Punctuated Equilibrium: A Qualitative Case Study of the Influence of American Medical Education’s Structure, Governance, and Function on Curriculum Reform
Sullivan, Corrin C
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The efficacy, relevance, and primary objective of medical education to develop student competencies necessary for the modern practice of medicine in an ever-evolving and advancing society has been questioned frequently throughout the past four decades. Over a hundred years ago, Abraham Flexner’s report (1910), under the aegis of the Carnegie Foundation for the Advancement of Teaching, was commissioned by the American Medical Association (AMA) to examine existing medical education institutions in the United States and Canada. Flexner’s findings exposed a number of deficiencies in instruction, facilities, and most notably in educational and student outcomes (the primary supposition for the AMA’s charge for the report). Since the Flexner Report, the reoccurrence of medical education reform efforts and major themes suggest that U.S. medical schools are exceptionally resistant to change. This single case study analysis supposes that medical education reform tends to be mainstream and recurrent, and renewal measures aiming to refurbish instruction or traditional curriculum schematics evolve only into modest curriculum extensions. That is, curricular changes are legitimized as efforts toward reform in a “classic adaptive mode,” which maintains the status quo while adding and/or integrating curriculum content to include more humanistic, current “hot” topics (e.g. the integration of medical ethics, cultural competency, leadership and interpersonal communication, etc.) to give the overall impression of wide-scale, progressive institutional change. Yet, what results is institutionalized innovation whereby the conception of change is embedded as pioneering new norms without eliciting any radical modifications to the function, instructional methodology, or process of medical education. This qualitative research study explores the historical, administrative, organizational, and/or political structures that impact fundamental education reform within American medical schools; how governance structures influence the process of reform policymaking within medical education; and, the extent to which existing medical education structures and politics can be altered or adapted to create core, foundational change within medical schools. The identification of major themes is noted in the qualitative case analysis to evaluate the extent to which a medical school can stray from customary, sanctioned models of medical education and time-honored, core education practices while maintaining institutional stability and status.
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