Applying activity theory to undergraduate medical curriculum reform: Lessons in contradictions from multiple stakeholders’ perspectives

Abstract

Purpose

Medical school curricula require regular updating. We adopted an activity theory lens to conduct a holistic, multiple stakeholder-informed analysis of curricular reform, aiming to understand how the social relations between groups contribute to unanticipated tensions and outcomes.

Methods

A research assistant conducted semi-structured interviews with purposively sampled (N = 19) administrative staff, faculty course leads, faculty tutors, curriculum developers, change leaders and student leaders. The team applied a framework analysis to guide within and between stakeholder comparisons.

Results

Participants reported unique (N = 21) and cross-cutting (N = 17) contradictions underscoring emerging drivers of current and potential change. Unique contradictions raised by 1–2 groups represented seeds of change that had the potential to spread across all groups. By contrast, two general types of cross-cutting contradictions arose when one group had a dominant, confirming voice or two or more groups had contrasting perspectives.

Conclusions

While finding contradictions was expected, our analysis profiled their nature and some of the specific tensions they raised across and within stakeholder groups. The activity theory lens provided an accessible way to unravel curricular reform into manageable units of analysis. Systematically identifying contradictions arising from curricular reform will help stakeholders collaborate with a shared purpose toward positive, sustained change.

Keywords:

• Change
• planning
• undergraduate

Glossary

Contradiction (according to Activity theory): Refer to disturbances or conflicts, often between or within stakeholder groups in a large system, that serve as drivers of both positive and negative change.

Acknowledgements

The authors wish to thank the study participants and the University of Toronto, Temerty Faculty of Medicine MD Program, who supported this work.

Disclosure statement

There are no declarations of interest to declare.

Additional information

Notes on contributors

Marcus Law

Marcus Law, MD, MBA, MEd, CCFP, FCFP, is Associate Professor of Family Medicine and Associate Dean, MD program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Paula Veinot

Paula Veinot, MHSc, is an independent research consultant, Halifax, Nova Scotia, Canada.

Maria Mylopoulos

Maria Mylopoulos, PhD, is Associate Professor, Temerty Faculty of Medicine, and Scientist, Wilson Centre, University of Toronto, Toronto, Ontario, Canada.

Pier Bryden

Pier Bryden, MPhil, MD, FRCPC, is Associate Professor of Psychiatry, and Senior Advisor, Clinical Affairs and Professional Values, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Ryan Brydges

Ryan Brydges, PhD, holds the Professorship in Technology-Enabled Education, St. Michael’s Hospital, Unity Health Toronto, and is an Associate Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.