Managing change in postgraduate medical education: still unfreezing?

Background: Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors. Aims: To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change. Methods: We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change. Results: 12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'. Conclusions: At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.