By Prof Dr Zabidi-Hussin

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 are unable to keep pace with online learning.

For most medical schools, this new norm in medical education is now becoming normal. Beginning with online teaching and online assessment, further creativities will result in online virtual clinics and consultations by students. A whole assortment of gadgets and tools, including virtual and augmented reality, will eventually be employed to enhance the teaching and learning efforts. The truth is virtual teaching and assessment is here to stay. This will have major implications for the field of medical education worldwide.

The interaction between the physical and virtual world has led to the birth of Industrial Revolution 5.0. Adoption of such interaction provides such an enormous room for ingenuities and creativities. Already, remote robotic surgeries, augmented and virtual reality in rehabilitation, remote 3D organ printing and virtual consultations are some of the lists of healthcare activities that had started over the last 5 years.

The new normalcy

To students of medicine, this accessibility to the IR 5.0 and the human-robot interaction will result in total radicalisation and revamp of the medical curriculum. Gone are the days where remembering and rote learning is emphasised. 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 the areas of remote awake and pinhole surgeries, capsule endoscopies with cameras and biosensors for diagnosis of gastrointestinal tract disorders, in the same way as 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 was once quoted “Why memorise when you can refer?” This is a very good indicator to say that memory should be used for higher-order thinking and not for rote learning and recall of facts. The acquisition of knowledge through recall of facts and regurgitating them fluently may now be obsolete as students have instant access to theoretical knowledge on their mobile phones.

In fact, 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, the understanding of a bodily function is still relevant as this understanding is critical when diseases disrupt the body system.

Visualisation of concepts

Students learn better through the visualisation of concepts. Thus, they will understand the function and the disruption of a body better through animation, augmented or virtual reality which will be the new normal on medical education. The knowledge acquisition will no longer be through lectures or presentations of PowerPoint slides or even a voiceover PowerPoint because the 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 and his ability to empathise and to remain compassionate, despite having to deal with these creative technologies. This cannot be done through virtual means. This is only possible through actually witnessing the sufferings of people, smelling the environment and touching the sick. It is only through this that a doctor could appreciate the pains of his patients and join in the celebration and joys of being cured.

The medical education training can thus be revised and revolutionised. The traditional five-year training may be too long if all the theoretical knowledge could be done at students’ own pace. More time should be spent on enhancing the ‘hidden curriculum’ where students are on-site witnessing illnesses and the nuances in all settings.

As an example, regular classroom teachings could be suspended when a terrible earthquake or tsunami strikes somewhere 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 perhaps could probably 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 produce a significant impact on these young minds and, of course, measures must be taken to mitigate the psychological distress that may happen as a consequence. Those real-life exposures will strike these young minds positively because this will etch a permanent image as they witness the illness and the suffering of the carers.

Hidden curriculum

The elements of a hidden curriculum are powerful determinants in shaping the persona of medical students. These critical experiential learning will make the difference 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, of interaction between humanity and their environment, plus the philosophy underlying these interactions.

This will perhaps be the future of medical education.

-- BERNAMA

Prof Dr Zabidi-Hussin FRCPCH is Fellow of the Royal College of Paediatrics and Child Health of the United Kingdom and member of the Expert Panel of the European Research Agency.