Participation, complexity and the practice of education change

Short abstract

Read our latest commentary on ‘Participation, Complexity, and the Practice of Educational Change’ by Dr Herman Tam

Change in health professions education (HPE) is both constant and unpredictable. The ongoing glocalisation towards competency‐based medical education (CBME) has exemplified the complexity of change implementation, as challenges from stakeholder buy‐in to technical compliance and long‐term sustainability can hamper even the best laid plans. ¹ How can educators be better prepared to navigate the ever‐evolving landscape of education change?

Al‐Bualy et al. offer a refreshing stance through their use of the Change Laboratory (CL), a participatory process, to redesign workplace‐based assessment (WBA) by engaging educators, learners and administrators in structured dialogue and co‐creation. ² Here I offer additional reflections aimed at helping to think through the strengths and potential gaps inherent in CL in education change.

The CL process allowed participants to surface tensions and envision solutions from diverse perspectives, fostering individual, collective and organisational learning and agency. This approach sets the conditions for several forms of leadership that I will detail by drawing on the dimensions of complexity leadership theory. ³ CL aligns well with the entrepreneurial and enabling dimensions in which contradictions become catalysts for innovation rather than barriers for change under intentionally supportive environments. Yet, as the authors note, the generalisability and sustainability of contradiction‐catalysed changes remain challenging within broader systems. The operational dimension may help bridge this gap by converting emergent innovations into productive outcomes across organisational structures and systems through sponsorship and alignment. The CL process also reflects the early behaviours for enacting the leadership of emergence, whereby leaders generate disequilibrium by disrupting existing patterns and amplify action by encouraging novelty. ⁴ Change leaders may therefore utilise CL to establish effective conditions to complement and strengthen their own leadership practices.

Change leaders may therefore utilise CL to establish effective conditions to complement and strengthen their own leadership practices.

Crucially, participation in change management depends on the presence of psychological safety, the shared belief that members can comfortably question assumptions, voice dissent and take interpersonal risks without fear of negative repercussions. ⁵ In HPE systems and cultures often rooted in hierarchy and compliance, CL can create a protected space that legitimises curiosity and vulnerability. Psychological safety sets the stage for the transformative process of developing authentic agency, moving beyond compliance. Educators may even extend this approach to tackle the unique governance challenges in medical education such as diverse stakeholders, multi‐level programme interactions and lack of contractual obligations. ⁶

In HPE systems and cultures often rooted in hierarchy and compliance, CL can create a protected space that legitimises curiosity and vulnerability.

To get there, it is important that stakeholder involvement not be a tokenistic gesture, but a means to cultivate buy‐in and momentum through iterative engagement. These steps echo the early phases of generating a climate for change in classic change management models such as Kotter's change model ⁷ and Rogers' diffusion of innovations, ⁸ where early adopter development plays pivotal roles in mobilizing others. Unlike these more linear models, however, CL incorporates iterative cycles of reflection and design, aligning more closely with the fluid dynamics in complex systems. Less clear is whether CL can adequately address the later change management stages of implementation and sustainability. In other words, how can participatory processes like CL be scaled across larger or resource‐constrained systems? What managerial and systemic supports can facilitate the diffusion and integration of CL‐generated solutions? How can the insights and enthusiasm of early adopters meaningfully reach late adopters who have less agency or readiness for change?

Less clear is whether CL can adequately address the later change management stages of implementation and sustainability.

The bottom‐up direction in CL contrasts with the top‐down nature of some education reforms. For instance, Canada's national roll‐out of CBME in postgraduate medical education was experienced as a large‐scale mandated change. Institutional leaders were tasked with maintaining direction and momentum towards the externally defined vision while making adjustments when it often felt like ‘the ship had already sailed’. ⁹ A key barrier for CBME implementation was stakeholder resistance to deviating from ingrained practices. Participatory approaches such as CL may offer a structured pathway by engaging stakeholders early to generate the intrinsic motivation and collective engagement often lacking in mandated change.

Whether bottom‐up or top‐down, however, the key thing to keep in mind is that HPE operates as a complex adaptive system. ¹⁰ In such systems, a dynamic network of self‐organizing agents interact non‐linearly in response to change, often leading to the emergence of unpredictable outcomes. In this regard, it is important that the CL process mirrors broader systems thinking approaches that view education change not as a series of linear interventions, but as an interconnected ecosystem in which relationships shape outcomes. If CL is typically grounded within a defined activity system, it may not easily engage more peripheral stakeholders who are nonetheless affected by the change. Depending on the scale, phase and context, both formal scaffolding (to provide direction and alignment) and emergent participation (to enable local adaptation) are essential for education change.

Both formal scaffolding (to provide direction and alignment) and emergent participation (to enable local adaptation) are essential for education change.

From a theoretical standpoint, CL builds on the framework of cultural–historical activity theory (CHAT), founded by Vygotsky and expanded by Engeström. In CHAT, the activity system serves as the primary unit of analysis and tensions among multiple perspectives (multi‐voicedness) within cultural and historical contexts drive potential expansive learning. ¹¹ CHAT is increasingly applied in HPE to uncover the contradictions and interdependencies in complex education systems. Because CL focuses on the local culture of the activity system, its solutions may be less generaliserable to other settings or tiered organisational change.

Ultimately, education changes, from large‐scale CBME shifts to grassroots WBA redesign, are not only technical but also contextual, cultural and relational. While mandates, structures and timelines are necessary, so too are movements, conversations and collective agency.

For education changes to be not only implemented but also embraced, educators must acknowledge complexity, engage diverse stakeholders and foster shared ownership. The work of Al‐Bualy et al. offers an encouraging model: By turning participation into an engine for innovation, the CL demonstrates how adaptive, meaningful change can take root and thrive within complex educational systems.

By turning participation into an engine for innovation, the CL demonstrates how adaptive, meaningful change can take root and thrive within complex educational systems.

AUTHOR CONTRIBUTION

Herman Tam made substantial contributions to the conception and design of the study, drafting the work and final approval of the version to be published and is accountable for all aspects of the work.

CONFLICTS OF INTEREST STATEMENT

None.

Tam H. Participation, complexity and the practice of education change. Med Educ. 2026;60(3):221‐223. doi: 10.1111/medu.70134

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.