Mento's change model in teaching competency-based medical education

Abstract

Background: Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching.

Aim: Here we define a framework designed using Mento's model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum.

Methodology: Using Schein's "unfreezing" as a guide term we critically reflected on the popular change-management models, to home in on Kotter's model of change to transform organizations. However, Kotter's change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by "The Leader Team", we decided to adopt Mento's change-model for our study. Mento's model not only draws from the precepts of Kotter's model, but also incorporates axioms of Jick's and GE's change-models.

Results: Using Mento's model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin's framework.

Conclusion: To our knowledge this is the first report of the use of Mento's model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.

Keywords: 6D-approach; Active learning; Change-management; Competency based medical education; Flipped-teaching; Kotter’s model of change; Leadership theory; Mento’s model of change.

Fig. 1

Change management plan of Mento, which was used in this project. The plan is a blend of three popular models (Refer to text for references and details). The step of the plan where the Leader Team pursued a SWOT (strengths, weaknesses, opportunities, and threats) analysis is indicated using a callbox. (Note: The rationale for adapting Mento’s model in this project is discussed in text)

Fig. 2

Full Range Leadership Model elaborating the Leader Team’s role in implementing change using Mento’s change-model. (Note: The Leader Team exhibited both Transactional and Transformational Leadership, as well as allowed the stakeholders to express their independent thoughts and concepts (Laissez-Faire Leadership))

Fig. 3

The undergraduate medical curriculum at Mohammed Bin Rashid University of Medicine and Health Sciences. The curriculum is divided into three phases and spans over 6 years. Each phase of the undergraduate medical curriculum includes integrated courses and builds on the preceding one, such that the curriculum is a “spiral,” and the students repeat the study of a subject, each time at a higher level of difficulty and in greater depth

Fig. 4

The different steps of the 6D-Approach. (The initial steps are mentor dependent, whereas the concluding steps are student driven)

Fig. 5

Leadership Model Adopted by The Leader Team. (Note: We adapted The Duke Healthcare Leadership Model, substituting Patient Centredness with Learner Centredness)