Embarking on the era in new medicine: reshaping the systems of medical education and knowledge

Introduction

Ongoing revolutions in modern science and industry are accelerating their cross-integration and broadly penetrating all aspects of society. These revolutions have driven medical science into a new era. With changes in ecological and urban environments, patterns of disease spectrum, and healthy behaviours, interventions targeting single risk factors cannot fully satisfy the diverse needs and high expectations of healthcare services [1]. Simultaneously, advancements in medical technologies such as gene sequencing, molecular targeted therapy, telemedicine, and bioinformatics are shifting treatments from conventional empirical medicine to precise and personalised medicine. Cutting-edge advancements in medical science have both expanded people’s understanding of health and increased the emphasis that modern medicine has on the holistic and systematic aspects of well-being.

Recently, the concept of New Medicine (NM) has emerged as a transformative pathway to revamp the medical system that aligns with rapid advancements in technology, life sciences, medical knowledge, and educational methodologies [2, 3]. It is seen as a pivotal strategy for fostering the development of world-class universities consistent with the global principles of higher education, which emphasises quality, quality assurance, and reinventing higher education for a sustainable future [4]. Three key characteristics of NM have been proposed. First, NM introduces a novel concept from prevention to treatment that aims to encompass the entire spectrum of health and the entire life cycle of care. Second, NM is rooted in a new context, leveraging advancements in scientific and technological revolutions and industrial transformations. Third, NM represents a new interdisciplinary field that integrates medicine, engineering, natural sciences, and humanities to development innovative disciplines, such as precision medicine, translational medicine, and intelligent healthcare [5].

NM incorporates the latest scientific and technological advancements from the ongoing revolution of science and industry, fostering collaboration, practical applications, and synergy across the medical sciences, engineering, physics, informatics, and humanities [6]. Although the revolution brought forth by NM has significantly transformed modern medicine, a need for a clearer understanding of its core essence remains. This review aims to offer insights into NM, intending to promote deep reflection, constructive discussions, and further advancements in this evolving field.

Changes in medical requirements in the era of Industry 4.0

Systems, holistic, intelligent, and precision (SHIP) in recent medicine

The expanding understanding of health, taking the human body as a whole system and integrating real-world practices, environmental, and social factors as an integrated science system, has led to a shift in the philosophy of medical science. Systems medicine, holistic medicine, intelligent medicine, and precision medicine (abbreviated as SHIP medicine) are exemplary medical philosophies that encapsulate the concept [6].

Reshaping the core essence of NM for the future medical education

The emergence of the innovative medical education model often requires a long and complex evolution. In the NM era, New Medical Education (NME) is no exception. NME was proposed in the context of the medical science revolution. Influenced by the dual impact of the Industry 4.0 and the Life Science Revolution 3.0, higher education experts are considering NME as an innovative education model that changed from a biomedical-science-based education perspective to a cross-discipline medical perspective known as “Medicine + X”. By integrating medical science with science, humanities, engineering, and X discipline, NME aims to foster medical innovators capable of adapting to a new generation of technological revolutions represented by AI and applying interdisciplinary knowledge to address cutting-edge medical challenges [37]. The fundamental purpose of NME construction is to improve the quality of talent cultivation; thus, it is important to identify cultivation goals and integrate them with the social development goals.

Disentangling the core essence of NM at the aspects of science, healthcare, and education systems and reaching a consensus for the construction of NME are important. The comparison of core essences and characteristics between conventional modern medicine and NM was summarized in Table 1. The core essence of NM is systematic and holistic from a scientific standpoint. It can achieve precise and intelligent treatment processes and outcomes through technology and its practical application. Fundamentally, NM is a science of health and well-being [38]. Compared with conventional modern medicine, NM emphasises understanding health from the perspective of systems theory. The science and technology of NM are based on systems and subsystems, focusing on interdisciplinary and system integration, and are prone to promoting a technical system with gene therapy and organ synthesis [6]. NM contends that health involves functional coordination across individual organs, is the adaptation of group organizational structure and behaviour, and is the mutual adaptation to the natural ecological environment. NM attempts to contribute to human health and well-being by promoting diversified innovation in medical science and achieving medical goals; thus, it is not limited to the treatment of diseases but also includes health promotion, disease prevention, early diagnosis, and improved quality of life [2]. This design is thought to reduce medical costs and improve the treatment effects [13]. Further, NM is expected to provide guidance for doctors to conduct health interventions using the big data approach to reduce the incidence of adverse health outcomes [39]. The process in the context of NM requires comprehensive treatment and management, which includes conventional treatments, such as medication, as well as multilevel treatments, such as a physiological and lifestyle interventions [40]. Meanwhile, NM focuses on a series of health risk factors, including macro- (e.g. lifestyle, working conditions, and socioeconomic development) and micro-factors (e.g. genes and heredity) and emphasises the improvement of physical and mental health by promoting quality of life and optimising the living environment [41, 42].

There are notable differences in the science system of NM compared to modern medicine in both structure and content (Table 2). The core characteristics of science systems of modern medicine is dominated by disciplines related to disease and molecular medicine, while that of NM is dominated by disciplines related to health and well-being, systems, and holistic medicine. Specifically, the key focus of NM extends beyond the fields of biomedicine or clinical medicine, and incorporates substantial data to create systematic models that can grasp various relationships between biomedicine and clinical medicine [43]. Compared to modern medicine with clear disciplinary characteristics, NM encourages broad integration across disciplines and systems.

The application attributes of NM are consistent with those of modern medicine, as both aim to intervene in human diseases or health conditions through healthcare systems. However, the concepts and paradigms of NM in the healthcare system have been greatly improved (Table 3). Compared to modern medicine, NM actively adapts to changes in human society, moving from passive and consistent treatments to the entire life and health cycle. NM aims to achieve a preventable, predictable, personalised, and participatory healthcare process. The core features of NM are transformed from an empirical approach to a data-driven approach and comprehensively integrate with new medical fields, such as precision medicine and translational medicine – that is, modern medical science is integrated with robotics, AI, and big data [2].

Moreover, in the context of NM, medical humanities play increasingly important roles in coordinating the development of modern medicine. The Association of American Medical Colleges indicated that medical students who lack a grounding in the humanities may lose their ability to challenge intellectual issues and respond to such challenges during their medical careers [44, 45]. Ignoring the importance of medical humanities may lead to some healthcare workers only focusing on diseases, medical technologies, and economic benefits, but overlooking the needs of patients. In the updated medical paradigm of “biology-psychology-social-eco-environment”, incorporating humanities into NM is crucial to promote the focus of medicine from patients to human beings, from illness to well-being.

Recommendations to revamp the medical education system

Modern medical education has undergone three stages of reform [46]. In 1910, the Flexner Report categorised the medical education curriculum into biomedicine and clinical medicine, marking the first stage of medical education reform [47]. In the mid-twentieth century, several universities such as Case Western Reserve University in the United States and McMaster University in Canada pioneered the “organ system-based” and “problem-based” curriculum reform in medical education, which ushered in the second stage of medical education reform by enhancing interdisciplinary integration [48]. Thereafter, over 40 institutions worldwide have gradually adopted problem-based curriculum modes to optimise and integrate medical courses, profoundly impacting global medical education [49]. In the early twenty-first century, the global consensus on competencies in medical education proposed a new curriculum model that centred on patients and populations and was guided by competency-based approaches, representing the third stage of medical education reform [50]. In particular, this reform emphasised the need for a coordinated development between the healthcare and education systems. Medical education reform propelled the rapid development of medicine, and the development of modern medicine prompted the re-evaluation of medical education for the new generation.

Overall, the construction of an NME system should adapt to changes in medicine, and ecological teaching environments should adapt to educational reforms as well. The NME system should comprehensively address the entire development plan of medical schools, subjects, curricula, and teaching resources [51, 52]. The differences in education systems between modern medicine and NM were summarized in Table 4.

For the construction of medical schools, optimising current medical schools and contemplating the design of new medical schools are critical. This requires reforming student enrolment, designing medical talent cultivation goals that match the training programs and curriculum systems of the NME, constructing relevant teaching resources, optimising teaching methods and evaluation modes, training NME teaching staff, and updating management modes for medical education [37, 39]. Medical schools in comprehensive universities should take advantage of multiple disciplines and humanistic environments to design interdisciplinary subjects for NME. Medical schools should also strengthen their connections with comprehensive universities to imbue them with the features of NME.

For the development of academic subjects, considering both current subject planning and the integration of interdisciplinary subjects is crucial. Efforts should be made to actively integrate emerging medical subjects, such as AI, data science, and intelligent medicine, and to promote innovations in current medical subjects. Existing medical subjects should enhance their support for emerging subjects, such as data science, material science, biomedical science, medical humanities, and social sciences. In addition, emerging subjects such as intelligent medicine and precision medicine must be explored to cultivate outstanding and comprehensive innovative medical talents. To meet the needs of NM, some new subjects have been proposed, such as medical engineering, health management, chronic disease management, and medical information [39]. These subjects aim to cultivate interdisciplinary talents to improve the accuracy and efficiency of treatment decisions and engage with full life cycle health management. For example, undergraduate students majoring in Intelligent Medical Engineering at Tianjin University, China were expected to engage in intelligent surgery, precision medicine, intelligent rehabilitation, telemedicine and other related work in large general hospitals or medical institutions [53]. Postgraduate students majoring in One Health at Shanghai Jiao Tong University School of Medicine, China were encouraged to focus on complex health issues at the interface of humans, animals, and the eco-environment, and promote the overall health of all elements involved. In addition, several universities encourage students to pursue dual degrees simultaneously, such as students majoring in both Preventive Medicine and Administration, or nursing students obtaining a second degree in Administration [53].

For curriculum construction, it should focus on both optimising existing course content and incorporating interdisciplinary courses in line with “Medicine + X”. For example, beyond the existing foundation courses of mathematics, physics, chemistry, and biology, the curriculum of NME should be enhanced with courses in statistics, data science, and biophysics. Beyond the existing foundation courses of the human anatomy and function, biomedical science courses such as artificial neural networks and molecular and neural imaging technologies can be considered. In addition to existing foundation courses of ideology and humanities, new courses, such as national and global health, in the humanities and social sciences can also be considered.

For student enrolment, it should focus on comprehensive quality evaluations and admitting students from different disciplinary backgrounds. Further, changing the traditional entrance selection process, in which test scores are considered the sole criterion, is necessary. Recently, several provinces in China have initiated comprehensive evaluation reforms for college entrance examinations, which takes into account students’ diverse qualities in a holistic manner. For example, the students’ backgrounds of the “4 + 4” training programme for clinical medicine can be expanded to graduates from science and engineering programme, and even those from business or humanities programme. Simultaneously, the enrolment of former graduates could be considered to enrich the interdisciplinary backgrounds of medical students.

For the teaching staff, it is necessary to strengthen training for existing teachers of medical-related subjects on the concept and knowledge system of “Medicine + X”, and integrate teachers from multiple disciplines, such as engineering, science, and humanities, to build innovative cross-disciplinary teaching teams. Due to the application of advanced modern technologies in the field of medicine, medical teachers of NME should continuously acquire new knowledge, optimise teaching teams to align with the construction of the NME, and nurture interdisciplinary and innovative teaching teams with cross-school, cross-disciplinary, and cross-field characteristics. NME teachers must enhance their interdisciplinary cooperation with teachers from other disciplines and promote the cultivation of NME talents.

For teaching methods, it should strengthen mixed teaching techniques, encourage practical teaching within and outside the curricular, and encourage the cultivation of student-centred learning capabilities. Utilising modern teaching methods and abundant online resources is crucial for providing independent learning platforms. Further, collaboration between medical practice and education that fully utilizes teaching bases, such as schools, hospitals, communities, disease prevention and control centres, laboratories, and research centres, should be strengthened to enhance the practical abilities of medical students in both clinical settings and research activities. In the digital era of modern technology, teaching instruction should also actively integrate the internet and AI. Finally, cultivating students’ independent learning abilities is necessary for them to explore novel knowledge in their majors autonomously.

Last but not the least, NME-related teaching resources should be constructed with the support of innovative interdisciplinary teaching teams and practical teaching bases. Teaching resources, including traditional and electronic resources, should be established to match the NME goals. Medical schools should encourage teachers to apply for interdisciplinary projects to promote academic and teaching research on NME. Programs can provide medical students with in-curricular and extracurricular “Medicine + X” innovative practical projects. Hospitals can serve as practical teaching bases for cultivating NME talents and encompass smart healthcare for medical personnel, smart services for patients, and smart management for hospital administration to facilitate the construction of information-based smart hospitals.

Conclusions

In summary, the development of NM suggests a roadmap that follows the logic of modern medicine development in the context of the global industrial and life science revolutions. Following the change of NM, engagement in the construction of NME in line with the updated healthy needs is important for creating a healthy world. For the construction of NME, it is crucial to break through the disciplinary boundaries of modern medical science, strengthen multidisciplinary integration and innovation, target on the forefront of the development of science and technology, and cultivate outstanding NM talents that meet updated health needs. Adapted to the era of NM, there should be substantial efforts in the construction of NME via comprehensive and systematic development of medical schools, medical disciplines, curriculum, teaching resources and teaching staff. The development of NM and NME would provide a global perspective that can make great contributions to human health.