Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Calls for organizational culture change are audible in many health care discourses today, including those focused on medical education, patient safety, service quality, and translational research. In spite of many efforts, traditional “top–down” approaches to changing culture and relational patterns in organizations often disappoint.
In an effort to better align our informal curriculum with our formal competency-based curriculum, Indiana University School of Medicine (IUSM) initiated a school-wide culture change project using an alternative, participatory approach that built on the interests, strengths, and values of IUSM individuals and microsystems.
Employing a strategy of “emergent design,” we began by gathering and presenting stories of IUSM’s culture at its best to foster mindfulness of positive relational patterns already present in the IUSM environment. We then tracked and supported new initiatives stimulated by dissemination of the stories.
The vision of a new IUSM culture combined with the initial narrative intervention have prompted significant unanticipated shifts in ordinary activities and behavior, including a redesigned admissions process, new relational practices at faculty meetings, student-initiated publications, and modifications of major administrative projects such as department chair performance reviews and mission-based management. Students’ satisfaction with their educational experience rose sharply from historical patterns, and reflective narratives describe significant changes in the work and learning environment.
This case study of emergent change in a medical school’s informal curriculum illustrates the efficacy of novel approaches to organizational development. Large-scale change can be promoted with an emergent, non-prescriptive strategy, an appreciative perspective, and focused and sustained attention to everyday relational patterns.
- Hafferty F. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7. CrossRef
- Inui TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges; 2003.
- Stern DT, Papadakis M. The developing physician—becoming a professional. N Engl J Med. 2006;355:1794–9. CrossRef
- Leape LL, Berwick DM. Safe health care: are we up to it? We have to be. BMJ. 2000;320:725–6. CrossRef
- Oswald WW. Creating a service culture. Healthc Exec. 1998;13(3):64–5.
- Zerhouni EA. Translational and clinical science—time for a new vision. N Engl J Med. 2005;353:1621–3. CrossRef
- Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff. 2002;21(5):103–11. CrossRef
- Suchman AL. A new theoretical foundation for relationship-centered care. J Gen Intern Med. 2006;21:S40–4. CrossRef
- Stacey RD. Strategic Management and Organisational Dynamics. 3rd ednHarlow, England: Financial Times Prentice Hall; 2000.
- Streatfield PJ. The Paradox of Control in Organisations. London: Routledge; 2001. CrossRef
- Indiana University School of Medicine. The Indiana initiative: Physicians for the 21st century. Indianapolis: Indiana University School of Medicine; 1996.
- Tresolini CP, and the Pew-Fetzer Task Force. Health Professions Education and Relationship-centered Care. San Francisco, CA: Pew Health Professions Commission; 1994.
- Watkins JM, Mohr BJ. Appreciative inquiry: Change at the Speed of Imagination. San Francisco, CA: Jossey-Bass/Pfeiffer; 2001.
- Cooperrider DL, Srivasta S. Appreciative inquiry in organizational life. Res Organ Change Dev. 1987;1:129–69.
- Stacey RD. Complex Responsive Processes in Organizations. London: Routledge; 2001.
- Suchman AL, Williamson P, Litzelman DL, et al. Towards an informal curriculum that teaches professionalism: transforming the social environment of a medical school. J Gen Int Med. 2004;19:501–4. CrossRef
- Taking Root and Growing: Becoming a Physician at Indiana University School of Medicine. Indianapolis: Indiana University School of Medicine; 2004.
- Reflecting Caring Attitudes through Action. Indianapolis: Indiana University School of Medicine; 2006.
- Helping Hands: Reflections on Humanities in Medicine. Indianapolis, Indiana University School of Medicine; 2007.
- Palmer PJ. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. 1stSan Francisco: Jossey-Bass; 1998.
- Baldwin DC. Evaluation Report to the President and Board of Trustees of the Fetzer Institute. June 30, 2006.
- Rogers E. Diffusion of innovation. Fifth EdNew York, NY: Free Press; 2003.
- Litzelman DK, Cottingham AH. The new formal competency-based curriculum and informal curriculum at Indiana University School of Medicine: overview and five-year analysis. Acad.Med. 2007;82:410–21. CrossRef
- Brater DC. Infusing professionalism into a school of medicine: perspectives from the Dean. Acad Med. 2007;82:1094–7. CrossRef
- Deming WE. Out of the Crisis. Cambridge, MA: Massachusetts Institute of Technology, Center for Advanced Engineering Study; 1986.
- Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change
Journal of General Internal Medicine
Volume 23, Issue 6 , pp 715-722
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- organizational culture change
- learning environment
- informal curriculum
- medical education
- professional competence
- Industry Sectors
- Author Affiliations
- 1. Medical Education and Curricular Affairs, Indiana University School of Medicine, Indianapolis, IN, USA
- 2. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- 3. Relationship Centered Health Care, Rochester, NY, USA
- 4. Regenstrief Institute, Inc., Indianapolis, IN, USA
- 5. Richard L. Roudebush VAMC, Indianapolis, IN, USA
- 6. The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 7. Accreditation Council for Graduate Medical Education, Chicago, IL, USA