The significance of a dialectical approach to enrich health professions education

Abstract

The Lancet Global Independent Commission has called for a systems-based approach to health professions education. They emphasised the acquisition of collaborative skills, critical reasoning and ethical conduct to prepare students for interprofessional collaborative practice (IPCP). Interprofessional education (IPE) has been put forward as a promising strategy. However, despite the global efforts to incorporate IPE in health professions education curricula, the evidence for a positive impact on IPCP is still inconclusive. This may be related to the misalignment between competency-driven IPE programs that focus on end-stage professional competence and the non-linear development of students’ competence that is necessary for the dynamical nature of IPCP. Therefore, we argue that health professions education, and IPE in particular, needs to incorporate these dynamical processes including social and organization sensitivity. We present a conceptual framework that integrates the Cultural-Historical Theory, the principles of dialectical thinking and the concept of metastable attunement. While dialectical thinking is the ability to perceive the complexity of a dynamic reality that is in a state of constant transition, metastable attunement refers to the consequent adjustment to it. The subsequent instructional design employs a dialectical approach to teaching and learning, based on mediating activities and dialectical inquiry. To reach the full potential of this approach, the mediating activities should ensure a continuum of learning across the curriculum. In addition, faculty development needs to focus on the principles of dialectical inquiry as a pedagogy to optimally guide students. Further research into the extent to which healthcare professionals and students think dialectically may inform improvements to the proposed instructional design, the structure of the learning continuum and the essential requirements for faculty development.