“…Despite being rooted in theories of Vygotsky and Leont'ev from the early 20 th Century, CHAT is highly relevant to problems in 21 st century practice, whose complexity lends itself poorly to care processes that are rooted in historically-set divisions of labour. Change Laboratory offers a new way of conducting the shared redesign and reworking of complex care systems, which may otherwise be defeated by complexities of systems that prevent education translating into improved patient outcomes (see Teodorczuk and MacLullich 2018). It can be hard, at first, to understand the conceptual and methodological tools of CHAT, which require clinical educators to rethink, radically, the relationship between learning and system development.…”