ORCID Profile
0000-0001-8873-2270
Current Organisation
University of Aberdeen
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Publisher: Springer Science and Business Media LLC
Date: 18-08-2023
DOI: 10.1186/S41077-023-00259-Y
Abstract: Applying simulation-based education (SBE) into surgical curricula is challenging and exacerbated by the absence of guidance on implementation processes. Empirical studies evaluating implementation of SBE interventions focus primarily on outcomes. However, understanding the processes involved in organising, planning, and delivering SBE adds knowledge on how best to develop, implement, and sustain surgical SBE. This study used a reform of early years surgical training to explore the implementation of a new SBE programme in Scotland. It aimed to understand the processes that are involved in the relative success (or failure) when implementing surgical SBE interventions. This qualitative case study, underpinned by social constructionism, used publicly available documents and the relevant surgical SBE literature to inform the research focus and contextualise data obtained from semi-structured interviews with core surgical trainees ( n = 46), consultant surgeons ( n = 25), and key leaders with roles in surgical training governance in Scotland ( n = 7). Initial data coding and analysis were inductive. Secondary data analysis was then undertaken using Normalisation Process Theory (NPT). NPTs’ four constructs (coherence, cognitive participation, collective action, reflexive monitoring) provided an explanatory framework for scrutinising how interventions are implemented, embedded, and integrated into practice, i.e. the “normalisation” process. Distributed leadership (in idual SBE initiatives assigned to faculty but overall programme overseen by a single leader) and the quality improvement practise of iterative refinement were identified as key novel processes promoting successful normalisation of the new SBE programme. Other processes widely described in the literature were also identified: stakeholder collaboration, personal contacts/relational processes, effective communication, faculty development, effective leadership, and tight programme management. The study also identified that learners valued SBE activities in group- or team-based social environments over isolated deliberate practice. SBE is most effective when designed as a comprehensive programme aligned to the curriculum. Programmes incorporating both group-based and isolated SBE activities promote deliberate practice. Distributed leadership amongst faculty attracts wide engagement integral to SBE programme implementation, while iterative programme refinement through regular evaluation and action on feedback encourages integration into practice. The knowledge contributed by critically analysing SBE programme implementation processes can support development of much needed guidance in this area.
Publisher: Wiley
Date: 13-03-2023
DOI: 10.1111/MEDU.15071
Abstract: Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top‐down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national‐level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. Adopting a case study approach, we used document data for contextualisation purposes and semi‐structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow‐up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second‐generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.
Publisher: Wiley
Date: 12-07-2021
DOI: 10.1111/MEDU.14587
Abstract: Medical schools are complex organisations existing at the intersection of higher education and healthcare services. This complexity is compounded by many competing pressures and drivers from professional and regulatory bodies, the wider political environment and public expectations, producing a range of challenges for those involved in all stages of medical education. There are established approaches that have been used to address research questions related to these challenges some focus on organisational structures, characteristics and performance others on the interactions that take place in a particular setting. Less common are approaches that integrate data on macro‐level structures with the micro‐level interactions of the people who inhabit those structures. Looking at the interaction of the macro and the micro opens up possibilities for the new insights. We propose using an approach with roots in social theory—Inhabited Institutionalism (II)—that is largely unexplored in medical education. II has been described as Janus‐faced, looking both outwards, at the broader context of medical education, and inwards, at the ways in which meanings are constructed and re‐constructed by participants within a particular setting. After describing the theoretical framework of II, we explain how it can be used to understand medical education as subject to both broader societal structures (the macro level) and interactions between people (the micro level), as well as—crucially—their mutual influence. II offers the opportunity to combine macro‐ and micro‐level perspectives, leading to a more expansive understanding of the operation of medical education which sees its form and function as neither entirely determined by structures nor a construction of in iduals engaged in it. In doing so, it potentially offers a valuable way of considering the intractable problem of how to successfully manage change, offering a combined top‐down and bottom‐up perspective.
Publisher: Wiley
Date: 12-12-2022
DOI: 10.1111/MEDU.14994
Abstract: Curricular 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)? 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. The 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. Our 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.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Kim Walker.