S.M. van Schaik is professor of pediatrics and Baum Family Presidential Chair for Experiential Learning, University of California, San Francisco, San Francisco, California. S.A. Reeves is professor and dean, School of Nursing and Health Professions, Colby-Sawyer College, New London, New Hampshire, and chief nurse executive, Dartmouth-Hitchcock Health, Lebanon, New Hampshire. L.A. Headrick is professor emerita of medicine, University of Missouri School of Medicine, Columbia, Missouri.
Acad Med. 2019 Jul;94(7):975-982. doi: 10.1097/ACM.0000000000002689.
In this article, the authors propose a vision for exemplary learning environments in which everyone involved in health professions education and health care collaborates toward optimal health for individuals, populations, and communities. Learning environments in the health professions can be conceptualized as complex adaptive systems, defined as a collection of individual agents whose actions are interconnected and follow a set of shared "simple rules." Using principles from complex adaptive systems as a guiding framework for the proposed vision, the authors postulate that exemplary learning environments will follow four such simple rules: Health care and health professions education share a goal of improving health for individuals, populations, and communities; in exemplary learning environments, learning is work and work is learning; exemplary learning environments recognize that collaboration with integration of diverse perspectives is essential for success; and the organizations and agents in the learning environments learn about themselves and the greater system they are part of in order to achieve continuous improvement and innovation. For each of the simple rules, the authors describe the details of the vision and how the current state diverges from this vision. They provide actionable ideas about how to reach the vision using specific examples from the literature. In addition, they identify potential targets for assessment to monitor the success of learning environments, including outcome measures at the individual, team, institutional, and societal levels. Such measurements can ensure optimal alignment between health professions education and health care and inform ongoing improvement of learning environments.
在本文中，作者提出了一个典范学习环境的愿景，即在这个环境中，所有参与医疗保健专业教育和医疗保健的人都能共同努力，实现个人、人群和社区的最佳健康。医疗保健专业的学习环境可以被概念化为复杂适应系统，这是指一组相互关联的个体代理，其行为遵循一组共同的“简单规则”。作者使用复杂适应系统的原则作为提出的愿景的指导框架，假设典范学习环境将遵循以下四个简单规则：医疗保健和医疗保健专业教育有着改善个人、人群和社区健康的共同目标；在典范学习环境中，学习就是工作，工作就是学习；典范学习环境认识到，与不同观点的协作和整合对于成功至关重要；学习环境中的组织和代理机构了解自己以及他们所属的更大系统，以实现持续改进和创新。对于每个简单规则，作者描述了愿景的细节以及当前状态与该愿景的差异。他们提供了一些可操作的想法，以通过文献中的具体例子来实现这一愿景。此外，他们确定了潜在的评估目标，以监测学习环境的成功，包括个人、团队、机构和社会层面的结果衡量。这些衡量标准可以确保医疗保健专业教育与医疗保健之间的最佳协调，并为学习环境的持续改进提供信息。
