Curriculum Reform and Organizational Change

Organizational activities that change the curriculum

Curriculum reform involves setting educational goals and restructuring learning experiences and assessments. In medical education, this process involves faculty in basic science and clinical fields, educational support staff, students, healthcare institutions, and regulatory bodies. It also involves decisions about allocating educational time and facilities. Changes in the curriculum take shape through course organization as well as the roles, collaborative practices, and decision-making procedures of the people responsible for implementing it.

Continuity of student-centered education and accumulation of reform systems

A longitudinal study of the Yonsei University College of Medicine shows how student-centered education has taken shape in educational systems and support structures through successive reforms (Ahn, 2018). The study analyzed reforms to the four-year medical course since 1970, examining the priorities and reform directions of each period and factors influencing change. The case was selected for its historical emphasis on education and experience with reform. The reforms were analyzed in stages: the emergence of needs and goal setting, design and implementation, and evaluation of implementation. This approach maps the six steps of curriculum development onto the progression of the reforms (Kern et al., 1998). Factors influencing change in each period were examined through the interaction of driving and restraining forces, using force-field analysis based on Lewin’s change management model.

The reforms were divided into four periods. In the first period, 1970–1983, the curriculum and all faculty members were evaluated, an educational planning committee was formed, and educational aims and goals were established. Efforts were also made to reduce lecture hours, expand clinical clerkships, introduce integrated courses and electives, and secure time for autonomous learning. In the second period, 1984–1995, external demands were addressed while maintaining the framework of a subject-centered curriculum. In the third period, 1996–2010, the CDP task force led the reform following the establishment of the Department of Medical Education and the introduction of the medical school accreditation evaluation system. CDP2004 introduced a fully integrated curriculum organized by organ system and reduced lecture hours while expanding time for autonomous learning, PBL, and electives. The fourth period ran from 2010 to the time of writing in 2018. CDP2013 pursued student-centered, outcomes-based, and research-centered integrated education. Absolute grading, a curriculum to develop research capacity, a DMH curriculum, and learning communities were introduced. The administration of required and elective curricula and individualized student advising were strengthened.

Following CDP2004, responsibility for implementation shifted to the Gwanghye Education Committee. The Department of Medical Education handled pedagogical theory and research, and the Office of Educational Support took charge of administrative support. Externally, international trends in medical education, accreditation standards, and social changes accelerated reform. Internally, curriculum evaluation and critical reflection drove change. Alternative models and fair decision-making procedures supported strategic communication in response to faculty disagreements and a culture organized around departments and relative grading. Related literature addresses organizational history, participation, resource allocation, group norms and relationships, and the transmission of values through policies and evaluations (Bland et al., 2000; Burnes, 2004; Hafferty, 1998; Lewin, 1947).

Expanding electives in premedical courses and designing learning support systems

A study of premedical curriculum reform at Seoul National University analyzed a case in which educational goals were redefined and course organization and advising systems were adapted to reflect student diversity (Hwang et al., 2013). The premedical department became part of the College of Natural Sciences in 1975. Reforms began when a proposal to transfer its affiliation to the College of Medicine was approved in 2011, alongside a decision to transition to a medical college system in 2015. The new curriculum was implemented in the 2012 academic year. The research team compared the formal and informal curricula before and after the reform, drawing on the senate policy task report and the curriculum improvement committee reports. During curriculum development, surveys asked all faculty and students about problems and areas for improvement in the existing curriculum. The validity of the procedures was examined across four stages—setting educational goals, selecting educational experiences, organizing educational experiences, and evaluation—using the models of Tyler and Lee Seong-ho.

The reports identified an absence of educational goals, reduced motivation to learn under a uniform curriculum, a limited sense of belonging, and insufficient character education. In response, efforts were made to redefine educational goals, expand customized curricula and electives, and increase education in the humanities and social sciences. Total required credits increased from 68 to 74, while mandatory credits decreased from 49 to 41, and elective credits increased from 19 to 33. The customized curriculum (curriculum path model) was designed to allow students to study one field in the natural sciences or humanities and social sciences intensively. The requirement to take courses in all three subjects—physics, chemistry, and biology—was replaced with a choice of two. In core liberal arts, students were required to complete 9 credits or more in literature and art, history and philosophy, and society and ideology. Compared with four other domestic medical schools in the 2012 academic year, the proportion of mandatory credits was approximately 12% to 38% lower, and the proportion of elective credits was approximately 12% to 45% higher.

A self-development portfolio and 60 hours or more of volunteering during enrollment were established as mandatory achievement goals. In lifestyle mentoring, four students were assigned to one faculty member. Advising was based on short- and long-term plans for the two premedical years and self-reflection reports. Over one semester, ‘Science and Technology Writing’ progressed from research proposal presentations through discussion and revision to final research paper presentations. ‘Free Topic Research’ was structured to develop skills in reasoning about problems, communication, and data research and analysis. Freshman seminars, an introduction to medicine, medical research mentoring, and Korean language education for students admitted through the special admissions process for foreigners were also provided. The research team determined that this structure aligned with the four stages of the curriculum development model. The authors suggested that subsequent evaluations examine students’ achievement of goals, opportunities to demonstrate target behaviors, and how the curriculum operated in practice.

Reform as negotiation surrounding educational time and integration

A qualitative case study of a UK medical school drew on the concept of wicked problems to analyze how participants defined the same curriculum reform problem differently (Hawick et al., 2017). The research site was a medium-sized public medical school with about 170 students per year. Its existing five-year curriculum consisted of theory and basic science for the first two years, followed by clinical education for the subsequent three years. The reform aimed to reduce lectures, increase small-group classes and the use of clinical cases, and integrate basic science with clinical education. Basic science faculty, family medicine physicians, and hospital doctors in 26 clinical specialties participated in teaching. The GMC’s graduate outcomes, teaching, and assessment standards, together with conditions for clerkships at local healthcare institutions, influenced implementation. The research team conducted an exploratory qualitative case study grounded in social constructivism and purposively sampled senior faculty members serving on the reform steering committee.

There were 11 participants in total, 6 men and 5 women, and 17 interviews were conducted. Of these participants, 6 took part in follow-up interviews 4–6 months later. The median interview duration was 43 minutes, with a range of 26–55 minutes. About 50 documents and files were also analyzed, including meeting minutes, reform proposals, action items, and discussion and presentation materials. The interviews underwent inductive thematic analysis using NVIVO 10. The resulting themes guided a directed content analysis of the documents. The concept of wicked problems was used to develop the interpretation. Participants perceived the reform as a threat to existing classes, an opportunity to expand their specialty, or an operational challenge. Increasing educational time in one field involved adjusting time in another, and clinical clerkship placements depended on educational facilities and capacity. Reactions to reform also depended on whether the effort invested in developing existing classes was recognized.

Minutes concerning the integration of family medicine education recorded repeated discussions about consulting the group and incorporating new learning objectives. Less progress was reported than for other activities. Several factors contributed: the extent to which the existing course was integrated, the basis for requesting additional time and resources, political difficulties within the group, tutors’ firm views on educational content, and the course’s popularity. Attempts at integration continued at the time of writing. The research team interpreted this as reflecting a characteristic of wicked problems: they have no stopping rule. Because the study analyzed documents and the recollections of senior faculty members who led the reform, the results are best interpreted in light of the negotiation and uncertainty experienced by this group.

Educational organizations changing while learning quality improvement and interprofessional collaboration

A case study of the University of Missouri-Columbia School of Medicine analyzed the integration of QI and ICP education from 2003 to 2013 through the lens of Complex Adaptive Systems (CAS) (Stevenson et al., 2025). The reform originated in the ‘MU 2020 Initiative’. The mission of effective patient-centered care was translated into 8 core characteristics of graduates: ethics, knowledge, problem solving, communication, collaboration, quality and safety improvement, lifelong learning, and professional identity. The research team conducted an interactive single case study and invited 19 faculty members to participate. The 12 participants included 7 from medicine, 3 from nursing, 1 from pharmacy, and 1 from health administration. Seven also worked in quality improvement organizations linking the university and clinical practice. Data were collected over one week in January 2013 through 11 individual interviews and class observations, followed by second interviews with 6 members. A stimulated recall interview with 1 member was added during observation. Interviews, observation records, class materials, and organizational documents were analyzed abductively through systematic combining. This involves repeated comparisons among data, theory, and analysis.

The research team identified all 9 characteristics of the 2023 CAS-based organizational change management framework in the changes at MU. The team modified 4 existing management practices to reflect common purpose and learning, alignment within and outside the organization, and interdependence among actors. In total, 11 management practices were presented, including leadership emerging through interaction, collective identity, and productive tension. Formal leaders communicated a shared direction through the core characteristics of graduates. They allowed autonomy in the detailed design of teaching methods, guided by the rules of experiential learning and support from experienced facilitators. The Center for Health Care Quality (CHCQ) connected the university, healthcare institutions, and departments. Faculty learned QI and ICP through formal training, practical improvement projects, and mentoring. Students’ fall prevention activities linked learning objectives to the hospital’s quality and safety goals. In ‘Legacy Teachers’, third-year medical students used writing, poetry, and artwork to honor patients who had influenced them, reflecting on patient-centered care and professional formation. Over about 6 years of efforts to develop QI and ICP capacity, the number of trained medical faculty grew from a small number of interested individuals to nearly 60.

When some gains in ICP attitudes returned to baseline after one year, a strategy to develop organizational capacity was established in 2004. ‘Retooling for Quality and Safety’ in 2009–2010 revised learning activities and fall risk assessment forms through 6 improvement cycles. From 2010, passing a patient-centered care OSCE became a graduation requirement. Faculty and staff with less QI experience and senior learners were assigned to practical improvement projects together. Experienced faculty gained mentoring experience. Dedicated administrative support and protected time were lacking. There was also tension between system-centered safety education and a culture of individual blame in some clinical settings. Follow-up contact with some participants confirmed that QI and ICP education continued up to the time of publication.

Reading notes

The Seoul National University premedical study analyzed data covering less than two years after implementation. Its results show how the courses and support systems reflected the reform’s intentions. In the University of Missouri-Columbia School of Medicine study, 10 years elapsed between data collection and final analysis and reporting. The analysis drew on the 2023 framework. The modified framework presents a set of hypotheses for follow-up research. In HRD research, consultation, mentoring, and collaborative work among reform participants can be analyzed as workplace learning to trace how that experience informs subsequent curriculum design and the development of support systems.

References

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