Self-organisation, integration and curriculum in the complex world of medical education Stewart Mennin CONTEXT The world of medical education is more complex than ever and there seems to be no end in sight. Complexity science is particu- larly relevant as medical education embraces a movement towards more authentic curricula focusing on integration, interactive small-group learning, and early and sustained clinical and community experiences. DISCUSSION A medical school as a whole, and the expression of its curriculum through the interactions, exchanges and learning that take place within and outside of it, is a complex system. Complexity science, a derivative of the natural sciences, is the study of the dynamics, conditions and consequences of interactions. It addresses the nature of the conditions favour- able to change and transformation (learning). CONCLUSIONS The core process of com- plexity, self-organisation, requires a system that is open and far from equilibrium, with ill- defined boundaries and a large number of non-linear interactions involving short-loop feedback. In such a system, knowledge does not exist objectively ‘out there’; rather, it exists as a result of the exchange between participants, an action that becomes knowing. Understanding is placed between participants rather than being contained in one or the other. Knowledge is not constructed separately in the mind of the knower, but, rather, it emerges; it is co-created during the exchange in an authentic recursive transactive process. Learning and knowing become adaptive responses to continuously evolving circumstances. An approach to curric- ulum based on self-organisation is characterised as rich, recursive, relational and rigorous and it illuminates how a curriculum can be understood as a complex adaptive system. The perspective of complexity applied to medical education broadens and enriches research questions relevant to health professions educa- tion. It focuses our attention onto how we are together as human beings. How we respond to and frame the issues of learning and under- standing that challenge contemporary medi- cine and, by extension, medical education, in a complex and rapidly changing world can have profound effects on the preparedness of tomorrow’s health professionals and their impact on society. complexity in education Medical Education 2010: 44: 20–30 doi:10.1111/j.1365-2923.2009.03548.x Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA Correspondence: Stewart Mennin, Rua Inhambu 1708, Moema, Sa ˜o Paulo CEP 04520-015, Brazil. Tel: 00 55 11 2501 8345; Fax: 00 55 11 2501 8346; E-mail: smennin@gmail.com 20 ª Blackwell Publishing Ltd 2009. MEDICAL EDUCATION 2010; 44: 20–30