Integrating Physician Judgement and Social Systems in Practice-Based Medical Education

Most efforts to improve physician practice through educational interventions have framed individuals as the focus of change. As a result, much of the theory and research in continuing medical education has been driven by the question of how physicians learn. If the focus is on changing practice, however, we need a wider focus to take into account the new environment for medical practice. Educational efforts must take physicians’practicing in a system as the focus of change, which reframes our attention to the places where physicians learn. In support of this position, the paper: 1) offers a brief historical context for the use of practice-based models in continuing medical education, 2) argues that physicians’ judgments in social systems should form the basis of clinical practice and learning, and 3) discusses the implications of integrating physician judgment and social systems in practice-based medical education.