Can the tools of activity theory help us in advancing understanding and organisational change in undergraduate medical education?
Abstract
Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an 'assistantship' period in the final year of study, where senior medical students 'shadow' the work of junior doctors, with an expectation that they will be better 'prepared' for work. However, there is little guidance about what an 'assistantship' entails and the current emphasis on preparedness of students arguably underplays the importance of contextualised learning within the workplace environment. This paper will describe a modified Development Work Research (DWR) (Engeström in Developmental work research: activity theory in practice. Lehmanns Media, Berlin, 2005) approach to organisational change, enabling academic, clinical and administrative partners to develop assistantship placements in different hospitals. Our findings indicate that a modified DWR approach can reveal factors indicating organisational readiness to support change within a locally contextualised framework. The process has significant practical applications across a range of healthcare disciplines, as all professions seek to engage with the challenge of enabling successful transitions of graduates to the workplace.
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There have been several examples of CL interventions in medical education and healthcare.
“There have been several examples of CL interventions in medical education (Reid et al., 2015;Dornan et al., 2021;Engeström & Pyörälä, 2021) and healthcare (Skipper, 2016;Vilela et al., 2020;Morris et al., 2021;Kerosuo et al., 2010).”
From SimLab: an intervention to promote expansive learning and organisational change in team-based emergency care simulation (2025) · cites this paper as Reid et al., 2015
Medical training and practice occur within healthcare organizations that are undergoing constant change.
“Medical training and practice occur within healthcare organizations which are undergoing constant change.1,2”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [2]
Using change laboratories with three hospital teams, Reid et al facilitated professionals in identifying cultural and historical influences on current practice and developing a new structure of practice so that final year medical students could take on more active clinical roles.
“Utilizing change laboratories with three hospital teams, Reid et al2 facilitated professionals in identifying cultural and historical influences on current practice, and developing a new structure of practice so that final year medical students could take on more active clinical roles.”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [2]
CHAT has varied application, including undergraduate education, postgraduate education, and continuous professional development.
“CHAT has varied application as the examples presented here have included undergraduate education (eg, clinical assistantships for final year medical students),2 postgraduate education (eg, surgical training),30 and continuous professional development (eg, medical revalidation for trained doctors).32”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [2]
The Change Laboratory has been shown to be of use in medical education contexts.
“The Change Laboratory has been shown to be of use in medical education contexts.”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [2]
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References 23 · Cited by 31
- Authors
- Reid, A.-M., Ledger, A., Kilminster, S., & Fuller, R.
- Affiliations
- University of Leeds (GB)
- Corresponding author
- Reid, Anne-Marie
- ORCID
- Reid, Anne-Marie
- Venue
- Advances in Health Sciences Education
- Published
- 2014-10-08
- Volume
- 20
- Issue
- 3
- Pages
- 655-668
- ISSN
- 1382-4996 (ISSN-L)
- 1573-1677
- OpenAlex
- W1980483802
- Cited by
- 31
- References
- 23
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 4 · 2018: 5 · 2017: 3 · 2016: 2 · 2015: 2
- FWCI
- 11.97
- Type
- book chapter
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Advances in Health Sciences Education (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Human Factors and Ergonomics › Innovative Education and Learning Practices
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Keywords
- activity theory, organizational change, undergraduate medical education, transition to practice, contextual learning, workplace learning, graduate preparedness, organizational readiness
- MeSH terms
- Education, Medical, Undergraduate, United Kingdom, Models, Theoretical, Organizational Innovation
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