How can inhabited institutionalism inform the analysis of medical education

Alexsandra Gulusaryan*, Gillian Aitken, Tim Fawns, Derek Jones, Jordan Napier, Kim Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
2 Downloads (Pure)


CONTEXT Medical schools are complex organizations existing at the intersection of higher education and healthcare services. This complexity is compounded by many competing pressures and drivers from professional and regulatory bodies, the wider political environment and public
expectations, producing a range of challenges for those involved in all stages of medical education. There are established approaches that have been used to address research questions related to these
challenges; some focus on organizational structures, characteristics, and performance; others on the interactions that take place in a particular setting. Less common are approaches that integrate data on
macro-level structures with the micro-level interactions of the people who inhabit those structures. Looking at the interaction of the macro and the micro opens up possibilities for the new insights.
FRAMEWORK We propose using an approach with roots in social theory – Inhabited Institutionalism (II) – that is largely unexplored in medical education. II has been described as Janusfaced, looking both outwards, at the broader context of medical education, and inwards, at the ways in
which meanings are constructed and re-constructed by participants within a particular setting.
METHODS After describing the theoretical framework of II, we explain how it can be used to understand medical education as subject to both broader societal structures (the macro-level) and interactions between people (the micro-level), as well as – crucially – their mutual influence.
CONCLUSION II offers the opportunity to combine macro and micro level perspectives, leading to a more expansive understanding of the operation of medical education which sees its form and function as neither entirely determined by structures nor a construction of individuals engaged in it. In doing so, it potentially offers a valuable way of considering the intractable problem of how to successfully manage change, offering a combined top-down and bottom-up perspective
Original languageEnglish
Pages (from-to)1363-1368
Number of pages6
JournalMedical Education
Issue number12
Early online date12 Jul 2021
Publication statusPublished - 1 Dec 2021

Bibliographical note

Fundings: Scottish Medical Education Research Consortium R46490 – SMERC Large Grant.


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