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Health Professions Education: Complexity, Teaching, and Learning

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Abstract

Health professions education is about learning to care for and about fellow human beings and the environment we coinhabit. Health, as a resource for daily life and well being, emerges from a constellation of interdependent conditions embedded in webs of social, cultural, political, economic, and geographic events that influence access to food, water, shelter, employment, education, safety, peace, a stable ecosystem, sustainable resources, social justice, and equity [3]. Becoming a health professional is necessarily relational and dynamical. Relationships are about the quality of the exchanges we have, i.e., communication, and the extent to which they are adaptive for shared understanding, health, and well being [4]. Health professions in this chapter refer to all persons who have earned the privilege to care for those in need and to those who promote and optimize healthy lives and healthy families. How we think about and understand what we do as teachers and practitioners to help prepare future health professionals is guided by cultural and historical frameworks that evolve through periodic paradigm shifts [5–12].

The past is not what it used to be.

JA Goldstein [1]

To think complexly is to adopt a relational, a system(s) view.

That is to look at any event or entity in terms, not of itself, but of its relations.

WE Doll Jr and D Trueit (p. 845) [2]

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Notes

  1. 1.

     It is worth noting that Flexner very soon after the implementation of his reforms became aware and concerned about the “unintended consequences” of the emerging “sole focus” on the basic sciences in medical education and the plea to not loose the virtues of the humanities. He wrote: … the very intensity with which scientific medicine is cultivated threatens to cost us at time the mellow judgment and broad culture of the older generation at its best. Osler, Janeway, and Halsted have not been replaced. (Flexner A. (1930) Universities, American, English and German (p. 95)).

  2. 2.

     Note the distinctions between information, knowledge, and wisdom. As T. S. Elliot put it in his poem The Rock: Where is the Life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?

References

  1. Goldstein JA. Classic Paper: Emergence and identity. E:CO. 2007;9(3):75–81.

    Google Scholar 

  2. Doll Jr WE, Trueit D. Complexity and the healthcare professions. J Eval Clin Pract. 2010;16:841–8.

    Article  PubMed  Google Scholar 

  3. Westin S, Johnsen R. List-based systems and gatekeeping on the international agenda [Editorial]. Eur J Gen Pract. 1998;4:53–4.

    Article  Google Scholar 

  4. Gergen KJ. Relational being: beyond self and community. Oxford: Oxford University press; 2009.

    Google Scholar 

  5. Bleakley A, Bligh J, Browne J. In: Hamstra SJ, editor. Medical education for the future: identity, power and location. Dordrecht: Springer; 2011.

    Chapter  Google Scholar 

  6. Doll Jr WE. A post-modern perspective on curriculum. New York: Teachers College press; 1993.

    Google Scholar 

  7. Bak P. How nature works: the science of self-organized criticality. New York: Springer; 1996.

    Google Scholar 

  8. Capra F. The turning point: science, society, and the rising culture. Toronto: Bantam Books; 1982.

    Google Scholar 

  9. Capra F. The web of life: a new scientific understanding of living systems. New York: Anchor books; 1996.

    Google Scholar 

  10. Engestrom Y. From teams to knots: activity-theoretical studies of collaboration and learning at work. Cambridge: Cambridge University Press; 2008.

    Book  Google Scholar 

  11. Engel C. Medical education in the 21st century: the need for a capability approach. Capability. 1995;1(4):23–30.

    Google Scholar 

  12. Davidson AW, Ray MA, Turkel MC, editors. Nursing, caring, and complexity science: for human-­environment well-being. New York: Springer; 2011.

    Google Scholar 

  13. Kuhn TS. The structure of scientific revolutions. Chicago: University of Chicago press; 1962.

    Google Scholar 

  14. Goldstein JA. The unschackled organization: facing the challenge of unpredictability through spontaneous reorganization. Portland: Productivity Press; 1994.

    Google Scholar 

  15. Kuhn L. Complexity and educational research: a critical reflection. In: Mason M, editor. Complexity theory in the philosophy of education. Oxford: Wiley; 2008. p. 169–80.

    Chapter  Google Scholar 

  16. Zimmerman B, Lindberg C, Plsek P. Edgeware: insights from complexity science for health care leaders. Irving, TX: VHA; 2001.

    Google Scholar 

  17. Mennin S. Complexity and health professions education: a basic glossary. J Eval Clin Pract. 2010;16:838–40.

    Article  PubMed  Google Scholar 

  18. Cilliers F. Understanding complex systems. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in health. New York: Springer; 2012 p. 39–62.

    Google Scholar 

  19. Sturmberg JP. The complex nature of knowledge. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in Health. New York: Springer; 2012.

    Google Scholar 

  20. Cilliers F. Complexity and postmodernism: understanding complex systems. London: Routledge; 1998.

    Google Scholar 

  21. McDaniel RR, Driebe DJ. Complexity science and health care management. In: Fottler MD, Savage GT, Blair JD, Payne GT, editors. Advances in health care management. Amsterdam: Elsevier Science; 2001. p. 11–36.

    Google Scholar 

  22. Kauffman S. At home the in universe: the search for laws of self-organization and complexity. New York: Oxford University press; 1995.

    Google Scholar 

  23. Mennin S. Self organisation, integration and curriculum in the complex world of medical education. Med Educ. 2010;44:20–30.

    Article  PubMed  Google Scholar 

  24. Radford M. Prediction, control and the challenge to complexity. Oxf Rev Educ. 2008;34(5):505–20.

    Article  Google Scholar 

  25. Sullivan WM, Rosin MW. A new agenda for higher education: shaping a life of the mind for practice. San Francisco: Jossey-Bass; 2008.

    Google Scholar 

  26. Capra F. The hidden connections: integrating the biological, cognitive, and social dimensions of life into a science of sustainability. New York: Doubleday; 2002.

    Google Scholar 

  27. Kelso SJA, Engestrom DA. The complementary nature. Cambridge, MA: MIT Press; 2006.

    Google Scholar 

  28. Glouberman S, Zimmerman B. Complicated and complex systems: what would successful reform of medicare look like?Discussion paper No. 8, 2002. Available from: https://docs.google.com/viewer?url= http://www.plexusinstitute.org/resource/collection/6528ED29-9907-4BC7-8D00-8DC907679FED/ComplicatedAndComplexSystems-ZimmermanReport_Medicare_reform.pdf.

  29. Edelman G. Second nature: brain science and human knowledge. New Haven: Yale University Press; 2006.

    Google Scholar 

  30. Freeman WJ. How brains make up thier minds. New York: Columbia University Press; 2000.

    Google Scholar 

  31. Freeman WJ, Nunez R. Restoring to cognition the forgotten primacy of action, intention and emotion. J Conscious Stud. 1999;6(11–12):ix–xix.

    Google Scholar 

  32. Glouberman S, Zimmerman B. Complicated and complex systems: what would successful reform of medicare look like? Comm Future Health Care Can. 2002;8:1–54.

    Google Scholar 

  33. Plsek P, editor. Redesigning health-care with insights from the science of complex adaptive systems. Crossing the quality chasm: a new health care system for the 21st century. Washington DC: National Academy press; 2001.

    Google Scholar 

  34. Borrell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576–82.

    Article  PubMed  Google Scholar 

  35. West BJ. Homeostasis and Gauss statistics: barriers to understanding natural variability. J Eval Clin Pract. 2010;16:403–8.

    PubMed  Google Scholar 

  36. West BJ, editor. Where medicine went wrong: rediscovering the path to complexity. New Jersey: World scientific; 2006.

    Google Scholar 

  37. Ahn AC, Tweari M, Poon C-S, Phillips RS. The limits of reductionism in medicine: Could systems biology offer an alternative? PLoS Med. 2006;3(6):e208.

    Google Scholar 

  38. Federoff HO, Gostin LO. Evolving from reductionism to holism: is there a future for systems medicine? JAMA. 2009;302(9):994–6.

    Article  PubMed  CAS  Google Scholar 

  39. Stacy RD. Complex responsive processes in organizations: learning and knowledge creation. Stacy RD, Griffin D, Shaw P, editors. London: Routledge; 2001.

    Google Scholar 

  40. Stacy RD. Strategic management and orgnaizational dynamics. London: Pitman Publishing; 1996.

    Google Scholar 

  41. Snowden D. Complex acts of knowing: paradox and descriptive self-awareness. J Knowl Manage. 2002;6(2):100–11.

    Article  Google Scholar 

  42. Davis B, Sumara D, Luce-Kapler R. Engaging minds: changing teaching in complex times. 2nd ed. New York: Routledge; 2008.

    Google Scholar 

  43. Ludmerer KM. Time to heal: American medical education from the turn of the century to the era of managed care. Oxford: Oxford University press; 1999.

    Google Scholar 

  44. Smith SR. Outcome-based curriculum. In: Dent JA, Harden RM, editors. A practical guide for medical teachers. 3rd ed. Edinburgh: Churchill Livingstone, Elsevier; 2009. p. 161–7.

    Google Scholar 

  45. Schuwirth LWT, van der Vleuten CPM. Changing education, changing assessment, changing research? Med Educ. 2004;38:805–12.

    Article  PubMed  Google Scholar 

  46. Groopman J. How doctors think. Boston: Houghton Mifflin; 2007.

    Google Scholar 

  47. Stern DT, editor. Measuring medical professionalism. Oxford: Oxford University press; 2006.

    Google Scholar 

  48. Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner report. N Engl J Med. 2006;355:1339–44.

    Article  PubMed  CAS  Google Scholar 

  49. Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3–18.

    Article  PubMed  CAS  Google Scholar 

  50. Mennin S, Kaufman A, Urbina C, McGrew M. Community-based medical education: toward the health of the public. Med Educ. 2000;34:503–4.

    Article  PubMed  CAS  Google Scholar 

  51. Mennin S, Petroni-Mennin R. Community-based medical education. Clin Teach. 2006;3:90–6.

    Article  Google Scholar 

  52. Worley P, Silagy C, Prideaux D, Newble D, Jones AH. The parallel rural community curriculum: an integrated clinical curriculum-based in rural general practice. Med Educ. 2000;34:558–65.

    Article  PubMed  CAS  Google Scholar 

  53. Duban S, Kaufman A. Clinical skills: enhancing basic science learning. In: Kaufman A, editor. Implementing problem-based medical education: lessons from successful Innovations. New York: Springer; 1985. p. 89–105.

    Google Scholar 

  54. Suchman AL. A new theoretical foundation for relationship-centered care: complex responsive process of relating. J Gen Intern Med. 2006;21:S40–S4.

    Article  PubMed  Google Scholar 

  55. Flexner A. Medical education in the United States and Canada. A report to the Carnegie Foundation for the Advancement of Teaching 1910. http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf.

  56. Dornan T, Mann K, Scherpbier A, JS, editors. Medical education: theory and practice. Edinburgh: Churchill Livingstone, Elsevier; 2011.

    Google Scholar 

  57. Mennin S. Small-group problem-based learning as a complex adaptive system. Teach Teach Educ. 2007;23:303–13.

    Article  Google Scholar 

  58. Mennin S. Teaching, learning, complexity and health professions education. JIAMSE. 2010;20(2s):162–5.

    Google Scholar 

  59. Norman G. Chaos, complexity and complicatedness this: lessons from rocket science. Med Educ. 2011;45:549–59.

    Article  PubMed  Google Scholar 

  60. Bleakley A, Brice J, Bligh J. Thinking the post-colonial in medical education. Med Educ. 2008;42:266–70.

    Article  PubMed  Google Scholar 

  61. Friedenberg J. Dynamical psychology: complexity, self-organization and mind. Litchfield Park, AZ: ISCE Publishing; 2009.

    Google Scholar 

  62. Lakoff G. Women, fire, and dangerous things: what categories reveal about the mind. Chicago: University of Chicago press; 1987.

    Google Scholar 

  63. Johnson M. The meaning of the body: aesthetics of human understanding. Chicago: University of Chicago press; 1999.

    Google Scholar 

  64. Gallagher S. How the body shapes the mind. Oxford: Clarendon press; 2005.

    Book  Google Scholar 

  65. Varela FJ, Thompson E, Rosch E. The embodied mind: cognitive science and human experience. Cambridge, MA: The MIT Press; 1991.

    Google Scholar 

  66. Bateson G. Mind and nature: a necessary unity. Cresskill, NJ: Hampton Press; 2002.

    Google Scholar 

  67. Clark A. Being there: putting brain, body, and world together again. Cambridge, MA: The MIT Press; 1997.

    Google Scholar 

  68. Gibbs Jr RW. Embodiment and cognitive science. Cambridge: Cambridge University press; 2005.

    Book  Google Scholar 

  69. Arrow H, McGrath JE, Berdahl JL. Small groups as complex adaptive systems: formation, coordination, development, and adaptation. Thousand oaks: Sage; 2000.

    Google Scholar 

  70. Engestrom DA. From teams to knots. Cambridge: Cambridge University press; 2008.

    Book  Google Scholar 

  71. Group WS. Increasing the relevance of education for health professionals: Report of WHO study group on problem-solving education for the health professions. Geneva: Group WS; 1993.

    Google Scholar 

  72. Kauffman S. The origins of order: self-organization and selection in evolution. Oxford: New York; 1993.

    Google Scholar 

  73. Guastello S, Koopmans M, Pincus D, editors. Chaos and complexity in psychology: the theory of nonlinear dynamical systems. Cambridge: Cambridge University Press; 2009.

    Google Scholar 

  74. Hollis G, Kloos H, Van Orden GC. Origins of order in cognitive activity. In: Guastello SJ, Koopmans M, Pincus D, editors. Chaos and complexity in psychology: the theory of nonlinear dynamical systems. Cambridge: Cambridge University press; 2009. p. 206–41.

    Google Scholar 

  75. Wheatley M. Leadership and the new science: discovering order in a chaotic world. 2nd ed. San Francisco: Berrett-Koehler; 1999.

    Google Scholar 

  76. Hazy JK, Goldstein JA, Lichtenstein BB, editors. Complex systems leadership theory: new perspectives from complexity science on social and organizational effectiveness. Boston, MA: ISCE Publishing; 2007.

    Google Scholar 

  77. Goldstein J. Riding the waves of emergence: leadership innovations on complex systems. In: Business AU-SoMa, editor. Plexus Institute: Garden City; 2010.

    Google Scholar 

  78. Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.

    Google Scholar 

  79. Kelso SJA. Dynamic patterns: the self-organization of brain and behavior. Cambridge: MIT Press; 1995.

    Google Scholar 

  80. Davis B, Sumara D. Complexity and education: inquiries into learning, teaching, and research. Mahwah: Lawrence Erlbaum Associates; 2006.

    Google Scholar 

  81. Johnson M. The body in the mind: the bodily basis of meaning, imagination, and reasoning. Chicago: University of Chicago Press; 1990.

    Google Scholar 

  82. Arrow H, Henry KB. Using complexity to promote group learning in healthcare. J Eval Clin Pract. 2010;16:861–6.

    Article  PubMed  Google Scholar 

  83. Stacy RD. Complexity and group processes: a radically social understanding of individuals. London: Routledge; 2003.

    Google Scholar 

  84. Brito PQ, Roschke MA, Ribeiro EC. Educacion permanente, proceso de trabajo y calidad de servicios de salud. In: Haddad J, Roschke MA, Davini MC, editors. Educacion permanente de personal de salud. Washington, DC: OPS/OMS; 1994. p. 34–60.

    Google Scholar 

  85. Otero Ribeiro EC, Mennin S. Continuing medical education: Guide supplement 35.2 - Viewpoint. Med Teach. 2010;32:172–3.

    Google Scholar 

  86. Davis B, Sumara D. ‘If things were simple…’: complexity in education. J Eval Clin Pract. 2010;16:856–60.

    Article  PubMed  Google Scholar 

  87. Snowden D. The Cynefin Framework; 2010. http://www.youtube.com/watch?v=N7oz366X0-8&list=PL5CB210886A3E51AE&index=1&feature=plpp_video. Accessed 3 Jan 2012.

  88. Griffin D. In: Stacy RD, Griffin D, Shaw P, editors. The emergence of leadership: linking self-organization and ethics. London: Routledge; 2002.

    Google Scholar 

  89. Bleakley A. Blunting Occam’s razor: aligning medical education with studies of complexity. J Eval Clin Pract. 2010;16:849–55.

    Article  PubMed  Google Scholar 

  90. Bleakley A. Social comparison, peer learning and democracy in medical education. Med Teach. 2010;32(32):878–9.

    Article  PubMed  Google Scholar 

  91. Bruffee KA. Collaborative learning: higher education, interdependence, and authority of knowledge, Second edition ed. Baltimore: The Johns Hopkins University press; 1999.

    Google Scholar 

  92. Christensen CR, Garvin DA, Sweet A, editors. Education for judgement: the artistry of discussion leadership. Boston, MA: Harvard Business School Press; 1991.

    Google Scholar 

  93. Haidet P, Stein HF. The role of the student-teacher relationship in the formation of physicians: the hidden curricuum as process. J Gen Intern Med. 2006;21:S16–20.

    Article  PubMed  Google Scholar 

  94. Bates CK, Babbot S, Williams BC, Stern DT, Bowen JL. Are we making progress in medical education? J Gen Intern Med. 2006;21(5):542-3.

    Google Scholar 

  95. Stern DT, Papadakis M. The developing physician: becoming a professional. New Engl J Med. 2006;355(17):1794–9.

    Article  PubMed  CAS  Google Scholar 

  96. Christensen CR. The discussion teacher in action: questioning, listening, and response. In: Christensen CR, Garvin DA, Sweet A, editors. Education for judgement: the artistry of discussion leadership. Boston: Harvard Business School Press; 1991. p. 153–74.

    Google Scholar 

  97. Cole M, John-Steiner V, Scribner S, Souberman E, editors. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.

    Google Scholar 

  98. Abraham JL. Dynamical systems theory: application to pedagogy. In: Tschacher W, Dauwalder J-P, editors. The dynamical systems approach to cognition: concepts and empirical paradigms based on self-­organization, embodiment, and coordination dynamics. Singapore: World scientific; 2003. p. 295–307.

    Chapter  Google Scholar 

  99. Kelly PA, Haidet P, Schneider V, Searle N, Seidel CL, Boyd F. A comparison of In-class learner engagement across lecture, problem-based learning, and team learning using the STROBE classroom observation too. Teach Learn Med. 2005;17(2):112–8.

    Article  PubMed  Google Scholar 

  100. Cilliers P. Complexity. In: Sturmberg JP, editor. Complexity and health; 2012.

    Google Scholar 

  101. Morin E. Seven complex lessons in education for the future. Paris: UNESCO; 2001.

    Google Scholar 

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Authors and Affiliations

  1. Department of Cell Biology and Physiology, University of New Mexico, Albuquerque, NM, 87131, USA

    Stewart P. Mennin (Professor Emeritus)

  2. Educational Development and Research, School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA

    Stewart P. Mennin (Assistant Dean Emeritus)

  3. Mennin Consulting & Associates, Inc. and Mennin Consultoria em Saude, Ltda., Rua Inhambu, 1708, Sao Paulo, Brazil

    Stewart P. Mennin (Professor Emeritus)

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  1. , Department of General Practice, Monash University, PO Box 3010, Wamberal, 2260, New South Wales, Australia

    Joachim P. Sturmberg

  2. Northern Ontario School of Medicine, Merchandise Mart Plaza, Suite 1212 222, Chicago, 60654, Illinois, USA

    Carmel M. Martin

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Mennin, S.P., Mennin, S.P. (2013). Health Professions Education: Complexity, Teaching, and Learning. In: Sturmberg, J., Martin, C. (eds) Handbook of Systems and Complexity in Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4998-0_43

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