AMEE Medical Education Guide No. 23 (Part 1): Curriculum, environment, climate, quality and change in medical education - a unifying perspective

This paper looks at five focal terms in education-curriculum, environment, climate, quality and change-and the interrelationships and dynamics between and among them. It emphasizes the power and utility of the concept of clim ate as an operationalization or manifestation of the curriculum and the oth er three concepts. Ideas pertaining to the theory of climate and its measur ement can provide a greater understanding of the medical curriculum. The le arning environment is an important determinant of behaviour. Environment is perceived by students and it is perceptions of environment that are relate d to behaviour. The environment, as perceived, may be designated as climate . it is argued that the climate is the soul and spirit of the medical schoo l environment and curriculum. Students' experiences of the climate of their medical education environment are related to their achievements, satisfact ion and success. Measures of educational climate are reviewed and climate m easures for medical education are discussed. These should take account of c urrent trends in medical education and curricula. Measures of the climate m ay subdivide it into different components giving, for example, a separate a ssessment of so-called Faculty Press, Student Press, Administration Press a nd Physical or Material Environmental Press. Climate measures can be used i n different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they ha ve experienced and , second, to report on their ideal or preferred environm ent. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. In addition to the education c limate of the environment that students inhabit, it is important to conside r the organizational climate of the work environment that staff inhabit. Th is organizational climate is very significant, not only for staff, but for their students, too. The medical school is a learning organization evolving and changing in the illuminative evaluation it makes of its environment an d its curriculum through the action research studies of its climate. Consid erations of climate in the medical school, along the lines of continuous qu ality improvement and innovation, are likely to further the medical school as a learning organization with the attendant benefits. Unless medical scho ols becomes such learning organizations, their quality of health and their longevity may be threatened.