Abstract
Context: Université de Montréal medical school implemented Competency-based medical education, an important organizational change. Recognizing and reporting progress towards change is critical for success. Yet, informative frameworks that allow educators to track progress aren’t available. We used the Organizational Knowledge Creation Model for such a purpose. Purpose: This paper reports on how we used the Organizational Knowledge Creation Model to recognize change towards Competency-based Medical Education implementation. Method: Because Organizational Knowledge Creation Model focuses on the relationships between individuals and social structures, we selected an embedded case study approach. Diverse case sampling was used to select three academic departments: internal medicine, surgery and psychiatry. Data collection was conducted at two intervals, two years apart. Semi-structured interviews (individual and group) were conducted with Department Heads and Educators. Thematic analysis was conducted on the 15 interview transcripts and coded according to the four Organizational Knowledge Creation Model stages. Results: As implementation begins, selected and trained Educators critically revisit teaching routines and develop common conception of Competency-based medical education. This enables communication with wider audiences and intervene within existing working groups where Competency-based medical education is “broken down” into practical concepts. Educators’ roles evolved from “expert” who disseminates knowledge about Competency-based medical education, to responsive and pragmatic tutors who develop practical tools with peers and program directors. Conclusion: The Organizational Knowledge Creation Model framework provided a deep understanding of ongoing change. Study participants, interviewed twice, described their perception of change as it progressed as well as insights into the underlying dynamics. As medical schools evolve, Organizational Knowledge Creation Model may be a valuable conceptual tool to track progress and describe tangible changes.
Highlights
This paper reports on how we used the Organizational Knowledge Creation Model to recognize change towards Competency-based Medical Education implementation
We relied on the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to report the findings of our study (Tong, Sainsbury, & Jonathan, 2007)
We sometimes got time off and worked some files a little more, we brought it back to a wider group because we thought that it was important that the work be done at each teaching site. [...] We worked more in detail [...] and we submitted our work to the committee and the committee made comments, and we came back. [...] and so it was that last autumn we organized a whole day for the implementation of Entrustable Professional Activities (EPAs) [...] we managed to get about 50 psychiatrists who answered the call to whom we presented the EPAs and started working on the generic EPAs, chose the ones that were most relevant for [psychiatry] and got all our groups working
Summary
Competency-based medical education implementation has been increasingly construed as organizational change (Albanese et al, 2010; Carraccio et al, 2016; Englander et al, 2017; Hall et al, 2020; Klamen, Williams, Roberts, & Ciancolo, 2016; Kogan, Conforti, Yamazaki, Iobst, & Holmboe, 2017; Van Melle et al, 2019). Medical schools are being increasingly held to account for the social relevance of the skills graduates bring to health care (Carraccio et al, 2016). These orientations for medical training entail important organizational changes to schools, hinging on paradigmatic shifts, (Carraccio, Wolfsthal, Englander, Ferentz, & Martin, 2002) that reflect how instructors on the ground adapt. EPAs comprise the link between CanMEDs (Frank, Snell, & Sherbino, 2015) competencies and the professional activities that a budding physician must master to graduate
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