Skip to main content

Table 2 Factors hindering the implementation of change

From: How clinical teaching teams deal with educational change: ‘we just do it’

Factors Quote
Resistance Program director, interview 16: ‘The most important changes, you just push them trough. And then starts the pushing and shoving, the sabotaging. […] Just see how much you can win back from what you had before, that is what is going on.’
Disbalance in tasks Trainee, interview 13: ‘They (clinical staff) know about CBME, but there is a difference between knowing and doing. If my individual training program interferes with their clinical practice, my training is sacrificed for their logistics.’
Behavior change Program director, interview 6: ‘The translation of a change into actual behavior change, I experience myself how much effort that costs. That I know I need to do things, but that it is not internalized yet.’
Lack of involvement Clinical staff member, interview 11: ‘I first heard of EPAs on a symposium. After that, I asked the program director about EPAs. He said that he wanted to implement them shortly. I thought, why don’t I know about this? Just tell us that. During the symposium I also found out that the preparations for EPAs were almost ready and they would be implemented within 2 weeks. Really weird I didn’t know this.’
Lack of consensus Program director, interview 10: ‘I have the feeling that it (the implementation of CBME) is very much laid down on us from top down. Without people asking us, are we alright with this.’
Unsafe culture and hierarchy Trainee, interview 13: ‘You are enormously dependent on them (clinical staff). They say, you need to swallow anything for 5 years. If you do that, you will have a nice career, if not […], you will feel that for the rest of career. For instance because they give you bad references. That is a sort of hidden rule.’