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Surgical Education as a Complex Adaptive System: The Need for Pedagogical Competence
Mackenzie Cook1, Ruchi Thanawala1
1Department of Surgery, Oregon Health & Science University, Portland, Oregon.
Journal of Surgical Education
|June 26, 2026
Summary
Surgical training is a complex adaptive system, not a simple teacher-student link. Faculty need pedagogical competence to guide residents effectively in today's changing healthcare environment.
Area of Science:
- Medical Education
- Surgical Training
- Health Systems Science
Background:
- Surgical graduate medical education (GME) faces transformation due to competency-based education, complex health systems, and sociotechnological changes.
- The training environment is unstable, impacting how surgeons learn and faculty teach.
- Traditional teacher-learner dynamics are insufficient in modern healthcare.
Purpose of the Study:
- To reframe surgical education as a complex adaptive system.
- To define the essential pedagogical competencies required for surgical faculty.
- To advocate for structural reforms in surgical GME.
Main Methods:
- This is a perspective piece, not an empirical study.
- It analyzes the impact of systemic changes on surgical training.
- It synthesizes current challenges and proposes a new framework for faculty development.
Main Results:
- Surgical learning emerges from interactions within a complex adaptive system, involving learners, faculty, teams, institutions, and regulations.
- Faculty require pedagogical competence, including dialogue-based alliances, entrustment decisions, learning opportunity creation, and assessment skills.
- Lack of faculty preparation compromises competency-based assessment and entrustment.
Conclusions:
- Surgical education must be viewed as a complex adaptive system.
- Pedagogical competence is crucial for faculty to navigate the evolving healthcare landscape.
- Structural reforms are needed to support faculty development and ensure training integrity.
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