Complexity and medical education

As a major quality management issue, in health care we have to deal with limitless complexity, be it at the level of the individual patient or at the level of the health system. Today complexity is characterized by four aspects: (1) unprecedented diversity, (2) interconnectedness, (3) speed, and (4) limited influenceability. In constrast, one has to admit that all our medical interventions are single measures (or a couple of single measures) with effects difficult to predict. Therefore formal medical education has to reduce complexity in order to make it understandable and manageable to our students. Though we will not be able to grasp complexity as a whole, we should at least aim at a multi-perspective view, as it is, for example, offered with the bio-psycho-social model. At the same time, one has to remain aware of the limitations of our cognitive approaches and to avoid relapsing in mechanistic world views. In due balance, we will enable our students to acquire a sense of coherence according to Antonovsky, comprising understandability, manageability and meaningfulness. This will help our students and our physicians to act with modesty and a sufficient and realistic degree of self-confidence. This will turn out as a paramount prerequisite for reducing risks, promoting patient safety and maintaining and fostering quality in health care.

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