COVID-19 has forced many medical training institutions to go virtual. Although this is easy for some, its full incorporation into the curriculum may be challenging to others who are caught flat-footed and unable to keep pace with online learning. For most medical schools, this new norm in medical education is now becoming routine. Beginning with online teaching and online assessment, further creativity will result in online virtual clinics and student consultations. Various gadgets and tools, including virtual and augmented reality, will eventually enhance teaching and learning efforts. The truth is virtual teaching and assessment are here to stay. This will have significant implications in the field of medical education worldwide.
The interaction between the physical and virtual world has led to the birth of the Industrial Revolution 5.0. The adoption of such interaction provides enormous room for ingenuities and creativity. Already remote robotic surgeries, augmented and virtual reality in rehabilitation, remote 3D organ printing and virtual consultations are some of the healthcare activities that have started over the last 5 years. To medical students, this accessibility to IR 5.0 and the human-robot interaction will result in total radicalization and revamp of the medical curriculum. Gone are the days when remembering and rote learning is emphasized. Recall of knowledge in examinations will probably be obsolete.
Clinical skills examination will be replaced by advanced technology and sophisticated equipment like the Bluetooth-enabled stethoscope with Artificial Intelligence (AI) capability for making a clinical diagnosis. Pen-sized ultrasounds will be used in clinical examinations, making the traditional clinical examinations irrelevant and a thing of the past. Elements of IR.5.0 will move on to remote awake and pinhole surgeries and capsule endoscopies with cameras and biosensors for diagnosing gastrointestinal tract disorders like targeted genetic engineering-assisted cancer diagnosis. Photos of skin conditions will be immediately matched to known diseases through the AI database. Combinations of different symptoms and signs through artificial intelligence will make provisional diagnosis more accurate. This future expectation and advancement in healthcare will have a bearing on the way we train medical doctors.
The well-established Bloom’s taxonomy in medical education and learning objectives will thus be challenged. Traditional teaching and assessment are commonly associated with ‘absorption’ and recall of facts, names and terminologies. Those with the best recall capabilities will get good grades and are considered ‘clever’. The same can no longer be true in the new normalcy. Einstein once said, “Why memorise when you can refer?” This is an excellent indicator that memory should be used for higher-order thinking, not for rote learning and recall of facts. Acquiring knowledge through recalling facts and regurgitating them fluently may now be obsolete as students have instant access to theoretical knowledge on their mobile phones.
The entire profession of a doctor may be in jeopardy as more and more people resort to readily available knowledge on the web. Medical knowledge is, thus, no longer a privilege of doctors. The ‘Remember’ portion of Bloom’s taxonomy may no longer be valid. However, understanding bodily function is still relevant as this understanding is critical when diseases disrupt the body system.
Students learn better through the visualisation of concepts. Thus, they will better understand a body's function and disruption through animation, augmented or virtual reality, which will be the new normal in medical education. The knowledge acquisition will no longer be through lectures or presentations of PowerPoint slides or even a voiceover PowerPoint because animation will take over. Teachers will thus need to acquire the art of animation of concepts that require special skills.
As a consequence, the duration of medical training could be shortened as knowledge could be acquired at students’ own pace. Examinations will also be tailor-made to suit students’ readiness. The space in the curriculum could then be used to expand experiential learning as this part of the ‘hidden curriculum ‘is still the key test in assessing the quality of a doctor.
The overwhelming challenge is to train an emphatic doctor in his ability to empathise and remain compassionate despite dealing with these creative technologies. This cannot be done through virtual means. This is only possible through witnessing people's sufferings, smelling the environment and touching the sick. Only through this can a doctor appreciate his patients' pains and join in the celebration and joys of being cured.
Medical education training can thus be revised and revolutionised. The traditional 5-year training may be too long if all the theoretical knowledge can be done at the student’s pace. More time should be spent on enhancing the ‘hidden curriculum’ where students are on-site witnessing illnesses and the nuances in all settings. For example, regular classroom teachings could be suspended when a terrible earthquake or tsunami strikes around the region. Students will be deployed to witness, help and see all the humanitarian disasters that could be seen during his training.
The first year could start with full exposure in the wards rather than in the classroom, in the Intensive Care Unit (ICU), talking to the sufferers of diseases and relatives of those suffering. This will significantly impact these young minds, and measures must be taken to mitigate the psychological distress that may result. These real-life exposures will strike these young minds positively because this will etch a permanent image as they witness the carers' illness and suffering.
The elements of a hidden curriculum are potent determinants in shaping the persona of medical students. This critical experiential learning will differentiate between a scientifically and technologically advanced doctor and those with empathy, humanity and ethical behaviour.
Bloom’s taxonomy should also be modified to include the elements of humanity, the interaction between society and their environment, and the philosophy underlying these interactions.
This will perhaps be the future of medical education.
Please note that the views expressed in this article are those of the author and do not necessarily reflect the opinions or positions of Vital Signs.
