Tackling wicked problems: how theories of agency can provide new insights.
OBJECTIVE
This paper reviews why and how theories of agency can be used as analytical lenses to help health professions education (HPE) scholars address our community's wicked problems. Wicked problems are those that resist clear problem statements, defy traditional analysis approaches, and refuse definitive resolution (e.g. student remediation, assessments of professionalism, etc.). We illustrate how theories of agency can provide new insights into such challenges by examining the application of these theories to one particular wicked problem in HPE: interprofessional education (IPE).


METHODS
After searching the HPE literature and finding that theories of agency had received little attention, we borrowed techniques from narrative literature reviews to search databases indexing a broad scope of disciplines (i.e. ERIC, Web of Science, Scopus, MEDLINE and PubMed) for publications (1994-2014) that: (i) examined agency, or (ii) incorporated an agency-informed analytical perspective. The lead author identified the theories of agency used in these articles, and reviewed the texts on agency cited therein and the original sources of each theory. We identified 10 theories of agency that we considered to be applicable to HPE's wicked problems. To select a subset of theories for presentation in this paper, we discussed each theory in relation to some of HPE's wicked problems. Through debate and reflection, we unanimously agreed on the applicability of a subset of theories for illuminating HPE's wicked problems. This subset is described in this paper.


RESULTS
We present four theories of agency: Butler's post-structural formulation; Giddens' sociological formulation; cultural historical activity theory's formulation, and Bandura's social cognitive psychology formulation. We introduce each theory and apply each to the challenges of engaging in IPE.


CONCLUSIONS
Theories of agency can inform HPE scholarship in novel and generative ways. Each theory offers new insights into the roots of wicked problems and means for contending with them.
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Lara
L
Varpio
Association of American Medical Colleges (retired), Washington, District of Columbia, USA.
Carol
C
Aschenbrener
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.|Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada.
Joanna
J
Bates
D006281:Health Occupations / Q000193:education*; D006801:Humans; D011340:Problem Solving; D018794:Problem-Based Learning / Q000379:methods*; D011582:Psychological Theory; D066269:Social Theory