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...
| Main Authors: | , , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
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2023
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| Online Access: | https://hdl.handle.net/10356/165823 |
| _version_ | 1826112804927569920 |
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| author | Shah, Adarsh P. Walker, Kim A. Walker, Kenneth G. Cleland, Jennifer |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Shah, Adarsh P. Walker, Kim A. Walker, Kenneth G. Cleland, Jennifer |
| author_sort | Shah, Adarsh P. |
| collection | NTU |
| description | 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. |
| first_indexed | 2024-10-01T03:12:46Z |
| format | Journal Article |
| id | ntu-10356/165823 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T03:12:46Z |
| publishDate | 2023 |
| record_format | dspace |
| spelling | ntu-10356/1658232023-04-16T15:37:49Z Context matters in curriculum reform: an analysis of change in surgical training Shah, Adarsh P. Walker, Kim A. Walker, Kenneth G. Cleland, Jennifer Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Medical Education 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 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. Submitted/Accepted version This work was supported by the Royal College of Surgeons of Edinburgh [Grant number RG-15026]. 2023-04-11T07:54:40Z 2023-04-11T07:54:40Z 2023 Journal Article Shah, A. P., Walker, K. A., Walker, K. G. & Cleland, J. (2023). Context matters in curriculum reform: an analysis of change in surgical training. Medical Education. https://dx.doi.org/10.1111/medu.15071 0308-0110 https://hdl.handle.net/10356/165823 10.1111/medu.15071 36869257 2-s2.0-85150595109 en Medical Education © 2023 The Authors. All rights reserved. This paper was published by Association for the Study of Medical Education and John Wiley & Sons Ltd in Medical Education and is made available with permission of The Authors. application/pdf |
| spellingShingle | Science::Medicine Medical Education Surgical Training Shah, Adarsh P. Walker, Kim A. Walker, Kenneth G. Cleland, Jennifer Context matters in curriculum reform: an analysis of change in surgical training |
| title | Context matters in curriculum reform: an analysis of change in surgical training |
| title_full | Context matters in curriculum reform: an analysis of change in surgical training |
| title_fullStr | Context matters in curriculum reform: an analysis of change in surgical training |
| title_full_unstemmed | Context matters in curriculum reform: an analysis of change in surgical training |
| title_short | Context matters in curriculum reform: an analysis of change in surgical training |
| title_sort | context matters in curriculum reform an analysis of change in surgical training |
| topic | Science::Medicine Medical Education Surgical Training |
| url | https://hdl.handle.net/10356/165823 |
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