Role boundaries and complex health systems: Implications for medical education
Bibliographic record
Abstract
Health professions practice is becoming increasingly complex with a rapid growth in knowledge and technology, as well as increasing specialization and sub-specialization within and between health professions. This has resulted in a blurring of the lines of expertise and professional responsibility in health care delivery. In addition, instability in the funding and regulation of education, research and health care has resulted in frequent shifts in how health care is structured and practiced. These challenges raise the questions: what are the roles of physicians in shaping and delivering the future of health care? And how can medical education best prepare physicians to assume those roles? To answer these questions, the authors synthesize the literature on role boundaries and boundary work emanating from various disciplines, including sociology, anthropology and public health. They describe the importance of physicians being able to engage in effective boundary work to address the increasingly complex and rapidly changing health care systems in which they will work. In addition, they provide a critical synthesis of the theoretical origins of role boundaries, the strategies employed in and the outcomes of boundary work, and the evolution of who has been involved in boundary work throughout the history of the medical profession. Using insights gained from this analysis, the authors propose strategies to assist medical educators in preparing future physicians to engage explicitly, deliberately and inclusively in boundary work. These include being able to work in rapidly changing and less clearly demarcated roles and being equipped to actively negotiate the future of health care. By meaningfully incorporating role boundaries and boundary work into medical education, the authors contend that medicine and medical education will be better equipped to navigate the growing complexity and instability that is likely to define health care practice moving forward.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.013 | 0.073 |
| Scholarly communication | 0.014 | 0.024 |
| Open science | 0.003 | 0.015 |
| Research integrity | 0.007 | 0.007 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".