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Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective
Umeå University, Faculty of Social Sciences, Department of Education.
2013 (English)In: Rural and remote health, ISSN 1445-6354, Vol. 13, no 2, 2173Article in journal (Refereed) Published
Abstract [en]

Introduction:  In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally.

Method:  To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes.

Results:  The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized.

Conclusion:  This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.

Place, publisher, year, edition, pages
2013. Vol. 13, no 2, 2173
Keyword [en]
activity theory, contradictions, digital technologies, ICT, implementation, management, medical program, regionalized medical program, rural clinical school, technology enhanced learning.
National Category
URN: urn:nbn:se:umu:diva-71561ISI: 000322365600018PubMedID: 23574374OAI: diva2:624923

Published: 10 April 2013

Available from: 2013-06-03 Created: 2013-06-03 Last updated: 2016-05-04Bibliographically approved
In thesis
1. Learning to be at a distance: structural and educational change in the digitalization of medical education
Open this publication in new window or tab >>Learning to be at a distance: structural and educational change in the digitalization of medical education
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

As an expression of current challenges faced by contemporary societies, past decades have witnessed heavy demands for higher education to change and transform. One key question here has been the increased digitalization of higher education. Within this wider setting, this thesis deals with an attempt to handle the increasing shortage of physicians in Sweden by way of digitalizing medical education. The aim of this explorative and longitudinal thesis is to describe and analyze structural and educational transformation work in medical education during the digitalization of the program and the transition from face-to-face to distance education. This thesis focuses on teachers, students and management, who are all heavily involved in this transition of the medical program. Two questions guide the research: (1) what are teachers’ and students’ expectations pending the transition, and what are the influences of already established tools and activities on the program and (2) in what ways do conflicts and changes occur over time, and how do teachers, students, and management deal with these as part of the transition? Cultural-historical activity theory (CHAT) serves as the theoretical framework of the thesis. In particular, the concepts of dominant and non-dominant activities, conflicts, transitional actions, and levels of learning inform the analysis. The data are generated by surveys (N = 108), logging of actors’ activity patterns (N = 100 teachers and 100 students), field studies (65 hours), and interviews (N = 62). The data cover teachers’, students’ and management’s roles in the transition. The analysis shows that the way of theoretically understanding the transition – from a dominant face-to-face activity to a new and unproven non-dominant distance activity – have proved to contribute to deeper understanding of the process of digitalizing medical education. The analysis further displays how the transition from face-to-face to distance education creates considerable conflicts that over time force teachers, students and management into structural and educational transformation work. This type of work successively renders new educational design solutions and new flexible ways of organizing distance medical education. This thesis discusses how the structural and educational transformation work forces actors to collectively engage in the transition by experimenting with new suitable methods and designs, as digital technologies and technology-enhanced learning (TEL) could make sense to teachers and students when they are at a distance.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2015. 89 p.
Akademiska avhandlingar vid Pedagogiska institutionen, Umeå universitet, ISSN 0281-6768 ; 115
Distance education, medical education, medical program, regionalized medical program, rural clinical school, digitalization, digital technologies, technology-enhanced learning, TEL, cultural-historical activity theory, CHAT, transition, transformation, conflicts, contradictions, dominant- non-dominant activities, levels of learning
National Category
Research subject
urn:nbn:se:umu:diva-110740 (URN)978-91-7601-356-4 (ISBN)
Public defence
2015-11-20, Hörsal E, Humanisthuset, Umeå, 10:00 (Swedish)
Available from: 2015-10-29 Created: 2015-10-27 Last updated: 2015-10-28Bibliographically approved

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