title: Impact of national context and culture on curriculum change: a case study.
abstract: BACKGROUND
  Earlier studies suggested national culture to be a potential barrier to curriculum reform in medical schools. In particular, Hofstede's cultural dimension 'uncertainty avoidance' had a significant negative relationship with the implementation rate of integrated curricula.
  
  
  OBJECTIVE
  However, some schools succeeded to adopt curriculum changes despite their country's strong uncertainty avoidance. This raised the question: 'How did those schools overcome the barrier of uncertainty avoidance?'
  
  
  METHODS
  Austria offered the combination of a high uncertainty avoidance score and integrated curricula in all its medical schools. Twenty-seven key change agents in four medical universities were interviewed and transcripts analysed using thematic cross-case analysis.
  
  
  RESULTS
  Initially, strict national laws and limited autonomy of schools inhibited innovation and fostered an 'excuse culture': 'It's not our fault. It is the ministry's'. A new law increasing university autonomy stimulated reforms. However, just this law would have been insufficient as many faculty still sought to avoid change. A strong need for change, supportive and continuous leadership, and visionary change agents were also deemed essential.
  
  
  CONCLUSIONS
  In societies with strong uncertainty avoidance strict legislation may enforce resistance to curriculum change. In those countries opposition by faculty can be overcome if national legislation encourages change, provided additional internal factors support the change process.
authors.affiliation: Department of Educational Development and Research FHML, Maastricht University, POB 616, NL-6200 MD Maastricht, The Netherlands. mjippes@gmail.com
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Jippes
authors.forename: Erik W
authors.initials: EW
authors.lastname: Driessen
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Majoor
authors.forename: Wim H
authors.initials: WH
authors.lastname: Gijselaers
authors.forename: Arno M M
authors.initials: AM
authors.lastname: Muijtjens
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
mesh_terms: D001317:Austria; D003469:Culture; D003479:Curriculum; D004501:Education, Medical / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007857:Leadership; D019982:Organizational Case Studies; D009936:Organizational Innovation; D012577:Schools, Medical / Q000458:organization & administration* / Q000592:standards; D035501:Uncertainty