Blunting Occam's razor: aligning medical education with studies of complexity.

Clinical effectiveness and efficiency in medicine for patient benefit should be grounded in the quality of medical education. In turn, the quality of medical education should be informed by contemporary learning theory that offers high explanatory, exploratory and predictive power. Multiple team-based health care interventions and associated policy are now routinely explored and explained through complexity theory. Yet medical education--how medical students learn to become doctors and how doctors learn to become clinical specialists or primary care generalists--continues to refuse contemporary, work-based social learning theories that have deep resonance with models of complexity. This can be explained ideologically, where medicine is grounded in a tradition of heroic individualism and knowledge is treated as private capital. In contrast, social learning theories resonating with complexity theory emphasize adaptation through collaboration, where knowledge is commonly owned. The new era of clinical teamwork demands, however, that we challenge the tradition of autonomy, bringing social learning theories in from the cold, to reveal their affinities with complexity science and demonstrate their powers of illumination. Social learning theories informed by complexity science can act as a democratizing force in medical education, helping practitioners to work more effectively in non-linear, complex, dynamic systems through inter-professionalism, shared tolerance of ambiguity and distributed cognition. Taking complexity science seriously and applying its insights demands a shift in cultural mindset in medical education. Inevitably, patterns of resistance will arise to frustrate such potential innovation.