Diversity in Medical Education: A Review Article

Background : Medical education and training differ substantially throughout the world. Several teaching approaches have been used in medical education, which is a dynamic area of educational research. Objective: To assess the process of medical education, its development, and related obstacles to having proper and enhanced medical education, as well as improvement in various aspects related to medical education. Conclusion: Medical educational programs play a critical role in preparing individuals for careers in medicine. These programs offer an organized curriculum that comprises preclinical & clinical education, electives and specialized training, professional development, and research.


Introduction
Medical education refers to the process of training and educating persons to become competent healthcare professionals, such as physicians, nurses, pharmacists, & other healthcare providers [1][2][3][4][5][6].It encompasses a wide range of educational activities and programs that are designed to impart the knowledge, skills, attitudes, and values required for the practice of medicine and other healthcare professions [5,[7][8][9].Medical education typically involves several stages, including: Pre-medical education: This typically involves completing undergraduate studies, usually in a science-related field, as a prerequisite for medical school.Pre-medical education provides a foundation in basic sciences, such as biology, chemistry, physics, and mathematics, as well as humanities and social sciences [10,13].Medical school is a graduate-level program that provides comprehensive education and training in medical sciences, clinical skills, and professional values.It typically includes classroom lectures, laboratory work, and clinical rotations in hospitals or other healthcare settings.Medical students learn about various aspects of medicine, including anatomy, physiology, pharmacology, pathology, clinical skills, ethics, and patient care [11,[14][15][16][17].Following graduation from medical school, physicians typically enter into a residency program, which provides further training in a specific medical specialty or subspecialty.Residency programs are characteristically several years in duration and involve hands-on clinical training under the supervision of experienced physicians [2,6,[17][18][19][20].Residents gain practical experience in diagnosing and managing patients, as well as developing clinical skills and competence in their chosen specialty.Some physicians may choose to pursue additional training in a subspecialty through a fellowship program after completing their residency.Fellowships provide specialized training in areas such as cardiology, gastroenterology, oncology, or other specialized fields of medicine.[10,11,21].Medical education is a continuous process that extends beyond formal training.Healthcare professionals are expected to engage in lifelong learning through continuing medical education (CME) to stay updated with the latest advancements in medical knowledge, technologies, and best practices.CME activities can include conferences, workshops, online courses, research, and other educational opportunities [22,23].Other important components of medical education include assessment and evaluation of learners' knowledge & skills, accreditation of educational programs, professional development, and adherence to ethical & professional standards [11,13,24,25].Medical education is constantly evolving in response to advances in medical knowledge, technology, and changes in healthcare delivery It plays a critical role in producing competent and compassionate healthcare professionals who can provide safe, effective, and high-quality care to patients.

Development
In the context of medical education, "development" refers to the process of growth and improvement in different aspects of medical education, including curriculum design, teaching methods, assessment strategies, educational technologies, faculty development, and accreditation [1,4,7,20,24,25].
Medical education development aims to consistently improve the quality of education and training provided to healthcare professionals in order to ensure they are well-prepared to address the evolving needs of patients and the healthcare system.[10,11,15,20].

Curriculum design
Medical education programs constantly evolve to reflect advances in medical knowledge, changes in healthcare practices, and societal needs [7,[26][27][28][29][30]. Curriculum design involves the development of educational goals, objectives, and content that are aligned with the latest evidencebased medicine, clinical guidelines, and best practices.This may include integrating new topics, technologies, and teaching methods, as well as ensuring a comprehensive and cohesive curriculum that prepares learners for the clinical practice [11,27,28,29].

Medical
educators are continually exploring and adopting innovative teaching methods that are effective in facilitating learning among healthcare learners.This may involve incorporating active learning techniques, simulation-based training, casebased learning, problem-based learning, team-based learning, and other learner-centered approaches to engage and empower learners in the educational process [8,14,18,31].

Assessment strategies
Assessment is a critical component of medical education to measure learners' knowledge, skills, & attitudes.Development in assessment strategies includes the use of authentic, competency-based assessments that measure learners' abilities to apply knowledge in real-world clinical scenarios, as well as formative assessments that provide feedback for learning and improvement [16,18,19].This may involve the use of various assessment methods such as written exams, practical exams, OSCEs (Objective Structured Clinical Examinations), portfolios, and workplace-based assessments.

Educational technologies
Technology plays an increasingly important role in medical education.Development in educational technologies involves the integration of digital tools, e-learning platforms, simulation technologies, virtual and augmented reality, and other innovative technologies to enhance the educational experience, facilitate access to learning resources and promote active engagement collaboration among learners [5,8,14,32].

Faculty development
Effective faculty development is crucial in ensuring that medical educators have the necessary knowledge, skills, and attitudes needed to effectively teach and mentor learners.Faculty development programs may include training in teaching methods, as sessment strategies, curriculum design, educational leadership, and other aspects of medical education also attending conferences, workshops, symposia, inside and outside the country [8,18,19].This helps educators to continually improve their teaching skills and stay updated with best practices in medical education.Accreditation is a process of evaluating medical education programs against established standards to ensure quality and accountability.Development in accreditation involves regular review and improvement of educational programs to meet accreditation standards set by accrediting authorities.This includes continuous quality improvement, self-assessment, and evidence-based changes to meet the evolving needs of learners, patients, and the healthcare system [22,27,29].
Development in medical education is an ongoing process that involves continuous improvement, innovation, and adaptation to changing healthcare needs, technological advancements, and educational best practices.It aims to ensure that healthcare professionals receive the highest quality education and training to provide safe, effective, and compassionate care to patients.

Challenges
There are several obstacles that may be encountered in the development of medical education, which may include: Limited resources: Medical education programs require adequate resources, including funding, faculty, facilities, and educational materials.Limited availability of such resources can hinder the development and implementation of effective educational programs, particularly in low-resource settings or underfunded institutions [27,33].[11,13,18].Evolving healthcare landscape: The healthcare landscape is constantly evolving with advances in medical knowledge, changes in healthcare practices, and shifts in healthcare delivery models.Keeping up with the rapidly changing healthcare landscape and incorporating the latest evidence-based practices into medical education programs can be challenging and require ongoing updates and revisions [28,30,31].Technological challenges:While educational technologies can greatly enhance medical education, they can also pose challenges.Technologic challenges may include limited access to technology, difficulties in integrating technology into curricula, and addressing issues related to privacy, security,and data management [9,30,33].

Resistance to change: Medical education has traditionally been rooted in certain established practices and traditions, and
Overcoming these obstacles requires collaborative efforts among stakeholders, including educators, administrators, learners, and policymakers.It

Improvements
There are several potential improvements that can be implemented in medical education to solve the previously described obstacles and challenges which may include the followings: Increased funding and resources: Highquality medical education programs can be developed and implemented with adequate funding and resources.Investments in faculty development, curriculum development, educational technologies, simulation facilities, and other educational resources may be included.

Standardization of guidelinesand best practices:
Developing standardized guidelines and best practices for medical education can provide a framework for institutions to follow, ensuring consistency and quality in educational programs.National and international organizations can play a role in developing and disseminating such guidelines [16,17,20

Other potential improvements in medical education may include:
Emphasis on diversity, equity, and inclusion: Ensuring diversity, equity, and inclusion in medical education can promote a more inclusive learning environment, reduce health disparities, and better prepare healthcare professionals to serve diverse patient populations.This may involve integrating cultural competency training, promoting diversity among faculty and learners, and addressing unconscious biases in curricula and assessment.
Competency-based education: Shifting towards competency-based education can focus on the acquisition of specific knowledge, skills, and attitudes necessary for competent medical practice.Competencybased education can provide clear learning objectives, assessment rubrics, and feedback mechanisms, allowing learners to progress at their own pace and ensuring that they are competent in the skills they need for their future practice [18,19,22].
Entrusted Professional Activities (EPAs) are a bases used in medical education to distinguish the specific tasks and responsibilities that medical students and residents are entrusted to execute as they progress in their training.EPAs help bridge the gap between theoretical knowledge and practical clinical skills, providing learners with opportunities to apply their knowledge in real-world healthcare settings.Early clinical exposure: of learners can facilitate the integration of theoretical knowledge into practical clinical skills.This may involve incorporating clinical experiences, such as shadowing, simulations, or clinical rotations, early in the curriculum to help learners understand the real-world context of healthcare practice.Longitudinal integrated clerkships: Implementing longitudinal integrated clerkships, where learners follow patients over time and across different clinical settings, can give a more comprehensive and integrated learning experience.This approach can foster continuity of care, promote clinical reasoning, and enhance the understanding of the patient's journey through the healthcare system [14,15,19,33].
Mentorship and coaching: Providing mentorship and coaching opportunities for learners can enhance their professional development, provide guidance and support, and promote reflective practice.This may involve assigning mentors or coaches to learners, who can provide guidance, feedback, and mentorship throughout their medical education journey.

Addressing mental health and well-being:
Recognizing the importance of mental health and well-being in medical education, efforts be made to address stress, burnout, and other mental health challenges among learners.This may include providing resources for mental health support, promoting self-care, and addressing systemic issues that contribute to learner stress and burnout [1,11,24].

Source of funding:
The current study was funded by our charges with no any other funding sources elsewhere.
Review Article Published: 25 December 2023 Doi: 10.26505/DJM.25027500419change might be faced with resistance from stakeholders including faculty, administrators, and learners.Resistance to change can slow down the development of new teaching methods, curriculum revisions, and adoption of innovative educational technologies.Lack of standardized guidelines: Medical education is a complex field with varying standards and guidelines across different institutions and countries.The lack of standardized guidelines and best practices can create challenges in developing consistent and high-quality medical education programs, particularly for institutions seeking to meet accreditation standards or align with national or international guidelines [18,19,26,30].Accreditation and regulatory requirements: Accreditation and regulatory requirements can sometimes pose challenges in the development of medical education programs.Meeting accreditation standards and regulatory requirements may require additional resources, documentation, and processes which can be time-consuming and burdensome for educational institutions.Time constraints: Medical education is often packed with a vast amount of knowledge and skills that need to be covered within a limited timeframe.Time constraints can challenge the development of comprehensive and well-structured curricula that adequately cover all the necessary content and allow for active learning and skill development.Faculty workload and burnout: Medical educators often face heavy workloads due to clinical responsibilities, research commitments, and administrative duties which can impact the time and effort they can dedicate to medical education development.Faculty burnout and lack of time can be obstacles to the development and implementation of innovative teaching methods, assessment strategies, and faculty development programs.Diversity of learners: Medical learners come from diverse backgrounds, including different cultural, educational, and experiential contexts.Addressing the diverse learning needs of learners can be challenging, particularly in large class sizes or when dealing with learners with varying levels of prior knowledge and skills may involve strategic planning, resource allocation, faculty development, stakeholder engagement, and a Review Article Published: 25 December 2023 Doi: 10.26505/DJM.25027500419commitment to continuous quality improvement in medical education programs.Overcoming these obstacles requires collaborative efforts among stakeholders, including educators, administrators, learners, and policymakers.It may involve strategic planning, resource allocation, faculty development, stakeholder engagement, and a commitment to continuous quality improvement in medical education programs.
Community engagement and social accountability: Incorporating community engagement and social accountability into medical education can help learners in understanding the social determinants of health and the importance of addressing health disparities.This may entail involving learners in community-based projects, promoting advocacy skills, and instilling a sense of social responsibility among healthcare professionals.Global health education: Incorporating global health education into medical curricula can raise awareness about global health issues, promote cultural competency, and prepare healthcare professionals to work in diverse global settings.This may involve incorporating global health topics, experiences, and opportunities for learners to participate in global health initiatives.Social sciences: it is a pillar in medical education, By integrating social sciences into medical educationintricate factors prompting health and healthcare delivery.This knowledge arms them to afford sympathetic, patient-centered care while adopting the social, cultural, and ethical magnitude of medical practice.Performing medical researches : Research in medical education encompasses a wide range of topics and methodologies aimed at improving the quality of medical education and enhancing the training of healthcare professionals.Technology and artificial intelligence (AI) are increasingly being integrated into medical education to enhance learning experiences, improve clinical skills training, and support evidence-based decision-making.AI brings numerous benefits to medical education, they should be integrated thoughtfully and ethically.It's crucial to consider issues of data privacy, security, and the ethical implications of AI algorithms in healthcare decision-making.Additionally, maintaining a balance between technology and human interaction is essential to ensure the development of essential interpersonal and communication skills in medical students.Conclusions Medical educational programs play a critical role in preparing individuals for a career in medicine.These programs provide an organized curriculum that comprises preclinical and clinical education, electives and specialized training, professional development, research & scholarly activities, as well as assessments and evaluations to Review Article Published: 25 December 2023 Doi: 10.26505/DJM.25027500419ensurecompetency.However, medical education faces challenges and obstacles such as increased medical knowledge complexity, limited resources, and changing healthcare environments.Nonetheless, improvements in medical education continue including novelties in teaching methods, incorporation of technology, emphasis on inter-professional education, and recognition of the significance of lifelong learning.Medical education is an unremitting process that entails ongoing efforts to adjust to the changing landscape of healthcare and to safeguard that healthcare professionals are well-prepared to provide safe and effective care to patients throughout their careers.Recommendations1.Integrate more hands-on experience: Medical education should focus on practical skills and afford more chances for students to gain hands-on experience.This can be achieved through clinical rotations, simulation training, and practical exercises.2.Upsurge variety in medical schools: Medical schools should aim to rise diversity among students and faculty in order to better represent the patient community they will serve.This can be accomplished through targeted enrolment efforts and the creation of more inclusive environments.3.Concentration on inter-professional education: Medical education should integrate more inter-professional education where students from diverse healthcare professions learn together.4.Integrate technology into the program of study: Technology should be included in medical education and integrated into the curriculum.This can include using simulated reality and amplified reality to pretend medical processes and by means of telemedicine to attach with patients in distant settings.5.Adopt a culture of lifetime education: Medical education should encourage a culture of lifetime learning in which health care workers are encouraged to continue their education and stay up-to-date with the recent research and progresses in their field.
]. Emphasizing a culture of continuous quality improvement in medical education can ensure that educational programs are regularly reviewed, evaluated, and updated based on feedback, evidence, and changing healthcare needs.This may involve regular assessment of educational outcomes, feedback from learners and stakeholders, and iterative revisions of curricula and teaching methods.These are just few examples of potential improvements in medical education.