Dealing with the complex dynamics of teaching hospitals

Tiuri R. van Rossum, Fedde Scheele, Albert J. J. A. Scherpbier, Henk E. Sluiter, I.C. Heyligers

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


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.

Original languageEnglish
Article number104
Pages (from-to)104
JournalBMC Medical Education
Publication statusPublished - 5 Apr 2016


  • Change management
  • Competency based medical education
  • Competency-Based Education
  • Complexity theory
  • Diffusion of innovations theory
  • Education, Medical, Graduate
  • Flexible medical education
  • Hospitals, Teaching
  • Humans
  • Implementation
  • Journal Article
  • Organizational Innovation
  • Organizational science
  • Postgraduate medical education
  • Research Support, Non-U.S. Gov't
  • Teaching hospital

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