The purpose of this study is to find out what kind of strategies are needed to lead to changes in educational practice through changing factors and process of change in medical curriculum of Korea. For this study is to examine the contents of the med... The purpose of this study is to find out what kind of strategies are needed to lead to changes in educational practice through changing factors and process of change in medical curriculum of Korea. For this study is to examine the contents of the medical curriculum change, the reason of change, the process of change and the factors for the change of curriculum in Korea since 2010, and to find implications for what policy and support are needed to bring about change. The research questions of this research are as follows. First, what is the content of the curriculum change that has been taking place in Korean medical education institutions since 2010? Second, what are the factors of the curriculum change? Third, what is the process of changing the medical curriculum? Fourth, why is it different in the degree of change of curriculum according to each educational institution, and what kind of supports are necessary for the change of curriculum to lead to practical change? I used an integrated mixed method that conducted quantitative research through questionnaires and qualitative research that analyzed related documents and interviews. The questionnaires were carried out mainly in medical education department in 41 medical schools. Interviews were conducted with 6 medical education professors and interviewed about the process of curriculum change and the factors influencing change in each step. I analyzed the factors curricular changes in levels of structure, institutes, and agents through framework of historical new institutionalism. The results of research problem are as follows. First, the content of the medical curriculum change was outcome based curriculum. Many schools have been trying to set outcomes for graduation and to establish outcome based curriculum. They were trying to improve and change of clinical practice, medical humanities programs, evaluation system, research practice course, career development programs. This result shows that many universities were trying to change into outcome based curriculum according to the post 2nd cycle accreditation standards. Second, the factors of change in the medical curriculum were analysed the factors of structure, institutions, and agents using the framework of historical new institutionalism. In the level of structure, the medical education system in Korea was changed from the college of medicine to the graduate school of medicine, and then it was returned to college of medicine. So medical schools were given the right and duty to change the medical curriculum In the level of institutions, the quality management of medical education is influenced on medical education accreditation standards, and change of the National Medical Licensing Examination. In this process, a group of medical education experts were formed naturally and they were leading the change of the medical curriculum. In the level of agents, dean and the medical education experts worked together to persuade the general professors to participate in the implementation of the change. The general professors role were teaching, evaluation, development of teaching materials in the context of new curriculum. The actual changes that appeared with making positive feedbacks of students. Third, the major trend of outcome based curriculum can be explained through of isomorphism of new institutionalism. The quality of management medical care at the national level is required social accountability by evaluation of medical school program and licensing system. The standards of medical school accreditation were made by coercive isomorphism that all medical schools were forced to adopt, and the changed by new standards based on the outcome based curriculum. The diffusion of outcome based curriculum was done through mimetic process, Some schools had taken the lead in the new curriculum, and other schools had attempted to change their curriculum while copy their experiences. The acceptance of outcome based curriculum in each schools was explained by normative pressure. In the early of the curricular change, there were coercive aspects from the outside, but the demands of the education change were born by the medical education experts and general professors of each schools. It was implemented and developed according to the contexts of each schools. The process of change of medical curriculum at the individual school level was explained by a four step model which was explained initiation of change, preparation for implementation, institutionalization, and reinforcement & elaboration. The facilitating factors in the beginning of curricular change were the leadership, external evaluation including the accreditation, change of recognition by all school members. The facilitation factors in the preparation implementation were faculty development to persuade and understand the professors about curricular change, participations of committees, making team of assistance of implementation. The facilitation factors in the institutionalization were the experiences of success, the diffusion of experiences through core manpower, positive feedback from students. The facilitation factors in reinforcement & elaboration were composition of evaluation team, understanding of organizational culture and sharing of educational philosophy and to have ownership so that it could operate as intended by the medical school authorities. After all, the obstacles to change in curriculum were the indifference, resistance of the general professors. In the case of aggressive resistance, it may be transformed into a good supporter through persuasion and understanding, but consistency with indifference is the biggest obstacle. However, the researcher can also find that indifference may be helpful in determining the change, which may facilitate decision making without obstacles due to the absence of any objection. Indifference, however, causes the greatest problems at all steps of change. If the professors do not modify the methods, and contents of the classes in accordance with the flow of change, the change will be limited to formal and external changes. Therefore, it is the most important task for the indifferent professors to be interested in change, understand the meaning and necessity of change, and actively participate in the change for the successful settlement. Fourth, The essential factors of the curriculum implementation were to identified the reason why the curriculum change is different according to the school. The results of the analysis show that the major factors of implementation change, are the organization and support of the school that leads changes, the construction of the manpower leading the change of the medical education, the commitment, perseverance, energy, and enthusiasm of the group, the creation of environment in which the general professors and students can participate, As well as the philosophy and principles of maintenance of education change. School differences were found to be differences in the context of school. There were conflicts of vested rights of departments, differences of school culture, and resource allocations by the background, history, foundation, scale, regional location of schools. The problem of rights among the departments and the institutional strategy, lack of resources can be overcome by the efforts of the school headquarters and medical leadership. But the difference of organizational school culture is very difficult problem. If the value of physicians of teaching hospitals is higher than the value of medical teachers, it will not be easy to implementing the curricular change because general professors are very busy so they don’t consider important their role of teachers. As a successful strategy for changing the curriculum, first, leadership is essential to support the educational change. Second, the organization of key persons, including medical education experts, is needed. Third, it is necessary to create an environment to encourage participation in the change of the curriculum. Fourth, institutional supplement is needed to have external influences such as accreditation, national licensing examination affecting curriculum change. Fifth, efforts about the change management is very important. In conclusion, the acceptance of outcome based curriculum in Korean medical schools reasonable result according to the trend of global medical education. The medical education system strategically included this in the accreditation criteria which forced all schools to accept this mandatory. In the early process of change, there were resistances and difficulties, but progressive changes were made by professors who were interested in implementing them. Especially, as self-directed learning experiences of students were expanded, education that focuses on changes in attitudes and competencies. Changes in the curriculum do not directly lead to changes in education. However, in the change of the system the persons can be changed, and the change of the persons can lead to the change of the education practice.
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