Breastfeeding: A Case Study in Organizational Change of One Medical School’s Curriculum

Race, income and education have a significant impact on health outcomes, and these social factors influence a person’s health-related behaviors. A physician’s counsel has been found to have a positive impact on these behaviors, but the more sophisticated skills needed to encourage patients to engage in effective preventive health practices are not routinely addressed in medical school curricula. This dissertation study provides an examination of the existing values and structures which underpin curricular decision-making at one medical school, and how they impact the inclusion of preventive medicine practices in the curriculum. Specifically, this case study utilizes an organizational learning framework to explore ways in which curricular decisions are made regarding the implementation of preventive medicine training at Western School of Medicine (WSM), using breastfeeding as an exemplar case. The WSM is a highly ranked school of medicine in the western United States, which has an expressed interest in the practice of breastfeeding. This mixed-method design sought to identify the norms and values driving curricular decisions at WSM, and how they impacted the incorporation of breastfeeding material within the curriculum. The researcher found that the underlying norms and values guiding curricular decision-making at WSM were similar to those found in the literature. Faculty did not deviate from these norms when making curricular decisions, nor did they critically examine how these norms guided their behavior, leading to a narrow definition of roles and problems, a focus on technical elements, and a system, which was misaligned with stated goals and objectives. The quantitative results of this study further showed that the current curriculum had a limited impact on students’ general knowledge of breastfeeding. Implications for social justice and leadership in higher education institutions are also discussed.