AMEE Medical Education Guide No. 23 (Part 2): 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 en vironment is an important determinant of behaviour. Environment is perceive d by students and it is perceptions of environment that are related to beha viour. The environment, as perceived, may be designated as climate. It is a rgued that the climate is the soul and spirit of the medical school environ ment and curriculum. Students' experiences of the climate of their medical education environment are related to their achievements, satisfaction and s uccess. Measures of educational climate are reviewed and the possibilities of new climate measures for medical education are discussed. These should t ake account of current trends in medical education and curricula. Measures of the climate may subdivide it into different components giving, for examp le, separate assessment of so-called Faculty Press, Student Press, Administ ration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, st udents may be asked to report, first, their perceptions of the actual envir onment they have experienced and, second, to report on their ideal or Prefe rred environment. The same climate index can be used with different stakeho lders giving, for example, staff and student comparisons. The climate is im portant for staff as well as for students. The organizational climate that teaching staff experience in the work environment that they inhabit is impo rtant for their well-being, and that of their students. The medical school is a learning organization evolving and changing in the illuminative evalua tion it makes of its environment and its curriculum through the action rese arch studies of its climate. Considerations of climate in the medical schoo l along the lines of continuous quality improvement and innovation are like ly to further the medical school as a learning organization with the attend ant benefits. Unless medical schools become such learning organizations the ir quality of health and their longevity may be threatened.