title: Culture Matters in Successful Curriculum Change: An International Study of the Influence of National and Organizational Culture Tested With Multilevel Structural Equation Modeling.
abstract: OBJECTIVE
  National culture has been shown to play a role in curriculum change in medical schools, and business literature has described a similar influence of organizational culture on change processes in organizations. This study investigated the impact of both national and organizational culture on successful curriculum change in medical schools internationally.
  
  
  METHODS
  The authors tested a literature-based conceptual model using multilevel structural equation modeling. For the operationalization of national and organizational culture, the authors used Hofstede's dimensions of culture and Quinn and Spreitzer's competing values framework, respectively. To operationalize successful curriculum change, the authors used two derivates: medical schools' organizational readiness for curriculum change developed by Jippes and colleagues, and change-related behavior developed by Herscovitch and Meyer. The authors administered a questionnaire in 2012 measuring the described operationalizations to medical schools in the process of changing their curriculum.
  
  
  RESULTS
  Nine hundred ninety-one of 1,073 invited staff members from 131 of 345 medical schools in 56 of 80 countries completed the questionnaire. An initial poor fit of the model improved to a reasonable fit by two suggested modifications which seemed theoretically plausible. In sum, characteristics of national culture and organizational culture, such as a certain level of risk taking, flexible policies and procedures, and strong leadership, affected successful curriculum change.
  
  
  CONCLUSIONS
  National and organizational culture influence readiness for change in medical schools. Therefore, medical schools considering curriculum reform should anticipate the potential impact of national and organizational culture.
authors.affiliation: M. Jippes was, at the time of this research, a PhD candidate, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Currently, she is a plastic surgery resident, Diakonessenhuis, Utrecht, the Netherlands. E.W. Driessen is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. N.J. Broers is assistant professor, Department of Methodology and Statistics, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands. G.D. Majoor is associate professor (retired), Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. W.H. Gijselaers is full professor, Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, the Netherlands. C.P.M. van der Vleuten is full professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Jippes
authors.forename: Erik W
authors.initials: EW
authors.lastname: Driessen
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Broers
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Majoor
authors.forename: Wim H
authors.initials: WH
authors.lastname: Gijselaers
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003466:Cultural Characteristics; D003479:Curriculum / Q000639:trends*; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015233:Models, Statistical; D015279:Organizational Culture; D009936:Organizational Innovation; D012577:Schools, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires