title: How lead consultants approach educational change in postgraduate medical education.
abstract: BACKGROUND
  Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change.
  
  
  OBJECTIVE
  This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches.
  
  
  METHODS
  From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis.
  
  
  RESULTS
  The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture.
  
  
  CONCLUSIONS
  Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME.
authors.affiliation: Department of Education, St Lucas Andreas Hospital, Amsterdam, the Netherlands. joanne.fokkema@gmail.com
authors.forename: Joanne P I
authors.initials: JP
authors.lastname: Fokkema
authors.forename: Michiel
authors.initials: M
authors.lastname: Westerman
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.forename: Nadine
authors.initials: N
authors.lastname: van der Lee
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.forename: P Joep
authors.initials: PJ
authors.lastname: Dörr
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000379:methods* / Q000592:standards; D003253:Consultants / Q000523:psychology*; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D013663:Teaching / Q000379:methods* / Q000592:standards