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  • Communication

    In Turbulent Times, Thoughtful Change Management Minimizes Chaos and Resistance

    This blog deviates a bit from our normally discussed topics on the #MedEdChat blog. Recently, I’ve spent time working with two organizations on strategic planning, and change management has been front and center in my mind. After a recent negative experience with proposed changes that arose after the planning process, I felt a need to discuss this topic.

    Organizational change is inevitable, but the way it is enacted has profound implications for the people who make up that organization’s community. This is especially true in academic and professional organizations, where individuals often form a deep sense of belonging and identity—an “academic home.” When change is delivered abruptly, without meaningful consultation, explanation, or consideration of members’ lived experiences, the disruption can extend far beyond operational adjustments (1). It can challenge long-standing values, weaken trust, and erode the very affinity that binds a community together.

    The psychology of the practicing physician (and scientists) is predicated on the emphasis on autonomy. In fact, autonomy, mastery, and purpose may be more important motivators than things like salary and incentives. Evidence demonstrates that the perception of the lack of control at work is associated with burnout, or intentions to leave that organization (2). The costs to an organization associated with replacing a physician are not insignificant.

    Effective change management recognizes that transitions are not merely technical shifts; they are human processes that depend on transparency, communication, and shared purpose (1). Research across medical education, healthcare, and organizational science demonstrates that successful change efforts are grounded in early engagement with stakeholders, clear articulation of the rationale for change, and intentional attention to culture (3). When members understand not only what is changing but why, they are better able to situate the transition within the organization’s broader mission.

    Conversely, when change is imposed in an autocratic manner, several predictable consequences emerge. Stakeholders feel unheard or devalued, leading to disengagement and frustration. Resistance can then arise not because people oppose progress, but because they have not been given the opportunity to contribute perspectives that could improve the change effort and mitigate harm (3,4). Most critically, trust—one of the most important currencies of any organization—can be damaged when decisions appear opaque or misaligned with the community’s identity. This loss of trust can endure long after the operational change is complete.

    Thoughtful change management requires leaders to approach transitions with deliberate care (5). Listening to stakeholder voices, acknowledging the emotional impact of change, communicating early and consistently, and remaining open to adjustment are essential actions by leaders that honor the expertise and commitment of those who volunteer their time to make the organization a success. When organizations treat change as a collaborative process rather than an announcement, they strengthen their culture rather than destabilize it.

    As leaders reflect on recent decisions and consider future steps, consulting the various change management models available may minimize future missteps (4-6). When change management is not considered, the following questions might help recovery:

    • Why were stakeholders disregarded in the decision-making process, and how can they be intentionally incorporated going forward?
    • How did the change affect stakeholders’ sense of identity, belonging, or academic home within the organization?
    • In what ways has trust been weakened or broken, and what specific actions are needed to rebuild it?

    References

    1. Practical Pschology. Lewin’s Change Theory (Definition + Examples). 2020. Available at: https://practicalpie.com/lewins-change-theory/. Accessed November 7, 2025.
    2. Sinsky CA, Brown RL, Rotenstein L, Carlasare LE, Shah P, Shanafelt TD. Association of Work Control With Burnout and Career Intentions Among U.S. Physicians : A Multi-institution Study. Ann Intern Med. 2025 Jan;178(1):20-28. doi: 10.7326/ANNALS-24-00884.
    3. Karimi E, Sohrabi Z, Aalaa M. Change Management in Medical Contexts, especially in Medical Education: A Systematized Review. J Adv Med Educ Prof 2022; 10(4):219-227. DOI: 10.30476/JAMP.2022.96519.1704
    4. Banerjee Y, Tuffnell C, Alkhadragy R. Mento’s Change Model in Teaching Competency-based Medical Education. BMC Med Educ 2019; 19:472. DOI. 10.1186/s12909-019-1896-0
    5. Prosci. What Is Change Theory? Definition and Applications Explained. 2025. Available at https://www.prosci.com/blog/change-theory. Accessed November 7, 2025.
    6. Harrison R, Fischer S, Walpola RL, Chauhan A, Babalola T, Mears S, Le-Dao H. Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. J Healthc Leadersh 2021; 13:85-108. DOI: 10.2147/JHL.S289176

    Author: Gary L. Beck Dallaghan, Ph.D.; Council on Medical Student Education in Pediatrics

  • Communication

    What Did You Just Say? Fostering Civil Discourse in Medical Education

    Let’s talk about talking.  It seems given the current environment in the U.S., we’re walking on eggshells, not really sure what we can or should say. These challenges with conversing have resulted in a pressure cooker within academic health centers amongst many other places. Stress, long hours, and differing opinions can sometimes lead to terse discourse (1,2). Whether it’s a vigorous debate during rounds, a classroom discussion has gone awry, or a tense exchange between colleagues, communication seems to be broken. The ability to de-escalate conflict and promote respectful conversations is paramount. As medical educators, we must model and cultivate civil discourse to create a positive learning environment and equip future healthcare professionals with essential communication skills.

    Are you still with me?  Good! In Robert Livingston’s book The Conversation (3), he references cognitive heuristics that we use. A heuristic is a tendency to overweight information readily available in your mind when making a decision. As clinicians, illness scripts are a medical application of a cognitive heuristic. You’ve seen many presenting with nearly identical symptoms, so you immediately go to the diagnosis you believe it is. Without additional contrary evidence to sway you, you proceed to treat accordingly (and of course run the risks associated with premature closure).

    Where cognitive heuristics occur in normal discourse, these have been built over time based on an individual’s experiences and knowledge. When confronted, for example, with an initiative related to diversity and inclusion, their heuristics may lead them to believe diversity of thought is a bad thing, something undesirable. Why? Who knows? The reaction may then be the polar opposite of what you expect and will clearly interfere with what you hope to accomplish. This can even occur in simple conversations.

    The bigger question is how can we break this cycle of high-tension communication? How do we gain an understanding and respect of others’ experiences to converse in a civil manner? How can we carry on conversations that seek to find mutual understanding and maintain mutual respect (even if we do not agree)?

    As you can well imagine, there are a lot of approaches described online. When a conversation becomes heated, it’s crucial to act as a calming influence. Here are some techniques to de-escalate:

    • Establish Psychological Safety: Remind everyone that you’re on the same team and want to find a resolution together. Use inclusive language and express a willingness to work through the issue collaboratively.
    • Ask Open-Ended Questions: Encourage reflection and sharing of perspectives. Instead of accusatory questions, try “Can you help me understand your perspective on this?” or “What’s most important to you in this situation?”.

    Finding common ground is essential for moving past conflict and fostering understanding, which is a key premise of Livingston’s book (3). Probably the most important advice offered in several other articles is active listening. Truly listen to understand, not just to respond. You have to avoid the temptation to be contemplating your response when they are speaking. Pay careful attention to the underlying concerns or values being expressed (4,5). Don’t worry if there’s a gap, a brief silence, in a conversation.

    Livingston’s framework for structuring dialogue to promote deeper understanding and collaboration involves asking deliberate, thoughtful questions to elicit information and encourage reflection (3). These are a few that may help:

    • Start with “What Happened?” or “What’s the issue we’re facing?”: Encourage a factual recounting of events or perspectives to establish a shared understanding of the situation.
    • Move to “Feelings”: Ask about the emotions involved: “How did that make you feel?”. Acknowledging feelings can help de-escalate tension and build empathy.
    • Explore “Identity”: Consider how the situation impacts individuals’ sense of self and their role within the group. This can help uncover underlying motivations and perspectives.
    • Examples of Dialogue-Enhancing Questions:
      • “Can you tell me more about how you see it impacting the situation?”
      • “What would a successful resolution look like for you, and how can we work toward that?”
      • “What are some other approaches we could consider here?”

    The house of medicine has to interact with people of varied backgrounds. Although some of those people may not share any of our own values, it is essential to be able to converse with one another in a respectful, caring manner.

    This Med Ed Chat blog is a bit different, but it felt needed in our current environment. Here are some questions for you to consider:

    • How can we, as medical educators, create a culture that encourages open and respectful dialogue, even when discussing contentious issues?
    • What strategies can we implement to ensure that all voices are heard and valued in discussions about diversity, equity, and inclusion?
    • How can we equip future healthcare professionals to navigate and resolve conflicts that arise from differing perspectives and experiences?
    • How can we prepare when someone is intransigent? What might that conversation look like – especially if you’re the intransigent one?

    Thank you for indulging my musings on this topic.

    References:

    1. May H. Create a CULTURE of belonging. HR Future 2022 (6); 46-47.
    2. Medina FJ, Benitez M. Effective behaviors to de-escalate organizational conflicts in the process of escalation. Sp J Psychol 2011; 14(2):789-797.
    3. Livingston R. The Conversation. New York, NY: Currency, 2021.
    4. Del Bel JC. De-escalating workplace aggression. Nurs Mgmt 2003 (9); 30-34.
    5. Albardiaz R. De-escalating emotions: A process. Educ Primary Care 2017; 28(1):54-55.

    Blog Author: Gary L. Beck Dallaghan, Ph.D.; Administrative Director, Alliance for Clinical Education.