Chapter I

Introduction

Background Information

A Medical Education Unit (MEU) was defined in this

study as a formal organizational subunit in a medical school

that conducts educational research and provides educational

services. Brown (1970) examined the objectives of these

MEUs in North America and summarized them as the

following:1. Evaluation of the effectiveness of medical school

programs.2. Conducting research and providing services in

teaching methods.3. Conducting research and providing services in the

development, application, analysis, and reporting of tests and testing methods.

4. Training others in medical education research.5. Assisting medical school faculty in the

development of instructional strategies and materials.

6. Serving in curricular, evaluative, and media committees of medical schools. (p.40)

The first MEUs in North America were established in

1959. In 1970 Brown reported one Canadian and 16 United

States MEUs (pp. 104-105), while the revised April, 1977,

Non-group, Medical Education Research Directors list

(Appendix A) documents five Canadian and 40 United States

MEU. In this study the growth of these MEUs was reviewed

with the aid of Kurt Lewin’s change process model and Beer

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and Driscoll’s strategic considerations in managing change

(Suttle, 1977, pp. 20-22; Beer & Driscoll, 1977, pp. 370-388;

compare Chin & Benne, 1976, pp. 22-45).

The Change Process and Its Management

Kurt Lewin’s change process model indicates that

changes in a system’s structure or behavior take place in three

separate but overlapping stages—the unfreezing stage, the

actual change, and the refreezing stage. In the unfreezing

stage the equilibrium of the system is disturbed and the

system is made ready for the change. Actual change begins

when the system tries to adopt a new structure or behavior.

During the refreezing stage the system’s new structure or

behavior is stabilized, until the next unfreezing stage.

The strategic considerations for the proactive control of

a change process, or for an after-the-fact analysis of a change

effort, suggested by Beer and Driscoll (1977, pp. 370-388) are

the following:

1. The focus of change: an individual, a group, an

organization, or a macro-system.

2. To change the individuals’ behavior directly through

training and education or indirectly through altering

the social structure.

3. Power vs. collaborative strategies : to use pressure

and coercion or to collaborate.

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4. R & D vs. Process Facilitation : to develop new

knowledge and technology or to help the system

identify the problems and formulate its own

solutions.

5. Market vs. Collective Strategies : to create model

systems or organize individuals into political interest

groups.

6. Growth vs. Decrement Strategies : to mobilize

individuals who believe that growth and

improvement are possible or to take advantage of

the momentum that builds when there is discontent.

The authors also underscored that the selection of the

proper mix and sequence of the strategies ought to be based

on such situational factors as the purpose of the change effort,

the legitimacy of the change agent, the availability of change

resources and time, the completeness of the diagnosis of the

situation, and the extent of the readiness of the system.

Change Efforts in Medical Education Research

in North America

The refreezing stage of the 1910 Flexner Report change

effort, in the form of licensing and accrediting regulations,

created a growth condition in North American medical

education that led to the next unfreezing stage. Some of the

leading medical schools were deeply concerned that these

licensing and accrediting procedures might impede the growth

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of sound medical education.

In 1925 medical educators and licensing groups reached

an agreement that medical schools would be allowed to

experiment in education without penalty. But the market

strategy that was about to be employed, by creating model

education programs, did not get started until the 1950s

because of the lack of funds (Bowers, 1959).

Also prior to 1950 efforts were being made to change

the dimensions of research in medical education, i.e., from

psychological to social psychological (or psychosocial)

(Levine et al., 1974; Merton, Reader & Kendall, 1957, pp. 53-

58).

Merton and others (1957) identified the unfreezing

factors in medical education and in sociology that brought

about this change:a. In medical education:

1. The great and possibly the accelerated advances of medical knowledge which raise new problems of how to make this knowledge an effective part of the equipment of medical students;

2. Stresses on the allocation of the limited time available in the curriculum which lead to continued review of the bases for one rather than another arrangement;

3. Renewed recognition of the importance of the social environment both in the genesis and the control of illness together with growing recognition of the role of the social sciences in providing an understanding of that environment;

4. A commitment to scientific method which calls for replacing howsoever skilled empiricism by the beginnings of more systematic and rational analysis of the process of education; and

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5. As a precipitating factor, substantial innovations in medical education which require systematic comparisons of the objectives of these innovations with their actual outcomes. (Merton et al., 1957, pp. 35-36)

b. In sociology:1. The marked and cumulating interest in the

sociology of professions, which includes, as a major component, studies of professional schools;

2. The growing utilization of social science as composing part of the scientific basis for the provision of health care in contemporary society;

3. The considerable recent growth in the empirical study of complex social organizations, among which schools constitute an important special class;

4. The similar growth of interest in the process of adult socialization in general which, in application to the field of medicine, is concerned with the processes by which the neophyte is transformed into one or another kind of medical man; and

5. The recent advances in methods and techniques of social inquiry which make it possible to examine these subjects and problems by means of systematic inquiry. (pp. 51-52)

The forces can be regarded as growth and research-and-

development conditions, that have influenced research

in medical education to change from its focus on the

individual attributes of medical students to its

consideration of the student’s social environment. Prior

to this change, Jason (1962) observed, medical

education research was mainly concerned with the

subject matter and curriculum of medical schools, the

problems related to the transition from premedical to

medical training, the selection of medical students, and

the characteristics of medical students and medical

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schools. He said, further, that it lacked in the examination of the

teacher and teaching practices.

When funds became available in the early 1950’s,

especially from the Commonwealth Fund, innovations and

experiments in education went into operation at a number of

medical schools. In 1952, for example, the Western Reserve

University (WRU) commenced its new curriculum, and the

University of Colorado and Cornell University started their

comprehensive health care and teaching programs. In 1954, the

University of Pennsylvania set out its studies of

professionalization and undergraduate learning processes, and in

1956, the University of Buffalo (UB) launched its Project in

Medical Education to educate and train medical faculty in the

teaching-learning process (Abrahamson, 1960; Darley, 1964;

Lee, 1962, pp. 29-45; Merton, Bloom & Rogoff, 1956; Miller,

1956; 1966; Miller & Rosinski, 1959; Rosinski & Miller, 1962;

Reader, 1967, p. 276).

The research programs at Colorado, Cornell, and

Pennsylvania never reached the refreezing stage at the respective

medical schools. They belonged to an outside group, the Bureau

of Applied Social Research at the Columbia University as part of

a study on the sociology of the professions. The research

programs were not stabilized in the structure or the behavior of

the medical schools (Lee, 1962, p. 34).

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The Bureau of Applied Social Research was also involved in

the WRU experiment. But in this case its responsibility was to make

observations on students for the Evaluation Subcommittee of the

Committee on Medical Education. The structure and processes of

the medical schools were altered to facilitate the experiment.

In 1945, Joseph T. Wearn became Dean of the WRU Medical

School. His first strategy was to change the organizational structure.

In 1946 he founded the General Faculty as a policy making body

with regards to student affairs, curriculum and instruction, and

interdepartmental cooperation. The departments were responsible for

personnel, research, and for the teaching content. The administration

took care of the implementation of the program; and the Committee

on Medical Education was responsible for defining educational

objectives, evaluating programs, and developing and recommending

changes in programs to the General Faculty. The Committee on

Medical Education appointed subcommittees for special studies and

programs, e.g., for the curriculum, student facilities, free time,

educational environment, and evaluation.

Through this structure, collaboration and process facilitation

were promoted. Faculty members, the administration, students, and

outside expert were encouraged to participate and commit

themselves to the program. Democratization, integration, and

cooperation were the key words in Dean Wearn’s plan. Because of

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his leadership and change endeavor, research in medical education was

internalized in the medical school.

To further stabilize research in medical education at WRU, an

adequately staffed MEU, with full-time faculty positions, was formed in

1958. This MEU is considered by many to be the first of its kind

established in North America, with T. Hale Ham as its first Director

(Dingle et al., 1958; Ham, 1959; Handler, 1965; Horowitz & Herzberg,

1960; Lee, 1962, pp. 62-78; Wearn, 1956).

At the University of Buffalo (UB), however, research in medical

education was not institutionalized until 1975. This development at UB

was probably the result of an emphasis on the training and education

strategy without proper attention to structure of the medical school.

Before the initiation of the Project in Medical Education at UB,

Edward M. Bridge, Professor of Pharmacology, and Nathaniel Cantor,

Professor of Sociology and Anthropology, conducted seminars on

problems in medical education with a small group of medical faculty. After

three years of discussions, further training and education with the School

of Education took place. During the next year this small group of medical

faculty studied education while the professional educators observed the

educational process at the medical school. Together they then planned and

carried out a series of training and educational programs focusing on the

study of the teaching-learning process, particularly for faculty members of

other medical schools.

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This small group of medical faculty at UB were highly

successful in collaborating with the School of Education, but they

were much less so within the medical school itself. Research in

medical education did not reach the refreezing stage at the

medical school. In 1959 these innovators, from the medical

school and the school of education, broke up and spread to other

medical schools in North America. In retrospect this was a

fortunate circumstance, for they, and the other pioneers they have

produced, introduced research in medical education at other

medical schools. And to guarantee its continuity this time they

established MEUs, with or without proper unfreezing

preparations.

Consequently, in July 1959, Edwin F. Rosinski organized

an MEU at the Medical College of Virginia; in September 1959,

George E. Miller, at the University of Illinois; in February 1963,

Stephen Abrahamson, at the University of Southern California;

and in September 1964, Hilliard Jason, at the University of

Rochester (Abrahamson, 1960; 1977; Jason, 1962; Miller, 1956;

1966; 1977; Miller & Rosinski, 1959; Rosinski & Miller, 1962).

In Canada the first MEU was established the University of

Toronto in 1967; the next, at the University of Calgary in 1969;

and another, at the University of Western Ontario in 1971

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(Miller, 1977). In 1965, MEU Directors decided to meet. The

first informal meeting was held at the University of Illinois in

April 1965. They never formalized it into a real organization and

referred themselves as the “Non-Group”; but they continued to

meet until 1969. In 1975 they started meeting again

(Abrahamson, 1977; Miller, 1977).

Purpose of the Study

The general purpose of the study was to examine how well MEUs in North America internalized research in medical education in their respective medical schools. And because a number of them were assigned, or assumed, an added responsibility of providing educational services, such as the management of instructional media and the administration of tests, the general questions of investigation became: how effective were these MEUs in conducting educational research and providing educational services. Specifically this study sought (1) to identify the determinants and criteria of MEU organizational effectiveness (OE) and (2) to find significant correlations between the two.

Importance of the Study

In 1956, a Columbia University Seminar on the Professions, attended by 23 participants, representing eight professions, expressed a concern over the fact that: “There is little systematic knowledge about the social and psychological environments provided by the schools in the various professions and about the ways in which the

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processes and results of learning are related to these environments” (Merton et al., 1957, p.37).

At the narrower scope of inquiry this concern was still in evidence a decade later. In 1967, for example, B. A. Olive, a librarian at the Graduate School of Business and Public Administration, Cornell University, commented on the status of writing and research in the area of higher education administration as the following:

In the thorough bibliographic search undertaken here, it finally became apparent that the failure to find published research was not due to difficulties in locating and identifying the material, but to the fact that few research studies exist. Compared to the coverage given to industry, business, government, and even to secondary and elementary education, the attention given to college and university administration has been miniscule.

The bibliography becomes even scarcer as one specializes in the investigation of OE (organizational effectiveness) in higher education.

Across types of organizations the amount of the literature on OE is not that scarce (Katz & Kahn, 1966, p. 149). The major concern here is in the conceptualization and the standardization of measurement. Note following statements by authorities of OE:

Much of the present work that has been done on effectiveness ignores the diversity in organizations, size and shape, technologies, environments, work climates, types and goals. (Steers, 1977, p. 15)We are badly in need of an improved conceptual framework for the description and assessment of organizational effectiveness. Nearly all studies of formal organizations make some reference to organizational effectiveness; the growing field of

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comparative organizational study depends in part upon having some conceptual scheme that allows comparability among organizations with respect to effectiveness and that guide the empirical steps of operationalization and quantification. (Yuchtman & Seashore, 1967)Much remains to be done in the development of knowledge about the components of effectiveness. There is little consensus not only about the relevant components, but also the relationships among them and the effects of managerial actions on them. (Gibson, Ivancevich & Donnelly, Jr., 1973, p.37)Ideally, a standardized measure of effectiveness should be developed and applied to all types of organizations. Only in this way is it possible to classify organizations on a continuum from high to low effectiveness. However, relatively few studies of organizations have dealt explicitly with effectiveness, and, even where the problem is explicitly treated, diverse measures of effectiveness have been used. (Price, 1968, p.5)

The importance of this study is more in its contribution

to the study of OE of higher education organizations, than to

the clarification of concepts and measurement standards of

OE.

Delimitations

In this study the following intentional limitations were exercised:

1. The review of empirical studies was restricted to an

examination of the main articles of periodicals

suggested by Gibson and others (1973, p. 18), and of

periodicals on higher education administration that

can be found at the Education Library, University of

Southern California, which were published between

1968-1977. Only articles on OE of higher education

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and of R & D organizations were reported.

2. The hypotheses were formulated within the

boundaries delineated by the responses from a Panel

of Experts to a preliminary unstructured interview.

The interview questions were developed on the basis

of the review on OE theories.

3. The members of the Panel of Experts were selected

by the Dissertation Committee; the subjects for the

study were drawn from the revised April, 1977,

Non-group, Medical Education Research Directors

list, which was modified by the Panel of Experts

(Appendix B).

4. A structured questionnaire was selected as the

instrument of inquiry; and an analysis of cross-

breaks as the data analysis technique. Validation of

the instrument was limited to consultations with the

Dissertation Committee and the Panel of Experts.

The questionnaire responses were also compared

with available written documents of the MEUs.

5. To avoid adverse response behavior during the

questionnaire survey, questions on psychological

attributes and certain external factors were excluded.

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Limitations

Because an after-the-fact, simple correlation method

was employed, no control could be exercised on:

1. The assignments of subject and treatments.

2. Alternative models, spuriousness, correlated

independent variables, interaction effects,

measurement errors, and reciprocal causation

(Blalock, Jr., 1970, pp. 68-78; Gay, 1976, pp. 10-

11; 56; Isaac & Michael, 1971, pp. 4; 21;

Kerlinger, 1973, pp. 314-316).

Definitions

Organizational Effectiveness (OE) was broadly defined

as organizational success. Other terms found in the literature,

with the same connotation, were “organizational health”,

“organizational worth”, and “organizational performance”. It

was viewed as a construct which constitutes a model for

identifying the variables and their interrelations (Campbell,

1976, p. 30).

Organization Effectiveness Criteria are the indicators of

organizational success from the standpoint of the organization

under study, or the dependent variables. The determinants of

OE are the factors, external and internal to the organization,

that contribute to or predict organizational success, or the

independent variables.

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Bennis regarded the latter as “the institutional pre-requisites

that provide the conditions for the attainment of [OE] criteria”

(1971, p. 127).

The internal factors were classified into individual,

group, and organizational factors (Lawless, 1972, pp. 397-

398). Internal factors of other organizations and macro-

systems that influence the organization under study were

considered as external factors – Individual, group, and

organization wide factors, internal and external, possess

descriptive and behavioral characteristics.

Behavioral characteristics, or processes, are the

cognitive, psychomotoric, and affective actions of

organization members as individuals, as groups, or as an

organization. All non-action attributes, of people and of

physical facilities, were regarded as descriptive, e.g., age,

educational background, and external appearance of the

individual; size of the group; and size of the organization.

Kimberley (1976) operationalized size as the physical

capacity, the number of organization members, the volume of

work faced, and the magnitude of available discretionary

resources of groups or the organization. Power, influence,

production, motivation, satisfaction, decision-making, and

leadership are examples of behavioral characteristics, because

they imply actions.

The policies, goals, plans, procedures, and regulations

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which the management of the organization employs to control

the descriptive and behavioral characteristics of internal and

external factors were called structures of the organization. A

few examples are hierarchy of authority, production

procedures, personnel selection and socialization regulations,

and reward systems.

To clarify the above mentioned definitions, the

following OE model was constructed as shown in Figure 1.

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OE Determinants OE Criteria

Internal Factors

Descriptive and behavioral characteristics, structured and unstructured, of individual, group, and total organization factors of the organization under study

External Factors

Descriptive and behavioral characteristics, structured and unstructured, of individual, group, and total organization factors of other organizations and macro-systems

OE indicators of the organization under study

OE indicators of other organizations and macro-systems

Figure 1Organizational effectiveness model for indentifying

the independent and dependent variables and their interrelations

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