1) Medical education needs radical reform to address outdated curricula and produce graduates better equipped to work in healthcare systems. 2) New models call for integrated, competency-based curricula emphasizing population health, team-based care, and lifelong learning. 3) Technology, changing student and workforce needs, and the "fourth industrial revolution" require medical education to transform from fact-based to knowledge navigation and application.

1. Redefining Medical Education
A personal view
Vaikunthan Rajaratnam
a student with no teacher a teacher with no student

2. A disclaimer
These are
•personal views
• not of any of my affiliations
• based on my current thought
•which may change
• all ignorance demonstrated are mine and mine alone!
vaikunthan@gmail.com

3. The Strategic Education Unit for Medicine
Learners
Patient
Teacher
Employer
• Impact of technology
in medical education
• Mobile devices for
learning, teaching
and assessment
• Electronic portfolios
for CME
ENVIRONMENT

4. The Problem
• enthusiasm for reform
• novice to master takes time
• produce graduates deficient
in excellence
• discontent among academics
and professionals
• Pedagogy and curriculum
under severe criticism
“Medical education needs a radical revisit from us all who are the effective
stakeholders in the education and practice of medicine. We must free
ourselves from the shackles of organisations, politics (medical schools and
governmental) and their bureaucracy with their stated and unstated agenda.
Political correctness and the fads of educational theories and practices have
diluted and corrupted the process of medical education.” Rajaratnam V Sep 2019

5. Problem
• fragmentary, outdated, and static curricula
• producing ill-equipped graduates from underfinanced institutions
• Medical Education
• curricula rigidities
• professional silos
• static pedagogy (ie, the science of teaching),
• insufficient adaptation to local contexts and
• commercialism in the professions
• Reduce competencies for effective teamwork / effective leadership
• revolution in education not applied in medicine
• Irrational / epidemiological unsound governments influence on supply of health
professionals- secondary to political situation
• Global markets for health professionals
The Lancet, Vol. 376, No. 9756, p1923–1958

6. Sacrifice excellence on an altar of the good
“the essence of excellence in medicine is more than doing what we know to
do well, but must include a commitment to discovering what will make the
better possible, and a dedication to perpetuating the best of the
profession”…….
“Excellence is the essential infrastructure of a sustainable good and
infrastructure is a fragile beast that does not tolerate neglect for very long.
For an enterprise that nurtures its infrastructure, prosperity endures.”
Brigham K, Johns MME. Good enough medicine: are we “averaging excellence out”? The Pharos.
2018:32–4.

7. Reform movement and integrated curriculum
• Trendy pedagogical styles∗
vs traditional lecture format
• Radically redesigned curriculum
• Health Systems Science third pillar of medical education co-equal with basic
and clinical medical sciences
• population health, health policy, healthcare delivery systems, and interdisciplinary care
• balance testing in the natural sciences with testing in the social and behavioural
sciences and assessing critical analysis and reasoning skills
• heavy emphasis on professionalism and professional identity development
∗ small group sessions, problem−based learning, self−directed learning, team−based learning, and flipped classrooms
“The cognitive load on the learner of an excessive curriculum needs to be addressed to facilitate meaningful and achievable
learning against the pressure from theoretical educators to include non-clinical content as core curriculum. It is estimated that
the volume of medical knowledge will be doubling every 73 days! “ Rajaratnam. V Sept 2019

8. The Lancet Commissions
vision
• educated to mobilise knowledge
• engage in critical reasoning
• ethical conduct
• competent to participate in patient
and population-centred health
systems
• members of locally responsive and
globally connected teams
• universal coverage of care
• transformative learning and
interdependence in education
The Lancet, Vol. 376, No. 9756, p1923–1958
Experts in the pathophysiological aspects of a disease but also
effective members of interprofessional teams that are
responsive to the needs of individual patients, their families
and the communities in which they live.
Am J Med Sci. 2016 Jan;351(1):77-83

9. 4th Industrial revolution in medicine
and the curriculum
• impact of elderly population and health
• technology for assessing health care need(Artificial Intelligence, Big Data and Analytics,
Virtual and augmented reality ,Nanotechnologies, Modern machines (robotics, drones,
3D-printing)
• Biological systems approach - prevention, surveillance, early detection, and intervention
• Precision medicine
• Immunotherapy
• Microbiology
• Genetic engineering
• Regenerative medicine
• Narrative medicine
The community as the classroom and the patients the teachers.

10. Today’s medical students
• assertiveness
• self-liking
• narcissistic traits
• Perfectionism
• high expectations
• high I.Q.s
• little desire to read long texts
• Multimedia/interactive format
.
• stressed
• anxiety
• poor mental health
• low on self-reliance
• high burnout
• asynchronous online learning
• study aids
• autonomy
• educational environment
Twenge JM. Generational changes and their impact in the classroom: teaching generation me. Med Educ. 2009;43:398–405
Zazulia AR, Goldhoff P. Faculty and medical student attitudes about preclinical classroom attendance. Teaching Learning
Med. 2014;26:327–34

11. Transformative learning
1. from fact memorisation to searching, analysis, and synthesis of information
for decision making
2. from seeking professional credentials to achieving core competencies for
effective teamwork in health systems
3. from non-critical adoption of educational models to creative adaptation of
global resources to address local priorities
• Medicine has to be a sustainable career with opportunities for
doctors to change roles and specialties throughout their careers.
• Local workforce and patient needs should drive opportunities to
train in new specialties or to credential in specific areas.

12. Circle of learning
Find
Understand
Apply
Reflect

13. Lifelong learning
student - practitioner continuum
• work based assessment on real life situations
• aggregation and analysis of evidence from different sources collected
over time of the learners performance
• mobile technology / smart devices - multisource stake holder
assessment
• digital learning artefacts management - lifelong learning portfolio
enabling evidence based appraisal and revalidation process.

14. Educational Environment
• System centred and not learner centred
• The education system is not fit for purpose
• Authentic curriculum with sound pedagogy founded on effective team based
care for patients
• Master teachers – “referees” and “coaches”
• Funding for teaching – back fill teachers clinical role with non teaching
clinicians ( 1 RP : 5 Faculty )
• Value / Academy for teachers ( e.g. FFST RCSEd, FAoME)
Am J Med Sci. 2016 Jan;351(1):77-83

15. ‘‘anyone can now learn anything from anyone
at anytime’’ Bonk
• cross over learning - informal setting
• “These connections work in both directions. Learning in schools and colleges can be enriched by experiences from
everyday life; informal learning can be deepened by adding questions and knowledge from the classroom. These
connected experiences spark further interest and motivation to learn”. (Sharples et al., 2015, p. 3).
• authentic practice based learning
• mobile learning platform and asynchronous learning
• learning by argumentation
• adaptive learning and teaching
• a personalized learning system
• community based learning
• patient mentors
• incidental and just in time learning
• reusable learning objects (OER)
• SOLE Sugata Mitra
Bonk, C. J. (2009). The world is open: How web technology is revolutionizing education. John Wiley & Sons.
Sharples, M., Adams, A., Alozie, N., Ferguson, R., FitzGerald, E., Gaved, M. & Roschelle, J. (2015). Innovating Pedagogy 2015: Open University Innovation Report (4).
two sorts of academics to shape the curriculum. Most prominent
are the traditional and necessary medical subject experts –joined
by less important educational theorist as advisors

16. skilled in a broad range of mentorship, teaching and evaluation techniques

17. Ten tips for the future
• real world and the authentic curriculum
• just-in-case to just-in-time learning
• full integration of the basic sciences with clinical medicine
• recognition of teaching and teachers
• student as a partner
• a mapped journey
• adaptive curriculum with adaptive (personalise) learning
• exploit fully learning technology to its creative and effective use
• program-focused assessment for learning
• from working in relative isolation to greater collaboration
Ronald M. Harden (2018): Ten key features of the future medical school—not an impossible dream, Medical Teacher

18. “We can no longer remain the irrelevant silent majority, confined to our
querulous rants in the “teh Tarik” shops, pubs and private pedestals. It is time
for us to articulate our perceptions of the current gap in the educational
processes. The challenges of resource constraints, work-life balance, patient
safety and reduced work-based learning opportunities provide the impetus for
a drastic transformation of curricular design, innovative and evidence-based
pedagogy for competency and meaningful authentic assessment based on
dynamic and evolving standards founded on excellence and mastery”
Rajaratnam. V Sep 2019
MMA. (n.d.). Malaysian Medical Association. Retrieved 24 September 2019, from https://mma.org.my/mma-september-berita-2019/