Change is never easy: How management theories can help operationalise change in medical education

Abstract

Context Medical education is neither simple nor stable, and is highly contextualised. Hence, ways of perceiving multiple connections and complexity are fundamental when seeking to describe, understand and address concerns and questions related to change. Proposal In response to calls in the literature, we introduce three examples of contemporary organisational theory which can be used to understand and operationalise change within medical education. These theories, institutional logics, paradox theory and complexity leadership theory, respectively, are relatively unknown in medical education. However, they provide a way of making sense of the complexity of change creatively. Specifically, they cross‐cut different levels of analysis and allow us to ‘zoom in’ to micro levels, as well as to ‘zoom out’ and connect what is happening at the individual level (the micro level) to what happens at a wider institutional and even national or international level (the macro level), thereby providing a means of understanding the interactions among individuals, teams, organisations and systems. We highlight the potential value of these theories, provide a brief discussion of the few studies that have used them in medical education, and then briefly critique each theory. Conclusions We hope that by drawing the attention of readers to the potential of these management theories, we can unlock some of the complexity of change in medical education, support new ways of thinking and open new avenues for research.

Main challenges to international student mobility in the European arena

“…A paradox deals with “contradictory yet interrelated elements that exist simultaneously and persist over time” (Smith & Lewis, 2011 : 382), pushing individuals to address competing demands simultaneously and to engage and accommodate tensions, rather than resolve them (Smith & Tracey, 2016 ). Recently, this approach has been used within the educational field to explore the university–community partnerships (Strier, 2014 ), understand and manage change in medical education (Gordon & Cleland, 2021 ), teacher evaluation processes (Paige, 2013 ), and as a tool to foster the development of students’ capabilities in Management education (Knight & Paroutis, 2017 ), among others. It can be also a suitable lens to explore the multiple tensions linked to ISM (such us social-academic objectives, easiness to pass-curriculum distinction, comfort zone-multiculturalism engagement, home university demands-host university requirements, etc.).…”

Critical reflections on academic leadership during Covid-19: Using Complexity Leadership Theory to understand the transition to remote and blended learning

“…Complexity Leadership Theory (CLT) is a relatively new theory that recognises the inherent complexity of modern organisations, which must continually adapt while operating within intricate internal and external networks known as complex adaptive systems (CAS). Interconnectivity lies at the heart of CLT, which in turn, regards leadership as a collective endeavour (Gordon & Cleland, 2021;Uhl-Bien & Arena, 2017;Uhl-Bien, Marion & McKelvey, 2007). Furthermore, CLT is primarily devised of three leadership functions (Table 1).…”

How can inhabited institutionalism inform the analysis of medical education?

“…Gordon and Cleland 7 highlight some possibilities for examining organisational change in medical education through institutional logics. For example tensions between logics of science and care create misalignment between the medical model of ‘patients’ who must be treated, and broader, community‐based preventative health and social care strategies.…”

“…Although these approaches all have a role to play and contribute valuable knowledge, they tend to reflect either only institutionalism (which focuses on the structure and operation of organisations, and the wider culture within which they exist), or interactionism (the analysis of small‐scale local interactions between members of organisations). There is, however, growing interest in approaches that seek to capture the complex interactions between structures and people, combining both a macro (institutional) focus and attention to micro (interactional) phenomena 6,7 . We consider the potential value of introducing another approach, inhabited institutionalism (II), that aims to address some of the ‘wicked problems’ of medical education 8 .…”