Unraveling the complexities of enacting change in undergraduate medical curricula

In medical schools, significantly revising an undergraduate medical curriculum has become a frequently recurring process. Those processes take a lot of time and energy of many stakeholders. We tend to spend considerable time on the content and pedagogical designs of our curricula, while often neglecting the importance of the organizational processes. In order to support future change processes, this thesis focusses on better understanding the complexities of enacting change in undergraduate medical curricula. The role of change leaders, educational scientists, governance and context were investigated. The results showed that change leaders experienced the curriculum change processes to be highly dynamic and complex, in which the involvement of a large and diverse group of stakeholders plays an important part. One of these stakeholders, the educational scientists, do not always seem to be optimally engaged in curriculum change processes, which is inconvenient in the light of utilization of available resources. The ways in which governance is structured at the teacher level also influences how the change process proceeds, and how well it succeeds in achieving the desired changes. Additionally, awareness of differences in organizational contexts seems to be important when implementing (transnational) educational changes. We conclude that curriculum change processes are the shared responsibility of different stakeholders, and not of just one leading person. Therefore, the emphasis should be more on the formation of teams in the organization. Furthermore, we suggest exploring the possibilities of a threefold leadership team, which includes expertise in the field of medical content, education and organizational processes.