Umeå universitets logga

In 2011, the first regionalized medical program (RMP) started in Sweden. The Swedish RMP means that students are distributed in groups while doing their five clinical clerkship semesters. To enable the medical students' theoretical studies when being regionalized, digital technologies are used for educational and administrational purposes. This paper explores medical teachers' and administrators' understanding of faculty preparations, their own preparedness and expectations related to the implementation of the RMP supported by digital technologies. A survey was distributed to teachers and administrators before the first regionalized semester was conducted. Findings indicate that the use of digital technologies began at a small scale, but that there is potential for increased development. It is concluded that although teachers and administrators have limited experience of distance education, the faculty has been able to create a feeling of being prepared.

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.

This paper examines possibilities and challenges when implementing distance teaching of theoretical content in a regionalized medical program (RMP). It will be argued that Cultural-Historical Activity Theory (CHAT) and the concepts of dominant and non-dominant activities, including conflicts and transitional actions, can lead to an understanding of the distance teaching implementation process. The concepts further provide a theoretical lens through which one can understand the complex relationship between the established and historically rooted, face-to-face teaching activity and the new non-dominant distance teaching activity introduced in the educational setting. Data in the study was collected through an online survey, log data, observations, and in-depth interviews. During the analysis, conflicts between the dominant face-to-face teaching and non-dominant distance teaching activity were identified, and they partly inhibited medical teachers at the program from adopting and developing distance teaching. By illustrating transitional actions as small, innovative bottom-up solutions, further analysis revealed how medical teachers tried to overcome those conflicts to facilitate the adoption and development of distance teaching. The non-dominant distance teaching activity, even if not fully adopted, actually influenced and facilitated change in educational practice. The discussion argues that understanding the implementation of a non-dominant teaching activity in medical education in terms of mere success or failure is not fruitful. Instead, we should strive for sensitivity by closely analyzing the implementation process as interplay between dominant and non-dominant teaching activities. Such sensitivity will make it possible to cultivate future educational development and change.

This chapter focuses on medical students’ experiences in transforming from faceto-faceto distance learners in a Swedish regionalized medical program (RMP).One group of students (n=100) were followed during six semesters through surveys,log data, observations, and in-depth interviews. A research model built on theCultural-Historical Activity Theory (CHAT), including the notion of dominant andnon-dominant activities, was used in order to identify factors that influence students’stepwise transformation from face-to-face to distance learners. The analysis containsthe investigation of pedagogical, institutional, and historically grounded conflictsthat seem to inhibit medical students from making a complete transformation todistance learners. By going deeper into the analysis of transitional actions, whichseems to help in solving conflicts, the chapter discusses implications to facilitatingmedical students’ future transformation from face-to-face to distance learners.These implications are examples of curriculum redesigns, such as new educationaldesigns and integration of technology and pedagogy in the curriculum.