The Future of Medical Education and Practice

Abstract

Technological breakthroughs are continuously changing our world. Information technology has revolutionized our lives. In a not-too-distant future, robotics and artificial intelligence will further reshape our environment, and might even usher in a new era of space travel, migration, and physical development. The workforce profile and requisite skills will also be affected, so our learning and academic curriculum must evolve. Today's medical education, practice, and health care, still rooted in mid-20th-century principles, are slow to adapt to these changes. For centuries, medicine focused on diagnosis of diseases and palliative care. Technology helped us to be more precise with those tasks and is moving us toward health maintenance and disease prevention. Despite considerable progress in understanding, especially of the social determinants of health, the prevention of diseases, risk management, and translational and behavioral sciences continue to lag. More than 200 years has elapsed since Jenner proved the benefit of vaccination against infections, avoiding unnecessary morbidity and mortality. Yet many groups are still contesting its benefit, often with pseudoscientific methods. In the mid-1800s, Gregor Mendel described recessive and dominant traits, opening the field of genetics. Almost 100 years later, the discovery of the “double helix” by Watson and Crick (1953) transformed the field of medicine. Following the introduction of the polymerase chain reaction (PCR) method, rapid gene sequencing and genetic engineering, a new multi-billion-dollar biotechnology industry is being continuously created. The human genome mapping project, the development of molecular medicine with new, highly effective therapies, and revolutionized assisted reproductive medicine collectively evoke hope, as well as controversy about the ethical limits of medicine. Life sciences knowledge is advancing at an ever-accelerated pace thanks to international collaboration, the creation of large-scale health data banks, information technology tools, and new data mining and analysis techniques. The introduction of 3-D printing, together with genome editing and nanotechnology, hold the promise of newly effective therapies and better preventive strategies. When introduced into our educational and practice systems, a multidisciplinary approach to medicine (Harris et al., 2015) will result in better delivery of individualized care and preventive interventions before an illness becomes symptomatic. Drug design will be accelerated, requiring less time to reach the market, thanks to sensors embedded on a microchip allowing testing for novel medications’ efficacy and safety. The natural result should be better affordability and faster access. Today we can only guess what is in store for the future. Anticipating scientific breakthroughs dictates that major educational, economic, legal, ethical, and policy issues be addressed now (Dove et al., 2015; Irby, Cooke, & O'Brien, 2010). Our policymakers, service providers, and manufacturers should understand the coming changes, and include representatives from academia, the sciences, health sectors, and patient communities along with informed political advocates in current deliberations over health insurance provision. The goal should remain population health and patient care outcomes and not just economic value or profits In 2016, the U.S. Congress enacted bipartisan legislation—H.R.1831—Evidence-Based Policymaking Commission Act, to ensure that future policies are underpinned by appropriate evidence. This commission brings together leading researchers and social scientists to inventory government-collected data and propose best practices for policymakers to make use of that information. We do hope that this commission will address some of the issues raised in their editorial. We encourage our readership and editorial board to submit manuscripts on the prospects and reforms for medical education, ethics, and policies, taking into consideration future convergence of technology, science, and health implications.