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• W3210182574 abstract "Purpose: Wicked problems are those that involve multiple causes, are unpredictable, involve intractable people, and usually have layers of political and social factors to consider. 1 The complexity of wicked problems requires new approaches for problem solving and evaluation since there is not a simple linear relationship between root causes and outcomes. The education field has developed a new evaluation approach using a systems thinking lens to account for multiple factors interacting in different ways to impact an outcome. 2–5 Systems thinking is “the ability to see patterns of change and how parts affect the whole.” 6 Systems thinking may be beneficial for solving “wicked medical education problems,” such as mistreatment. Approach: We used a systems thinking approach akin to conducting a root cause analysis (RCA) to examine why University of Utah School of Medicine students report higher rates of mistreatment than other medical students nationally and why our local interventions, to date, have not resulted in mistreatment incident decreases. From August to November 2020, a facilitator led our 41-member Curriculum Committee through a systems thinking approach by which members: (1) identified factors relevant to problem; (2) mapped out how the factors related to each other via a concept map; (3) identified patterns and underlying structures in the concept map; (4) identified factors most important to the situation; and (5) determined the most important factors. The last step of the approach was not completed by the Curriculum Committee (see Discussion section for why). The systems thinking approach is different from RCA because prompts/questions are designed to help members consider the entire system and a concept map allows members to better visualize the relationships among individual factors. Themes for factors most important to the problem were voted on by Curriculum Committee members. Each theme was then categorized as requiring a solution beyond Curriculum Committee authority (e.g., system-wide solution) or within Curriculum Committee’s authority to solve. Results: A concept map of 50 factors the Curriculum Committee thought to be related to the mistreatment problem was created and used to identify patterns and structures, which were then grouped into 12 themes. Only 2 themes emerged as within Curriculum Committee’s authority—lack of a centralized mistreatment reporting system/closing the loop with students and consistent faculty/resident training. The Curriculum Committee felt that the remaining 10 themes were outside their authority, with most relating to “cultural factors” of the learning environment. The 2 themes prioritized for the solution stage were culture and creation/implementation of a centralized reporting system/closing the loop. Discussion: There was a reluctance by Curriculum Committee members to move into the solution stage based on the analysis of results because of the lack of authority for making sustainable change outside the bounds of the curriculum. As a result of our systems analysis of student mistreatment, we determined solutions would need to be developed with broad representation of the institution including leadership at clinical sites where students rotate outside the University hospital. Significance: Wicked problems in medical education, like mistreatment, have cause and effect on multiple parts of a system. The learning environment, in particular, extends beyond what a Curriculum Committee has authority over. Systems thinking allowed our Curriculum Committee to see that any solutions to our student mistreatment problem would need to be developed with broad input/support from all areas of the system—academic affairs, residency, etc." @default.
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• W3210182574 date "2021-10-27" @default.
• W3210182574 modified "2023-09-26" @default.
• W3210182574 title "Systems Thinking to Solve Wicked Problems Like Mistreatment" @default.
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• W3210182574 doi "https://doi.org/10.1097/acm.0000000000004312" @default.
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