Lingard Lorelei
Dr. Lingard: Director, Centre for Education Research and Innovation Professor, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
J Contin Educ Health Prof. 2016 Summer;36 Suppl 1:S19-21. doi: 10.1097/CEH.0000000000000078.
Medicine has conventionally had an individualist orientation to competence. Individual competence is conceptualized as a stable possession that, once acquired, holds across contexts. Individual competence is necessary; however, it is insufficient for quality health care. We also need to attend to collective competence in order to grapple with paradoxical truths about teamwork, such as: competent individuals can form incompetent teams. Collective competence is conceptualized as a distributed capacity of a system, an evolving, relational phenomenon that emerges from the resources and constraints of particular contexts. This article outlines a set of paradoxical truths about teamwork in health care and uses the concept of collective competence to explain how they can hold true. It then considers a set of persistent myths about teamwork which have their roots in an individualist orientation, exploring how they hold us back from meaningful change in how we educate for, and practice as, health care teams. Finally, the article briefly considers the implications of these truths and myths for educational issues such as interprofessional education and competency-based health professional education.
传统上，医学对能力的关注侧重于个人主义。个人能力被概念化为一种稳定的属性，一旦获得，便适用于各种情况。个人能力是必要的；然而，对于高质量的医疗保健来说，这还不够。为了应对团队合作中一些自相矛盾的事实，比如：有能力的个体可能组成无能力的团队，我们还需要关注集体能力。集体能力被概念化为一个系统的分布式能力，是一种从特定情境的资源和限制中产生的、不断演变的关系现象。本文概述了关于医疗保健团队合作的一系列自相矛盾的事实，并运用集体能力的概念来解释它们如何成立。接着，本文探讨了一系列源于个人主义倾向的关于团队合作的持续存在的错误观念，研究它们是如何阻碍我们在医疗团队的教育和实践方式上做出有意义的改变的。最后，本文简要考虑了这些事实和错误观念对诸如跨专业教育和基于能力的卫生专业教育等教育问题的影响。
