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Medical school in 2029

It is lovely to hear from you and learn of your interest in entering academic medicine with a focus on medical education. Many things have changed since you graduated with a degree in medicine in 2019. I am not sure where to start, but perhaps a quick summary will help put things in perspective. For well over 100 years, medical schools trained students in essentially the same manner without any meaningful change. Education was still heavily lecture based, physical exam taught students to conduct named maneuvers that had little clinical value and to use tools and instruments that were a vestige of years past. The medical student was told to be prepared to be the captain of the ship. For this task, preparation consisted of memorized facts, evaluations relied heavily on multiple choice exams, and clinical training entailed short periods spent in a variety of clinical settings with a heavy emphasis on skills and knowledge acquisition assessed by exam rather than on processes, teamwork, and problem-solving. Frankly, medical education was ripe for a major disruptive innovation. Medical education was too elitist, too expensive, and too complex for the service that was needed. For decades, medical schools made small incremental changes in education – sustaining innovations – for example implementing problem based/case-based learning, using simulation, and implementing longitudinal clerkships. Schools were convinced these changes would keep them modern and relevant. Some of the changes were innovative, but none fundamentally changed the problems impacting medical education (access, quality and cost).