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Context matters in curriculum reform: An analysis of change in surgical training.

Introduction: Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top‐down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curric...

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Published in:Medical Education Vol. 57; no. 8; pp. 741 - 753
Main Authors: Shah, Adarsh P., Walker, Kim A., Walker, Kenneth G., Cleland, Jennifer
Format: research tables/charts Journal Article
Published: Wiley-Blackwell Aug2023
Online Access:View this record in EBSCOhost
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      dt: Aug2023
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        10.1111/medu.15071
        164779738
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        atl: Context matters in curriculum reform: An analysis of change in surgical training.
      aug:
        au:
          Shah, Adarsh P.
          Walker, Kim A.
          Walker, Kenneth G.
          Cleland, Jennifer
        affil: Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
      sug:
        subj:
          Surgery, Operative Education
          Curriculum Development
          Curriculum
          Human
          Qualitative Studies
          Case Studies
          Descriptive Statistics
          Data Analysis Software
          Semi-Structured Interview
          Snowball Sample
          Male
          Female
          Male
          Female
      ab: Introduction: Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top‐down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national‐level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. Methods: Adopting a case study approach, we used document data for contextualisation purposes and semi‐structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow‐up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second‐generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. Results: The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. Conclusions: Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice. Activity theory and complexity theory are used to understand how history, systems, and contexts influence curriculum reform. Meaningful evaluation of educational change should consider context and all its complexity.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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