Since the emergence of modern natural philosophy, the structures governing information have been based on a foundational myth where a central authority or force defines the goals, paradigms, structures, distribution channels and beneficiaries of the knowledge and its wealth. This creates a very concentrated type of pyramidal constitution, where creation and management is restricted to a few societal groups ruling the correct paradigms, creation methods and channels for dissemination. In others words, this is a centralized hierarchical and authoritarian managed system.
In contrast to the centralized model designed by humans utilizing creational myths, Complex Adaptive Systems (CAS) are being recognized as the model explaining how nature, biological beings and data are organized. CASs are defined by the ability to self-organize, adapt to the changes of internal and external conditions and provide a survivability advantage to the organism (community) as a whole. Many things that surround us are CASs, like social media networks, cities, wolf packs, swarms of insects and memes.
When knowledge and ideas are organized as CASs, they are based in the concept of stigmergy, where cues created by individuals (nodes) influence the behavior of others members of the community (network) changing the overall output of the group. A classic example of this is ant troops building an ant colony. This stigmergic collaboration requires communication, social negotiation and a creative output. Humans associated this way for thousands of years, from hunting mammoths to building cathedrals. But as information became more complex, the creative outputs became more difficult to socially negotiate and stigmergy faded into the background.
Gilles Deleuze and Félix Guattari rediscovered and described the concept of rhizomatic organization (a form of stigmergic collaborative network), where the network is non-hierarchical, self-governed, distributed, maximally connected, multi-domain, semiotic and where the behavior and outputs can not be predicted by the characteristics of the nodes as they change when they communicate with each other. We have written about this before on this blog.
Medical education for centuries and even after the advent of the Flexnerian era has been based on the centralized, hierarchical and authoritarian paradigm of information and knowledge management. Despite quantum leaps in the last decades such as competency-based education, the overall framework remains founded in a stratified model, where some members of the group are directors, others are teachers and others are students with unidirectional flow of information.
Our world is changing rapidly in the way we manage data and knowledge. For most practical purposes the average individual now has access to an almost incomprehensible amount of information, and this includes medical science and education. Users of the information, in this case our learners, want to turn it into knowledge without necessarily having a preceptor telling them what is right and what is wrong. What learners want is a community to give contextual meaning to the information in order to create their own personal learning networks and educational artifacts. This is partially an explanation of the erruption and success of the Free Open Access Medical Education movement.
Centralized, authoritarian and hierarchical structures are per definition inefficient and non-resilient as they can’t manage problems with unbounded data and not able to react nimbly to changes in conditions. After hundreds of years they way we teach medicine remains one within these structures. On the other side, CASs are a core part of our lives, from the way we share news with our friends and family, shop for items on the internet, how the traffic lights are organized in our commute, and how our insurance premiums are calculated. This is the time to move medical education to a new social constructivism paradigm based on CASs, rhizomatics and open knowledge. This new construct is predicated on an engaged community, robust knowledge exchange, and self-governance, where collaboration is encouraged and facilitated, curators are enablers but not authorities, and the system is controlled by multiple iterations of social negotiation as via an evolutionary algorithm. David Cormier better describes this as “the community is the curriculum”.
(Stay tuned for Part 2 next Tuesday, when artificial intelligence makes an appearance as a process to facilitate non-hierarchical learning in medicine .)
References and further reading
- Complex Adaptive Systems. Chans S. MIT.
- Evolution and Memes: The human brain as a selective imitation device. Blackmore S.
- Stigmergic Collaboration: The Evolution of Group Work. Elliott M.
- How do we structure knowledge? … Enter the rhizome. Cabrera R and Roland D.
- A Non-Hierarchical Model for Learning in the Health Professions…The “Rhizogogy” Chain. Cabrera D and Roland D.
- Hacking Medical Education with FOAM. Nickson C.
- Social Constructivism. GSI Berkeley Graduate Division. http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/social-constructivism/
- Life in the fast lane.
- Rhizomatic Education. Community as Curriculum. Cormier D.
Image Bernard Goldbach via flickr under Creative Commons License CC2.0