Medicine is practiced in environments of volatility, uncertainty, complexity, ambiguity, and disruption (VUCAD). Medical educators are tasked with providing an education that prepares graduates to successfully practice medicine in those types of environments. While medical education is continually evolving to incorporate new content and educational approaches, there are two mega-evolutions that have permeated medical education: increased curricular structure and content integration. Structure and integration are assumed to be positive changes; however, they may alter the development of higher cognitive skills such as information management, planning, breadth of approach, strategy, and initiative. As new graduates will practice in VUCAD environments, it seems prudent to consider the effects of medical education’s mega-evolutions on the development of higher cognitive skills critical to those types of environments. This paper explores the potential consequences of the increased curricular structure and content integration in medical education for learners who will practice in VUCAD environments and proposes a research agenda to better understand the relationship between curricular structure and integration and higher cognitive skill development.

中文翻译：

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医学教育的大进化：对高级认知技能的发展有帮助还是有害？

医学在波动性、不确定性、复杂性、模糊性和破坏性 (VUCAD) 的环境中实践。医学教育工作者的任务是提供一种教育，使毕业生做好在这些类型的环境中成功行医的准备。在医学教育不断发展以纳入新的内容和教育方法的同时，医学教育有两个巨大的演变：增加的课程结构和内容整合。结构和整合被认为是积极的变化；然而，它们可能会改变更高认知技能的发展，例如信息管理、规划、方法的广度、战略和主动性。由于新毕业生将在 VUCAD 环境中练习，考虑医学教育的巨大进化对发展对这些类型环境至关重要的高级认知技能的影响似乎是谨慎的。本文探讨了医学教育中增加课程结构和内容整合对将在 VUCAD 环境中实践的学习者的潜在后果，并提出了一项研究议程，以更好地理解课程结构和整合与更高认知技能发展之间的关系。