Role boundaries and complex health systems: Implications for medical education

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.