How to unlock the technology and wisdom of tomorrow?

What does the future hold for young doctors and medical students, their training and first experience of medicine distorted by the powerful lens of covid-19? Wisdom of the ages is being lost. How do we adequately train this generation? How will they learn the clinical skills that William Osler was refining even as he was about to die during the pandemic of 1918–19.¹ By then, Osler was an established leader, but how could he have developed if his training had begun in a pandemic?

The responsibility to younger people is a heavy burden. Medical schools are struggling to face this challenge, of harnessing technology, virtual reality and augmentation, to substitute for the time lost at the bedside and in operating theatres. The bold and better decision is to seize this opportunity to redefine medical teaching, to end hours of passive time spent on wards and replace it with focused and valuable learning opportunities.²

As sensible as that sounds, technology remains a barrier. And even when devices and WiFi are fit for purpose, the dilemma of organising time with patients to learn the essential skills of clinical examination will remain hard to overcome. Perhaps clinical examination will one day become a crude and ancient art but for now, at least, it remains a core ritual in the guild of doctoring.

Our growing reliance on technology is also testing and exposing the technological capabilities of hospitals. Some are excelling while others are suffering because of a technological debt. The NHS recognises the problems and putting them right is a challenge of considerable commitment and resource, but it is central to delivering care in a world that is reconfiguring around us.³

Part of the rebuild is a way of making better sense of real world data, a byproduct of advanced digital services, products and lives. The most impressive studies during the pandemic were rapid clinical trials of vaccines and treatments, but research was placed under stress as never before by the demands of clinical and policy decision making. The countries that performed best, as suggested by research in this month’s issue, were the ones that built their capabilities according to World Health Organization’s International Health Regulations.⁴

However quickly you do them, trials take months, and often the need for a decision is here and now. The evidence options in this scenario are modelling and real world studies. But with an abundance of real world data, how is it possible to reduce research waste, unreliable research and misconduct?⁵ The answers, again, are unclear, although real world data will become increasingly important.

Another option is to create dedicated centres of excellence within government that can make best use of data, advise on what new data needs to be collected, and guide policy. Bhugra and Persaud suggest exactly this in their proposal for an office for minority health.⁶ But perhaps we need to look beyond the sages of today towards the wisdom of tomorrow? This month, we start a new series of articles, all finalists in a competition organised by Doctors for the NHS, in which young doctors imagine themselves in the job of minister of health and tell us how the NHS should be run.⁷