Medical education reform has seen significant changes since the days of the Flexner report. What remains true are the rigorous entrance requirements, the scientific method of thinking, learning by doing, and the need to undertake original research (1). The advent of technology over the past decade and more has meant that learning by doing has taken on a whole new meaning.

Simulation, particularly high fidelity simulation, has meant that learners are able to replicate medical and surgical scenarios in a safe learning environment, ensuring realism to some degree and subsequent instructor feedback. The concept was born courtesy of the aviation industry, where pilots are expected to undertake regular simulation based sessions in order to maintain their licence. This makes perfect sense; both professions are charged with the care of human lives on a grand scale. Simulation is as yet not a requirement to maintain a medical licence. But it is a regular feature of competency based assessment and undergraduate examinations on a global scale. A variety of skills can be ascertained through simulation including medical knowledge, patient care, interpersonal communication skills, professionalism, team training, and critical decision making to name but a few.

However all this intervention is not without a cost. The AAMC report Medical Simulation in Medical Education: Results of an AAMC Survey 2011 noted that 22% of medical schools and 57% of teaching hospitals had an annual operating budget of up to $250,000 for simulation, with 15% of medical schools and 11% of teaching hospitals serving an annual budget of between $1-2 million plus. Staggering expenses by any means. The question then arises with the increased emphasis on such technology are those less developed countries losing out? Obviously so.

Medical education is an interesting field. What typically occurs is a domino effect. If one institution invests in a particular intervention, others scramble to follow suit. And often there may be limited evidence for doing so. As we draw further and further into the depths of technology, understanding its true value will become more hazy. Drawing parallels to the field of medical biodesign, Paul Yock highlighted the cost disparity between the United States and India. Using the example of breaking his leg, he highlighted that the cost of a splint varies between the US and India, with it costing $120 vs $4 respectively, despite equal treatment effectiveness. He went on to say that technology for patients must not only enhance patient care but should be cost-effective, emphasising a need for technologies that “cure the system.” The same certainly holds true in medical education.

Neel Sharma graduated from the University of Manchester and did his internal medicine training at The Royal London Hospital and Guy’s and St Thomas’ NHS Foundation Trust. Currently he is a gastroenterology trainee based in Singapore. 

Competing interests: None declared.