In 1950, newly trained physicians may have gone the entire lengths of their careers without experiencing a doubling in medical knowledge. In 2011, Densen predicted that medical knowledge would have a doubling time of approximately 73 days – or 0.2 years – by 2020. “What was learned in the first three years of medical school,” according to Densen, “will be just 6 percent of what is known at the end of the decade from 2010 to 2020.” Today, physicians of all ages – from students to experienced attendings – continue to struggle and keep up with the exponential growth, or “flood,” of new medical knowledge. Thus, critical transformations in the culture, structure, and educational approaches of medicine are urgently required for sustained, successful education of current and future generations of physicians and improved patient outcomes moving forward.
One motto, however, is preventing this prompt transformation in medical education (MedEd): We’ve always done it this way.
According to Forbes, this is the “most dangerous” motto in business. Career experts state that this cold, belittling, and “toxic” motto, like its relative motto back in my day, we had it worse, must be removed from the vocabularies of professionals. This is because the refusal to change and adapt new, innovative ideas or strategies – as these mottos suggest – leads to stagnation, complacency, and, ultimately, failure to reach maximum potential. Additionally, these mottos imply that a certain level of professional suffering is justified and to be expected for success without a reasonable opportunity for alleviation. In MedEd’s case, this frequently results in the exacerbation of maladaptive professional behaviors and identity formation, contributing to negative health consequences. Always doing things a certain way (as is often done in MedEd) without evaluating the implementation of alternative approaches does not lead to continuous improvement and halts the professional development of both individuals and organizations.
I am not necessarily saying that we need to make MedEd easier because, as Proverbs 27:17 states, iron sharpens iron; humans must sharpen one another to grow continually. What I am saying, though, is that we, as an academic community, must critically reflect on our current educational climate and ask ourselves if our current educational practices are optimal or if they could be significantly improved to meet the needs of 21st-century health care. Because extensive recent literature suggests the latter and that MedEd is failing to keep pace.
Remember Blockbuster Video? Its outdated business model prevented it from adapting quickly to modern times and consumer needs (i.e., the flexibility to rent videos at home rather than at a physical store). This resulted in a poor series of financial choices, such as passing on the acquisition of Netflix for only $50 million, and the company filing for bankruptcy in September 2010 to overcome an almost $1 billion debt. The American Medical Association recently issued a call to end this motto in emergency physicians. This call must now be extended to all medical fields and the widespread institutionalization of modern, evidence-based practices is imperatively needed to address this call.
Educational and clinical protocols were altered to accommodate the demands of social isolation worldwide during the coronavirus-2019 (COVID-19) pandemic. Advancements in technology, Internet, and infrastructure access resulted in new virtual MedEd practices to also uniquely meet these demands. Now that we are beyond the COVID-19 pandemic, we have a chance to continue refining and elevating these virtual practices (like video sessions, pre-recordings, online web pages, digital flashcards, and social media) and balance them with back-to-in-person activities. We can engage with these multimedia tools, which are normally time- and cost-effective (many I can access on my mobile device in seconds for free), to keep up with the rapid expansion of medical knowledge and growing demands of physician learning at all ages. I.e., we cannot afford to flatten this virtual learning curve now that the COVID-19 pandemic is done.
Educators and learners proved to each other that MedEd could be more flexible, accessible, impactful, and self-driven compared to what it was before the COVID-19 pandemic. Let’s face it: MedEd has forever changed, and many believe for the better. For years, many have recognized the need for MedEd to transform, and the COVID-19 pandemic may end up being the catalyst to do so. This current virtual era of MedEd can be leveraged to attract newer generations of physicians and help them manage their workdays more efficiently as they are asked to increasingly accomplish more tasks (such as patient visits, electronic health record charting, hospital learning modules, studying for boards, etc.) with less time amidst rising physician shortages. The same goes for older generations of physicians as the expansion of free, reliable digital tools/resources means that less time or money may be needed to be spent preparing educational materials for their learners, reviewing topics for their own self-study, or adequately addressing patient questions on uncertain topics.
The bottom line is this: If we start rejecting these virtual practices in MedEd and attempt to completely go back to ‘traditional’ learning practices (such as in-person lectures, textbooks, journal articles, and academic conferences), we will fall into we’ve always done it this way trap and will continue failing to meet the needs of 21st-century health care. To “recruit and retain the best and brightest” physicians moving forward, MedEd can no longer be slow to adapt to modern times like how BlockBuster Video was.
Now, am I suggesting that we need to completely do away with ‘traditional’ learning practices? Not at all. When executed correctly, in-person lectures can be lively and engaging, textbooks or journal articles can be fun and exciting to peruse, and academic conferences can be educational parties that help build a sense of community. Even in today’s digital age, medical students still appreciate face-to-face learning, particularly of new topics being first introduced. But, unfortunately, these ‘traditional’ learning practices are usually executed poorly. Many in-person lectures are “boring” and unnecessary, many physical textbooks are outdated and cumbersome to explore, and national academic conferences can be costly for learners to attend without offering much additional professional benefit when compared to smaller student/trainee-focused alternatives.
Virtual learning, just like in-person learning, has its limitations too, when not designed accordingly and may result in negative clinical learning outcomes, including in resource-limited environments. On top of this, eliminating in-person learning from MedEd curricula would likely do more harm than good since we (after all) are human beings and social creatures who benefit from physical interaction with one another. So, the likely foreseeable solution is to develop new and powerful hybrid (or blended) learning models that focus on patient-case-based learning and “high yield” medical knowledge. If we want to improve health care quality and return on investment in the long term, educators and learners must reach a cooperative, collegial, and communicative steady state where all parties feel equally heard. I.e., we must give each other more freedom to teach and learn as we mutually feel best. Hierarchical structures that grew from years of ‘traditional’ learning practices must be unpacked globally to steadily democratize 21st-century MedEd and make medical knowledge more accessible and equitable to learn – this can be augmented with virtual tools.
I am a young generation physician. I am self-motivated, want to learn medicine, and care deeply for my patients like many of my cohort. I have worked hard to excel at the early stages of my career while still fulfilling my obligations as a human being and future spouse. I appreciate the hundreds-year-long tradition of medicine, but we’ve always done it this way. The motto no longer works in MedEd. Physicians, like the rest of humankind, are often resistant to change and adapting new ideas or behaviors because this is uncomfortable. Whether just beginning medical school or thirty years into clinical practice, however, we must all recognize that if we want to be better physicians and deliver superior patient care, then we must be comfortable with the uncomfortableness of modern learning. We cannot fear failure and disappointment – the reward is far greater in the end.
In conclusion, we need to embrace a successful business mindset in MedEd and institutionalize evidenced-based curricular changes now. Times in health care are different today than they were even ten years ago. Back in your day, being told “what to memorize” and what to do was the norm; literature suggests this is an insufficient norm that failed many high-potential learners and, consequentially, patients. Medical students and trainees today can find the high-yield medical information they need to know on their laptops and phones and on their own time when they are motivated to do so. What we lack the most now – and what new MedEd models need to supply us with – are guided opportunities to refine our critical thinking skills and systematically apply medical knowledge to solve problems and achieve effective clinical decision-making competencies. I.e., the absolute best way for us to get better at medicine is to practice it repetitively and through multiple modalities by seeing patients regularly, navigating electronic health records, actively rehearsing board-style questions, rinsing, and repeating.
As de Oliveira et al. (2024) declare: “We have more evidence than ever about how to provide high quality, person-centered care and to keep patients safe. Shame on us if there is any hesitation about applying this knowledge to make the health care experience better for patients and providers.” MedEd needs to train physicians for the times which they are in and about to enter, not the times of before. Otherwise, MedEd – like any other outdated business – will end up just like Blockbuster Video … and soon.
Casey Paul Schukow is a pathology resident.
