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Table 3 Significant Challenges Encountered when Contemplating Curricular Changes

From: Post-Carnegie II curricular reform: a north American survey of emerging trends & challenges

Types of challenges encountered (Representative quotes in italics) Number and percent of total respondents (N = 55) citing similar challenges
Faculty Resistance to Change 17 (30.9%)
 -- “Faculty reluctance to change. Much rested on faculty identity with their discipline-based courses.”
 --“Frustration of faculty with ‘new generation learners”
 --“Faculty resistance to reducing pre-clinical time”
 --“…recently completed an LCME review that resulted in a perfect score. Within this context it was challenging to convince some faculty of the need for change.”
 --“Getting faculty on board, fear of change, fear of loss. It took a lot of consensus building, process, and listening.”
 --“The insecurity/fears of the basic science departments about losing control of courses”
 --“Reluctance by anatomy faculty to move to integrated systems courses, including anatomy, rather than the stand-alone course they had for many years!”
 --“Fear by basic scientists that they would be marginalized”
 --“Faculty resistance to losing course control (basic science faculty) when we integrated clinical and basic science”
 --“Faculty buy-in and resistance to change”
 --“The biggest challenge was getting Basic Science faculty to accept the shortened science curriculum. In the first year, it seemed like they tried to sabotage the curricular change at every turn.”
Faculty Development/Competing Faculty Demands/Limited Faculty Time 9 (16.4%)
 -- “Competing other faculty demands (clinical work, research, other educational roles) that may reduce the time faculty have to develop new content or implement new teaching methods.”
 --“Faculty preparedness and availability continues to be the most difficult challenge to overcome. Most basic science faculty are unable or unwilling to contribute to the clinically-relevant learning experiences and clinical faculty are time-constrained, being expected to earn the clinical income that keeps the whole enterprise going.”
 --“There has been insufficient attention to teacher and educational leader development”
Financial Considerations/Resources 9 (16.4%)
 --“Money—primarily compensation for clinical involvement. Clinical capacity.”
 --“Getting enough time for our faculty to be small group facilitators”
 --“Availability of clinical faculty for pre-clinical teaching”
 --“Resources—recruiting hundreds of community-based physicians to serve as preceptors in our curriculum.”
Overall Resistance to Change 6 (10.9%)
 --“General resistance to change”
 --“Change is hard”
--“Change management. Loss of familiar courses/structures.”
 --“The most significant challenge is change itself, in the eyes of students and faculty. This has been especially true as incorporated Health Systems Science into the curriculum. Students appreciate its importance in the big picture but not in the short term when Step 1 is what matters.”
 --“The curriculum revision required a change in culture so that Departments no longer managed the curriculum....”
 --“Reframing student and faculty expectations as we transitioned to primarily student directed small group learning. (Will the students learn enough and the right things? How will they do on national exams? Don’t they need a faculty to tell them the ‘right’ answer and exactly what they need to know?)”
Technology Related 5 (9.1%)
 --“Technological challenges—software that doesn’t interface well, glitches, or that takes some time to learn or use.”
 --“Software to accomplish dashboarding and curricular organization”
 --“…scheduling problems that caused much angst with the students….”
 --“There has been insufficient planning for IT infrastructure needs to support the upcoming changes.”
Regulatory and/or USMLE Step 1 Related Considerations 4 (7.3%)
 --“Increased emphasis on the importance of USMLE exams…with the common result of a ‘parallel curriculum’ emerging that uses commercially available board-prep material and competes for student time.”
Competition for Limited Amount of Curricular Time 3 (5.5%)
 --“Limited time in the schedule coupled with increasing content students are expected to master”
--“Compression of time/schedule in which to teach the same content.”
--“Finding time for the additional curriculum. When something is added something must be cut.”
Student Resistance to Change 2 (3.6%)
--“This is not the program I was admitted into”
--“How do you keep the current students engaged and enthusiastic about their ‘old’ curriculum while trying to get faculty and staff excited about a new curriculum? The messaging is very challenging here.”