Health care and health professions education environments are changing in three dimensions. First, the value of a clinician is moving away from being a vessel of knowledge towards being a facilitator of collective wisdom. Second, a clinician’s professional identity is evolving from binary (you are either a physician or not a physician) to quantum (you are both a physician and informaticist or even a new identity yet to be created) Third, the center of gravity for innovation in health care and health professional education is moving from the core of historical hierarchical institutions to the periphery of non-hierarchical trust, communication, and personal learning networks.
How do we navigate this environment? What language do we use? What are some of the mental models we can apply to help in sense-making? This is a three-part about the future of medical education using the frameworks of The Frog, The Fox, and The Electric Sheep. Welcome to Part 1: The Frog
“If a frog is put suddenly into boiling water, it will jump out, but if the frog is put in tepid water which is then brought to a boil slowly, it will not perceive the danger and will be cooked to death”
Health profession education (HPE) cannot be conceived as isolated from the technological, financial, and overall societal trends of an era. If the educational academe is blind to the trends around it and fails to react to the slowly boiling water, it will perish. We still live in a medical education world that Abraham Flexner would recognize as part of his magnus opus.
The main overarching theme to prepare the HPE infrastructure for the future is the migration from an artisanal or industry economy towards an intellectual or an intellectual-innovation-digital economy (known as Industry 4.0). We need to move away from the assembly line concept of a patient with a disease who is given advice about diagnosis, treatment, and prognosis to a world where most of the workflow will be augmented or performed by non-human agents such as algorithms and robots, distributed in loose networks, and that is focused on solutions rather than fragmented processes. The healthcare industry is rapidly adopting this new paradigm. The educational establishment has been slow to respond.
A consequence about the advent of Industry 4.0 is the rapid reconsideration of the work force in terms of size, scope, and identity. In a future world where many or all significant decisions are made by sophisticated Artificial Intelligence (AI) appliances and many procedures are performed by smart machines and robots, the roles of human health care providers will become radically different. The current industry taxonomy of physicians, advance practice clinicians, nurses, respiratory therapists, surgical techs, etc.; will become irrelevant. It is simpler and more efficient to have staff identified with specific tasks that are better performed by humans than non-humans such as empathic interview, counseling, and emotional support. We do not have a name job description for these new set of roles but will be very likely a mix of facilitator and advocate. Repetitive or data-complex actions are expected to be performed by non-human agents.
The next order consequence is related to education. If the industry is moving from the primacy of identity (i.e., physician, nurse) to the primacy of competency (i.e., emergency perfusionist or psychosocial diagnostician) that is not mapped to a specific degree, the classic approach to teaching towards a professional identity becomes misaligned, costly, and outdated. Educational institutions and regulatory bodies that are linked to binary identify formation will need to evolve dramatically. If an AI in the future will decide the best antibiotic for a patient, will medical schools need to teach pharmacology and infectious diseases? Do we have the theoretical and practical structure to allow us to train and teach learners for the future, for jobs we may not know yet that they will exist?
The current time is a liminal space. Sometimes we feel that we are asking our learners to make a leap of faith and to become healthcare professionals for a future job that will be radically different to their current training and expected competencies. This is the proverbial frog in the boiling water, the temperature is going up in the water and the frog is not perceiving the change until is too late. We hope that people can start jumping out of the water soon.
This is Part One of a three-part series. Don’t miss the second post [The Fox], coming out Tuesday, November 23, 2021!
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