title: Dealing with the complex dynamics of teaching hospitals.
abstract: Innovation and change in postgraduate medical education programs affects teaching hospital organizations, since medical education and clinical service are interrelated.Recent trends towards flexible, time-independent and individualized educational programs put pressure on this relationship. This pressure may lead to organizational uncertainty, unbalance and friction making it an important issue to analyze.The last decade was marked by a transition towards outcome-based postgraduate medical education. During this transition competency-based programs made their appearance. Although competency-based medical education has the potential to make medical education more efficient, the effects are still under debate. And while this debate continues, the field of medical education is already introducing next level innovations: flexible and individualized training programs. Major organizational change, like the transition to flexible education programs, can easily lead to friction and conflict in teaching hospital organizations.This article analyses the organizational impact of postgraduate medical education innovations, with a particular focus on flexible training and competency based medical education. The characteristics of teaching hospital organizations are compared with elements of innovation and complexity theory.With this comparison the article argues that teaching hospital organizations have complex characteristics and behave in a non-linear way. This perspective forms the basis for further discussion and analysis of this unexplored aspect of flexible and competency based education.
authors.affiliation: Maastricht University - School of Health Professions Education, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands. tiurivanrossum@gmail.com.
authors.forename: Tiuri R
authors.initials: TR
authors.lastname: van Rossum
authors.affiliation: OLVG Teaching Hospital, VU Medical Center - Athena Research Institute, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
authors.affiliation: Maastricht University Medical Centre - Faculty of Health Medicine and Life Sciences, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.affiliation: Deventer Hospital -Internal medicine and nephrology, Nico Bolkesteinlaan 75, 7415 SE, Deventer, The Netherlands.
authors.forename: Henk E
authors.initials: HE
authors.lastname: Sluiter
authors.affiliation: Zuyderland MC Teaching Hospital, Maastricht University - School of Health Professions Education, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
authors.forename: Ide C
authors.initials: IC
authors.lastname: Heyligers
mesh_terms: D003162:Competency-Based Education; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D009936:Organizational Innovation
keywords: Change management; Competency based medical education; Complexity theory; Diffusion of innovations theory; Flexible medical education; Implementation; Organizational science; Postgraduate medical education; Teaching hospital