LAUSR

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Cultural historical activity theory (CHAT) provides a framework to analyze complex systems both in research and in curriculum design and evaluation. By using CHAT, scholars and leaders can study new educational innovations or existing processes to discover the facilitators of and barriers to change.1 CHAT emerges from Vygotsky’s concept of object-oriented action (an activity) mediated by tools (both symbolic [e.g., competencies] and physical [e.g., a patient’s chart]).2 Engeström, a prominent CHAT theorist, uses the activity system as the unit of analysis to explore the myriad relationships that are part of a complex setting.3 CHAT can be used to understand systems of different scales—from daily interpersonal interactions to large institutional initiatives.