CHICAGO, March 18, 2005 – Embracing complexity will lead to innovation in graduate medical education, said Brenda J. Zimmerman, PhD, who presented the Marvin R. Dunn Memorial Lecture at the 2005 Accreditation Council for Graduate Medical Education Annual Educational Conference. The conference took place March 3-5 at the Gaylord Palms Resort and Convention Center in Kissimmee, Fla.
Dr. Zimmerman, a professor of strategic management at the Schulich School of Business at York University in Toronto, discussed the difference between complicated and complex approaches to learning. A complicated approach stresses machine metaphors, formulas and rules, she said. A complex approach, in contrast, stresses biology metaphors, relationships and paradoxes.
“In education, we overprivilege the complicated and ignore the complex,” said Dr. Zimmerman.
Dr. Zimmerman highlighted Brazil’s approach to a burgeoning AIDS crisis during the 1990s as an example of a successful complex solution. Instead of assuming that the country could not afford to treat all who were infected with HIV, Brazilian leaders reduced the costs of AIDS drugs to make treatment available to all who needed it, and built upon an existing infrastructure of churches and non-governmental organizations to communicate to people how to prevent and treat AIDS.
Dr. Zimmerman also discussed how slime cells self-organize by responding to environmental cues to function either alone or in aggregate with other cells. For years, scientists assumed there had to be a “pacemaker cell” that regulated this, she said. Researchers discovered, however, that no such pacemaker cell existed; individual slime cells self-organized into aggregate groups when needed.
The lesson to be learned from slime, Dr. Zimmerman said, is “are we missing self-organization? Does everything have to be driven by a central teacher?”
The examples of Brazil and the slime cells can teach physician educators to assume an abundance of resources, look at patterns that already work and built on those, and focus on relationships and social connectors, said Dr. Zimmerman.
Following Dr. Zimmerman’s speech, another presentation was given by Paul Griner, MD, a professor of medicine emeritus at the University of Rochester School of Medicine and a senior fellow at the Institute for Healthcare Improvement in Boston. Dr. Griner spoke about the IHI/Medical School Collaborative, in which member medical schools work with the IHI to teach medical students how to contribute to the improvement of health care at individual and systems levels.
The goal for residency programs, said Dr. Griner, is that “entering residents will be interested in furthering their knowledge and skills in the improvement of care through experience at exemplary learning sites.”
Nearly 1,000 residency program directors and coordinators, designated institutional officials and others involved in graduate medical education attended the ACGME’s 2005 Annual Educational Conference. The conference included more than 60 sessions on topics including teaching and assessing the general competencies, patient safety, and the common duty hours, as well as several specialty-specific sessions. Information about next year's conference will be posted later this year on the ACGME’s Web site, www.acgme.org.
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The ACGME is a private, non-profit council that accredits 7,800 residency programs
in 27 specialties affecting 100,000 residents. Its mission is to improve the quality
of health care in the United States by ensuring and improving the quality of graduate
medical education for physicians in training.
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