Future of Med Ed
by fkankel

Medical education as a system.  Mental models for 2025

By: Felix Ankel, MD

Medical education operates within a complex adaptive system that continually evolves in response to our changing relationship with medical knowledge, professional identity, and structural frameworks.  One of the persistent challenges for #meded leaders is the reliance on personal mastery and expertise to advance systems work.  This is primarily due to academic promotions guidelines, which often emphasize individual achievements such as grants, peer-reviewed publications, and invited lectures. Personal mastery will get you promoted, developing and socializing mental models to advance systems work will not.

Peter Senge, a systems scientist, described the five disciplines of a learning organization in his seminal work, The Fifth Discipline: personal mastery, mental models, shared vision, team learning, and systems thinking. Among these, mental models are crucial for establishing a shared vision that fosters team learning and systems thinking. Here are a few #meded mental models to consider as we look toward 2025.

1 – Assessment as a System

    One of my favorite articles, Schuwirth and van der Vleuten’s “The History of Assessment in Medical Education,” outlines the evolution of assessment from measurement to judgment to a system-level continuum. For clinicians, this “system” incorporates components like self-assessments, workplace-based assessments (WBAs), and independent assessments (e.g., board certification exams). Each component offers unique opportunities and limitations. For instance, residents may overestimate their abilities due to the Dunning-Kruger effect (DKE). Residency programs may also exhibit organizational DKE tendencies, especially when pressured to graduate residents who might not yet be ready for independent practice. Similarly, medical boards face challenges in balancing the reliability, validity, and fairness of their examinations. The interdependence of these assessment components calls for a systems approach to optimize their collective impact.

    2 – Quantum medical education

    Historically, medical education has focused on mastering medical knowledge through an expertise-driven model. However, with the widespread accessibility of information and the advent of artificial intelligence, the focus is shifting toward navigating wisdom. This new paradigm operates at the intersection of patients, families, healthcare teams, machines, and communities.

    Quantum medical education aims to train both “vessels of knowledge” (the particle) and “navigators of wisdom” (the waveform). This shift highlights the dynamic interplay between knowledge, professional identity, and structural systems. Future #meded must prepare clinicians to function effectively within this dual framework.

    3 – Fusion skills

    To optimize the “waveform” aspects of wisdom navigation, tomorrow’s clinicians will require skills beyond traditional medical knowledge acquisition. These fusion skills include:

    • Deep listening and understanding of diverse perspectives.
    • Analysis, synthesis, reflection, and articulation of others’ contributions.
    • Collaboration across diverse voices in patient care.
    • Healthy skepticism toward inputs like AI-generated insights.
    • Patient-centered advocacy in navigating collective wisdom.

    4 – Waveform assessments

    Assessments serve as a forcing function for medical education. As we shift from knowledge testing (particle) to the assessment of fusion skills (waveform), new assessment models will be needed. How can these assessments ensure validity, reliability, and fairness? How will skills such as patient-centered communication, difficult conversations, conflict management, reassessment and troubleshooting, teaming behavior, and working with electronic medical records and AI be assessed in residencies? How will they be assessed by certification boards?

    5 – Moneyball

    Another article I admire is Kinnear et al.’s “Finding Medicine’s Moneyball: How Lessons From Major League Baseball Can Advance Assessment in Precision Education.” It explores mental models like precision education, the Medici effect, intersectionality, and learning analytics. It also draws parallels to Major League Baseball’s evolution from observation (scouting) to analytics (Sabermetrics) to technology (Statcast).  The central question is: Will technology in #meded serve as infrastructure supporting education, or will it become a superstructure that drives it? This distinction will shape the future of medical education assessments.

    Questions to consider for 2025

    • What role does technology play in supporting or driving your #meded environment?g times lie ahead.
    • What is the “systemness” of your current #meded environment? Which mental models resonate with you?
    • How much of your system focuses on knowledge acquisition versus effective navigation of the patient environment?
    • Is formal education on fusion skills integrated into your curriculum or assessments?
    • Are you assessing “waveform” skills?

    References

    Image from IStock

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