Accounting for complexity in medical education: a model of adaptive behaviour in medicine

Abstract

Context Medicine is practised in complex systems. Physicians engage in clinical and operational problems that are dynamic and lack full transparency. As a consequence, the behaviour of medical systems and diseases is often unpredictable. Medical science has equipped physicians with powerful tools to favourably impact health, but a reductionist approach alone is insufficient to optimally address the complex challenges posed by illness and public health. Concepts from complexity science, such as continuous quality improvement and teamwork, strive to fill the gap between biomedical knowledge and the realities of practice. However, the superficial treatment of these systems‐thinking concepts in medical education has distorted their implementation and undermined their impact. ‘Systems thinking’ has been conflated with ‘systematic thinking’; concepts which are adaptive in nature are being taught as standardised, reductionist tools. Methods Using concepts from complexity science, the history of science and psychology, this problem is outlined and a theoretical model of professional development is proposed. Results This model proposes that complex problem solving and adaptive behaviour, not technical expertise, are distinguishing features of professionalism. Discussion The impact of this model on our understanding of physician autonomy, professionalism, teamwork and continuous quality improvement is discussed. This model has significant implications for the structure and content of medical education. Strategies for enhancing medical training, including interventions in recruitment, the curriculum and evaluation, are reviewed. Such adjustments would prepare trainees to more effectively utilise biomedical knowledge and tools in the complex high‐stakes reality of medical practice.

The agility of ants: lessons for grappling with complexity in health care teamwork

“…He asserts that a systematic approach ‘fails to provide the flexibility and leverage of diverse perspectives (systems approach) required to solve complex problems’. For instance, privileging systematic over systems approaches might be the catalyst of a ‘healthcare system that is plagued by fragmented care’ . As researchers interested in teamwork and complexity, we echo Woodruff's sentiment.…”

Continuing Professional Development through the lens of complexity science: Becoming agents of change in the healthcare system [Version 2]

“…Through reflective practices, case-based discussions and simulation scenarios as a group, these influence intrinsic motivation (using group MI techniques) as well as increase technical expertise ("intrinsic characteristics") both working alongside each other. Through the sharing of experiences and peer norming, this promotes a sense of a common purpose ("attractor") which then leads to an increase in the capacity to collectively adapt ("adaptive capacity") (Woodruff 2019). This is followed by process mapping discussions around staff and patient feedback.…”

“…Other contributing factors are social (Wailling et al, 2020), cultural (Braithwaite et al, 2017), and historical (Classen et al, 2011). Woodruff suggests that we cannot solve complex problems using a reductionist paradigm because complexity exists within all layers of the healthcare system and affects the efforts of clinicians and policy makers to improve and reconcile individuals' healthcare experience, population outcomes and healthcare costs (Woodruff, 2019). To better account for the complex nature of medicine, such systems should instead be viewed through a "complex adaptive systems framework" (CAS).…”

Learning technologies: A medium for the transformation of medical education?

“…These assumptions do not seem to hold up in reality as research has consistently shown that teachers do not readily accept new technologies and, even when they do, technologies are used to support existing teaching practice rather than to exploit new pedagogies 8,9 . This reductionist conceptualisation of learning technologies as a solution fails to acknowledge that medicine, and therefore medical education, operates as a complex adaptive system where even a well‐defined intervention may lead to unexpected outcomes or system‐wide behaviours 10 . A structured appreciation of influences of change in complex adaptive systems is undoubtedly necessary to more effectively implement change in medical education 11 …”