1 Introduction

Medical education has gone through many major changes. Modern medical education, to put it succinctly, arguably began in the Middle Ages, when medical education was relocated to universities. Prior to that, doctors were educated through apprenticeships (Custers & Cate, 2018). At the time, medical education at universities was predominantly for “learned gentlemen” while surgeons generally apprenticed themselves with a seasoned practitioner. The structure of teaching “basic and clinical sciences” (as we would call them today) in the earlier years and providing clinical exposure in the later years was established at universities during this period (Custers & Cate, 2018).

In the twentieth century, a major change in medical education came when Abraham Flexner, an educational reformer, examined medical education in the United States and Canada. His report in 1910 recommended higher admission standards and higher-quality research and teaching (Cooke et al., 2006). This resulted in a much higher-quality and more uniform medical education and the training of more competent doctors. The medical schools that could not meet standards also closed.

Since then, there have been many more changes in medical education. Two examples are the introduction of problem-based learning by McMaster University in Canada (Servant-Miklos, 2019) and the creation of objective structured clinical exams in 1975 at the University of Dundee in Scotland (Harden et al., 1975). Changes are continuing to push medical education into the future. In this discussion, we, as practicing medical doctors with academic roles, will discuss the constant evolution and future of medical education in the areas of curriculum and the implementation of future technologies.

2 Curriculum

As medical science has advanced and knowledge has increased, the need to provide future doctors with a large volume of new and updated information and insights has been a constant challenge. One of the first things that one of our teachers at medical school said was that we were going to learn more scientific content in medical school than he had done only 10 years earlier. This has been made possible especially with advancements in technology. Medical articles and texts are now readily available online. Students can easily access journals through PubMed or electronic versions of their texts, saving the time it would take to search for the content in a library. Having these resources available so readily contributes to learning larger volumes of information.

Another contribution to improving the learning experience is the streaming and recording of lectures. This enables students to attend lectures from the comfort of their homes if they are unable to attend in person or to prioritize their schedule and attend the lecture later. As medical students, we often found it helpful to maximize our productivity by reviewing lectures according to our own schedules and skipping the parts of lectures that covered subjects with which we were already familiar. As medical education continues to advance, remote learning and virtual lectures will become more prominent. The current pandemic has demonstrated that many learning activities can be done remotely. Before the pandemic, while lectures may have been done remotely, tutorials and other group-based sessions were always done face-to-face. Now, as tutorial leaders, we use Zoom or Skype sessions to conduct tutorials effectively. Many laboratory sessions such as pathology and anatomy labs have also been moved to online sessions. While the argument exists that nothing can replace the feeling of touching human tissues and structures in an anatomy laboratory, some medical schools operate their anatomy labs without a cadaver program for financial and/or logistical reasons. These schools rely on models, photographs, and anatomy software that produce 3D models for their anatomy teaching. As medical education moves toward the future, technology will play a larger role in helping medical educators deliver material online for the convenience of both students and teachers and to help students assimilate larger amounts of information.

Furthermore, to help instructors teach larger amounts of information, there has been a shift from passive to more active learning. Some schools have done away with lectures entirely and left it up to the students to learn the material with supplied and supplemental resources. Students who learn in this way solidify their understanding through group discussions and tutorials.

One of the first major shifts from passive to active learning began with the introduction of problem-based learning, also known as case-based learning (Norman et al., 1993). In this learning forum, students discuss a medical case among each other while being supervised by an expert tutor who is also a medical doctor. From our own experiences, we have noticed the many benefits of problem-based learning, such as benefiting from the strengths of colleagues, including the expertise they have derived from life experiences such as previous involvement in research or in other healthcare professions. We have found that case-based learning helps foster teamwork and communication, which are key skills in clinical practice.

Most importantly, case-based learning simulates real-life situations that students will encounter on the wards as the cases are drawn from real clinical cases. However, case-based learning is not without its faults. Certain topics are difficult to grasp through self-learning and case discussions and require a dedicated lecture. We have noticed that this is especially true for topics related to anatomy that cannot be explained in detail in case-based learning due to time constraints and the lack of models or resources. This can also be said for topics involving basic science that can be distracting to explain in group sessions. Case-based learning also depends significantly on student participation, but discussions can often be dominated by more extroverted students and not necessarily by those who have the correct answers. Despite this, the benefits of case-based learning outweigh its deficits. Many studies have shown that case-based learning can be beneficial in multiple areas such as collaboration and problem-solving (Burgess et al., 2021; Cen et al., 2021; Zhao et al., 2020) However, schools should use passive learning such as lectures together with active learning opportunities in order to maximize each student’s potential if they want to produce proficient doctors. Indeed, some medical schools have been moving back toward giving more lecture content while still retaining active learning and case-based learning sessions. Some medical schools have created separate streams of learning, which allows students to select the track that best suits their career interests and styles of learning.Footnote 1 This will likely become more prominent in the future as more medical schools move toward separate pathways.

While it is true that changes in how content is delivered and changes in the curriculum have made important strides in helping students learn content in the preclinical years of medical school, there have also been changes in what content medical school education emphasizes. Because there has been a heavier emphasis on the ever-evolving science of biomedicine in order to deal with the increasing complexity of health conditions, doctors graduating from medical school today are becoming more and more scientifically sound in their knowledge but also progressively less independent than doctors who graduated in prior years. We distinctly recall that a classmate during the first week of medical school told us that her doctor parents graduated medical school just 30 years earlier equipped with the knowledge to practice independently as general practitioners in a rural area and the ability to perform “minor” surgical procedures such as uncomplicated appendectomies. Today, general practitioners are their own specialty, and the graduating doctor needs to undergo several years of specialty training in order to practice independently in their chosen specialty. Medicine has become more and more specialized. Procedures such as appendectomies, which were once general skills for graduating doctors, are now progressively being taught at the postgraduate level and are firmly in the realm of their own specialties. As medical science evolves, medical education will become more scientifically oriented, and many more procedural skills will be taught at the postgraduate level.

3 Technology and the Future of Medical Education

In addition to distance learning, advancements in simulations and virtual reality can improve the education of future and current doctors.

Medical education has long employed the use of simulated situations and used simulated or actor patients. However, the use of mixed-reality simulations could further aid the integration of formal knowledge and clinical experience. These offer realistic medical scenarios but eliminate patient harm. Users in a controlled learning environment could observe abnormal pathology that is not otherwise readily available through live patient encounters. This would enable them to practice deliberately and reflect on their performances individually or via team training and could safely learn from their mistakes in order to achieve a well-defined benchmark (Guze, 2015). Medical faculty could review their performance and provide individualized/effective feedback, especially in an exam scenario. Blended learning approaches using virtual worlds and other serious games can provide repeated exposure to meet different students’ requirements when combined with face-to-face simulation or clinical placement.

There has also been exploration into using virtual or augmented reality in medical education. This technology has the potential to revolutionize the teaching of anatomy, surgery, and clinical medicine. Augmented reality can provide 3D models that are difficult to visualize in a classroom, allowing users to grasp concepts and visually absorb how those systems work, both independently and with one another. This method of integrating theoretical materials is most effective with visual learners and has proven to improve students’ engagement and support self-directed learning (Bogomolova et al., 2020).

The US National Library of Medicine has created the Visible Human Project that involves digitized color photographic slides with 1 mm anatomical sections, allowing users to visualize cross-sectional cryosection, CT, and MRI images obtained from one male cadaver and one female cadaver.Footnote 2 Some notable applications or software that provide 3D anatomy images with augmented reality include Complete Anatomy ‘22 (3D4Medical/Elsevier) and Human Anatomy Atlas (Visible Body). For detailed learning of cardiac anatomy, HeartWorks AR (Intelligent Ultrasound) combines cardiac structure with overlaying transthoracic and transesophageal echocardiogram ultrasound views and can be integrated clinically. HoloHuman (GigXR and Elsevier) is a 3D human anatomy atlas that features full-size immersive holograms that allow instructors to provide students with a holographic learning environment via mixed reality headsets.

Ma et al. (2016) have developed a personalized and interactive augmented reality “magic mirror” system, using a sensor to track the user positions, allowing personalized in situ visualization of anatomy on the user’s body. It also shows text information, medical images, and interactive 3D models of organs. One study showed that students who used augmentation of traditional lecture and cadaveric dissection laboratories in conjunction with 3D technologies had significantly higher test scores than those who used two-dimensional pictures, graphs, and text (Peterson & Mlynarczyk, 2016). Another study showed that mobile augmented reality resulted in better test scores, and more permanent learning was achieved in a shorter time as compared to traditional lectures (Küçük et al., 2016). Given that dissection with cadavers is very expensive and time-consuming, the use of such “virtual slides” (at least at the introductory stages of anatomy) can make students’ learning more cost-effective and additionally reduce the cost of hiring instructors.

4 Conclusion

Medical education will continue to grow and evolve as we make advancements in medicine. Continuously adapting curricula and teaching methodologies is necessary in order to meet the needs of educating future doctors and provide them with the latest information and skills they need to be safe practitioners. This will require ongoing use of distance learning and improvements in telecommunications. While the teaching of increasing theoretical information may come at the cost of learning procedural skills at the undergraduate medical education level, this is necessary to deal with the increasing complexity of technical medical knowledge. That being said, advanced skills can be taught at the postgraduate level.

Other developments such as multiple learning streams in medical faculties have also begun to provide students with a tailored experience that best suits their learning styles. Simulations along with virtual and augmented reality have additionally been used at the undergraduate and postgraduate levels of medical education that show promising outcomes. As these technologies grow, they will become more mainstream in the training of the next generation of doctors.