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Personal view or opinion piece Open Access
A vision of the use of technology in medical education
after the COVID-19 pandemic
Poh-Sun Goh, John Sandars
Corresponding author: Dr Poh-Sun Goh email@example.com
Institution: 1. National University of Singapore, 2. Edge Hill University Medical School, Ormskirk, UK
Categories: Teaching and Learning, Technology
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.
Keywords: technology; medical education; transformative change; coronavirus, COVID-19
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
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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
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
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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
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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
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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
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
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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
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: http://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: http://orcid.org/0000-0003-3930-387X
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The author has declared that there are no conﬂicts of interest.
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This article has not had any External Funding
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