LAUSR

The present issue of Medical Teacher contains a significant paper: The Experiences of Community Organizations Partnering with a Medical School to Improve Students’ Understanding of the Social Determinants of Health: A Qualitative Study (Palakshappa et al. 2022). It embarks upon explicating the three-way relationships among a medical school, its students, and the communities in which learning about the determinants of health takes place within the curriculum. Indeed, its most significant innovation is its attention to the relationships between these three elements and some of the methodologies necessary to meaningfully study them. There are two reasons why this slight opening of a doorway to future studies to better understand adaptive curricular change is both important and urgent. The first rests in the theory of complex adaptive systems. The second arises from the first and relates to the atomization of curriculum, assessments and indeed medical knowledge itself into ever more refined, admittedly measurable, bits of information that frequently fail to amount to the transmission of knowledge let alone to the wisdom required to fulfill our aspirations of healing. As Eliot might have noted nearly a century ago, the meaning of human existence and hence the meaning of a healing profession is to be found in the wise application of information and knowledge; not its seemingly random allocation to parts of the human body—or parts of society for that matter. The authors of this study observe, with appropriate modesty, that they are embarking on an exploration of an understudied relationship between institutions of learning, their students, and the communities in which some of the curriculum of instruction takes place. They also report on some of the methodologies of learning and understanding required to better explore the possibilities for ‘transformative learning’ enabled by the relationships between the realm of study (social determinants of health), the context (community-based) in which such learning might most appropriately take place and the agents (community service organizations) best suited to facilitate that learning. As we will see, these complex relationships are not trivial and a better understanding of them will serve all parties; most hopefully the patients they all seek to serve. So why is this embarkation on a study of relationships so important? A brief overview of complex adaptive systems theory might help us here. With appropriate obeisance to Peter Gay,