C. Jorm is honorary associate professor, Sydney Medical School, Sydney, Australia. C. Roberts is associate professor in primary care and medical education, Sydney Medical School, Sydney, Australia.
Acad Med. 2018 Mar;93(3):399-405. doi: 10.1097/ACM.0000000000001828.
Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the relationship between learning and teaching, research, clinical care, and community engagement. The result is graduates who lack the necessary knowledge and skills for the modern health care system and an educational system that is limited in its ability to learn and change.To address this issue, the authors apply complexity theory to medical school evaluation, using four key factors-nesting, diversity, self-organization, and emergent outcomes. To help medical educators apply this evaluation approach in their own settings, the authors offer two tools-a modified program logic model and sensemaking. In sensemaking, they use the organic metaphor of the medical school as a neuron situated within a complex neural network to enable medical educators to reframe the way they think about program evaluation. The authors then offer practical guidance for applying this model, including describing the example of addressing graduates' engagement in the health care system. The authors consider the input of teachers, the role of culture and curriculum, and the clinical care system in this example.Medical school evaluation is reframed as an improvement science for complex social interventions (medical school is such an intervention) in this model. With complexity theory's focus on emergent outcomes, evaluation takes on a new focus, reimagining medical students as reaching their future potential as change agents, who transform health systems and the lives of patients.
当代医学院校的评估重点狭窄，往往不考虑学习与教学、研究、临床护理和社区参与之间关系的更广泛系统影响。其结果是，毕业生缺乏现代医疗体系所需的知识和技能，而教育体系也缺乏学习和变革的能力。为了解决这个问题，作者将复杂性理论应用于医学院校评估，使用了四个关键因素——嵌套、多样性、自组织和涌现结果。为了帮助医学教育工作者在自己的环境中应用这种评估方法，作者提供了两种工具——修改后的项目逻辑模型和意义建构。在意义建构中，他们使用医学院作为位于复杂神经网络中的神经元的有机隐喻，使医学教育工作者能够重新构建他们思考项目评估的方式。然后，作者提供了应用该模型的实用指南，包括描述解决毕业生参与医疗保健系统的例子。作者在这个例子中考虑了教师的投入、文化和课程的作用以及临床护理系统的作用。在这个模型中，医学院校的评估被重新定义为一种针对复杂社会干预措施（医学院校就是这样一种干预措施）的改进科学。随着复杂性理论对涌现结果的关注，评估呈现出一种新的焦点，将医学生重新想象为具有未来成为变革推动者的潜力，他们能够改变医疗体系和患者的生活。
