A systemic analysis of disincentives to integration of instructional technology in a graduate medical education program.

摘要

Graduate medical education (GME), also known as residency, is the period in the education of a physician "beyond the undergraduate medical school and the attainment of the professional degree, leading to eligibility for certification in a specialty". This was an exploratory study, the first to analyze institutional factors that influence instructional decisions, particularly use of instructional technology, in GME.;Methods. The study took place at one large voluntary midwestern hospital with nearly 200 resident physicians. Problematique Analysis, an analytic method using naturalistic data gathering techniques, was used to trace the root causes of factors that inhibit residency programs from the adoption of beneficial instructional practices, including the use of instructional technology. Data gathering included interviews with 34 individuals, non-participant observation within the Department of Medical Education over a period of four months, and analysis of internal and external documents. Integral to this methodology is the construction of problematique maps that display the interconnections among system deficiencies and their proximate and root causes.;Findings. Sixty-three factors, 11 occurring outside the boundaries of the system, were identified as inhibitors. They were grouped into three clusters, subsystems that were found to play a particularly key role in the instructional decision-making process: faculty-related cluster, resource-related cluster, and resident-related cluster. The cumulative effect of the deficiencies in these subsystems is to create conditions that are inhospitable to the adoption and maintenance of desirable instructional practices. The problematique maps graphically illustrate the points at which changes would have to be made in order to improve the instructional environment.