El Desarrollo Social y Humano como Ampliación de Capacidades

Several doctoral dissertations were mined pertaining to medical education reform, and a few relate closely to this study. Some even explored the faculty perspective as this study does, while that angle still seems to be lacking from more formally published research. The majority of studies mined were historical accounts of changes in different institutions or regions focusing on different eras, and in some cases different countries; yet they are still examples of scholarship in this area and a number have tangential relationships to this study. One focused on mid-twentieth century changes from 1947-

1967 at Dalhousie Medical School in Canada (Kiceniuk, 2000). It searched to find curricular transformations after World War II. That dissertation research summarized changes happening to the curriculum in the 1960s at Dalhousie and across North America being influenced by many of the same factors that influence curriculum changes today: “the philosophy by which medical educators developed and implemented curriculum revision was influenced by the increase in medical knowledge, technology, increased communication between institutions, and the subsequent increase in specialization, which prevailed and seized the medical education movement” (Kiceniuk, 2000, p. 382). After reviewing this and reflecting on this, it is apparent these same factors are still at play in medical education reform over 50 years later.

Two historical reviews focused on the tension between science and practice that also still exists today. One focused on reform in the United Kingdom from1770-1858, yet the account of tension is still germane today centuries later in U.S. Medical Education. It notes “a tension between the human-practical side of medicine and the theoretical or scientific side of medicine” (Thomas-Pollei, 2012, p.18.). Another dissertation focused on American medical school reform in the late 19th and early 20th century, and concluded: “Reform was an occasion for the manifestation and working out of an intellectual tension, the tension between scientists and practitioners” (Huddle, 1988, p. 11). It is easy to see these tensions still exist over 100 years later.

Although the era of the previous accounts differs greatly from this study that focused on 21st century changes, another student researcher studied the process of change purely from a document review perspective as she looked historically at reform in

Cincinnati from 1870-1930 and talked about how approaches changed in the era

immediately preceding and following the Flexner Report (Cangi, 1983). Again, schools are still striving to hit these four recommendation areas of (1) Standardization and individualization, (2) Integration, (3) Habits of inquiry and improvement, and (4) Professional formation, as noted in by Cooke, et al, in the 2010 Carnegie centennial report.

A more relevant study explored the integration of instructional technology (also a piece of this dissertation), yet did so in relationship to a graduate medical education (residency) program instead of at the medical undergraduate level. Zwirn (1996) did his study analyzing disincentives to the adoption of instructional technology and why it wouldn’t work at the time.

Two other relevant dissertations focused on areas connected to this study yet took different approaches to which are described next. A third appeared to align but did not at all once better reviewed. Although dissertation titles aren’t generally noted in-text citations, they will be included here below because of their relevance.

The first, titled, Changing a Medical School Curriculum: How Does it Happen? (Rieke, 2003), strived to learn about the change process a faculty committee took to implement a new curriculum model at a Midwestern medical school. Although there are similarities with its approach, it looked at just one of the threads from this study (change to a school’s curriculum model). It discussed similar components to changes that have been rolled out or will be rolled out at BUSM.

(which also happens in many BUSM classes), and this school also did away with traditional discipline-based individual courses in the first two years and created interdisciplinary blocks (similar to BUSM). In this study, all basic science principles were designed around weekly patient cases that were discussed every morning

throughout the blocks for first and second-year medical students for use in their lectures, labs, and small group discussions (Rieke, 2003, p.59). The dissertation wasn’t linked to any conceptual or theoretical frameworks. It was a historical account of what happened, and it concluded by summarizing the process that took place in reading conclusions about how the change happened. The recommendations all focused on the need for further examination and study, but there were no specific actions recommended (Rieke, 2003 p. 140).

The dissertation title, Examining Health Professional Educators’ Adoption of Learning-Centered Pedagogy and Instructional Technologies (Fox, 2014), initially appeared to be an even closer match than the previous study of instructional technology, as it explored two of the three focus strands of this study with Pedagogy and Technology. However, it also differed from this study in multiple ways. First, it did not focus on the education for medical students to become doctors but students training in the allied health professions to become occupational therapists, physical therapists, bioscience

technologists, couple therapists, family therapists, and radiology technicians (Fox, 2014, p. 58).

Although this student’s research was also conducted to capture the faculty perspective, it was largely quantitative in nature, looking for statistics reflecting to what

extent the educators adopted both instructional technologies and learner-centered pedagogies from a quantitative stance using instruments based on TPACK and Unified Theory on Acceptance and Use of Technology (UTAUT) (Fox, 2014, p. 86). This was difficult to capture and measure due to the researcher-defined limited sample sizes of 46 for the quantitative survey, and faculty interpretations of questions, e.g. some instructors considered using PowerPoint slides as a student-centered instructional technology. The qualitative piece asked only five faculty members to describe their adoptions practices of both new pedagogy and instructional technologies (Fox, 2014 pp. 54–55). Although pedagogical changes almost always result from technology adoption, the researcher linked these two so strongly it did not allow for the study to explore pedagogical shifts to learner-centered practices that don’t rely on technology, such as small-group discussion about a case, or in-class peer instruction that can happen in large lectures between pairs and triads.

A third dissertation’s title promised to be a close match, Understanding key constituents in change: Faculty Perceptions and Experiences with Curricular Change in Medical Education: A Human Science Study grounded in Phenomenology (Kunkle, 2001), but the study turned out to be done with a much different approach. The researcher included a lot autobiographical information and continually injected her own biases (which were largely negative, based on a poor employment experience at another university) throughout the work. If there were efforts to minimize bias, they were not apparent. The study focused on curricular changes at Medical College of Ohio (MCO) that were recommended by the LCME to add both pathophysiology and problem-based

learning components to its pre-clerkship curriculum. Her description of that recommendation illustrated one of many examples where her negative bias comes through, “The recent LCME recommended changes to MCO were based on the previous curriculum and reflects the LCME’s supposed understanding of what is required for minimal functional standards of professionals within the medical profession at the generalist level (pre-residency or pre-graduate medical education)” (Kunkle, 2001, p. 6). The word supposed is one example of such words that are frequently used, so the biased tone and approach is felt throughout the paper. The paper lacks researcher objectivity.

While not related to curricular changes in medical education, a dissertation that related in another way was a program evaluation study done at Boston University School of Medicine on a newly initiated BUSM faculty development program. The Academy for Collaborative Innovation and Transformation (ACIT) was offered for mid-career faculty “who represented the largest and most productive segment, but also the most dissatisfied” (Campion, 2015). The academy was put in place as a mechanism to minimize attrition and develop participant skills. It resulted in “marked gains in knowledge, skills, attitudes, and connectivity when compared to the referents...the majority of didactic sessions were rated highly for both content areas and speakers, while the group projects and learning communities received mixed reviews” (Campion, 2015). The study was titled: How Does a Mid-Career Faculty Development Program in Academic Medicine Impact Faculty Institutional Vitality? This topic will prove helpful later in Chapter Five’s discussion regarding findings of individuals in this group who may have participated in the present study three to four years later.