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Positioning the Work of Health Professions Education Scholarship Units: How Canadian Directors Harness Institutional Logics Within Institutional Orders to Convey Unit Legitimacy

Kahlke, Renate PhD; Varpio, Lara PhD

doi: 10.1097/ACM.0000000000002817
Research Reports

Purpose Health professions education scholarship unit (HPESU) leaders often struggle to articulate their impact within local contexts. Previous research has described what markers of success and institutional logics to consider when crafting statements of impact; there is a need to clarify how HPESU leaders convey their messages to navigate competing demands. This study examined how leaders argue the legitimacy of their HPESUs’ activities.

Method The institutional logics perspective offered a lens for understanding how legitimacy claims are constructed through larger institutional orders. Interviews with leaders from 12 Canadian HPESUs discussed their unit’s work, the stakeholders that leaders sought to satisfy, and how they defined success. Data were generated in 2011–2012 and analyzed anew in 2017–2018. The authors inductively analyzed the data, using institutional logics and institutional orders as sensitizing concepts to identify the linguistic constructions harnessed by participants.

Results HPESU leaders engaged with 2 dominant logics: research and service. These aligned with institutional orders: the profession and community, respectively. While a few HPESU leaders deployed only one logic throughout the course of an interview, many engaged with more than one, compartmentalizing logics specific to different audiences and activities or blending logics to create novel ways of framing their work.

Conclusions The institutional logics available in a context vary. What constitutes a compelling legitimacy claim is different from one institutional context to the next. The authors identify strategies that leaders used to position their HPESU for success and discuss the basis on which these claims are made.

R. Kahlke is research associate, Research Unit, Royal College of Physicians and Surgeons of Canada, and adjunct professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada; ORCID:

L. Varpio is professor and associate director of research, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID:

Supplemental digital content for this article is available at

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Ethical approval was obtained from the University of Ottawa’s Research Ethics Board.

Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect those of the United States Department of Defense or other federal agencies or the Royal College of Physicians and Surgeons of Canada.

Previous presentations: These data have been discussed in other manuscripts related to a larger research project.1,2,4 As noted in the Method section, the data from Canadian contexts have been reanalyzed to form the insights that are the basis of this article.

Correspondence should be addressed to Renate Kahlke, Royal College of Physicians and Surgeons of Canada, 774 Echo Dr., Ottawa, ON, Canada K1S 5N8; email:

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.