title: Developing a complex systems perspective for medical education to facilitate the integration of basic science and clinical medicine.
abstract: OBJECTIVE
  The purpose of medical education is to produce competent and capable professional practitioners who can combine the art and science of medicine. Moreover, this process must prepare individuals to practise in a field in which knowledge is increasing and the contexts in which that knowledge is applied are changing in unpredictable ways. The 'basic sciences' are important in the training of a physician. The goal of basic science training is to learn it in a way that the material can be applied in practice. Much effort has been expended to integrate basic science and clinical training, while adding many other topics to the medical curriculum. This effort has been challenging. The aims of the paper are (1) to propose a unifying conceptual framework that facilitates knowledge integration among all levels of living systems from cell to society and (2) illustrate the organizing principles with two examples of the framework in action - cybernetic systems (with feedback) and distributed robustness.
  
  
  METHODS
  Literature related to hierarchical and holarchical frameworks was reviewed.
  
  
  RESULTS
  An organizing framework derived from living systems theory and spanning the range from molecular biology to health systems management was developed. The application of cybernetic systems to three levels (regulation of pancreatic beta cell production of insulin, physician adjustment of medication for glycaemic control and development and action of performance measures for diabetes care) was illustrated. Similarly distributed robustness was illustrated by the DNA damage response system and principles underlying patient safety.
  
  
  CONCLUSIONS
  Each of the illustrated organizing principles offers a means to facilitate the weaving of basic science and clinical medicine throughout the course of study. The use of such an approach may promote systems thinking, which is a core competency for effective and capable medical practice.
authors.affiliation: VA Quality Scholars Program, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.|School of Medicine, Case Western Reserve University, Cleveland, OH, USA.|Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D015510:Clinical Medicine / Q000458:organization & administration*; D004501:Education, Medical / Q000458:organization & administration*; D006801:Humans; D008962:Models, Theoretical; D012586:Science / Q000458:organization & administration*; D013597:Systems Analysis; D013598:Systems Theory
keywords: basic sciences; complexity; health care; medical education; systems-based practice