technology in medical education

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Reimagining Medical Education: Using Technology to Educate, Innovate, and Captivate

Reimagining medical education.

Technology is changing many aspects of life and work, as well as the way Yale School of Medicine (YSM) students learn.

“For alumni and students, you know that the Yale System is the core of medical education at Yale. But today we have creative and novel technologies that enable that system in new ways,” said Nancy J. Brown, MD, Jean and David W. Wallace Dean and C.N.H. Long Professor of Internal Medicine, as she welcomed YSM alumni, students, faculty, and staff to the inaugural webinar, Reimagining Medical Education: Using Technology to Educate, Innovate, and Captivate , in the school’s Innovation in Medical Education series.

The four-part series that began on November 4 is designed to showcase “how that innovation enhances our already unique education,” Brown explained. The next session, on January 26, will focus on how simulation is used in medical education at YSM, followed by discussions of the adoption of telehealth in YSM’s clinical skills program and how innovation is being incorporated into the school’s pharmacology training.

The theme of the series aligns with one of the medical education priorities of Jessica Illuzzi, MD, MS, deputy dean for education and Harold W. Jockers Professor of Medical Education—to develop innovative approaches to medical education that are irrevocably engaging and compelling, enhanced by increased use of simulation and evolving technologies and resources. In her remarks, Illuzzi referenced how medicine looks a lot different than it did even a decade ago and will continue to evolve along with technology. In addition, she stated, “the learning style of our students has evolved as they become ever more technologically-savvy."

The panel’s moderator, Associate Dean for Curriculum Michael Schwartz, PhD, was appointed the inaugural director for innovation in medical education in July 2021, demonstrating the school’s commitment to enhancing medical education through technology. Schwartz shared the history of how YSM has been using technology to enhance student learning through devices like iPads and iPad Minis since 2010.

One theme of Schwartz’s remarks was the important role of students in decision-making about what technology to incorporate, since students know what will be useful, versus leadership and faculty trying to anticipate what might be useful. He noted the importance of ensuring students with different levels of tech-savviness pilot technology, since it has to work well for all users.

When a participant asked how faculty stay ahead of changing technology, Schwartz again pointed to students, explaining they “become technology educators for our faculty.” When students first had iPad Minis on the wards in 2013, during rounding, residents and attendings often turned to students to quickly access patient data in EPIC and other online information. This helped to integrate students into teams and allowed for bi-directional teaching and learning. As mobile devices have become more common in clinical spaces, residents and attendings are increasingly modeling their use in patient care.

Schwartz described how use of iPad Minis on the wards also improves interactions with patients and shared how during COVID-19, when telehealth was being used extensively, the iPad Minis importantly gave students access to electronic medical records on and off-site.

The learning style of our students has evolved as they become ever more technologically-savvy. Jessica Illuzzi, MD, MS, deputy dean for education and Harold W. Jockers Professor of Medical Education

In 2010, when YSM first introduced iPads in the pre-clerkship curriculum, it was one of three medical schools to use the technology. By fall 2011, the entire curriculum was delivered through iPads, allowing students to receive faculty members’ most current lecture notes and presentations and to annotate these course materials.

Four faculty panelists shared how they have been using technology to enhance their teaching. William Stewart, PhD, associate professor of surgery (gross anatomy), described how the anatomy lab now has 40 dissection tables with networked iMacs on an adjustable arm. Additionally, he and a team have created 24 interactive iBooks for use in anatomy that are also available to other institutions through the Apple bookstore.

Associate Professor of Emergency Medicine Rachel Liu, BAO, MBBCh, who is the director of point-of-care ultrasound (POCUS) education, noted that since 2015, POCUS transducers paired with iPads and other tablet devices have been available in all YSM educational physical exam practice rooms. Each year, Liu explained, 16 students are trained in the use of these devices and how to teach their peers. This has enabled students to practice POCUS on their own and enhance their ability to learn normal anatomy, physiology, and pathology. Using POCUS, a student will “see the spleen for the first time in their medical career,” Liu stated.

Technology altered how clinical skills were taught during the pandemic, changes that according to Jaideep Talwalkar, MD, associate professor of internal medicine (general medicine) and pediatrics and director of clinical skills, will have staying power because they enhanced learning. Pre-pandemic, small groups of students practiced clinical skills with each other in the clinical skills practice rooms, with faculty providing feedback. COVID restrictions forced creative adaptation. Students practiced on roommates, family members, or even mannequins, using mounted iPads at home if they did not have access to the school’s cameras, with faculty observing remotely providing formative feedback. Students engaged with standardized patients on iPads as they practiced the actual physical exam on a mannequin. Faculty brought iPads to hospital rooms so that students, who could not be physically present, could talk with patients and their team members and participate in care discussions remotely.

The portability and versatility of these tech-driven solutions improved clinical skills training because students were more engaged, there was increased access to faculty and patients, and more opportunities for physical exam practice and feedback.

Deliberate practice—premised on Dr. Anders Ericsson’s concept that people get better at a skill when they practice toward a discrete goal, receive immediate feedback, and have the chance to practice again—led Christine J. Ko, MD, professor of dermatology and pathology, to develop an app that trains people to visually recognize skin cancer. People look at images of skin lesions in a range of skin types and are asked to identify which lesions are skin cancer. Ko has visions of the app expanding to other diseases, specialties, and physical examination skills. Schwartz hopes that in his new role as director for innovation in medical education he will be able to encourage and support more new applications of technology to enhance learning.

Featured in this article

• Nancy J. Brown, MD Jean and David W. Wallace Dean of the Yale School of Medicine and C.N.H. Long Professor of Internal Medicine
• Jessica Illuzzi, MD, MS, FACOG Deputy Dean for Education and Harold W. Jockers Professor of Medical Education and Professor of Obstetrics, Gynecology and Reproductive Sciences
• Christine Ko, MD Professor of Dermatology and Pathology
• Rachel Liu, BAO, MBBCh, FACEP, FAIUM Associate Professor of Emergency Medicine; Director of Point-of-Care Ultrasound Education for YSM
• Michael Schwartz, PhD Associate Dean for Curriculum; Director of Innovation in Medical Education, MD Program; Emeritus Associate Professor, Neuroscience; Senior Research Scientist, Neuroscience; Director, Medical Studies, Neuroscience
• William Stewart, PhD Associate Professor of Surgery (Gross Anatomy); Section Chief
• Jaideep S. Talwalkar, MD Associate Professor of Internal Medicine (General Medicine); Assistant Dean for Education, Medical Education; Associate Program Director, Yale Combined Med-Peds Residency Program; Director of Clinical Skills, Office of Education; Associate Professor, Pediatrics; Editor, Yale Primary Care Pediatrics Curriculum, Pediatrics

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• Video: Yale School of Medicine: "Reimagining Medical Education"

Current Technology in Advancing Medical Education: Perspectives for Learning and Providing Care

• In Depth Article: Commentary
• Published: 13 June 2018
• Volume 42 , pages 796–799, ( 2018 )

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• Joshua Moran 1 ,
• Gregory Briscoe 2 &
• Stephanie Peglow 2  

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Healthcare and medical training have no immunity to universal, rapidly changing technology. In medical education, advances like simulations, virtual patients, and e-learning have evolved as pedagogical strategies to facilitate an active, learner-centered teaching approach. According to Chhetri et al., contemporary generations of trainees have grown up immersed in various technologies and are now less functional in the traditional classroom setting [ 1 ]. Yet, not all of today’s medical trainees or educators are equally adept and comfortable with technology. Educators are tasked with selecting and filtering appropriate technology-based curricula [ 1 ].

Advancement in education requires discerning which learning-assisting technologies merit usage in specific scenarios. To better improve patient care in contemporary times, continual innovative efforts between psychiatric educators and trainees remain essential for fully exploiting technology’s potential. The objective of this commentary is to discuss the various available medical training technologies and subsequent perceptions of trainees to these modalities. Additionally, this commentary considers how education-based technologies could improve or hinder the learning experience of medical trainees.

We conducted a review of articles published from 2007 to 2018 utilizing an online literature search with PubMed and Google Scholar, as well as a professional medical library search via the EVMS Brickell Medical Science Library System using the following key phrases: medical education or medical students and technology, e-learning, simulators, virtual reality, mobile devices, audience participation, computer based, medical illustration, or social media. To identify relevant systematic review articles, MeSH terms were also employed in the search to include these additional terms—medical students, attitude to computers, technology, computers, computer-assisted instruction, computer simulation, simulation training, internet, medical education, medical illustration, computer based, or curriculum. A second search was created to include multimedia use in medical lectures; search terms included the following: medical education, medical students and audiovisual aids, medical illustration, or educational technology. Additionally, the following MeSH terms were included in the second search: medical education, medical students, attitude to computers, multimedia, audiovisual aids, computer-based, or curriculum.

Inclusion and exclusion criteria for eligibility were established; no formal scoring system was employed. Systematic reviews written in English between the years of 2007–2018 were deemed eligible via inclusion criteria if written to inform medical educators on the fields of undergraduate medical training, postgraduate medical training, or continued medical education. An article met exclusionary criteria if only contributing redundant information seen in other (included) systematic reviews or otherwise failed to meet the above conditions. One author (GB) screened titles and abstracts of candidate articles to isolate studies which met the inclusion criteria; selected articles were then reviewed more thoroughly to analyze content.

To organize data from each systematic review meeting inclusion criteria, contributing authors read each review study in its entirety and subsequently consolidated article details into a shared Google Docs table. Chosen systematic reviews were organized into the following medical education topics of interest: e-learning, multimedia in lectures, technology-assisted audience participation, virtual reality and simulators, mobile devices, and social media. Systematic reviews not contributing to any of these specific technology-associated topics were deleted from our analysis. To appraise the quality and design of eligible systematic reviews, each review article was itemized based on outcome measures, review population studied, study purpose, results, identified conclusions, and reported or observed review limitations.

Database searches using our key terms of interest yielded 958 articles. As planned, one author scanned each title and abstract of searched articles to compile a list of 81 relevant systematic reviews (those passing inclusion criteria and escaping exclusion criteria). Sixty-two of the articles passing inclusion criteria failed to fit into any of our six-addressed technology-associated topics of interest; so, these articles were excluded. Of the articles passing inclusion criteria, 19 reviews were relevant to the following technology-associated educational modalities: 4 reviews on e-learning, 1 review on multimedia, 6 reviews on virtual patients and simulators, 3 reviews on audience response systems, 2 reviews on mobile devices, and 3 reviews on social media. No systematic reviews were found specific to multimedia usage in medical education lectures. Three of the smaller systematic reviews in the virtual patient and simulators category were assessed to only contribute information redundant to the other three larger systematic reviews; therefore, these smaller reviews were excluded. Our review appraisal yielded a final 16 articles to be included in our reflection on medical education technology.

A few exceptions were made for this commentary regarding cited articles. First, a non-systematic review (a brief literature review) was included in the introductory background information to provide a contemporary perspective on technological opportunities in medical education. Secondly, no systematic reviews were found specifically addressing the use of multimedia in medical education; therefore, a single review was included to reveal how media has altered the trainee’s experience in medical school classroom. Lastly, the Accreditation Council for Graduate Medical Education (ACGME) guidelines were included to address how the conclusion of our commentary may affect current and future postgraduate residency training in psychiatry.

Flexibility and active learning methods take precedence in contemporary medical education. E-learning—a web-based technology that extends teaching past the classroom—permits learners to hear and engage educators in lieu of or in addition to traditional classroom lectures. To formulate an effective e-learning course, collaboration must occur among course directors, teaching faculty, and technology experts.

Despite time and fiscal costs of initial creation, e-learning curricula offer a platform for easy tracking of trainee improvement in knowledge and performance mastery. E-learning helped clinicians circumvent geographic and scheduling restraints and therein promote participation in continuing medical education [ 2 ]. Web-based learning was perceived as most valuable when associated with real-time feedback, self-assessments, simple interface, extended time for completion, and topic relevance [ 3 , 4 ]. E-learning interventions that are perceived as too cursory and lacking relevance or interactivity are viewed less favorably [ 2 ]. A study interviewing orthopedic surgery trainees found that e-learning not only accelerated the learning of psychomotor skills but also offered superiority in cost-effectiveness, learner satisfaction, and self-directed pace and focus [ 5 ]. These qualities make e-learning ideal for exposing trainees to rare and complex medical scenarios. Such training interventions reinforce recognition of clinical patterns and orchestrate trainee reflection on key training points [ 5 ].

Various technological media categories have been employed to enhance the presentation of medical science topics to trainees. A meta-analysis of 266 studies conducted in 2010 revealed that 89% of web-based medical training courses included paragraph-form static written text, in addition to multimedia tools like videos, diagrams, and pictures [ 6 ]. Multimedia (such as tutorials and diagrams) and interactive self-assessments (such as patient cases, quizzes, or other feedback) were incorporated into over half of e-learning courses. Videos simultaneously fuse both auditory and visual information. Videos engage various areas of the trainee’s cognition during lectures [ 7 ]. Video-based lectures enable trainees to harness repetition, self-paced practice, and active learning. As with e-learning, trainees benefit the most from videos containing self-assessments, integrated lecture objectives, images, lecture PowerPoint slides, limited duration (< 15 min), quality design, and reputable featured lectures [ 7 ]. In fact, multimedia transforms the role of medical educators from that of hosting formal lectures to that of leading discussions and creatively maximizing trainee comprehension via media intervention tools [ 7 ].

Technology in Audience Participation

Audience response systems (ARS) technology has been increasingly utilized to stimulate more active learning in the classroom. ARS may facilitate student in-classroom participation and encourage group problem solving (depending on how the ARS is integrated into the experience) [ 8 ]. Anonymity in responses allows the learner to engage without fear of embarrassment or being singled out by peers or the instructor [ 9 ]. Regarding the incorporation of ARS into curricula, learners report strong positive acceptance, increased attentiveness, and enhanced engagement and enjoyment of the lecture experience. One controlled study suggested that immediate feedback after questions (as facilitated by ARS) may improve knowledge condensation [ 10 ]. Unfortunately, ARS have shown weak or equivocal results in long-term knowledge retention and learning outcomes; these inconclusive results have impaired academic institutional implementation of the ARS technology [ 8 ].

Virtual Reality and Simulations

As in the military and aerospace industry, medicine has helped to pioneer the use of simulators and virtual reality. To enhance knowledge application, educators have developed virtual patient (VP) encounters (realistic, animated clinical scenarios portraying a broad array of pathologies) to exercise the medical decision-making skills. Virtual reality has been frequently employed by procedural specialty trainees to improve skill development.

Research has yielded mixed reviews of the efficacy of simulations in medical training. A meta-analysis involving various medical professionals across 4 controlled trials compared simulation-based interventions to non-technological interventions [ 11 ]. Except for 1 trial, each of the other 3 trials revealed that high-fidelity simulations lacked superiority in areas of trainee confidence, performance, and knowledge [ 11 ]. In contrast, two meta-analysis studies comparing simulations to other non-technology-based interventions concluded that simulations yielded significant advantages in knowledge improvement, skill mastery, time to skill acquisition, and trainee satisfaction [ 12 , 13 ].

If designed and selected properly, simulation usage may bring specific advantages to medical education. Trainees have identified feedback, opportunities for repeated practice, realism, and team-focused communication skills as predictive variables contributing to a simulation’s success rate and acceptance. Although data regarding actual patient outcome improvement was not found, the use of simulators in medical education appears effective in engaging a medical trainee in active learning [ 13 ].

Mobile Devices

Mobile devices have evolved to accommodate the numerous demands of the highly mobile clinician and trainee. As of 2006, 85% of healthcare providers have adopted mobile devices in patient care [ 14 ]. Smartphones enable trainees the ability to multitask, while instantly refreshing knowledge on diagnoses, medical management, patient health information, medical calculations, or the most contemporary literature [ 15 ]. Now able to receive real-time, point-of-care computation, trainees can employ idle time and maximize learning by utilizing web-based study material and current literature. Mobile device apps offer improved accessibility to clinical literature, continued medical education, and error prevention tools [ 14 , 15 ]. Additionally, these devices also permit faster clinical communication and subsequent response times to patient’s needs [ 14 ]. Mobile devices remain limited in areas of battery life, malware risks, potential privacy breaches, or erroneous information in searches. Trainees express concern about smartphone usage appearing disrespectful to patients, attendings, or coworkers [ 15 ]. No current studies exist regarding mobile devices improving actual patient outcomes [ 14 , 15 ].

Social Media

Due to its prevalence, social media represents a potentially valuable tool for educators. As of 2012, 14.2% of the world’s population were active Facebook users; such estimates speak to the global prevalence of social media usage [ 16 ]. Medical students who blogged exhibited improved knowledge, empathy, exam scores, and reflective writing skills but failed to improve test scores [ 17 ]. Social media sites can function as a platform for students to exchange advice and medical information throughout their healthcare training [ 18 ]. Technical issues, variable participation levels, and privacy or security concerns were primary factors that thwarted full acceptance of blogging by medical students and educators [ 16 , 17 ]. Most learners described positive overall reactions to social media and blogging interventions [ 17 ]. Additionally, social media creates an avenue through which mental health professionals might be able to educate the public on mental health topics. Medical professionals must be taught and reminded to abstain from unprofessional conduct and privacy breaches while utilizing social media sites [ 16 ].

Increasingly integral to the practice of medicine, technology endeavors to streamline a clinician’s work and to offer credible, easily accessible information. To enhance trainee growth and empower innovative scientific leaders, educators should play a crucial role in how technology transforms medical education. Trainees prefer technology-associated modalities that offer learning material that is interactive, reputable, simple, pragmatic, and coupled with relevant feedback. Innovations like virtual reality and simulations effectively increase knowledge, performance skills, and team communication through realistic clinical cases. Educators utilize social media to promote student reflection and to address difficulties that trainees experience. The ACGME tasks psychiatry residencies with guiding trainees to employ technology to attain the following milestones: self-reflection and assimilation of relevant information for informed decision-making [ 19 ].

Educators must consider whether the benefits of added flexibility and real-time feedback implemented by technology-assisted learning outweigh the downsides of the social isolation associated with classroom-independent learning. This potential decline in camaraderie sparks some of medical educators’ support for implementing blogs and social media into curricula. In the presence of technology overload, educators must innovate curriculum that bolsters each trainee’s humanistic touch. Additionally, medical educators may advocate testing basic technological competencies in the Medical College Admission Test before matriculation or requiring continued education on technologies throughout medical training.

With the amount and variety of technology-based resources ballooning, educators receive expanding opportunity to create and modify new training techniques. Medical educators must instruct trainees how to consistently find the most pertinent, trustworthy, and contemporary information. Medical educators in psychiatry may enhance psychiatric training education by discovering ways to incorporate virtual reality into curricula. For example, educators could consider programming virtual patients and simulators to mimic psychotropic medication side effects, delirium, or drug intoxications. As artificial intelligence evolves, trainees may utilize virtual patients for psychotherapy skill development. Continued research into how integrated technology affects the trainee’s attitude and patient care outcomes remains vital for future advancement.

This commentary does not strive for exhaustive assessment or concluding judgment concerning each educational technology. Most reviews looked at studies of single-site implementation of educational outcomes, and few had non-technology controls; hence, the quality of the evidence was limited. Additionally, our literature search unearthed no actual patient outcome measures regarding each incorporated medical technology. Numerous factors, ranging from practice setting, personal preferences, and treatment population, affect how each trainee and physician perceives and adopts technological changes in medicine. Therefore, conclusions made from the experience of medical trainees cannot be generalized to all generations of practicing physicians. Further research into technology usage among different generations and practice types would isolate the most ideal technology-related training goals. Such innovation could help foster development of the best practice models for technology training in undergraduate and postgraduate medical education.

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Acknowledgements

The authors would like to thank Esther May Sarino, MLIS, for her expert help in crafting and refining the literary search.

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Moran, J., Briscoe, G. & Peglow, S. Current Technology in Advancing Medical Education: Perspectives for Learning and Providing Care. Acad Psychiatry 42 , 796–799 (2018). https://doi.org/10.1007/s40596-018-0946-y

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Received : 18 January 2018

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DOI : https://doi.org/10.1007/s40596-018-0946-y

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A vision of the use of technology in medical education after the COVID-19 pandemic

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Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19 pandemic and technology has been rapidly and innovatively used to maintain teaching and learning. The future of medical education is uncertain after the pandemic resolves but several potential future scenarios are discussed to inform current decision-making about the future provision of teaching and learning. The use of emergent technology for education, such as artificial intelligence for adaptive learning and virtual reality, are highly likely to be essential components of the transformative change and the future of medical education. The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world.

technology, medical education, transformative change, coronavirus, COVID-19

Introduction

The purpose of this Personal View is to offer a vision of the use of technology in medical education after the COVID-19 pandemic begins to resolve. Both authors have a keen interest in the innovative use of technology in medical education and an awareness of the current and future trends in the use of technology to enhance teaching and learning. We will begin by a reflection on the current increased use of technology as a major factor in enabling the continuation of medical education during the pandemic. This reflection will be followed by a discussion of several potential future scenarios that are based on the emergent trends in the use of technology but also an understanding of how complex social systems respond over time to the trigger of major events. We will also discuss the benefits and challenges of the future use of technology in medical education after the pandemic resolves.

A transformative change in the current approach to medical education across the world is inevitable and although the full extent is unknown at the current time it is essential to consider potential future scenarios to begin the process of preparing for the future ( Chermack, 2004 ). We fully appreciate the difficulty that many medical educators will experience in considering the future at a time when most educators across the world are deeply engaged in responding to the current enormous challenges, both personal and professional as clinicians and educators. However, it is essential that all educational policy makers, curriculum planners and educators across the continuum of medical education, from basic to continuing, can begin to critically reflect on the present situation and make appropriate decisions about the future of medical education for when the pandemic resolves.

The impact of the COVID-19 pandemic

The pandemic has resulted in the widespread disruption of medical education and professional training ( Ahmed et al. , 2020 ; Murphy, 2020 ). Examples include reduced teaching with redeployment of medical educators to clinical care and the quarantine and impact of illness on medical educators and students. Measures to ensure social distancing have included closure of medical schools and working from home for both educators and students. Local and international travel, and attendance at training programs has been halted. Physical attendance at workshops and symposia, conferences, clinical attachments and visiting fellowships has ceased. Tragically, there have also been an increasing number of deaths that include doctors and other healthcare professionals.

The current response to the COVID-19 pandemic

Overall, the current response to the pandemic has been the increased awareness and adoption of currently available technologies in medical education, and also in the wider education sector ( Iwai, 2020 ). These changes across the continuum of medical education have been mainly to replace existing approaches for the provision of medical education, driven by the urgency to implement a feasible and practical solution to the crises, with educators using familiar technology.

Medical schools and other medical education providers, including commercial organizations and professional bodies, have rapidly scaled up the provision of educational content and training online, as well as faculty development in the use of technology, especially by online courses. Large group in-person lectures have been replaced by streamed online lectures, using technologies for screen capture and online dissemination. Small group sessions and tutorials have been replaced with interactive Webinars using web conferencing platforms. All of these learning resources can be easily accessed from mobile devices.

A major challenge for medical educators at the present time has been to replicate the experience of clinical encounters. These encounters range from clinic and ward rounds to interactive patient sessions to training in interpersonal and inter professional communication and clinical skills. Currently available technology, such as videos, podcasts, simple virtual reality, computer simulations and serious games, are beginning to be used to assist educators and facilitate student learning and training in these areas. Simple online platforms, such as websites and blogs, can provide basic information but also offer opportunities to host videos for demonstrating essential skills, such as procedural clinical skills and communication ( Dong and Goh, 2015 ). Medical educators can remotely coach students with real time mobile video tools and apps.

The increasing trends of competency based medical education (CBME) and programmatic assessment require regular assessments of student achievement. Medical schools have creatively responded to the challenge of a lack of opportunities to observe student performance or to hold large scale examinations. Formative and summative assessments for core knowledge have started to use a variety of online tools and platforms. The range is from websites, discussions forums and online discussion spaces to real-time online chat and communication apps. Feedback on performance and the assessment of skills acquisition has similarly started to maximize the ubiquitous availability of video and audio on mobile devices to enable assessment in authentic contexts, either clinical or simulated. These assessments should be ideally based on high quality evidence and theory informed assessment and evaluation strategies ( Martin et al ., 2019 ).

We are heartened to see greater national collaboration between medical schools to share educational and training resources (PIVOT MedEd, 2020 ). Commercial providers are also increasing their engagement and collaboration with medical schools.

The future after the COVID-19 pandemic

We consider that it will be highly unlikely that there will be a return to the previous approach to the provision of medical education as existed before the pandemic, especially the contribution of technology for enhancing teaching and learning. The change will be transformative, with a major change in how individuals and the wider social system within which each individual lives and works. The uncertainty at the current time is around the extent of this transformation since it is dependent on the complex interaction between several major factors that are difficult, and some observers would say almost impossible, to predict. These conversion factors are mainly related to the length of time that the pandemic is disruptive, since a long disruption is likely to produce significant alteration in several of the factors. The factors include the number and availability of educators, economic constraints and the need to rapidly expand the clinical workforce. All of these factors will have a major impact on the future way that educators and their institutions will provide medical education.

Understanding the transformation

Our framework to understand transformative change is Normalisation Process Theory (NPT). This sociological theoretical framework has been increasingly used to understand how a new practice, such as the use of technology, becomes embedded within a social system (“normalisation”) through an active process, both individually and collectively, that occurs over a period of time ( Scantlebury et al ., 2017 ). The new practice becomes embedded when it is routinely incorporated in the everyday work of individuals and groups. The key phases of this dynamic interactive process between individuals and others in the social system begin with the development of a shared understanding of the benefits and importance of the change to be achieved, and this is followed by the building and sustaining of individual and collective commitment around an intervention. Finally, there is ongoing resolution of any issues around differences in opinions about the new practice and there is increased allocation of resources to enable the new practice to become embedded. Once the practice is embedded it is considered both individually and collectively as the usual way of working and the new practice is unlikely to revert back to the original practice, especially if there have been major conversion factors that have initiated the transformation.

The NPT framework suggests at the present time that the process of transformation in the increased use of technology in medical education is within the early phases, with what appears to be a rapid and progressive individual and collective acceptance and commitment to the use of technology to enhance teaching and learning. The extent to which the transformation leads to embedding of technology will be variable across different providers of medical education but one future potential future scenario is that only minor transformative change will occur, with increased use of current technology, especially with a greater emphasis on online learning and mobile devices to replace face to face group teaching and meetings.

However, another potential future scenario is that of major transformative change in medical education, especially if there has been a major disruptive influence on the way that we all live and work after the pandemic resolves. If there is a major disruptive challenge to medical education, such as a vastly reduced number of educators and the need to rapidly expand the education of the future workforce across the continuum of medical education, the variety of current technology being used to augment medical education will be inefficient and inappropriate to meet the high demand. Educators will need to develop and implement innovative solutions in response to this high demand and an awareness of future trends in the use of technology is invaluable in beginning to prepare for the future.

Understanding the emergent technology

The Horizon 2020 Teaching and Learning report was produced by an expert panel to highlight how emergent technology has the potential to transform future provision of higher education ( Brown et al ., 2020 ). There are two main envisaged changes; adaptive learning and extended reality.

The introduction of adaptive learning offers a personalized approach to enable all students to access a wide range of learning resources and to provide information to educators about how students are learning from their experience. Essential for adaptive learning is the integrated application of two types of emergent technology: artificial intelligence (AI) and learning analytics ( Chan and Zary, 2019 ; Wartman and Combs, 2019 ). The application of artificial intelligence creates “thinking machines” to provide learning content and assessments that can adaptively interact with students using text and voice. These applications range from learning anatomy to complex clinical diagnostic and management challenges. Robotic tutors that are adaptive to problem-solving have been used alongside school children to facilitate their individual self-regulated learning ( Jones and Castellano, 2018 ). Learning analytics collect information about the process and outcomes of learning that are essential to inform educators about the progress and trajectory of both individual and groups of students. The learning potential of these new approaches is that students can obtain personalized learning that is tailored to their individual needs and there is also the opportunity to reduce the time for the development of individual competence and to decrease the time required for face to face interaction with educators and patients.

Extended reality (XR) provides students with learning experiences that either blends physical and virtual elements (augmented reality or AR) or provides a totally virtual immersive experience (virtual reality or VR) ( Zweifach and Triola, 2019 ). The immersive experience has the intention to replicate a real-life experience and this can be delivered through headsets or mobile devices. An emergent trend in technology is haptic simulation which replicates the physical sensations of a real-life experience, such as touch. The learning potential is that these sophisticated experiences can be applied to a range of clinical topics, from communication and clinical skills to deliberate practice of surgical procedures, and also they can be integrated with adaptive learning to realize additional benefits.

The middle ground future scenario

The potential future scenario for medical education and the contribution of technology to enhance teaching and learning after the resolution of the pandemic is likely to be in the middle ground between the two extreme ends of the spectrum that we have presented in the two previous scenarios. It is highly likely that the use of technology will increase and this also includes an accelerated application of many of the newer types of emergent technology that have been described in the Horizon 2020 report. However, the extent to which these types of emergent technology have become, and continue to be, embedded will be dependent on the complex mix of factors within a particular context. These factors include the length of time of disruption to previous approaches to medical education and the available resources, including support from learning technologists and access to the emergent technology. Overall, an integrated approach that combines elements of both technology and face to face teaching and learning experiences is likely to characterise the future scenario.

The benefits of change after the COVID-19 pandemic

Whatever the change and extent of transformation in medical education after the pandemic it is inevitable that there will increased individual and collective awareness and acceptance of the innovative potential that technology, including emergent technology, can offer to enhance teaching and learning across the continuum of medical education ( Goh, 2016 ). The ‘anytime anywhere’ aspect of using technology offers new opportunities for specific groups of students, such as increasing access and participation to part-time students and providing shortened programmes for gifted or talented students.

It will be interesting to see if the current increased spirit of national collaboration of medical educators to freely create, share and curate learning content will continue. There is the exciting opportunity for these collaborations to spread and include educators from across the world. The benefits in meeting the World Health Organisation goals to provide universal health coverage through an urgent and rapid increase in trained workforce cannot be underestimated (World Health Organisation, 2015). However, the digital divide between countries, especially between high and low and middle income countries, is potentially a major challenge to these ventures. Technology that is appropriate to the local contexts, with lower bandwidth cellular and online networks, will need to be considered and international collaboration between medical schools will need to be developed.

The challenges of change after the COVID-19 pandemic

We have presented several potential future scenarios of the use of technology, including emergent technology, in medical education after the pandemic resolves and our overall vision has been positive, with a discussion of the advantages for teaching and learning. However, it is important to consider the challenges that will need to be addressed if the expected potential transformative changes are to continue to be embedded and further evolve over time.

The effective of use of technology for enhancing teaching and learning has been discussed earlier but achieving the desired outcome and impact will only be realised by continuing to develop all medical educators in how to skillfully align the various contributory factors, including the learner, the learning objectives, the learning content, the instructional design, the technology and the context ( Zaharias and Poylymenakou, 2009 ). The Horizon 2020 report also highlights the essential need to implement ‘learning engineering’ if an emergent technology, such as more sophisticated virtual reality, is being considered for use in teaching and learning. The components of this approach includes design thinking, agile and iterative development, user experience evaluation and the application of learning science to craft the learning experience ( Badwan et al. , 2018 ). Many educators are likely to require further development and training in the effective use of technology for enhancing teaching and learning.

The development of emergent technology, especially when specifically for teaching and learning, is often costly and requires a range of different expertise. However, the Horizon 2020 report also highlights the increasing trend for open educational resources (OER) that are available without restriction, including financial cost, to both educators and students across the world. We consider that the opportunity for all medical education providers to offer OER has never been more appropriate and we urge all providers to continue their current collaborative ventures.

Finally, at this time of transformative change in the use of technology in medical education, we recommend that the opportunity is grasped to increase the development of an educational scholarship related to the use of technology and to increase the implementation of global benchmarking standards ( Goh and Sandars, 2019 ). Both of these ventures have the future potential to ensure that the transformative change continues to benefit medical education across the world.

Take Home Messages

The COVID-19 pandemic has been a major disruptive change to medical education across the world and the use of technology has been rapidly and innovatively used in an attempt to maintain teaching and learning. When the pandemic resolves, transformative change is likely to occur in the way that technology will be used in medical education, especially with the integration of emergent technology. There are significant benefits to this transformative change but there are important challenges that need to be addressed if the future and continuing use of technology in medical education is to be effective and have a positive impact on both educators and students across the world.

Notes On Contributors

Poh Sun Goh, MBBS, FRCR, FAMS, MHPE, FAMEE, is an Associate Professor and Senior Consultant Radiologist at the Yong Loo Lin School of Medicine, National University of Singapore, and National University Hospital, Singapore. He is a graduate of the Maastricht MHPE program, a member of the AMEE TEL committee, and a Fellow of AMEE. ORCiD: https://orcid.org/0000-0002-1531-2053

John Sandars MB ChB (Hons), MSc, MD, MRCP, MRCGP, FAcadMEd, CertEd, FHEA is Professor of Medical Education at Edge Hill University Medical School, Ormskirk, UK, and is Co-Chair of the AMEE Technology Enhanced Learning Committee. ORCiD: https://orcid.org/0000-0003-3930-387X

Declarations

The author has declared that there are no conflicts of interest.

Ethics Statement

This is a Personal Opinion piece and does not require Ethics Approval.

External Funding

This article has not had any External Funding

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Comments on this article Comments (0)

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This review has been migrated. The reviewer awarded 4 stars out of 5

The article is a combination of a status analysis post COVID pandemic and a projection into the future of what is to come after the situation is over. I likes a lit the framework and think it is useful in documenting the situation but i believe more insight into the future sustainable gains if this chaos is needed

Competing Interests: No conflicts of interest were disclosed.

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This review has been migrated. The reviewer awarded 5 stars out of 5

I read this article by two experts in TEL with interest and found the framework very helpful indeed. It veered around a bit from being an opinion piece to a position paper with recommendations, and I think defining the focus and structure a bit more clearly would help.However, this is just my view and I thought it was excellent with some good signposting to helpful resources as well. There’s lots more literature on change management such as transition curves, etc and the leadership literature on collaboration etc that might be considered too.I also agree with other reviewers and the authors about Impact of the length of the lockdowns on the normalisation. At the moment we’re still a bit in the excited crisis management stage and we need to shift along the curve so all this learning and potential innovation and transformation isn’t lost A great paper, thank you

This is an interesting article on the use of technology in medical education after the COVID-19 pandemic. As mentioned by the authors the duration and extent of the disruption can influence the possible scenario of medical education. Emergent technology is becoming cheaper and more widely available and today most can be accessed using a smartphone or a tablet. One of the important issues will be the cost of the created content and what may be considered as a fair price for the developers. If it become too high then many educators in developing nations may not be able to access the same. This is another in a series of manuscripts in MedEdPublish on the COVID-19 pandemic and its effects on different aspects of medical education.

Interesting opinion on the use of technology in medical education after the COVID-19 pandemic with rich examples and data! It enlightens us to think deeply about the impact of the COVID-19 pandemic on medical education.

Note on Abstract and IntroductionThe abstract stated the thesis statement of the initiated work except explaining the design of the paper though the very last clause of the abstract “The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world” provided the trajectory of constructions of the paper.Introduction should initiate a thesis statement along with the explanation of the scope of ‘technology use’, ‘medical education’, ‘covid-19’ and ‘the vision’ on all these progress and trajectory.The Body of DiscussionThe opinion writing is argumentative and is constructed with examples and researched data. The authors have been tailored to make this conception convincing across the continuum of medical education by providing recent references.Note on Benefits and Challenges of changes:The paper has been neutrally justified with the address of benefits and challenges of the envisaged trajectory of distribution of medical education. But the later portions of both the paragraphs have introduced recommendation; for example, the following statement “Technology that is appropriate to the local contexts, with lower bandwidth cellular and online networks, will need to be considered and international collaboration between medical schools will need to be developed” should have been superimposed at the place of recommendation. Note on Take Home messages and ConclusionThe paper has not directly introduced any discussion on conclusion where the thesis statement of the paper becomes iterative and approved. This paper supposes to fail in this case; Take home messages has been concluding remarks of the paper and that’s why; the recommendation is underestimated. But irrespective of these constructional pitfalls, the introduced idea is constructive, adoptable and it claims novelty. The theme is clear and convincing.

This is an excellent article outlining trends in technology in medical education and how the covid 19 pandemic will affect these trends. The authors are very likely to be right that things will not go back to the way they were before. But how things will change is hard to predict. Technology enhanced learning has been becoming normalised for some time now – it is just another way for students and doctors to learn. Students and doctors often say they use online resources to stay updated. But the pace of change of the knowledge base around covid 19 has been unprecedented. Learners cannot read all of it or stay across all of it. Point of care learning will be needed as a result. This will be especially important for those final year students who are now rapidly preparing for actual practice. It would be interesting to hear the views of the authors and others about technology enhanced learning and a rapidly changing knowledge base.

If anything good can come out of the Covid-19 pandemic it is the change that will occur in health professions education ( and education in general) and the emergence of technology -enhanced learning, in all its forms. As someone whose children call a digital dinosaur when it comes to IT, I found this paper very easy to read and an excellent review of both the present and potential future situations re TEL.I strongly recommend it to all those involved in curriculum planning.

An interesting opinion piece from two authors with a major interest and understanding of the area of technology supporting learning. It would be useful to situate this paper with others where the current COVID situation has meant that educators have used technology in practice to over come difficulties for example the recent piece by Judy McKimm and colleagues: Manuscript ID: 2936Article title: Health Professions' Educators' Adaptation to Rapidly Changing Circumstances: The Ottawa 2020 Conference Experience

The authors have aptly putforth their views in the present article about the aid by technology in medical education. In the coming months, with a great hope of positivity, we can believe that medical education and the whole aim of equipping medical personels for the future can be achieved more prominently.The spread of the COVID-19 has brought a stark reality to the human kind that change is constant. And this should spring us back in action with better ways of teaching, learning and treating our patients. The ubiquitous availability of video and audio accessories in all our techologies including laptops, mobile phones has eased this difficult phase.Indeed, it is essential to assimilate and plan a new way of reaching out to all the concerned individuals.

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• Manish Khazane , SRM UNIVERSITY,RAMAPURAM,CHENNAI.
• Trevor Gibbs , AMEE
• Trudie Roberts , Leeds Institute of Medical Education
• Kieran Walsh , BMJ
• Shaoting Feng , The First Affiliated Hospital of Sun Yat-sen University
• P Ravi Shankar , American International Medical University
• Judy McKimm , Swansea University
• Samar Ahmed , Ain Shams University Faculty of Medicine

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Transformation of Undergraduate Medical Education in 2023

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The influence of technology on undergraduate medical education has had a long and bumpy road. Ludmerer 1 concluded one of his authoritative works on the history of medical education in the US by warning, nearly 40 years ago, about the deleterious effects of uncontrolled technology on the development of students. At the same time, some of the brightest opportunities for transformation in teaching and learning have been catalyzed by shifts in technology. In 2023, with the advent of generative artificial intelligence (AI) tools over the past year, society is facing one of those moments now.

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A national network of medical technology incubators provides experiential training for the next generation of medical entrepreneurs and enables creation of innovative technologies for pressing clinical needs.

Trainees at universities often have big ideas, motivation and the time needed to improve healthcare in meaningful ways. While there are a plethora of medical problems needing better solutions and trainees eager to engage, the lack of funding, mentorship and experience are considerable barriers to entry for student-innovators. Furthermore, the experiential, multidisciplinary and fluid nature of medical innovation is not conducive to the faculty-driven, classwork-based structure of traditional academic courses. In 2013, Sling Health, formerly known as IDEA Labs, started in St. Louis as a student-led medical technology incubator to overcome these challenges and enable trainees to go beyond learning the current state of healthcare to instead start advancing management 1 . Here we describe the multi-university, chapter-based structure and national impact of Sling Health over its first seven years. We highlight the importance of health technology education and innovation in academia, especially as COVID-19 disrupts so much of how we practice medicine.

Student experience

Sling Health is a student-led, grassroots initiative that brings together multidisciplinary students, physicians and mentors to develop innovative solutions to clinical challenges 1 . This program adopted the strengths of several leading biomedical design programs across the country 2 , 3 , 4 and modified them into an easily accessible, low-cost, scalable model. Sling Health forms multidisciplinary teams around clinician- and patient-identified problems, then provides an ecosystem including mentorship, training materials, funding and prototyping facilities needed to advance medical device and software development. Operating on a volunteer-run model, Sling Health consists of chapters, each with a local student leadership team that works with a national Sling Health leadership core consisting of students from various chapters, as well as advisory boards consisting of clinicians, academic professors, healthcare leaders and venture capitalists who help shape the overall direction of the organization. Chapters each adapt the overall program framework described below to best fit their local entrepreneurial ecosystem.

Academic centers are a renewable source of skilled and motivated students training in various disciplines. Sling Health leverages this talent pool to bring together students from different schools (for example, medicine, engineering, business and law) that rarely have opportunities to work together in their respective educational programs. Each cycle, selected project leaders present interesting problem areas to program applicants. Project leaders and the executive boards then form teams around problems on the basis of mutual interests and complementary skills. In contrast to comparable programs 5 , Sling Health does not offer any credit or payment to students, which results in the self-selection of individuals genuinely interested and motivated by medical innovation and medical business development. Additionally, many chapters have negotiated agreements with their associated universities so Sling Health teams maintain 100% ownership of their intellectual property.

Throughout the year, the local and national executive boards work with physicians, allied health professionals and external partners such as the American Medical Association (AMA) to identify key clinical problems and collate a vetted clinical problem database. While some project leaders bring problems from personal experience, many use Sling Health’s clinical problem database to identify interesting problem areas and clinical mentors. After teams form around problem areas of interest, students work with clinical and business advisors to hone the team’s guiding problem statement on the basis of clinical need analysis, market analysis and patent literature review. This problem-centric approach allows teams to design solutions targeted to the clinical needs and enables teams to pivot to different solutions and plans more effectively than teams anchored to a particular technology.

Sling Health teams go through a three-phase education and development program as described previously 1 (Fig. 1 ). This consists of the invention phase (needs assessment, market analysis, in silico design and iterative prototyping), the development phase (developing business plans and filing provisional patents), and the launch phase (creating a new company, seeking more funding and creating plans for their startup after Sling Health). Education is facilitated by a wiki-based curriculum curated by Sling Health, periodic design reviews for teams to get feedback from mentors and experts, and legal and funding support from national sponsors and local academic center resources. Each chapter also hosts a local Demo Day for teams to present prototypes, pitch to judges and outside investors, and compete for a chance to attend the National Demo Day.

Teams follow an entrepreneurial curriculum within the Sling Health program, leading teams from problem identification through to launching a startup or company.

Sling Health operates a multi-level structure consisting of a national board of directors, a network-wide executive board, and multiple chapter executive boards, guided by local and national strategic advisory boards, as well as hundreds of mentors providing direct assistance to teams. Student leaders at local chapters are attuned to needs, opportunities and challenges facing their peers on teams, enabling real-time adjustments to the program. The local and national boards have parallel structures that allow each member of local leadership teams to access relevant expertise from the national board and contemporaneous suggestions from their counterparts at other chapters to optimize chapter performance and, ultimately, team success.

There are practical limitations inherent to a volunteer-driven organization with yearly turnover that can threaten sustainability. To mitigate this risk, Sling Health continually refines a leadership pathway that facilitates institutional knowledge retention and accumulation. Leadership roles and responsibilities are closely aligned with members’ career goals to provide experiential professional training and maintain a motivated leadership base. Most participants choose to serve on executive boards for multiple years, while the advisory boards and the board of directors provide additional longitudinal oversight and continuity. Furthermore, executive transitional documents and project management technologies facilitate retention of institutional knowledge. This organizational structure has proven highly effective, sustainable and reproducible across chapters over the last seven years and across multiple transitions in national leadership.

National network results

Since 2015, Sling Health has rapidly grown as a national network with chapters spanning the country (Fig. 2 ), allowing leadership at each site to share knowledge, materials, infrastructure, operational costs and connections to the talent, mentors and investors best suited for each project. Sharing a suite of nationally managed back-end infrastructure including banking, accounting, legal, web hosting and IT resources reduces chapters’ operational responsibilities and allows each chapter’s volunteer leadership to focus on supporting teams and improving the local program. Sling Health’s national scale enables far more students to gain experiential training in medical innovation (Fig. 3a ) and allows all chapters to benefit from national partnerships and collaborations, as well as increased investor visibility, thus increasing chances of new technologies reaching patient care.

Sling Health helps to coalesce medical, engineering, scientific, legal, and entrepreneurial or business resources available at universities into a medical entrepreneurial community to support student innovation. Sling Health further connects these separate communities at different institutions across the country into a cohesive network. There are currently 11 chapters involving 15 universities in the United States. Active chapter sites include St. Louis, MO; Boston, MA; Philadelphia, PA; Ann Arbor, MI; Atlanta, GA; College Station, TX; Lubbock, TX; New Orleans, LA; Los Angeles, CA; and Santa Barbara, CA.

a , Number of participants and teams in Sling Health network from 2013 to 2019. b – d , Sample of distribution of members by discipline, race and gender from 2016–2019 (St. Louis and Ann Arbor chapter data).

Sling Health actively works with trainees at potential new chapter sites to build on the local entrepreneurial ecosystem and bring together the necessary resources to enable medical technology development. Typical new chapters start with three to five executive board participants spanning medical, engineering and business training programs at undergraduate through postdoctoral levels. Student founders at new sites leverage national advisory support, existing chapter models, operational timelines, example presentations, outreach materials, a playbook of training materials and a full suite of national back-end infrastructure. This process allows new sites to learn from the experiences accrued throughout the network and pull together the necessary local resources and support to develop a successful chapter much more quickly than ‘reinventing the wheel’ and starting new, independent programs at individual sites. As a result of this support, what took thousands of collective volunteer-hours to develop at the initial St. Louis location now takes approximately 100 volunteer hours to get up and running at other locations. Additionally, since Sling Health’s nonprofit program operates with pro bono mentorship and advising and a volunteer, trainee-led executive structure, as well as shared overhead costs nationally for economies of scale, the program operates at under $250,000 in annual expenses across all 11 current chapters. This is substantially less than the cost of one faculty member per site and equates to costing under $850 per student participant for a longitudinal medical innovation experience.

In addition to receiving direct network support with chapter formation and operations, the program’s national scale enables Sling Health chapters and teams to access resources that are often not available on the local level. Sling Health and the AMA developed a Clinical Problem Database that enables healthcare professionals around the country to submit problems to the program. This resource provides a fertile field of topics for Sling Health teams to pursue, as well as an opportunity for clinicians outside of academic roles to advise trainees and engage with developing medical technology. The AMA also supports Sling Health chapter development via connections to medical schools, seed grants and other support to improve medical entrepreneurial training opportunities nationwide, not just in major tech-centered hubs. Sling Health continuously hones its curriculum with guidance from past teams and partner institutions to deliver entrepreneurial education more effectively. Sling Health also partners with Veterans Affairs Innovation Centers to facilitate work on technologies for veteran-focused clinical issues by providing mentorship, a pathway to study new technologies and a funding pathway for successful initiatives to grow. Strong pro bono legal support from Husch Blackwell enables teams to receive assistance with intellectual property, as well as corporate creation, as technologies begin to commercialize. These partnerships help Sling Health provide access to high-level resources to chapters immediately upon founding. Partnerships with academic institutions across Sling Health’s network also enable teams to connect with potential talent, mentors, investors, and clinical trial sites outside their home institution.

At the end of the year, Sling Health’s National Demo Day brings together the top teams and partners from across the United States. By increasing the number of teams from a single site to a national scale, Sling Health’s new technology pipeline draws national investors to expand opportunities for teams. Demo Day enables publicity and funding opportunities for budding companies, facilitates recruitment of more team members, enables collaboration on curricular development between partner sites, and allows chapter leadership to directly work with partner sites and determine the best ways to interface with and augment local ecosystems. Through these efforts, Sling Health has now expanded to 11 chapters across 15 universities, with expected growth by 10 more chapters over the next 5 years on the basis of current new-chapter interest and historical growth rates (Fig. 2 ).

Impact and conclusions

Since forming in 2013, Sling Health has trained over 1,000 students nationally at 15 different universities to become better problem identifiers and solvers in healthcare. Team members span a wide variety of disciplines (Fig. 3b ), enabling students to teach each other throughout their projects. Many students do not otherwise have the resources or opportunities to engage with entrepreneurship alone. Sling Health represents the first entrepreneurial experience for 70% of participants. Sixty-three percent of members report that Sling Health influenced their career plans and choices, while 94% of members state the program offered medical technology exposure relevant to their professional goals. Membership to date has skewed toward male, white and Asian participants (Fig. 3c,d ). Sling Health is aligning partnerships across academia and industry to address this participant disparity and build a more diverse, equitable and inclusive program for student participants, mentors and advisors. This growth area promises to strengthen our teams and enable a more diverse participant base to engage in medical entrepreneurship through Sling Health.

By engaging students early in their careers, Sling Health enables education and entrepreneurial involvement in a relatively low-risk atmosphere where it will not jeopardize a student’s career path but will empower them to interface with medical technology development for life. Given that roughly 15 to 25% of trainees are medical students or residents (depending on chapter location), Sling Heath is actively training a generation of physicians to critically assess the status quo and address gaps with medical technology in order to advance patient care.

As it is a student-run nonprofit organization, Sling Health’s local and national leadership boards also provide opportunities for trainees to interface with many developing medical technologies at once and enhance their entrepreneurial and managerial skills. In addition to trainees, many mentors anecdotally note that working with Sling Health improves their awareness of medical innovation and entrepreneurship. Sling Health’s engagement of practicing physicians in particular connects doctors with clinical problems and knowledge to motivated students with the skills and time to develop new solutions. A small portion of members opt to pursue their Sling Health startups full time after the program, as most pursue further education or enter the workforce in a variety of roles. Regardless of career plans, the program provides experiential training for all members to communicate effectively across disciplines, assess clinical and market needs, analyze technical opportunities and limitations, iterate on prototypes and develop commercial implementation strategies to move ideas closer to helping patients.

Despite a plethora of minds interested in medical technology, the disconnect between disciplines and schools at large academic centers stifles innovation. Sling Health’s platform serves as a bridge between the different silos of resources that exist at any given university and integrates these resources to drive student learning and medical innovation. Student-run and faculty-guided chapters allow the organization to adapt to the unique circumstances and needs of the academic center. The sheer number of clinicians and students at these centers forming teams, developing prototypes and forming startups through Sling Health demonstrates that the program is addressing these needs.

By empowering Sling Health participants to perform clinical need-finding via direct patient and clinician interaction, Sling Health produces a grassroots pool of clinical problems that stem directly from the patient. This democratization of clinical problem sourcing identifies problems that are both primary concerns for patients and entrepreneurially viable. The success of the Sling Health model has started to become visible in patient care as startups formed through the program continue to develop. Sling Health student teams have developed over 30 pending patents, over 25 startups and over $18 million in investment in alumni companies, with clinical trials reaching over 80,000 patients. Sling Health’s integration into academic centers enables teams to design and run clinical trials locally while our national model facilitates multi-university connections for growth. More and more prototypes and medical technologies are being developed each year by an untapped pool of students and doctors. This growing ecosystem offers the opportunity to spark new medical technologies and change healthcare both through the program directly and indirectly throughout Sling Health trainees’ careers.

Sling Health’s cost-effective, experiential training platform supports medical technology development across several clinical problem and solution domains, including digital health and health information technology, medical devices, diagnostic screening and global health technologies. Examples of projects supported in each domain include the following:

Digital health

After noticing stark inadequacy achieving hemoglobin A1c (HbA1c) goals for patients with diabetes mellitus in low-resource settings, a Sling Health team developed and launched a digital health intervention using automated text messages 6 that led to an average 1.17% point reduction in HbA1c over four months in patients with baseline HbA1c > 8% in a randomized, controlled trial 7 . This startup company has now implemented this intervention with thousands of patients and developed disease-specific automated interventions for over 20 diseases.

Medical devices

Sling Health has supported a wide range of medical devices, from improved endoscopic equipment to mobility support devices to laparoscopic sutures with memory material that simplify tying.

Diagnostic screening

After recognizing the difficulty getting patients to comply with colonoscopy screening for colorectal cancers and high-risk adenomas, a team developed a higher sensitivity, cost-effective stool screening platform based on stool-derived eukaryotic RNA 8 .

Global health

A team with family in Nigeria observed high death rates from neglected tropical infectious diseases such as schistosomiasis, so they developed a point-of-care DNA amplification device with a culturally tested user interface to achieve early diagnosis of the infection and enable faster treatment.

These sectors align with Sling Health’s diversity of trainee expertise levels and focused initial prototype funds ranging from roughly $500 to $2,500, with further support available nationally. The program is unable to support drug development projects as they require more specialized education, resources and increased funds to study and pilot.

As evidenced here, this experiential, interdisciplinary approach balances the dual missions of training the next generation of medical innovators and advancing technologies with the potential to improve patients’ treatments and lives. We have a responsibility to provide trainees insight into the medical technology development process and the ability to engage that process thoughtfully to advance care for our patients. Sling Health aims to carefully balance private entrepreneurial interest, which is foreign to most medical training but necessary for implementing new medical technologies, with professional and technical development, service to patients, teaching and leadership through careful curricular decisions and mentor and speaker selection, guided by local advisory boards. Overall, by training students in medical technology research, development and strategies for commercial, regulatory and clinical implementation, Sling Health helps members experience and understand the motivations, needs and interplay among the many aspects of the medical technology ecosystem. This type of training is fundamental for participants to accelerate the translation of research into better patient care, especially during these challenging times with COVID-19 requiring new levels of ingenuity and problem-solving in healthcare.

Sling Health is actively expanding educational programming, partnerships with healthcare organizations and national infrastructure in order to enhance support for student innovators and tailor services to evolving needs. Amid the COVID-19 pandemic, Sling Health is leveraging its experience and network to provide an accelerated one-month virtual boot camp, enabling over 100 students and mentors nationally and internationally to address new healthcare problems arising from the pandemic. The program is also building mechanisms to increase crosstalk between chapters for mentors and team talent sourcing, as well as provide support for teams that have progressed into early company stages. Sling Health plans to strategically grow connections between more universities and entrepreneurial ecosystems to further facilitate medical technology development. Overall, this experience navigating multiple university, entrepreneurial and legal systems to create a student-driven, collaborative initiative can serve as a guideline to efficiently develop similar systems elsewhere, affecting medical education, innovation and commercialization.

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Acknowledgements

The authors would like to acknowledge all of Sling Health’s student volunteers, faculty mentors and academic and industry sponsors. This program exists because of substantial student and volunteer support from thousands of individuals over the first seven years. We especially appreciate all of the institutional and individual support from Washington University in St. Louis, which enabled Sling Health’s first chapter to grow and thrive since its infancy.

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Department of Medicine, Emory University, Atlanta, GA, USA

Stephen W. Linderman

Washington University in St. Louis School of Medicine, St. Louis, MO, USA

Stephen W. Linderman & Kavon Javaherian

Washington University in St. Louis School of Engineering and Applied Sciences, St. Louis, MO, USA

Stephen W. Linderman & Aadit P. Shah

University of Michigan Medical School, Ann Arbor, MI, USA

• Abhinav J. Appukutty

Harvard Medical School, Boston, MA, USA

• Mario V. Russo

Olin Business School, Washington University in St. Louis, St. Louis, MO, USA

Kavon Javaherian

Department of Medicine, University of California San Francisco, San Francisco, CA, USA

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S.W.L., A.J.A, M.V.R., A.P.S. and K.J. serve as trainee volunteers on the board of the Sling Health National Network. S.W.L., A.J.A. and M.V.R. wrote the manuscript and all authors contributed to revision.

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Correspondence to Stephen W. Linderman .

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Linderman, S.W., Appukutty, A.J., Russo, M.V. et al. Advancing healthcare technology education and innovation in academia. Nat Biotechnol 38 , 1213–1217 (2020). https://doi.org/10.1038/s41587-020-0689-7

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Calls for Papers from medical journals publishing in Artificial Intelligence

From JAMIA : ChatGPT and Large Language Models (LLMs) in Biomedicine and Health

Interactive Visualization of Health Data for Digital and Personal Health

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Inclusive Medicine and Medical Education: Increasing the Number of Clinicians With Disabilities

Deep Neural Networks in Computational Neuroscience

Artificial Intelligence [Big data, Language Systems, Machine Learning]

Big Data, Machine Learning and Contraceptive Use: A Scoping Review

ChatGPT: revolutionizing cardiothoracic surgery research through artificial intelligence

Independent Living With(out) Privacy: Artificial Intelligence Home Health Monitoring

Revolutionizing patient safety with artificial intelligence: the potential of natural language processing and large language models  

Towards realizing the vision of precision medicine: AI based prediction of clinical drug response

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An artificial intelligence-powered, patient-centric digital tool for self-management of chronic pain: a prospective, multicenter clinical trial  

Coproduction and Usability of a Smartphone App for Falls Reporting in Parkinson Disease

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Emerging computational technologies in human leishmaniasis: where are we?  

Stem Cells and Organs-on-chips: New Promising Technologies for Human Infertility Treatment  

Women’s perspectives on the use of artificial intelligence (AI)-based technologies in mental healthcare

Imaging and Surgical Advancements

Advances in neuroimaging studies of alcohol use disorder (AUD)

Artificial Intelligence in Clinical Practice: Implementation Considerations and Barriers

Comparing The Efficiency Of A Real-Time Artificial Intelligence Instructor To Human Expert Instructors In Simulated Surgical Technical Skills Training– A Randomized Controlled Trial

Present and future of machine learning in breast surgery: systematic review

Real-time detection of acromegaly from facial images with artificial intelligence  

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Artificial intelligence chatbots will revolutionize how cancer patients access information: ChatGPT represents a paradigm-shift

Development of a cervical cancer prevention text-messaging program for women living with HIV

How can artificial intelligence decrease cognitive and work burden for front line practitioners?

Scoping review: exploring the equity impact of current digital health design practices

The impact of Chat Generative Pre-trained Transformer (ChatGPT) on medical education

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Information technology in medical education: current and future applications

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Advances in medical technology over the next 20 years

Doctoring: The Nature of Primary Care Medicine

The Special Problem of Technology

Commentary: The Future Impact of Science and Technology on Medicine

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• Open access
• Published: 09 April 2024

Preparing medical students for their educational task as physicians: important, desirable and unexplored territory

• Bas PH ter Brugge 1 ,
• Lena Sophia Fegg 2 &
• Marjo Wijnen-Meijer 2 , 3  

BMC Medical Education volume  24 , Article number:  391 ( 2024 ) Cite this article

237 Accesses

Metrics details

Physicians engage in educational activities in daily practice and take over an important role in providing information and transferring knowledge to patients and medical students. Therefore, it is important to focus on methods to develop teaching skills during medical school. Peer-teaching is a teaching method that is connected to different positive learning outcomes. This study aims to investigate the perspective of medical students regarding teaching as a core competency of physicians and peer-teaching as an opportunity to acquire educational skills. The study also aims to examine to what extent medical students are prepared for their teaching role at medical schools.

This cross-sectional study was performed by an online survey amongst Dutch medical students from all medical schools across all years of study. In total, 2666 medical students filled out the survey. The survey was part of the annual online survey of the Dutch medical advocacy group (DeGeneeskundestudent) amongst all medical students in the fall of 2017. The data were analysed with descriptive statistics and statistical tests (chi-squared-test and binomial test).

The results show that 49% of medical students see teaching as one of the core tasks of a physician. However, only 25% feel well prepared by their medical school for this teaching role. Instead, there are many students who gain experiences and teaching skills on their own outside medical schools. 64% of the respondents agrees that senior medical students can educate junior medical students well.

Conclusions

Implementing peer-teaching in the curricular of medical schools could be an effective teaching method to prepare medical students for their future teaching role. It is important that medical schools focus on enhancing educational quality and designing learning environments for best learning outcomes to better prepare medical students for professional life.

Peer Review reports

The teaching role of physicians is a core competency in the new Dutch Medical Training Framework: “Physicians contribute as academics to the application, spread, translation and proliferation of knowledge in practice through lifelong learning, training others, evaluating evidence and contributing to scientific research” [ 1 ]. Every physician must be able to “create a safe learning environment”, “provide a teaching activity” and “constructively evaluate teaching activities to improve education” [ 1 ]. After all, every physician engages in educational activities in one way or another. It has been shown that a general practitioner spends up to 20% of his consultation time on patient education and a medical specialist up to 10% of his time on supervising residents or medical students [ 2 , 3 ]. Physicians play an important role in providing information and transferring knowledge to patients and medical students. Therefore, parallel to clinical skills the acquisition of educational skills should begin in medical school and continue throughout postgraduate training [ 4 ].

Educational skills are best developed by doing it yourself [ 5 , 6 ]. Peer-teaching, i.e. students teaching other students, is a method for medical students to practice teaching in a controlled environment [ 6 ]. In some medical faculties, both in the Netherlands and other countries, peer-teaching is a regular part of medical school [ 7 , 8 ]. To develop medical students’ teaching skills, peer-teaching programmes, teaching workshops, and community outreach programmes are used [ 9 ]. Many medical schools in the United States offer formal students-as-teachers (SAT) programmes, where students are assigned educational roles such as peer mentors, teaching assistants or contributing to the development of a curriculum design. These programmes benefit the students’ teaching skills, improve their clinical knowledge and communication- and professional skills. Peer-teachers can benefit from peer-teaching experiences in many ways. Teaching offers a chance to identify personal strengths and weaknesses by preparing complex medical knowledge, organizing classes, enhancing public speaking skills, giving- and receiving feedback, working in a team and leading near-peer students [ 6 , 7 , 8 , 10 , 11 ]. By actively participating in their training the medical students’ intrinsic motivation is improved [ 12 , 13 ].

In a recent non-randomized controlled trial by Veloso et al. (2019), it was shown that medical students who taught Basic Life Support skills to community health professionals had a better theoretical and practical performance in Basic Life Support, than medical students who didn’t teach these skills [ 14 ]. Peer-teaching is further supported by studies that have found no difference in medical students’ academic achievements when taught by peer-teachers or faculty staff. While peer-teachers are considered less knowledgeable than faculty staff, students actually feel more at ease asking questions and, due to peer-teachers being regarded as more approachable, they are better understood and guided in comprehending difficult topics [ 11 , 14 , 15 , 16 ]. A final reason for implementation of peer -teaching programmes is the rise in student numbers. Peer-teachers offer a solution to overcome the strained teaching capacity of faculty staff [ 11 , 17 ].

There is evidence that former peer-teaching physicians become more engaged in educational activities. A study by Kloek et al. (2016) indicated that these physicians themselves highly appreciated the teaching internship and are likely committed to building an educational career in their future professional life [ 18 ].

Unfortunately, little is known about the perspective of medical students regarding teaching as a physician and peer-teaching. This perspective is relevant to facilitate the introduction of peer-teaching by medical schools and better prepare medical students for their future teaching role as a physician. It is relevant to assess medical students’ perspective on the teaching role of physicians and their educational activities during medical school. Therefore, this study aims to gain insight into medical students´ opinion on teaching as a physician and peer teaching by answering the following research questions:

To what extent do medical students consider teaching a core competency of a physician?

How and to what extent are medical students prepared for teaching as a physician during medical school?

Study design and participants

This study has a cross-sectional design and is performed by an online survey amongst medical students.

The research population comprised of Dutch medical students from all medical schools across all years of study. In the Netherlands, there are eight medical schools that offer a six-year undergraduate medical training. The undergraduate program is divided in a three year Bachelor, with mostly theoretical education, and a three year Master, with both theoretical educations and clerkships.

The survey started with a general section on gender, university and study-phase. Next, five questions asked for the participants view regarding (the preparation for) teaching as a physician and peer-teaching (see Tables  1 and 2 ). The questions were grounded in literature [ 17 ]. Four questions were answered on a five-point Likert scale (strongly agree- strongly disagree), in which answer option 3 means “neutral” and for the question “older students can teach younger year medical students well” also “no experience”. The final question was a binary question (yes/no).

The survey was part of the annual online survey of the Dutch medical advocacy group (DeGeneeskundestudent) amongst all medical students in the fall of 2017. Participants voluntarily filled out the questionnaire and informed consent was given for anonymous use of the data.

Data analysis

Before data-analysis we excluded the following participants. Participants with an abbreviated medical study were excluded because they had already finished a wide range of different previous bachelor-studies. Participants who had not filled out the general section were excluded as well. The results were analysed with SPSS version 25. The general section was analysed with descriptive statistics. The study population was compared with available national data on medical students regarding gender, study-phase and university [ 19 , 20 ]. The questions on the participants view answered on a Likert scale were dichotomised to agree (strongly agree-agree) and disagree (strongly disagree-disagree). In the analysis, we left out the responses to category 3 to get an impression of students’ positive or negative attitude towards peer-teaching and, regarding question 2, to avoid bias from people who have no experience with it giving an opinion. The results were analysed with descriptive statistics. The participants view according to different gender, study-phase or university was analysed with a chi-squared-test or binomial test. The binary question on the participants view was analysed with descriptive statistics. The participants view according to different gender, study-phase or university was analysed with a chi-squared-test. The outcome of all tests was significant if p  < 0.05.

Respondents´ characteristics

The respondents´ characteristics are shown in Table  3 . A total of 2666 medical students filled out the survey. The percentage of male respondents was lower than the national average, 23% versus 34%, as well as the percentage of master students, 47% versus 53%. The percentage of respondents from the University of Amsterdam (UvA), Vrije Universiteit (VU) and Rotterdam was slightly lower than the national average, while the percentage of respondents from Groningen, Leiden and Nijmegen was higher than the national average. The distribution of respondents across years of study is similar to the distribution in the overall population.

View on teaching as a physician and peer-teaching

The results on teaching as a physician and peer-teaching are shown in Tables  1 and 2 . Significant results are highlighted in the paragraph below.

Teaching as a physician

49% of the respondents agrees that teaching is a core responsibility of a physician, while 22% of the respondents disagrees. Male respondents agree more often than female respondents, 58% versus 47%, as well as respondents in the master phase than respondents in the bachelor phase, 64% versus 35%. Agreement of respondents from different universities was between 43% and 56%.

• Peer-teaching

64% of the respondents agrees that senior medical students can educate junior medical students well, while 13% of the respondents disagrees. Respondents in the master phase disagree more often than respondents in the bachelor phase, 13% versus 11%. Agreement of respondents from different universities was between 53% and 75%.

View on preparation for teaching as a physician

The results on preparation for teaching as a physician by the formal education and respondents’ own experience are shown in Tables  1 and 2 . Table  4 shows the respondents own experience with teaching. Significant results are highlighted in the paragraph below.

Formal education

27% of the respondents agrees that the medical education prepares them well for teaching as a physician, while 39% disagrees. Male respondents agree more often than female respondents, 36% versus 24%. Respondents in the master phase disagree more often than respondents in the bachelor phase, 46% versus 33%. Agreement of respondents from different universities was between 19% and 33%.

Own experience

48% of the respondents agrees that their own experience with teaching prepares them well for teaching as a physician, while 22% disagrees. Male respondents agree more often than female respondents, 62% versus 44%. Respondents in the master phase agree more often than respondents in the bachelor phase, 56% versus 40%. Agreement of respondents from different universities was between 39% and 56%.

52% of the respondents have teaching experience. Male respondents more often have experience than female respondents, 59% versus 51%, as well as respondents in the master phase than the bachelor phase, 63% versus 42%. The percentage of respondents from different universities with teaching experience varies between 44% and 60%.

Of the respondents with teaching experience, 13% have experience as peer-teacher, 11% as part of the formal education and 37% outside the formal education. Male respondents have more experience than female respondents with teaching outside the formal education, 42% versus 36%, and as peer-teacher, 16% versus 12%. Respondents in the master phase have more experience in all manners of teaching than respondents in the bachelor phase. The percentage of respondents from different universities with teaching experience varies, as peer-teacher (4 − 17%), as part of the curriculum (6 − 21%) and outside the formal education (33-45%).

Half of medical students feel that teaching is one of the core tasks of a physician. Unfortunately, only 25% feel well prepared by their medical school for this teaching role. This is in line with the literature that students would benefit from more preparation in this area [ 21 , 22 ]. It is striking that students who are more advanced in their studies feel less prepared than students who are at the beginning of medical school. The explanation for this may be that older students have more insight into the complexity of the teaching task because they have more experience with the physicians who teach or have had some experience of this themselves. It is contradictory that on the one hand students are aware of their later teaching role and responsibility but on the other hand do not feel adequately prepared for this role. A core task of physicians is to provide knowledge, experiences and skills to different learning groups, e.g. to medical students, patients and other professionals and should therefore be a relevant part of medical education programs.

Almost half of the students feel well prepared for their later teaching role from their own experience. They look for teaching opportunities themselves in anatomy or skills courses or as a secondary job [ 23 ]. They agree that their own experience with teaching prepares them well for teaching as a physician. This finding highlights the importance of providing appropriate learning opportunities during medical education. Students engaging as peer-teachers have the chance to gain extracurricular experiences that are relevant not only for professional practice but also to strengthen soft skills and interdisciplinary competencies. Teaching experiences are beneficial in many ways, increase teaching skills, intensify knowledge, increase organizational and communication skills and enhance leading and speaking skills that are relevant for daily practice [ 6 , 7 , 8 , 10 , 11 , 24 ].

A large majority of medical students think that older students are good at teaching younger ones. At some universities, students have a more positive image of peer-teaching than at others. It is useful to find out whether these faculties use peer-teaching more as a teaching method.

Thus, medical students’ own views on peer-teaching do not seem to be an impediment to using peer-teaching to learn the role of a teacher. This is also in line with the literature on peer-teaching showing different advantages of learning from other students [ 11 , 25 ]. First, peer-teachers are closer to the student in experience. Therefore, they can better understand what the students find difficult and they also understand the knowledge level of the students better, compared to, for example, medical specialists [ 15 ]. In addition, peer-teachers can create a safe educational climate in which mistakes are allowed and questions can be asked, because peer-teacher are perceived as less threatening [ 15 ]. Peer-teachers and students both can profit from peer-teaching settings.

The use of students as teachers can improve teaching capacities and is also connected to economic aspects. To secure high standards in the quality of education in medical schools, peer-teaching programs should be accompanied by training and supervision [ 11 , 17 ].

A strength of this research project is that it is a cross-section of all Dutch universities and all study years. Therefore, the results give a good picture of the opinion of Dutch medical students. Furthermore, the study focuses on the perspective of medical students. This perspective can be beneficial for gaining insights into medical students’ opinions and for designing adequate learning environments in medical schools. A limitation is that due to the nature of the survey, questionnaires with multiple choice questions, it only provides a global picture. Furthermore, male and bachelor students participated significantly less, which may distort the results. Future research can focus on a comparison between universities with and without formal education in the study program in the area of teaching skills. Furthermore, follow-up research should focus on assessing gender differences. Interviews or focus groups can also provide insight into the motivation and argumentation of the students to gain deeper insights into students’ perceptions. Additionally, further research should also include medical teachers, professionals at medical schools, experts and physicians to gain multiple perspectives. It is also important to focus on the effectiveness of peer-teaching programs in comparison to other learning methods, particularly from a long-term perspective. As teaching skills are a core competence of physicians for daily practice, assessing learning opportunities and methods for physicians in the context of continuing education should also be taken into account.

Many medical students see teaching as a core task of physicians and are aware of their later teaching role. However, a large proportion of them, especially the students in the last phase of their studies, feel that their medical school program has not adequately prepared them for this role. Instead, there are many students who gain experiences and teaching skills on their own initiative outside medical schools. Preparing medical students for their educational tasks and supporting them in the acquisition of teaching skills should be an essential part of their education. The majority of medical students think that senior students can educate junior medical students well. Therefore, implementing peer-teaching in the curricular of medical schools could be an effective teaching method for learning success. In a broader context, preparing medical students for their teaching role can be beneficial for the patient-medicine relationship and the provision of knowledge and health competency for patients. This study and the literature show that peer teaching, combined with good supervision and feedback, is a good way to prepare medical students for the future teaching role. It is important that medical schools focus on enhancing educational quality and designing beneficial and positive learning environments for best learning outcomes to better prepare medical students for professional life.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to data protection guidelines of the institution but are available from the corresponding author on reasonable request.

Abbreviations

students-as-teachers

Universiteit van Amsterdam

Vrije Universiteit

Nederlandse Federatie van Universitair Medische Centra (NFU). Dutch Medical Training Framework 2020. Utrecht. 2020;1–82.

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ter Brugge, B.P., Fegg, L.S. & Wijnen-Meijer, M. Preparing medical students for their educational task as physicians: important, desirable and unexplored territory. BMC Med Educ 24 , 391 (2024). https://doi.org/10.1186/s12909-024-05328-y

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The office of Translational Research, Innovation, and Technology Transfer provides enhanced pathways and expanded access opportunities for students, researchers, and faculty who have biomedical ideas with the potential for commercialization or licensing.

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Seven UB researchers elected AAAS fellows

Aaas is the world's largest general scientific society; past fellows include thomas edison, w.e.b dubois.

By News Staff

Release Date: April 18, 2024

BUFFALO, N.Y. – Seven University at Buffalo scholars have been elected fellows of the American Association for the Advancement of Science (AAAS), which is the world's largest general scientific society and publisher of the journal Science.

The honor is bestowed annually upon scientists, engineers and innovators who have been recognized for their achievements across disciplines, from research, teaching and technology, to administration in academia, industry and government, to excellence in communicating and interpreting science to the public, according to AAAS.

The new UB fellows include: Sherry Chemler, Jean-Pierre Koenig, Kemper Lewis, Gabriela Popescu, Thomas Russo, Frederick Stoss and Janet Yang.

Sherry Chemler

“For distinguished contributions to synthetic chemistry, including developing new copper-catalyzed alkene additions that enable concise de novo synthesis of enantioenriched saturated nitrogen and oxygen heterocycles.”

Sherry Chemler , PhD, is a professor in the Department of Chemistry in the College of Arts and Sciences who has developed groundbreaking chemical methods that can aid drug discovery. In the mid-2000s, she invented new copper-catalyzed alkene additions that enabled concise synthesis of chiral nitrogen and oxygen heterocycles — valuable organic compounds that enable drug discovery. Supported by the National Institutes of Health and the American Chemical Society, Chemler and her team have spent the ensuing years expanding the scope of the transformations. A collaborator with Roswell Park Comprehensive Cancer Center, she has several ongoing projects to address challenges in drug discovery related to potency, selectivity and metabolism. Her publications have been cited over 8,200 times and she has been an associate editor for the AAAS journal Science Advances since 2016. 

Jean-Pierre Koenig

“For distinguished contributions to the language sciences and for integrating formal syntax and semantics studies of lexical knowledge across languages of the world with experimental, corpus, and computational techniques.”

Jean-Pierre Koenig , PhD, professor in the Department of Linguistics in the College of Arts and Sciences, studies the organization and use of words in a diverse array of languages, from English to Oneida. His work has focused on verbs, how their structure and meaning vary across languages, as well as how we deploy our vocabulary — especially of words with more than one meaning — when we read. One of his current projects is a comprehensive study of the structure of Oneida, an Iroquoian language, which will challenge the idea that certain properties of language are universal. His work has been published extensively and includes contributions to many language sciences disciplines, including to the “Grande Grammaire du français,” the largest comprehensive grammar of French written in the last 100 years.

Kemper Lewis

“For distinguished contributions to the field of design automation, advancing both fundamental decision theory and novel applications to systems design, design analytics, and Industry 4.0.”

Kemper E. Lewis , PhD, dean of the School of Engineering and Applied Sciences and professor in the Department of Mechanical and Aerospace Engineering, is a global leader in engineering design, system optimization and advanced manufacturing. He is director of UB’s Community of Excellence in Sustainable Manufacturing and Advanced Robotic Technologies (SMART), which develops advanced manufacturing and design automation solutions. Lewis is a Fellow of the American Society of Mechanical Engineers (ASME), and has served on the National Academies Panel on Benchmarking the Research Competitiveness of the United States in Mechanical Engineering. He has published over 200 refereed journal articles and conference proceedings and has been principal or co-principal investigator on grants totaling more than $33 million.

Gabriela Popescu

“For distinguished contributions to the field of molecular neuroscience, particularly in elucidating structural and functional aspects of neurotransmission in the central nervous system in health and disease.”

Gabriella K. Popescu , PhD, is a professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences. Her research centers around NMDA receptors, which produce electrical currents that are essential for cognition, learning and memory. Her current eight-year research grant from the National Institutes of Health focuses on the excess activation of these receptors, which can cause pathological cellular loss in stroke, brain and spinal cord diseases, including Alzheimer’s and Parkinson’s disease. Popescu uses her leadership positions in national organizations to promote diversity and inclusion in academic medicine as well as public support for the sciences.

Thomas Russo

“For distinguished contributions to the field of bacterial pathogenesis, and the development of therapeutics, as well as distinguished contributions as an educator of the public, schools, and businesses throughout the COVID-19 pandemic.”

Thomas A. Russo , MD, SUNY Distinguished Professor in the Department of Medicine in the Jacobs School, is an expert in infectious diseases. Russo, who cares for patients at the VA of Western New York, conducts research on gram-negative bacterial infections, antibiotic-resistant infections and works on developing targeted vaccines and drugs. Russo led the team that discovered the first biomarkers that help identify hypervirulent Klebsiella pneumonaie, a potentially lethal pathogen that can infect healthy individuals. He is also a go-to source for national and global media, sought for his straightforward explanations of complex medical topics.

Frederick W. Stoss

“For distinguished contributions in science librarianship and related realms, especially to provide scholars, students, and the general public with sound information relating to environmental issues.”

Frederick W. Stoss , MLS, and his service to the university, the library profession and the community has been guided by a deep commitment to education, equity, access, social justice, environmental responsibility and stewardship. His 40-year career in library and information sciences includes prior experience as a research scientist in the areas of toxicology and environmental health. This rich background provided Stoss with extensive and invaluable insights that contributed to the academic success and professional and personal group of UB faculty, students and staff in the areas of research, teaching and learning.

“For distinguished contributions to the field of science communication by evaluating public risk perceptions of various diseases and environmental hazards and conveying this information to the public and researchers.”

Janet Yang , PhD, professor in the Department of Communication in the College of Arts and Sciences, studies how people perceive risks related to science, health and environmental topics. Funded by multiple grants from the National Science Foundation, Yang’s work has revealed that many Americans did not want to get the COVID-19 and mpox vaccines because they viewed the vaccines as not sufficiently researched and therefore carry too much uncertainty, a finding that provides critical insight for vaccination messaging. She and her team have also examined risk perception in relation to climate change and per- and poly-fluoroalkyl substances (PFAS) pollution. Currently, as part of UB's Initiative for Plastics Recycling Research and Innovation, Yang explores effective communication strategies to encourage New York State residents to recycle, reduce, and reuse more effectively. 

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The Role of Technology in Health Professions Education During the COVID-19 Pandemic

Pamela r. jeffries.

1 P.R. Jeffries is professor and dean, School of Nursing, Vanderbilt University, Nashville, Tennessee.

Reamer L. Bushardt

2 R.L. Bushardt is professor and senior associate dean, School of Medicine and Health Sciences, The George Washington University, Washington, DC.

Ragan DuBose-Morris

3 R. DuBose-Morris is associate professor, Academic Affairs Faculty, Medical University of South Carolina, Charleston, South Carolina.

Colton Hood

4 C. Hood is assistant professor, Department of Emergency Medicine, The George Washington University, Washington, DC.

Suzan Kardong-Edgren

5 S. Kardong-Edgren is associate professor, Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts.

Christine Pintz

6 C. Pintz is professor, School of Nursing, The George Washington University, Washington, DC.

Laurie Posey

7 L. Posey is associate professor, School of Nursing, The George Washington University, Washington, DC.

8 N. Sikka is professor, Department of Emergency Medicine, The GW Medical Faculty Associates, Washington, DC.

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.

In this paper, we discuss the emergence and usage of various technologies to support the continued education, training, and practice of health professionals during the COVID-19 pandemic, which began at the end of 2019, but took firm hold in the United States in March 2020. Although some institutions and organizations have been early and prolific adopters of technology, academic health centers, health professions education (HPE) institutions, and credentialing bodies have shown a reluctance to change course, preferring to remain largely dependent on traditional methods requiring face-to-face, hands-on learning in the clinical setting to prepare graduates to enter the workforce. Due to the pandemic, increases in technology adoption that would have taken years instead took place in a matter of months. HPE and health care practice may return to an emphasis on in-person activities once the pandemic is over, but new knowledge, skills, technologies, and innovations will remain.

Transition to Online Learning

Online learning increased 900% worldwide between 2000 and 2016 1 and, in 2020, there were 1.22 billion online learners worldwide. 2 Evidence-based best practices and frameworks exist to guide faculty with online teaching and learning. In a recent survey, however, only 49% of faculty believed online learning was effective as a pedagogy. 3 Faculty beliefs changed somewhat after they received sufficient support and training, and improved dramatically after they actually taught an online course. 3 Those who believed they were well prepared to teach online during the pandemic were more likely to have adopted the evidence-based strategies that result in an engaging and effective digital learning experience. 4 Many of the innovative approaches implemented early in the pandemic were developed by experienced educators and consistent with what we already know about effective online learning.

As the pandemic worsened, many institutions moved to fully online teaching, increased hybrid approaches, or offered classes both in-person and online simultaneously. Most higher education institutions had resources and infrastructure to support the delivery of fully online or hybrid courses before the pandemic, but in spring 2020, were at varying levels of readiness for a complete transition to online learning. 5 Health professional educators at institutions with a centralized learning management system had access to an array of features to create and postinstructional materials online. For example, faculty could conduct synchronous videoconferencing sessions, facilitate learning through asynchronous discussions or small-group work, and assess learning through submitted assignments or online exams. Colleges and universities with instructional design and technology staff responded quickly to provide training and support faculty in using these resources effectively, including moving faculty development for online teaching to online formats. 6 Many colleges and universities made instructional technology, educational design, and round-the-clock support available to help assist novice faculty. 7

The need to pivot quickly from in-person to online learning sparked renewed interest in a teaching model known as “HyFlex,” a multimodal approach to hybrid course delivery that allows students to attend classes online or in-person simultaneously. 8 Several institutions adopted this approach to allow students the option to return to campus or continue learning from home. 9 At a minimum, HyFlex classrooms require live-stream videoconferencing that enables students to participate in real time or view class recordings asynchronously. HyFlex courses allow for instructional continuity in the face of disaster while allowing a diverse student body to choose the mode of instruction that best meets individual student needs. Successful adoption requires careful planning and adequate support for both students and faculty. 10

Innovations in teaching method

Easy, low-cost access combined with the ability to connect people in real time made videoconferencing one of the more popular ways to deliver virtual education to both students and practicing clinicians. Platforms such as Zoom, Microsoft Teams, WebEx, Skype, and Blackboard Collaborate offer a range of features to support virtual learning. These features allowed educators to facilitate active participation through real-time discussion, interactive tutorials, and student-led case and clinical topic presentations 11 ; Socratic questioning within virtual discussions of nursing care plans 12 ; collaborative case-based learning in biochemistry 13 ; and data analysis exercises during a virtual structural biology boot camp. 14 Another example of interactive videoconferencing is the University of New Mexico’s Project ECHO, which connects experts and health care providers in “all teach, all learn” telementoring sessions. These sessions, modeled on the grand rounds method of information sharing amongst clinicians, use case studies to promote discussion, disseminate knowledge, and offer support for participants.

While many health professions courses could be adapted to online formats relatively easily, replacing some types of clinical learning experiences challenged educators to explore alternative options. The spring 2020 closings of university campuses for in-person learning necessitated a rapid transition of clinical experiences and clerkships to online learning. Clinical entities closed their organizations to students due to the increased patient load and the need for COVID-19 precautions, which put a strain on health care providers, limited personal protective equipment supplies, and reduced the time they could spend with students. 15 With limited or canceled clinical experiences for students, some HPE programs adopted a service-learning approach. For example, through a partnership between a university and a local nonprofit organization, public health nursing students participated in a remote service-learning experience by making phone calls to older adults who may have been experiencing increased isolation during the pandemic. 16 In a similar project, medical students who called and interviewed homebound veterans with a goal of alleviating social isolation while improving history-taking skills found it to be a deeply meaningful learning experience. 17 When senior medical students required a comparable experience to replace clinical rotations, educators implemented virtual peer teaching, with senior medical students facilitating online problem-based sessions with other students. 18

Helping learners develop hands-on clinical skills online presented unique challenges. Some instructors used a blended approach to replicate different aspects of hands-on skills learning, such as replacing face-to-face, small-group ophthalmology skills sessions with a combination of written materials, video demonstrations, and small-group Zoom meetings. 19 Similarly, when students in a gross anatomy course could not access on-campus laboratories, instructors created narrated demonstrations on models and tissue slices, assigned application exercises, and held weekly synchronous “drop-in” sessions. 20 Bhaskar and colleagues delivered a spirometry practicum using Zoom to demonstrate the procedure and allowed students to conduct the analysis by controlling the instructor’s laptop remotely. 21 Other educators took advantage of existing online simulations and datasets to enable students to complete biochemistry and microbiology experiments remotely 22 or made use of items available to students at home, such as a cup of hot coffee to teach the principles of specific heat capacity. 23 Noted benefits of virtual labs included immediate feedback, the ability to repeat experiential activities without time limitations, and the opportunity to gain experience with technology in preparation for in-person laboratories. 24

Also, during the early waves of the pandemic, knowledge and skills assessments that were historically conducted face-to-face were moved online, which raised some academic integrity, validity, and reliability concerns. 25 Using critical thinking questions that cannot be easily looked up in a textbook and limiting the time and time frame during which learners can complete an online exam can minimize these concerns. 11 There are also many options to support remote proctoring of exams, although these can be costly and require careful planning. 26 Objective structured clinical examinations, in which students rotate through a series of virtual stations electronically, proctored by faculty using streaming technologies, can aid in the assessment of clinical skills.

The transition to online learning was challenging for some students. Students who chose traditional on-campus programs for the social and intellectual experience were forced to put those preferences aside. Some students may have lacked self-regulation or independent learning skills needed to be successful in online courses. 27 For others, mental health concerns may have been compounded by isolation and lack of connection to instructors and peers. 28 Students from lower-income and rural backgrounds may have had less access to technology and were more likely to face financial issues and health worries. 27 , 29 All of these issues highlighted the need for additional student support, including digital literacy education, academic coaching, access to technology, tutoring, and counseling.

Clinical education, interrupted

A major concern for HPE during the pandemic was clinical education; faculty and clinicians were needed to facilitate instructional continuity to keep students progressing so they could graduate successfully and be ready to enter an already depleted workforce. Many nursing school leaders engaged their state legislatures, boards, and regulators in making compromises that enabled students to matriculate and complete their education. Due to the lack of clinical sites, which made it difficult to meet program requirements for clinical care hours, some boards of nursing and other boards quickly began to modify their policies and expectations for direct patient care during this unprecedented time. One such policy change, supporting atypical, varying clinical experiences, was initiated by the state of Virginia. The state’s director of its Department of Health Professions, in concert with the Virginia Board of Nursing, initiated a temporary waiver for regulations governing nursing education programs. The waiver allowed nursing education programs to substitute competency in course outcomes for clinical contact hours. Because health care organizations, hospitals, community centers, and other clinical learning sites closed to students, faculty needed to turn to screen-based simulations, virtual simulations, and other types of simulated activities, designed for students to apply their knowledge and skills in a virtual environment. 7

Some educators used mannequins and standardized patients within a recorded Zoom platform while learners and facilitators were also in Zoom in real time or in an actual simulation room being directed by facilitators in various stages of assessment and patient care. Virtual simulation, described as head-mounted display software as well as augmented reality software, was used in addition to screen-based, vendor-prepared, or homegrown computer-based simulations. While different types of simulations were used, the pedagogical approaches, practices, and evaluations were embryonic and fragmented due to the lack of standardized terminology. The evolving pandemic accelerated the need for clarity even as the quick pivot to remote, distance, virtual, or screen-based simulations provided the instructional methodology and potential continuity needed for health professions’ clinical education to continue.

Both undergraduate and graduate medical education were also heavily impacted by the pandemic. 30 Many medical school programs worldwide completed clinicals in a telesimulation and virtual environment in the spring of 2020. 31 E-learning modules, virtual conferencing, and surgical and other skills simulation training were used in place of, rather than to augment, traditional educational methods. 30 Numerous trainees became immersed in telehealth patient opportunities as clinics closed. 32 While nursing students were often shut out of hospital settings, many physician fellows and residents were deployed into the clinical environment and pressed into service as additional clinical providers. 2 , 33 This placed them in high-risk and high-stress positions that they had not been prepared for, and many were “cognitively and emotionally challenged by the significant morbidity and mortality occurring over a sudden and short span of time.” 33

Wide-scale adoption of simulation to replace a portion of required clinical hours led to many uneasy moments and questions about the adequacy of this methodology, though learners, safe at home, understood faculty were doing the best they could in this time of crisis to help HPE students continue to progress. With all the hospitals, community centers, and other health care agencies closed to HPE students, the major shift to online simulations for clinical education on such a large scale presents questions about the effectiveness on clinical learning.

Facilitation and debriefing skills associated with simulation are adaptable and transferrable, but is this the case for online environments? The concept of debriefing, “a critical conversation to reframe the context of a situation to clarify perspectives and assumptions, both subjectively and objectively,” 34 is one of the major components of learning using simulation. The National League for Nursing suggested that the skill of debriefing be used across the curriculum and mastery of this aspect of simulation is necessary for student success. 34

Larger questions related to the pivot to online simulations, without direct patient care, also include teaching knowledge and skills around ethics and spirituality, cultural needs, family visitation, socioeconomic factors, and the concept of patient and family advocacy in a simulated environment. Whether faculty are teaching these concepts and students are embracing them remains unclear. Another challenge in using online simulations would be the aforementioned lack of faculty development in using, implementing, managing, and evaluating this type of clinical learning. The art of technology evaluation was nascent at best. 35 Professional organizations note the continued lack of faculty preparation for even well-established technologies such as simulation. 33

Digital Disruption for Health Care Providers and Patients

As use of telehealth, remote monitoring, and other digital technologies increased, health systems also faced challenges in ensuring their health care teams were adequately prepared to use these tools. In some cases, learners had their roles shift to providing technical support to patients, ensuring they were able to access their virtual consultations online. Even though basic phone-based protocols were put into place to support COVID-19 testing, urgent care needs, translational services, and continuity of care protocols, HPE students lacked training on the appropriate use of this simple technology in the sphere of complex consultations or when interpreter services were required. There was a lack of delineation between learner levels due to the need for care to continue in modified ways. 36

Layered training protocols were needed to allow students, residents, and providers with little prior knowledge to understand telehealth fundamentals at levels appropriate to their positions. Learners often assimilated into administrative or technical roles even though training was light or nonexistent on roles and responsibilities specific to telehealth. Equally challenging were instances where providers were required to demonstrate knowledge and skills they were just learning themselves without formal feedback.

There is a growing need to document training toward technology-enabled care and health informatics competencies to support learners as they complete training and move into their professional careers. 37 Before COVID, accrediting bodies and professional practice organizations had started to develop competencies for certification. The process moved from a future state to an immediate need based on the amount of clinical work being supported by telehealth technologies. As waivers and regulations shift, it will become imperative to document initial and continuing education exposure as part of credentialing and privileging systems.

Moving forward, opportunities exist to further support learners in their access to technology and supervision of roles that enhance their clinical education. 38 Improving the education and training of graduates in the health professions so they are workforce ready is an established priority, but the pandemic has created a sense of urgency to build upon the existing momentum to bridge gaps that exist from education to practice.

Telemedicine and telehealth education

Before the COVID-19 pandemic, telehealth had limited adoption in health care settings as well as in HPE programs. 39 Training and education around new telehealth services and in support of early telehealth adopters had been steadily gaining momentum, but there was no imperative regarding its inclusion in HPE curricula. Accreditors and professional associations were exploring formal requirements related to certification and competency. 40 Still, trainees were largely being given the option to engage in experiential education activities as electives or as part of capstone projects. COVID-19 accelerated the timeline for the preparation of trainees and the implementation of telehealth services by providers, thus necessitating a need for timely telehealth education interventions. 38 The need for documented training and certification is now seen as imperative in postpandemic planning.

In the decades preceding the pandemic, telehealth education and training were largely provided as part of the development and implementation process for new telehealth services and applications. Often this education was provided by telehealth platform vendors or as part of in-person training to prepare providers on organization-specific workflows and technologies. In early 2020, with the rapid decrease in patient volumes in the ambulatory, emergent, and inpatient care settings, providers quickly sought out the skills needed to provide telehealth visits. For many, this meant implementing a free or low-cost video conferencing platform followed by onboarding through live webinars and online training sessions delivered during lunch breaks or before clinics. Across the United States, the educational pedagogy that supported telehealth education shifted to account for the need to train in the basics of conducting a telehealth visit. The emphasis was placed on connecting with patients, completing some form of examination, and adequate documentation. There was little time or consideration for emergency protocols, web-side manner, virtual exam skills, patient engagement, operation efficiency, or even the inclusion of learners.

Limits on the number of patients who could safely receive in-person care as well as the procurement of personal protective equipment impacted how students could be trained and in which settings. HPE programs faced constraints and challenges in the provision of clinical hours required for graduation. 41 In addition, historical training models that used a hierarchy of learners (i.e., providers, residents, students) flattened with all learners needing to be trained simultaneously for several interwoven roles and responsibilities. The result was the need to implement a train-the-trainer approach that allowed all learners to receive training for immediate implementation.

Patients and privacy first

Intertwined with clinical services and education processes were the clinical needs of patients. Their roles as health care consumers and the study of quality and guideline adherence were documented before COVID-19, 42 but the need to ensure patient safety while reducing risk and improving access took on increased importance as health facility closures were extended in 2020. The application of telehealth moved beyond the concept of convenience to necessity for access. 43 Still, significant engagement is required to ensure patients are receiving care in a way that reinforces continuity of trust between patients, providers, and institutions as well as privacy for their sensitive health information and assurance of security through the knowledge that their needs will be met by reputable systems. 44 New venues for communication into the home or assisted-living environments require patient safety models to be examined and updated.

Addressing the technical and educational divides

Providing virtual care to patients in home settings is challenged by patients’ needs for digital health literacy as well as access to technology, including high-speed connectivity, and access to basic health services. The increased need for individuals to have access to health care services, such as screenings and data related to the pandemic, further drove the need to address access and equity. 45 These long-standing systemic issues have been further elevated to the forefront of conversations about long-term sustainability for telehealth and HPE.

Industry decision makers in health care and technology must ensure access to appropriate technical and connectivity solutions for both providers and consumers. 46 During the past year, health care systems and individual providers had to make quick decisions about appropriate modalities and available access points to facilitate telehealth in their communities, including nontraditional locations, such as providers’ homes. Little time was available for testing or pilot phases, so creativity was needed to ensure that providers could engage with their patients and provide the appropriate level of care while also including trainees in the patient care experience as part of their formal learning objectives. 36 Providers had to learn how to optimize data gathering in collaboration with patients to ensure that the information used for their decision making was of sufficient quality to meet the standards of care.

Behind the scenes, a great deal of integration occurred to facilitate learning and care provision using existing information systems as well as online learning platforms. These innovations in clinical care, application development, experiential education, and translational research previously would have been offered on a smaller scale. 47 The pandemic necessitated integration of physical and online systems to determine not only appropriate care settings but also appropriate learning settings based on the needs of patients. In many cases, digital health solutions became a prominent method of health care education.

Competencies and teams of the future

As telehealth becomes more widely adopted and more often requested by patients, telehealth education will focus on the shift from confidence to competency. Primarily, introductory materials will continue to ensure that future and existing providers have a baseline of technical and professional knowledge related to telehealth. This framework will shift to include more formal evaluation and metric components for documenting and tracking the competency of trainees and providers. 48 In addition, HPE will further integrate health informatics training to help inform effective and interoperable health information systems through a well-trained workforce that is knowledgeable, competent, and innovative in its response to current and future health care needs. Along with the creation of new telehealth sites and services, telehealth education will also highlight the concepts of interprofessional clinical support as a way of bolstering the provision of care and improving the ongoing care coordination activities that benefit from a team-based approach. 49 These approaches will be essential in services such as remote patient monitoring, where tiered teams will evaluate and adjust patients’ care plans to ensure improved health outcomes and reduced expenditures.

Summary and Recommendations

In 2020, health care delivery and HPE experienced an acceleration in opportunities for moves to digital platforms few could have anticipated. “COVID acted like a time machine: it brought 2030 to 2020” in a matter of months. 50 The pandemic may have fundamentally changed traditional HPE, with a hybrid blend of traditional and online learning becoming the norm. The following are recommendations for the use of technologies in HPE to better support patients, practitioners, faculty, and students:

• Embrace the “new normal” by carrying forward online teaching methods that have increased efficiency while maintaining or improving student engagement and learning. Blended courses that are carefully designed to optimize the benefits of online and in-person formats may offer the best of both worlds.
• Prepare faculty, courses, and classrooms for flexible delivery. Academic institutions should ensure that faculty members have the technology, training, and instructional design and technical support needed to develop courses that can easily pivot from in-person to online delivery.
• Address potential for inequities in education and health care delivery. Universities must do more to ensure all of their students have adequate access to technology. While the increased use of telehealth and other forms of technology-enabled access to medical services for many, some vulnerable populations, such as the elderly, the uninsured, and those in underserved communities, were further disadvantaged by these measures. Federal and state governments need to incentivize health care insurers and providers to find innovative solutions that extend the reach of telehealth and community health support to these groups.
• Establish systematic, ongoing evaluation to assess and monitor new uses of technology to inform continuous improvements. Like the health system as a whole, HPE should continuously improve based on evidence. Quality improvement principles including small, incremental tests of change and establishing measures to assess processes and outcomes can support a continuously learning health care education system.
• Expand the development of repositories of online resources within and across disciplines. Educators in and outside of the health professions have long recognized the value of shared online resources. Open education repositories have the potential to save faculty valuable time, allowing them to focus on facilitating learning rather than developing e-learning content.

Acknowledgments

The authors wish to thank Marie Brown, senior advisor to the dean at The George Washington University School of Nursing, for her invaluable assistance with editing, formatting, and revising this manuscript.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: This material was presented at a conference titled “COVID-19 and the Impact on Medical and Nursing Education,” sponsored by the Josiah Macy Jr. Foundation, July 12–15, 2021, via Zoom.