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.