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.’ |