Introducing Large-Scale Educational Reform in a Complex Environment: The Role of Piloting and Evaluation in Modernizing Medical Careers

Medical education and training in the United Kingdom is undergoing profound change driven by a governmental policy that has attracted the title Modernizing Medical Careers.The role of piloting and evaluation in Modernizing Medical Careers is described and the article argues that, in addition to the previously described rational, cultural and control functions of evaluation, a significant function of evaluation and pilot programmes is to facilitate the implementation of change in a complex system. Once at the `edge of chaos', given minimal direction, complex systems will self-organize and policy and context can be allowed to co-evolve. Pilot programmes and their accompanying evaluation provide a powerful catalyst for that process to occur.