The change laboratory in medical education: Two examples of tackling contradictory challenges
Abstract
Context: Medical education and workplace learning is bound to develop through tensions between providing high quality patient care and providing training of the future specialist healthcare workforce. This paper on the Change Laboratory and the theoretical framework supporting it, shows examples on how to explore inherent and contradictory tensions in medical education and healthcare and use them as a driving force for change. We argue that the traditional tools and theories for change and fixing tensions are inadequate and therefore suggest an alternative strategy found in Cultural‐Historical Activity Theory (CHAT) and the Change Laboratory method. Methods: The Change Laboratory intervention method builds on the theoretical framework of CHAT and specifically the theory of expansive learning. The Change Laboratory intervention method uses well‐defined steps for participants in collaboration with researchers/facilitators to co‐construct and develop new ways of going about their work practice. Results: Drawing on our own research on implementing the Change Laboratory intervention method we present two case examples of interventions in respectively a Finnish surgical unit and a Danish paediatric outpatient clinic. Conclusions: The Change Laboratory intervention offers ways to systematically leverage tensions in medical education and thus could be effective in developing and designing organisational and professional change. It is not a quick fix solution as participators must be motivated and engaged in uncovering inherent contradictions in their activity systems (workplace) and get familiar with the concepts and theory underlying the intervention and its procedures. Profound knowledge and transformative agency emerges when participants and facilitators/researchers are given the time and opportunity to analyse both historical practice, current data on practice, and organisational issues collaboratively in order to envision and redesign their practice and learning environment.
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Some studies have advised how researchers in medical education could modify a CL to better suit the complex setting in which it is delivered.
“For this reason, some studies (Skipper et al., 2021, Skipper, 2016) have advised how researchers among medical education could modify a CL, to better suit the complex setting in which it is delivered.”
From SimLab: an intervention to promote expansive learning and organisational change in team-based emergency care simulation (2025) · cites this paper as Skipper et al., 2021
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“For this reason, some studies (Skipper et al., 2021, Skipper, 2016) have advised how researchers among medical education could modify a CL, to better suit the complex setting in which it is delivered.”
- Authors
- Skipper, M., Nøhr, S. B., & Engeström, Y.
- Affiliations
- Aarhus University (DK)
- University of Helsinki (FI)
- Corresponding author
- Skipper, Mads
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2020-09-07
- Volume
- 55
- Issue
- 1
- Pages
- 93-100
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W3045668842
- Cited by
- 17
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 1
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Social Sciences › Human Factors and Ergonomics › Innovative Education and Learning Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Appreciative Inquiry and Organizational Change
- Keywords
- Change Laboratory, cultural-historical activity theory, expansive learning, tensions and contradictions, organizational change, workplace learning, surgical wards, pediatric outpatient clinic, transformative agency, learning environment redesign
- MeSH terms
- Child, Delivery of Health Care, Education, Medical, Health Personnel, Humans, Laboratories, Learning
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