The digital revolution that typifies the last few decades led us to an innovation imperative that crosses all areas of society. In this essay, we will look at the particularities of medical education, namely the way we can finally move forward in the digitalization of continuing medical education, reinforcing good practices that already produce high-quality health workers, and facilitating the adoption of new methodologies that allow to simplify and improve the process of professionals’ updating and development.
Medical education transformation, from digitalization to simulation, has been a slow and ambiguous process. On one hand, technology evolved and now offers the tools and resources for distance learning that could be fully used in hospitals and medical schools. On the other hand, there are teaching-learning moments in which physical contact and practice are needed. What tools and moments are we talking about? Which skills are needed? And what advantages are provided to healthcare professionals?
COVID-19 pandemic: the ideal environment to test new solutions
The COVID-19 pandemic has put us in a race against time and blindfolded by uncertainty, but it has also created the ideal environment to test new solutions.
The healthcare sector, which was essentially conformed with face-to-face formats, was forced to reinvent itself in a few days. The need for information exploded and it came from a wide range of sources, some more reliable than others. When face-to-face training stopped, scientific updating became more and more relevant. Health professionals were asked to quickly adapt to new functions, overcome themselves, adopt new learning and knowledge-sharing methodologies.
The status quo has changed and so has our resistance to change. Pre and postgraduate medical education resisted new learning tools; online training or webinars rarely happened, and, overall, health workers used to take advantage of the multiplicity of possibilities allowed by digital tools.
With the sudden change of context, what was under development, was launched immediately, clinical activity embraced teleconsultations, medical schools adopted online classes, and digital content production became the rule.
If, on the one hand, we knew how to reinvent ourselves and react during troubled times, how will it be in the “new normal”? Or will it not come back? If we want to take this opportunity and make the leap in medical training, what are the real paths we could follow?
Digital experiences in continuous medical education
As a starting point, let's think about the adoption of digital technologies in medical schools. When presential activities were suspended and hospitals reorganized, in early March, webinars and online courses were the window of opportunity for health workers in the most varied contexts. Countless digital experiences can contribute to healthcare professionals' continuous updates and development: online or mixed courses, intercalated with face-to-face moments, interactive algorithms to support evidence-based clinical decisions, high-fidelity clinical simulation for advanced clinical training, or digital communities that share knowledge in a faster and accessible way.
The advantages of technology are also profuse. Firstly, it allows health workers to access knowledge in a faster, more contextualized, and scrutinized way. This is essential in the context of a pandemic, but also in the everyday healthcare environment, in which it is not enough that professionals are aware of the most recent scientific evidence, but it is also preponderant that they know how to adapt this knowledge to daily clinical practice, to patients' needs and, at the same time, cooperate in growing communities of multidisciplinary providers. Furthermore, we are talking about methods that offer the convenience of being used when and where they are most needed, and a high level of personalization that allows each professional to work/learn in specific aspects, according to their needs.
Simulation and serious games on medical education
In addition to digital innovation, there are other opportunities that we must analyze and explore in continuing medical education. One of them is a virtual simulation, in which implementation is still residual. When we talk about simulation, we are talking about a training methodology that, due to its intrinsic interactivity, improves knowledge and clinical performance in quick sessions. It has proven its worth when it comes to reducing asymmetries between theoretical knowledge and care practice; it allows the control of a sequence of tasks and prevents risk situations, insofar as it allows failure and confronts each professional with its limits or gaps. The procedure is also relevant to anticipate the contact with rare diseases or for optimizing teamwork, to reduce uncertainties, and to learn in a safe, realistic, predictable, and risk-free environment, for both professionals and patients. The same happens to the possibility of repeating and improving processes, making diagnostic and therapeutic approaches clear, and consequently increasing the degree of confidence of health professionals in critical moments when the time to make complex decisions is short.
Simultaneously, serious games have been increasingly applied to medical education. The concept is simple: use gaming principles - such as curiosity, competition, and challenges - to provide an immersive and engaging training experience that leads to the acquisition of specific skills. The applicability of these methodologies is infinite since they can be designed around any pre-defined goal. We have several examples of serious games developed for patients, to promote therapeutic adherence, for example, but also for healthcare teams, including a clinical escape game designed to develop clinical and behavioral skills simultaneously.
Dealing with the emergence of a pandemic is complex. The COVID-19 outbreak imposed - and continues to impose - challenges to all health systems, even the most developed ones. In Portugal, it exposed the weaknesses of a system based on face-to-face formats, the lack of digital communication channels between the teams, which was the trigger to implement, in few days, complex processes that were under implementation for decades. It was the ideal setting to prove the usefulness of digital tools to filter scientific information, facilitate the clinical decision-making process, standardize care provision, and increase patient safety.
We now have the challenge and the opportunity to take a step forward on this path and use the creativity and innovation available to strategically rethink continuing medical education and produce consistent results in the long term as well.