Table 1 Inhibitors and their definitions

Irrelevant curriculum content

Curricular content that does not match with curricular outcomes.

Lack of resources in an institution

Resources that are not available according to the requirement of the course/ curriculum such as funds for library, ICT facilities, support staff, student advisors etc.

Low quality assessment

Assessment that is not aligned to instructional methods and content distribution and is not in accordance with principles of assessment.

Lack of sufficient time for studying

Less time available to students for self-study and exams.

Neglecting student needs and requirements

Students’ influence on the curriculum such as student evaluations and feedback taken into account when the curriculum is renewed or when new courses are developed.

Presence of strong disciplinary cultures

Culture over-concerned with procedures at the expense of efficiency, having more focus on inspection and control.

Lack of social interaction

Lack of interaction between the faculty and students and among them.

Research culture and patient care undervaluing education

Research or patient care is given more importance than teaching in terms of promotion and funding.

Lack of policies and procedures

Lack of formal policies and procedure documents in the institution affecting the curriculum and their implementation.

Leaders acting as communication gatekeepers

Leaders withholding, delaying, or passing selected information to all relevant stakeholders, e.g., teacher, students, educational managers, and maybe even others.

Lack of staff involvement in organizational decision-making

Lack of staff involvement in decisions that affect the curriculum, e.g., on the content of courses, time schedules, kind of educational activities, use of ICT etc.

Lack of sharing best practices across organisation

Lack of sharing existing practices that already possess a high level of widely agreed effectiveness.