Date of Submission


Document Type



Doctor of Education




curriculum, dichotomy, adaptive leadership, third space, sensemaking, medical education, organized anarchy


Medical education has seen minor changes over the decades, but a dynamic movement towards competency-based medical education (CBME) has swept across the field in recent years. Organizing medical education curriculum to respond to these changes can be challenging due to many factors, in both content and context. The public rightly expects that graduating medical students be competent physicians, ready to deliver effective health care. This Organizational Improvement Plan (OIP) looks at a relatively new medical school’s lack of an outcomes-based curriculum framework. The Problem of Practice (PoP) is focused on the difficulty of moving the school toward the development of a curriculum framework. The PoP is seen to have a high degree of instability and complexity due to the combination of markedly different administrative and academic governance structures. Strategies for driving change towards an OIP are grounded in adaptive leadership (Heifetz & Linsky, 2017), third space (Whitchurch, 2013) and sensemaking (Weick, 1995) theories.

The divide between the administrative and academic sides of the school can be bridged by the galvanizing influence of accreditation, which represents a potential existential threat to the school. The OIP proposes to move towards the dual goals of (a) developing a CBME curriculum framework, while (b) simultaneously fostering the growth of a third space in between the two sides of the organization, from which creative work can take place. This OIP also looks to deconstruct binaries in higher education and medical education, such as administration vs. academia. The change initiative is seen as a combination of both top-down and grass roots driven movments. By combining the two approaches, the school can still move towards change with urgency, while also protecting faculty’s academic freedom to take ownership of the issue and impact the direction of the change. Finally, while the OIP is a plan for implementing change, it is acknowledged that rigidly pre-determined plans can be counter-productive for effective and deep change that will have a lasting effect after the accreditation event has passed.

Keywords: curriculum, dichotomy, adaptive leadership, third space, sensemaking, medical education, organized anarchy