Embracing the future: Technological developments and sustainability in health professional education

Ten months ago, as of the moment this sentence is being written, ChatGPT was released to the public. Eight months ago, it was reported that over 100 million users had already engaged with the technology.¹ That same month, 71 days after ChatGPT's release, Medical Education started receiving papers speculating on, and exploring, the potential of this remarkable tool to facilitate better health professional education. The list of eye-popping statistics illustrating its uptake is endless. What will persist in our memories, however, is the lived experience of how quickly discussion about the technology seemed to become omnipresent, whether perusing the academic literature, listening to news reports or engaging in casual conversation with neighbours.

Most discussions about technology elicit varying degrees of fear and exhilaration. The rapid expansion of the perceived potential of generative artificial intelligence that ChatGPT prompted, however, led people to extremes in both regards. We harbour no doubt that the world has been made better for the development of this technology. At the same time, we do not think there should be any doubt that every action elicits a variety of reactions, some of which will be unintended and some of which will be harmful.

We cannot have a conversation, therefore, about technological advancement² and the future of health professional education without also having a conversation about sustainability. In that regard, we do not simply mean sustainability of technology itself; rather, we include the need to discuss how one conceptualises sustainability within the context of changing environmental, economic and social considerations that inherently shape health professional education.³ There is often a perception that technological developments can foster efficient and sustainable ways to address challenges.⁴ Even if that proves true to a degree, the growing demands on educational infrastructure, students, researchers and the quest for developing knowledge will create a race between development and sustainability that will continue to challenge our healthcare systems.

As a result, we curated the 2024 edition of the State of the Science series with a dual focus on technology and sustainability. We have titled it ‘Embracing the future’ not to imply that every change will be a good one (although this editorial comes exactly 10 years after a defence of fads that we continue to believe⁵). Rather, we see the title as a reminder that we have no choice but to grapple with finding the right, context-appropriate, balance between new opportunities and the dangers they create. Subthemes focus on what supports might be enabled and what supports are required for education, assessment, the workforce and education research. Within this array, a wide net is cast by considering topics such as the role of learning technologies,^{6, 7} how models of medical competence should evolve,⁸ the value of adopting ways of knowing that are broader than historical norms^{9, 10} and how god-terms like ‘patient outcomes’ and ‘productivity’ threaten health professional education scholarship.¹¹

Despite the variable focus, a common thread linking the perspectives in this issue is the centrality of the value of research data. That is, giving priority to purposefully collected observations of the world in service of developing new insights or refining and reinforcing old ones. Like waves jostling pebbles on a beach such that each loses its rough edges, successive iterations of research data collection serve to refine our theories and conceptualisations as they get rubbed one against the other. To remain sustainable, we need to move with the tide while each wave brings fresh challenges.

Thinking in these terms about embracing the future, it seems clear that in some domains, we are moving from an era of data scarcity to one of abundance and even excess.¹² Quantitative sample size calculations have generally been conducted to specify the smallest amount of data collection one could get away with while still mounting a credible argument for trustworthiness and generalisability. Now, we can often do studies with ALL the data relevant to a particular study population.¹³ Qualitative researchers, for their part, have typically used notions of saturation, information power and sufficiency that also trade off feasibility with ambition. Now, masses of transcribed text can create a research substrate that either overwhelms the individual researcher or requires the use of technological developments that significantly alter the research process.¹⁴

As alluded to above, such changes are eliciting feelings of fear, exhilaration or some mixture of both, dependent on who one talks to. Exhilaration tends to derive from the potential to address questions we have only been able to dream of addressing; fear tends to derive from worry about masses of data taking priority over well-established markers of methodological rigour, thereby undermining the scientific method. The super-abundance of data certainly carries the risk of misuse, but so too do all of our previous methods. Further, worries about sustainability of the scientific method are misplaced because there is no such thing as *the* scientific method.¹⁵ As Michael Strevens has observed,

The argument Strevens goes on to delineate is that science has been remarkably sustainable because of its adherence, not to a particular method, but to what he calls the ‘Iron Rule of Scientific Explanation’. The rule states that, to participate in scientific discourse, an individual must—whatever their private or informal hypotheses, beliefs and biases—present for peer review new evidence to justify a revision in what we know.

The scientific journal, as a result, will continue to play a central role, providing a space for theorisation and discourse about empirical data. That said, as we embrace the future of publication and the proliferation of the research enterprise, key questions with which we must continue to grapple include: How will scientific discourse change as research data become super-abundant and the portals for publication multiply? Does the resultant research become easier? Better? Or, paradoxically, does it threaten the sustainability of the scientific enterprise by virtue of watering down published content? One reason that these risks should be taken seriously is the potential for the increasing pace of evidence generation to outstrip the rate at which journals can supply thoughtful peer review.^{17, 18}

Another risk that must be managed is what happens when the new abundance is mal-distributed, exacerbating existing inequity? Paraphrasing Deming, ‘She who has the best data wins’. Our colleagues who wrote for this issue from the global South⁸ or who represent an Indigenous perspective⁹ know this only too well as they negotiate a world where all the scientific data seem to originate in the North, with serious implications for who ‘wins’ (i.e. who dominates the discourse). Unfortunately, there are multiple threats to sustainable practice that risk further inequities.

While the ebb and flow of health professional education scholarship will be altered by this sea change in data availability and distribution, innovative solutions are surfacing. Global partnerships and collaborations can ensure participation both in generating primary data and in presenting it to the scholarly community. Further, the peer review process might well be kept in balance through the development and judicious incorporation of AI and machine learning tools into the peer review workflow. Such optimism, however, demands that we continue to grapple with questions like those listed (in this editorial and focused upon throughout this special issue) if we are to effectively embrace the future.

In fact, perhaps the best guarantee of sustainability, despite an ever-changing health professional education landscape, is that we continue to be guided by the overarching scientific framework, continually investing effort to collect new observations in service of critically generating practical wisdom¹⁹ rather than using new technology simply to produce more information faster.