Transforming practice organizations to foster lifelong learning and commitment to medical professionalism

Practice organizations will increasingly engage in activities that are the functional equivalents of continuing medical education. The authors maintai n that if these activities are properly structured within practice organiza tions, they can become powerful engines of socialization to enhance physici ans' lifelong learning and commitment to medical professionalism. They prop ose that this prom ise can be realized if new or reformed practice organiza tions combine education and service delivery and institutionalize processes of individual and collective reflection. The resulting "institutions of re flective practice" would be ones of collegial, experiential, reflective lif elong learning concerning the technical and normative aspects of medical wo rk. They would extend recent methods of medical education such as problem-b ased learning into the practice setting and draw on extant methods used in complex organizations to maximize the advantages and minimize the disadvant ages that practice organizations typically present for adult learning. As s uch, these institutions would balance the potentially conflicting organizat ional needs for, on the one hand, (1) self-direction risk taking, and creat ivity; (2) specialization; and (3) collegiality; and, on the other hand, (4 ) organizational structure, (5) coordination of division of labor, and (6) hierarchy. Overall, this institutionalization of reflective practice would enrich practice with education and education with practice, and accomplish the ideals of what the authors call "responsive medical professionalism." T he medical profession would both con tribute and be responsive to social va lues, and medical work would be valued intrinsically and as central to prac titioners' self-identity and as a contribution to the public good.