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.

This study illustrates, hidden messages and contextual factors can enable or inhibit the translation of professionalism into curricula. Those involved in implementing professionalism must be reflective, keep the "hidden curriculum" in the spotlight to consider how presuppositions and prejudices of their cultural milieu may shape curricular outcomes.

Despite much effort and a focus on creating an idyllic space and place, the new medical school had both positive and (unintentionally) negative impacts on student experiences. These findings highlight the importance of reflecting on, and exploring, how space and place may influence and shape students' learning experiences during the formative years of their development of a professional identity, a necessary consideration when planning new medical school learning spaces or changing these spaces.

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IntroductionCurricular 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. ResultsThe 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, accountability), and the Control System (e.g., consultant job plans, service targets) -and how these interact. However, it did not shed light on the influence of exogenous events on change. DiscussionOur 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.

Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees’ (n = 46) and consultant surgeons’ (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers’ institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

IntroductionThe Objective Structured Clinical Examination (OSCE) is a key feature of healthcare education assessment. Many aspects of the OSCE are well‐investigated, but not so its sociomaterial assemblage. The Covid‐19 pandemic provided a unique opportunity to (re)consider taken‐for‐granted OSCE practices. Drawing on Law's modes of ordering, our aim was to demonstrate the ‘mangle of practice’ between space and people; the spatialised and spatialising processes of an OSCE.MethodsWe used a case study approach to critically examine a redesigned final year MBChB OSCE held during the pandemic. We used multiple sources of data to attune to human and non‐human actors: OSCE documentation, photographs, field notes and semi‐structured interviews with OSCE staff/organisers. Law's modes of ordering was used as an analytical lens to critically consider how people and things flowed through the adapted OSCE.FindingsThe overarching ordering was the delivery of a ‘pandemic safe’ OSCE. This necessitated reordering of ‘usual’ process to deliver a socially distanced, safe flow of human and non‐human actors through the assessment space. Each change had material and social ‘knock on’ effects. We identified three main interrelated orderings: Substituting technologies for bodies: Disembodied and dehumanised but feasible; Flow through space: Architectural affordances and one‐way traffic; Barriers to flow: Time and technology.DiscussionLooking at the OSCE through a sociomaterial lens allows us to critically examine the OSCE's essential and complex processes and the restrictions and affordances of the spaces and props within the OSCE. In doing so, we open the possibility of considering alternative ways of doing OSCEs in the future. Moreover, conceptualising the OSCE as a living set of socially (human) and materially (nonhuman) enacted processes changes the social perception of the OSCE and highlights that an OSCE has agency on people, places and things.