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Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

ABSTRACT: PURPOSE: Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. METHODS: We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. RESULTS: General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. CONCLUSIONS: This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.

SUBMITTER: Sturmberg JP

PROVIDER: S-EPMC3896540 | biostudies-literature | 2014 Jan-Feb

REPOSITORIES: biostudies-literature

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Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

Sturmberg Joachim P JP Martin Carmel M CM Katerndahl David A DA

Annals of family medicine 20140101 1

<h4>Purpose</h4>Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine.<h4>Methods</h4>We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to ...[more]

PMID: 24445105

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Project description:BackgroundGiven the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.MethodsSystematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.Results4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.ConclusionThis review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

Project description:ObjectiveTo learn from the experience of foreign general practice education mode, and to exploratory study on the mode and method of general education and training for general practice undergraduates in China.BackgroundThe rise of general practice medicine addresses the lack of holistic attention to patients in specialist medicine. General practice education is an important means of training general practice skills, but the development of general practice education in China is not yet matured.MethodsBy using the method of comparative education, taking the United States, Australia, France and Britain as examples. This article makes a comparative analyzes the status of general practice education in foreign countries and discusses the development of undergraduate general practice education in China from four perspectives: national policy, teacher resources, curriculum system, and education training modes.ConclusionsThe four countries attach great importance to general practice education, with mature training methods, registered practice and continuing education. It is hoped that this article can establish and improve the policy system for the development of general subject teachers and optimize the inclusive, assessment and evaluation system of general practice teachers. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences.

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Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

Publications

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

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