Gonzalo Jed D, Thompson Britta M, Haidet Paul, Mann Karen, Wolpaw Daniel R
J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-1253-2963. B.M. Thompson is professor of medicine and associate dean for learner assessment and program evaluation, Penn State College of Medicine, Hershey, Pennsylvania. P. Haidet is professor of medicine, humanities, and public health sciences and director of medical education research, Penn State College of Medicine, Hershey, Pennsylvania. K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. D.R. Wolpaw is professor of medicine and humanities, senior consultant for education innovation, Regional Medical Campus, and director, Doctors Kienle Center for Humanistic Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
Acad Med. 2017 Dec;92(12):1687-1694. doi: 10.1097/ACM.0000000000001778.
Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.
卫生系统正在经历一场由多种力量驱动的变革。这对医学教育工作者具有重要意义，因为临床实践环境在学习和专业发展中起着关键作用，而且不断发展的卫生系统开始要求医疗服务提供者具备“系统就绪”的知识、态度和技能。这些影响为医学院校明确规定了一项任务，即修改其目标，并使医生做好在团队中灵活执业的准备，从而有效地促进医疗服务质量的提高。在这种背景下，增值医学教育、真实学生角色和卫生系统科学等概念正变得越来越重要。在本文中，作者运用实践共同体理论提供的视角来探讨这三个概念，审视实践共同体理论在建设性地重新构建教育实践（尤其是常见的学生角色和经历）方面所具有的影响，并规划医学教育更好地满足卫生保健系统需求的未来方向。作者将实践共同体理论的几个关键特征应用于学生当前的体验式角色，然后提出一种针对学生临床体验的新方法——增值临床系统学习角色，为学生提供机会，使其在患者和人群层面学习卫生系统科学的同时，为患者护理做出有意义的贡献。最后，作者讨论了对专业角色形成的影响以及增值临床系统学习角色的设计与实施所预期面临的挑战。
