The setting for the study was a medium-sized (approximately 170 students per cohort), state-funded medical school in the UK. In doing so, we hope to give a new perspective on reform and extend knowledge in the field. To that end, our aim in this study was to produce a rich analytical description of the complex processes which occurred during a curriculum reform. Those involved in curriculum reform will then change their perspective from one that is relatively simplistic and linear (and maintains the circling round and round), which in turn will help to slow down or get down from Whitehead et al.’s carousel. To highlight how curriculum reform is a process rather than an outcome, rather than just focusing on ‘did it (the change(s)) work’, it would be useful to also think about ‘how did it work’ and ‘what have we learned’ (from the process of reform). Ī fresh perspective may be useful to address this gap. But questions have been raised as to whether these linear approaches to evaluating change are sufficient given the complex nature of curricula. Common approaches to curricular change (e. g ). However, in contrast, empirical studies of curricula change in medical education are often located in a paradigm of simplification, where reform is conceptualized as linear, a response to practical needs, overcoming uncertainty and ambiguity, and formulating clear and accurate diagnoses (and hence simple solutions).
Medical curricula, indeed curricula more widely, are understood to be complex entities. How can medical education get off this carousel? We propose that key to doing so is to explicitly acknowledge an implicit disconnect. This ‘carousel’ seems to be due to a combination of recurring themes underpinning the need for reform, a focus on the future with little acknowledgement of the historical nature of issues, and use of (relatively speaking) ‘quick fixes’ to address complex curriculum issues. In analyzing the language used by medical educators to describe these recurring calls for change, Whitehead and colleagues use the metaphor of a ‘carousel of ponies’ to illustrate that the returning themes of curriculum reform are like ponies circling around yet again on the curricular carousel, in the continual rediscovery of discursive ‘truths’ in medical education. Analysis of these recurring themes identified a prominent and recurrent discourse of ‘new.’ This discourse places focus on the future, ignores the ongoing historical nature of issues, suggests a sense of urgency and enables the proposal of modest solutions (P. 755). A series of recurring themes were identified, including the need to avoid over-specialization, the importance of generalism, and the need to broaden criteria for medical student selection. Whitehead and colleagues conducted an analysis of prominent recurrent themes in the North American medical education literature, focusing on the discourses of the good doctor from 1910–2010.
However, this activity often results in repetition of sameness with little actual reform. In the medical education literature there is a plethora of interest and research activity in curriculum reform.
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