Abstract
Curricular change is the “new normal” for medical schools. Assessing faculty readiness, perceptions about the necessity and urgency of change, and confidence in the capacity of the organization to successfully implement the process, have been identified as essential to managing the curricular change process. We used The Medical School’s Organizational Readiness for Curriculum Change Questionnaire (MORC) to assess and monitor faculty readiness for change. This 53-item survey uses a 5-point Likert scale to assess 3 factors. This project focused on the seven-item Communication subscale in order to guide the strategy for informing and involving faculty in the curricular change process. The MORC was distributed electronically to full-time faculty in December 2014 (pre-change), August 2016 (mid-change), and September 2017 (post-change). Respondents reported significantly increasing support and positive attitudes about curricular change, supporting the hypothesis that the communication strategies informed by MORC findings had a positive impact on faculty members’ perceptions of the process. As the leading faculty concerns reported in the MORC shifted from the merits of change to practical concerns about implementation, we adapted communications to address their priorities. The MORC proved useful in capturing quantitative data on faculty perceptions of curricular change but its value was limited by low response rates and unrepresentative samples. Scientists, full professors and tenure track faculty members were overrepresented in survey respondents. Survey lengths were identified as limiting participation. Our experience supports the development of a shorter version of MORC to retain validity and reliability while potentially increasing response rate.
Keywords: Curriculum change, Organizational change, Change management, Communication strategies, Faculty engagement
Background
Ongoing curricular change is the “new normal” for medical schools [1, 2]. Significant agreement has been documented on the principal directions of such changes [3–5] but information about optimal strategies to effect successful change in educational programs is largely projected from business literature [2, 6], descriptive reports from individual schools [7–11], and analyses of initiatives to expand primary care curricula [12–16]. The key factors identified as impeding or facilitating change have been incorporated into an “organizational readiness for change” construct, focusing on faculty attitudes and beliefs about the necessity and urgency of change plus confidence in the capacity of the organization to succeed [2, 6]. An instrument to measure organizational readiness for curricular change in medical school faculty, The Medical School’s Organizational Readiness for Curriculum Change Questionnaire (MORC), has been validated [2] but not widely used in planning, implementing, or assessing the change process. It consists of a 53-item survey using a Likert scale plus an open-ended question for comments. We utilized the MORC to inform comprehensive communication strategies during a major curricular transformation. Our goals were to increase faculty engagement, positively impact faculty perceptions of the change process, and provide data enabling leaders to better match the change process with the organization’s readiness for change.
Activity
The University of Kansas School of Medicine is a state school with three campuses and a class size of 211. Following 2 years of extensive internal discussions, planning began in 2013 to transform the curriculum to an Active-learning, Competency-based, Excellence-driven (ACE) model implemented for students entering in July 2017. The MORC was distributed electronically to full-time faculty in December 2014 (pre-change), August 2016 (mid-change), and September 2017 (post-change). This paper focuses on the MORC’s seven Communication items. Although the survey was administered three times to the same group, the surveys were anonymous, so individual responses could not be matched across administrations. One-way analyses of variance (ANOVA) followed by Tukey’s Honestly Significant Difference tests were used to detect differences. IBM SPSS Statistics, version 24, was used for all analyses. Content analysis was conducted on respondent comments. This project was approved by the University of Kansas Medical Center’s Institutional Review Board.
Following the pre-change survey, we implemented comprehensive communication strategies to inform faculty of the curriculum proposals and engage them in the change process. By the mid-change survey, faculty funding for curricular planning, focused faculty development programs, and presentations to departments, faculty and governance groups tailored to address curriculum evolution and changing faculty concerns, had been implemented. The post-change survey was distributed 2 months after the launch of the curriculum (Fig. 1). By then, many faculty members had completed faculty development sessions and were actively participating in the ACE curriculum (Table 1).
Fig. 1.
Number and Types of Communication Strategies Over Time
Table 1.
Communication Strategies During Curriculum Change
| Audience | Strategy | Responsible Party |
|---|---|---|
| Pre-change | ||
| Faculty, students, public | Launched new curriculum website | Office of Medical Education |
| Faculty, department chairs, Curriculum committees, governance groups | Meeting presentations | Curriculum Steering Committee Members |
| Faculty | Faculty participation in medical education and faculty retreats | Executive Dean |
| Faculty | Invitation to serve on curriculum planning committees | Office of Medical Education |
| Faculty, staff | Town hall meetings | Executive Dean |
| Faculty, students, staff | Promotional material created and distributed: brochures, logo, ball caps, hard hats, button | Office of Medical Education |
| Mid-change | ||
| Faculty | Funded key faculty for curriculum planning and development | Executive Dean |
| Faculty | Faculty recruitment for education activities | Office of Medical Education |
| Faculty | Curriculum-specific professional development opportunities, including active-learning, flipped-classroom, case-based collaborative learning group facilitation, exam item writing | Office of Faculty Affairs and Development |
| Department chairs, business administrators | Education and research allocation funding model | Executive Dean |
| Faculty, students, staff | New Health Education Building | Medical Center Leadership |
| Post-change | ||
| Faculty, department chairs, curriculum committees, governance groups | Updated presentation on changes and needs based on feedback from the field | Office of Medical Education |
| Faculty | Increased and varied faculty development opportunities based on needs identified by faculty actively engaged in the new curriculum | Office of Faculty Affairs and Development |
| Faculty | Ongoing faculty recruitment for educational activities | Office of Medical Education |
Results and Discussion
The survey was distributed to full-time faculty, as part-time faculty had minimal involvement in instruction and curriculum development. Seventeen percent responded to the first survey, 19% to the second, and 18% to the third. Ratings increased significantly from the first to the second and from the second to the third administration on all Communication items. The ANOVAs revealed that for each item Pre < Mid < Post at p < .05 (Fig. 2).
Fig. 2.
Change in Faculty Scores on MORC Communication Items During Curriculum Change
Respondent comments were coded by theme. The predominant theme in the pre-change survey was lack of communication (27/43 comments, 62%), “Need to improve the lines of communication... There is solid support from the teaching faculty. The lack of information will lead to more anxiety and misunderstandings.” In the mid-change survey, the focus was funding and resources (9/31 comments, 29%), with lack of communication decreasing to 23% (7/31 comments). “We have recently received some information about the change, but the departments are out of the loop and are the ones on the financial hook. I don’t mind the change; I am concerned about the funding.” Funding and resources remained the predominant theme (12/27 comment, 44%) in the post-change survey, followed by support for the curriculum changes (10/27 comments, 37%). “I think this curriculum change is timely and necessary if we are to continue producing the kind of doctors who reflect America today.” No comments asserting lack of communication were made in the post-change survey.
These results support the hypothesis that the communication strategies had a positive impact on faculty members’ perception of curriculum change. Survey data also informed strategies to adapt communication to faculty concerns. As priorities shifted from the merits of change to practical concerns about implementation (e.g., resources, compensation, personnel, and faculty development), we adapted communications to emphasize departmental updates, and faculty development, resource, and funding opportunities, including grants for pilot programs. Messaging to department chairs and faculty leaders was tailored to address the changing faculty concerns, primarily focusing on the expectations of faculty contributions and the related available financial resources. A refined funding model was implemented to ensure financial support for faculty to participate in ACE curricular activities.
The trend of growing faculty confidence and willingness to participate in the curricular change indicated by the MORC surveys is supported by other observations. These included increased interest in development and facilitation of learning activities, participation in faculty development activities, and response rates to faculty satisfaction surveys.
The results are encouraging but not without limitations. As a single institution study, the results may not generalize to other institutions. Roughly 60% of respondents across all administrations were clinicians and 35% basic scientists. However, the total population was about 75% clinicians and 22% basic scientists. Due to the small sample size respondents may not be representative of the entire group and therefore, the results may not generalize to all KUSM faculty. Although the MORC proved useful in capturing quantitative data on faculty perceptions of curricular change, its value was limited by the low response rate and unrepresentative sample. Comments by survey respondents indicated that the response rate was impacted by its length and complexity, as noted in a previous article [2]. Our experience supports development of a shorter version of the MORC to retain validity and reliability while potentially increasing response rate.
Compliance with Ethical Standards
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical Approval
The project was granted exemption status by the Institutional Review Board at the University of Kansas Medical Center on November 20, 2014.
Informed Consent
The invitation email to faculty members included details about the purpose of the project and information about data collection, analysis and use. In completing and submitting the questionnaire, the participant acknowledged consent.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Frenk J, Chen I, Butta ZA, et al. Health professionals for a new century; transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376:1923–1958. doi: 10.1016/S0140-6736(10)61854-5. [DOI] [PubMed] [Google Scholar]
- 2.Jippes M, Driessen EW, Broers NJ, Majoor GD, Gijselaers WH, van der Vleuten CPM. A medical school’s organizational readiness for curriculum change (MORC): development and validation of a questionnaire. Acad Med. 2013;88:1346–1356. doi: 10.1097/ACM.0b013e31829f0869. [DOI] [PubMed] [Google Scholar]
- 3.Skochelak SE, Stack SJ. Creating the medical schools of the future. Acad Med. 2017;92:16–19. doi: 10.1097/ACM.0000000000001160. [DOI] [PubMed] [Google Scholar]
- 4.Skochelak SE. A decade of reports calling for change in medical education: what do they say? Acad Med. 2010;85:S26–S33. doi: 10.1097/ACM.0b013e3181f1323f. [DOI] [PubMed] [Google Scholar]
- 5.Institute of Medicine Improving medical education. Washington DC: Institute of Medicine; 2004.
- 6.Kotter JP. Leading change. Boston mass: Harvard Business School Press. 1995.
- 7.Mejicano GC, Bumsted TN. Describing the journey and lessons learned implementing a competency-based, time-variable undergraduate medical education curriculum. Acad Med. 2018;93:S42–S48. doi: 10.1097/ACM.0000000000002068. [DOI] [PubMed] [Google Scholar]
- 8.Loeser H, O’Sullivan P, Irby DM. Leadership lessons for curricular change at the University of California, San Francisco, School of Medicine. Acad Med. 2007;83:324–330. doi: 10.1097/ACM.0b013e31803337de. [DOI] [PubMed] [Google Scholar]
- 9.Mennin S, Kalishman S, editors. Issues and strategies for reform in medical education: lessons for eight medical schools. Acad Med. 1998;7:73.
- 10.Lindberg MA. The process of change: stories of the journey. Acad Med. 1998;73:S4–10. [PubMed] [Google Scholar]
- 11.Irby DM. University of California, San Francisco School of Medicine. In: Whitcomb M, editor. The education of medical students: ten stories of curricular change. New York, NY: Millbank Memorial Fund; 2000. pp. 45–70. [Google Scholar]
- 12.Bland CJ, Starnaman S, Hembroff L, Peristadt H, Henry R, Richards R. Leadership behaviors for successful university-community collaborations to change curricula. Acad Med. 1999;74:1227–1237. doi: 10.1097/00001888-199911000-00018. [DOI] [PubMed] [Google Scholar]
- 13.Bland CJ, Starnaman S, Wersal L, Moorhead-Rosenberg L, Zonia S, Henry R. Curricular change in medical schools: how to succeed. Acad Med. 2000;75:575–594. doi: 10.1097/00001888-200006000-00006. [DOI] [PubMed] [Google Scholar]
- 14.Bland CJ, Starnaman S, Harris D, Henry R, Hembroff L. “No fear” curricular change: monitoring curricular change in the WK Kellogg Foundation’s National Initiative on Community Partnerships and Health Professions Education. Acad Med. 2000;75:623–633. doi: 10.1097/00001888-200006000-00014. [DOI] [PubMed] [Google Scholar]
- 15.Anderson B. A peer-reviewed collection of short reports from around the world on innovative approaches to medical education. Med Educ. 2018;52(5):546–547. doi: 10.1111/medu.13579. [DOI] [PubMed] [Google Scholar]
- 16.Muller JH, Jain S, Loeser H, Irby DM. Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Med Educ. 2008;42(8):778–785. doi: 10.1111/j.1365-2923.2008.03110.x. [DOI] [PubMed] [Google Scholar]