Swipe om te navigeren naar een ander artikel
“Nothing ever exists entirely alone; everything is in relation to everything else.” (Buddha)
In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers’ attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations. As such we need to shift the conversation from (1) problem solving to problem definition, and (2) from a problem definition derived exclusively at the level of the individual to a definition derived at the level of the situation in which the problem is manifested. Embracing such a focus on problem definition will enable us to advocate for novel educational practices that will equip trainees to effectively manage the problems they will encounter in complex, team-based healthcare.
Lucey CR. Medical education: part of the problem and part of the solution. JAMA. 2013;173:1639–43.
Ilgen JS, Eva KW, Regehr G. What’s in a label? Is diagnosis the start or the end of clinical reasoning? J Gen Intern Med. 2016;31:435–7. CrossRef
Leung A, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton CA. ‘First, do no harm’: balancing competing priorities in surgical practice. Acad Med. 2012;87:1368–74. CrossRef
Vandewaetere M, Manhaeve D, Aertgeerts B, Clarebout G, Van Merriënboer JJ, Roex A. 4 C/ID in medical education: How to design an educational program based on whole-task learning: AMEE guide no. 93. Med Teach. 2015;37:4–20. CrossRef
Honour EC. 6.2. 3 Understanding the value of systems engineering. INCOSE Int Symp. 2004;14(1):1207–22. CrossRef
Honour EC, Valerdi R. Advancing an ontology for systems engineering to allow consistent measurement. Online Proceedings of the Conference on Systems Engineering Research, Los Angeles, University of Southern California, 6.-9. Apr 2006. 2006.
Johnson CW. What are emergent properties and how do they affect the engineering of complex systems? Reliab Eng Syst Safe. 2006;1:1475–81. CrossRef
Reynolds M, Holwell S. Systems approaches to managing change: a practical guide. London: Springer; 2010. CrossRef
Cristancho S. Lessons on resilience: learning to manage complexity. Perspect Med Educ. 2016;5:133–5. CrossRef
Cristancho S. What can we learn from a soft sister? A complementary lens to the systems engineering approach in medical education research. Med Educ. 2014;48:1139–41. CrossRef
Checkland P. Systems thinking, systems practice: includes a 30-year retrospective. Hoboken: Wiley; 1999.
Checkland P. From optimizing to learning: a development of systems thinking for the 1990 s. J Oper Res Soc. 1985;1:757–67. CrossRef
Checkland PB, Haynes MG. Varieties of systems thinking: the case of soft systems methodology. Syst Dynam Rev. 1994;10:189–97. CrossRef
Armson R. Growing wings on the way: systems thinking for messy situations. Devon: Triarchy Press; 2011.
Cristancho S, Bidinosti S, Lingard L, Novick R, Ott M, Forbes T. Seeing in different ways introducing ‘rich pictures’ in the study of expert judgment. Qual Health Res. 2015;25:713–25. CrossRef
- From problem solving to problem definition: scrutinizing the complex nature of clinical practice
- Bohn Stafleu van Loghum