Today’s medical fellows are reaping the benefits of technological advances, such as telemedicine, simulation technology, and artificial intelligence—all of which may have seemed like science fiction not so long ago.
Tomorrow’s fellows may benefit from breakthroughs such as AR and VR (augmented and virtual reality), nanotechnology, and enhanced precision medicine.
Regardless of which technologies take root, the pace of tech advancements in medicine is likely to continue accelerating, and fellowship programs will have to evolve with it.
Think back to 2019: mRNA technology was a hypothetical, practical artificial intelligence (AI) was little better than autocomplete, and telemedicine was in its infancy. Then along came a pandemic, followed by the emergence of large language models (LLMs) like ChatGPT, and many in the medical community found themselves living and working in a world that had only recently seemed like the stuff of science fiction.
Today’s medical trainees have a new tangible and virtual armamentarium at their fingertips. And those fellows of the future have some promising emerging technologies to look forward to as well.
In practice: Telemedicine
Nascent telemedicine took root during the COVID-19 pandemic. Now, it’s difficult to imagine healthcare without it.
Telemedicine has also become a mainstay of clinical education. The Society for Academic Emergency Medicine and George Washington University offer telemedicine-specific fellowships. And a host of other institutions have created certificate-level programs for clinicians.
In addition to offering fellows flexibility in terms of where, when, and how they practice medicine, telemedicine also has documented benefits for patients. According to a 2022 literature review published in the World Journal of Clinical Cases, telemedicine has lowered healthcare expenditures, limited wait lists and crowding, and reduced time and geographical limitations in healthcare, globally.Related: Thriving abroad: Navigating the challenges of international fellowships
In practice: Simulation technology
According to James Stoller, MD, simulation technology is one of the forces that’s transforming fellowship training. Dr. Stoller is the chairman of the Education Institute at the Cleveland Clinic. Dr. Stoller told MDLinx that medicine is following an example set by other industries.
"Medicine has followed suit from commercial aviation, and expects that doctors, like airline pilots, will go to simulation equipment and practice procedures before they do their first procedure on a patient."
— James Stoller, MD
Evidence supports the efficacy of simulation-based training. A study published in 2019 in the Western Journal of Emergency Medicine compared the efficacy of simulation-based CPR training with conventional training among 4th-year medical students. Researchers found that students in the simulation group delivered CPR compressions that more closely followed the American Heart Association’s guidelines.
In practice: AI
This year, 2023, may go down in the history books as the year AI went mainstream. Suddenly, anyone with an internet connection had access to LLMs, such as ChatGPT, and almost limitless use cases—clinical and otherwise.Related: The evolution of fellowship: New tech, more competition, and the quest for inclusivity
For modern fellows, AI and machine learning (ML) are likely to be formative forces in medicine for years to come.
According to a review published in Frontiers in Digital Health, AI has already proven useful for clinical-decision support in recent years. For example, it continues to help triage non-operative patients upon admission to the hospital, and to aid in risk stratification for pre-operative patients.
While this is powerful technology, the Frontiers in Digital Health researchers cautioned it is subject to application bias; they highlighted a need for “physicians to change their educational infrastructure to facilitate understanding AI platforms, modeling, and limitations to best acclimate practice in the age of AI.”
Looking ahead: Virtual reality and augmented reality
Virtual reality (VR) and augmented reality (AR) are two other emerging technologies that will soon have a place in the medical field. In VR, the user wears a headset that fills the user’s field of view, creating an interactive, immersive, and simulated virtual space. AR technology creates more of a hybrid experience, overlaying digital images onto the real world, using cameras, smartphones, or heads-up displays.
While these technologies are in their infancy, the FDA noted that they are currently in use in domains such as telemedicine, pain management, mental health, and surgery planning.
Looking ahead, the FDA anticipates certain benefits from AR and VR, such as shortening time to diagnosis, helping underserved populations by fulfilling unmet needs, helping clinicians prepare for specific treatments, and limiting procedural invasiveness, among other benefits.
Clinicians can see a complete list of approved AR/VR devices here.
Looking ahead: Nanotechnology
Imagine delivering care with devices that are 10,000 times smaller than the diameter of a single hair. Deploying nanotechnology in medicine (known as nanomedicine) has been in progress for about 30 years, according to the authors of a review in the Journal of Internal Medicine, and tomorrow’s fellows could see the results of that work come to fruition.
Currently, nanomedicine is under investigation for thermal tumor ablation and MRI enhancement. Nanoparticles are in use for in vivo and in vitro microscopy.
As researchers writing in the Journal of Cutaneous and Aesthetic Surgery explain, the premise of nanomedicine is that these technologies could be capable of interfacing with tissues and cells at a molecular—that is, subcellular—level, owing to their small size, with high specificity.
"A solid foundation for nanomedicine is in place as we enter a new phase in its evolution."
— Authors, Journal of Internal Medicine
The future of nanomedicine hinges on how it brings direct patient benefits to market, according to the Journal of Internal Medicine review authors. But it will also involve leveraging new discoveries about how nanomedicine acts within the body into future design. Finally, it will be important to involve more clinicians, and not just engineers and chemists, in nanomedicine projects.
Looking ahead: Precision medicine
Millions of people have already benefited from precision medicine. Hopefully, that’s just the tip of the iceberg, and precision medicine will become a tool deftly wielded by tomorrow’s fellows.
Precision medicine researchers are hard at work in the fields of oncology, cancer immunotherapy, pharmacogenetics, and rare diseases.
In the precision oncology field, scientists are working to classify cancer into types and subtypes based on molecular markers. And in pharmacogenetics, researchers are striving to identify the precise dose at the precise time for patients with specific diseases. Finally, there’s hope that precision medicine could unlock treatments for the approximately 25–30 million Americans with rare diseases.
Already, precision medicine has ushered several categories of cancer immunotherapy drugs to market, signaling that this future may not be so far away.
What this means for you
The pace of technological advancements in medicine appears to be accelerating. This means the pace of change in fellowship will accelerate in tandem. Today’s fellows are already experiencing some of the benefits of these advances, but tomorrow’s fellows may see significant breakthroughs in nanotechnology, precision medicine, and VR and AR. If the past is prologue, these breakthroughs may not be as distant as they once seemed.