Getting off the carousel: De-centring the curriculum in medical education

It is refreshing to see a research study examining the specificities and particularities of a change process in medical education. ‘Getting off the carousel: Exploring the wicked problem of curriculum reform’ by Hawick et al. does exactly that, providing the medical education community with a very interesting case study [1]. As Hawick et al. note, there is a commonly held belief that curriculum reform is linear, with more focus on outcomes than on sociocultural factors. This may well contribute to the fact that many reforms lead to little real change. Hawick et al. set out to study this issue by examining what happened in a UKmedical school which changed its curriculum from a ‘traditional’ model (with the first two years being classroom-based and the final three years clinical) to a blended model that integrated clinical and basic science teaching and learning. The authors highlight the importance of context and values in shaping the change process they studied. They describe a multiplicity of views and voices from different stakeholders representing differing values that led to different definitions of ‘the problem’ being solved. The research team point to the roles of government and regulatory bodies in shaping how reforms were enacted, and identify the high degree of ambiguity inherent in a curriculum change process. In addition, they explore how power differentials and the values of individual leaders affected the reforms, revealing unintended consequences of the initiative. The authors are to be commended for undertaking this study. Alas, studies like this are few and far between, which is a significant gap: our understanding of the real-life ef-