Reforming Medical Education System: Using System Thinking as a Paradigm

Abstract

Background: In general, the crisis in higher education system and medical education system is an outcome of being functioning inside the dead machine boundary\skin of the modern science. Boundaries are threshold concept in all systems, regardless of their nature whether they are natural or artificial systems. There are two kinds of boundaries: physical and symbolic boundaries. The type of boundary defines the type of signals that can be received and communicated. Objective: Providing a new method and strategies for educational reformers to lead a systemic intervention at the level of the boundaries can change the whole system. Methods: In this paper, we used complexity science and phenomenology as theoretical framework providing a solid foundation for using dermatosemiotics as system thinking tool. Dermatosemiotics is a system thinking stance that understand the skin as a system boundary that function as a semiotic medium and physical model. Dermatosemiotics is a transdisciplinary, system thinking approach that emerge from the interaction of four systems: biological, cognitive, social and ecological systems. Results: Understanding system boundary \skin as an embodied intentionality is a major theme in this study. The intentionality of the system has different names. In natural science, Intentionality called a function, in an educational context, it is called learning outcomes and in complexity sciences, it is called mental models. All these names unified share the same metaphor, the skin, which function as semiotic boundary, communicative interfaces that unite different parts of the system into a complex whole. Intentionality \learning outcomes as a boundary\ skin will define what is inside and outside, the self from environment. Systems can’t function without a boundary (membrane \skin). Awareness of the system boundary is essential for selecting what is relevant and essential for that system. Presence of a boundary is essential for self-reference, self-control (cybernetic) and self-organization. Feedback loops, positive or negative are signs of being inside intact skin \boundary that connects the input \perception and output \action to ensure balance and homeostasis. Dermatosemiotic analysis of the current medical education system revealed that most of them still functioning within the skin\boundary of modern science which wear a solid, machine skin that respond to only one type of signals, the physical signals. Failure of most reforms is an outcome of focusing on the parts of the system and forgetting to step outside the skin of the system to examine its symbolic and physical boundaries. Conclusion: Sustainable reform need to be achieved at the level of the whole , the semiotic boundary \skin , that is , an ontological reform or triple loop reform, to ensure wearing new skin , new system boundary that select new input , new processes and new outcomes .This kind of reform can be called a reskinning, creating a new form , a new system rather than just repairing or renewing a dysfunctional part of the system and keeping the whole intact.