Abstract
IntroductionMaking substantial changes to the form and delivery of medical education is challenging. One reason for this may be misalignment between existing conceptualizations of curricula and curriculum reform in medical education, with the former perceived as ‘complex’ yet the latter as linear. Reframing curriculum reform as a process-driven, complex entity may enhance the possibility of change. To explore the utility of this approach, we carried out an exploratory case study of curriculum reform in a real-life context.MethodsWe used a qualitative case study approach. Data were collected from 17 interviews with senior faculty involved in curriculum reform in one medical school plus document analysis of approximately 50 documents and files, to provide background, context, and aid triangulation.ResultsData coding and analysis was initially inductive, using thematic analysis. After themes were identified, we applied the ‘wicked problem’ framework to highlight aspects of the data. This paper focuses on two main analytic themes. First, that multiple players hold different views and values in relation to curriculum reform, resulting in various influences on the process and outcomes of reform. Second, ‘solutions’ generate consequences which go beyond the anticipated advantages of curriculum reform.DiscussionThis is the first empirical study of curriculum reform in medical education which uses the wicked problem framework to conceptually illuminate the complex processes which occur in relation to reform. Those involved in reform must be reflective and attentive to the possibility that persistent and emerging challenges may be a result of wicked problems.
Highlights
Making substantial changes to the form and delivery of medical education is challenging
This is the first empirical study of curriculum reform in medical education which uses the wicked problem framework to conceptually illuminate the complex processes which occur in relation to reform
Those involved in reform must be reflective and attentive to the possibility that persistent and emerging challenges may be a result of wicked problems
Summary
Making substantial changes to the form and delivery of medical education is challenging. In analyzing the language used by medical educators to describe these recurring calls for change, Whitehead and colleagues [8] use the metaphor of a ‘carousel of ponies’ to illustrate that the returning themes of curriculum reform are like ponies circling around yet again on the curricular carousel, in the continual rediscovery of discursive ‘truths’ in medical education This ‘carousel’ seems to be due to a combination of recurring themes underpinning the need for reform, a focus on the future with little acknowledgement of the historical nature of issues, and use of (relatively speaking) ‘quick fixes’ to address complex curriculum issues [9, 10]
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