JMIR Publications

ABSTRACT

The fundamental goal of medical education is to develop physicians who can independently provide safe and effective patient care. This requires learners to acquire not only knowledge but also meaningful experience in order to progress along the continuum from novice to expert. In the last several decades, however, medical education has undergone numerous transformations that have resulted in decreased clinical experience for medical students and residents alike. These transformations include the increasing complexity of healthcare delivery in the inpatient and outpatient settings, duty hours restrictions, and the explosion of digital technologies, including the electronic health record and artificial intelligence. Additionally, the introduction and broad acceptance of competency-based medical education, which is focused on demonstrable behaviors rather than the time spent in training, risks exacerbating this loss of meaningful clinical experience if implemented without attention to trainees’ need for clinical volume, variation, and redundancy. While these changes in the number and intensity of patient encounters in educational programs are multifactorial in origin, when combined, they jeopardize the acquisition of experience, the development of expertise, and the resulting quality of patient care. Here, we discuss the importance of meaningful experience in the development of expertise using the Dreyfus model, highlight threats to its achievement resulting from the intersection of these transformations affecting medical training, and pose several solutions available to medical educators and the academic community.