Institutional change: embracing the initiative to train more generalists

Area of Science:

• Medical Education
• Healthcare Management
• Institutional Change

Background:

• Dartmouth Medical School received a Generalist Physician Initiative (GPI) grant in 1994.
• The institutional context was receptive to change when the GPI was launched.

Purpose of the Study:

• To describe institutional change at Dartmouth Medical School following a GPI grant.
• To identify and share principles of successful institutional change in medical education.

Main Methods:

• The study describes changes implemented across various school areas.
• It highlights key principles of change management utilized by Dartmouth.

Main Results:

• The GPI grant accelerated existing institutional changes.
• Successful principles included creating urgency, empowering a coalition, vision development, short-term wins, consolidating gains, and cultural anchoring.
• Changes were observed in admissions, medical education, and community practice support.

Conclusions:

• Dartmouth's approach to change, while specific in actions, offers generalizable principles for other institutions.
• Challenges included maintaining the guiding coalition and developing state-managed strategies.