching teams face the challenging task of successfully implementing the proposed changes in daily practice. It goes without saying that implementing change takes time and that you need to be patient. However, a successful change process needs more than that. Change models or strategies could offer a helping hand. The questionnaire Specialty training's Organizational Readiness for curriculum Change (STORC) is a tool aiming to do just that. With a focus on readiness for change, this questionnaire tries to support implementation efforts in PGME. Additionally, since change is a team effort, it focusses on clinical teaching teams particularly. In this paper, we offer a practical guide for clinical teaching teams on how to deal with any concerns or hurdles detected in any of the core elements of readiness for change, in order to smoothen and support the educational change processes these teams are confronted with.
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Affiliation(s)
- Lindsay Bank
- Department of Healthcare Education, OLVG Hospital, Amsterdam, the Netherlands
- Faculty of Earth and Life Sciences, Athena Institute for Transdisciplinary Research, VU University, Amsterdam, the Netherlands
| | - Mariëlle Jippes
- Department of Plastic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Albert JJA Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | | | - Fedde Scheele
- Department of Healthcare Education, OLVG Hospital, Amsterdam, the Netherlands
- Faculty of Earth and Life Sciences, Athena Institute for Transdisciplinary Research, VU University, Amsterdam, the Netherlands
- School of Medical Sciences, Institute for Education and Training, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Bank L, Jippes M, van Rossum TR, den Rooyen C, Scherpbier AJJA, Scheele F. How clinical teaching teams deal with educational change: 'we just do it'. BMC MEDICAL EDUCATION 2019; 19:377. [PMID: 31623596 PMCID: PMC6796387 DOI: 10.1186/s12909-019-1815-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- L Bank
- 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.
| | - M Jippes
- Department of Plastic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - T R van Rossum
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | | | - A J J A Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - F Scheele
- 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
- School of Medical Sciences, Institute for Education and Training, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Mahmood T. What models of change can be used to implement change in postgraduate medical education? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:175-178. [PMID: 29595832 PMCID: PMC5865584 DOI: 10.2147/amep.s160626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Taha Mahmood
- Barts and The London School of Medicine and Dentistry, London, UK
- Correspondence: Taha Mahmood, Barts and The London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK, Email
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