From static web to metaverse: reinventing medical education in the post-pandemic era

Figures & data

Table 1. Key aspects of medical education during the Flexner era and Modern era.

Key Aspects	Flexner Era (Early Twentieth Century)	Modern Era (Twenty-first Century)
Standardization	Lack of standardized educational requirements	Stringent standards and accreditation for medical schools
Curriculum Structure	Standardized, lecture-based curriculum	Integration of basic and clinical sciences with a more flexible schedule and competency-based curriculum
Teaching Methods	Traditional, didactic lectures with a strong emphasis on basic sciences (e.g. lectures, textbooks, and laboratory work)	Technology-enhanced, simulations, virtual patients. (e.g. patient-centered approach)
Learning Approach	Didactic lectures and passive learning	Active learning, problem-based learning, and case-based learning
Clinical/Practical Training	Limited clinical exposure during the early years and less clinical experience	Extensive clinical rotations, clerkships, and simulation-based training
Patient Interaction	Limited patient interaction during preclinical years	Early patient contact and continuity of care
Patient-Centered Care	Limited emphasis on patient-centered care	Focus on patient-centered care, empathy, and effective communication
Evidence-Based Medicine	Limited focus on scientific rigor	Emphasis on evidence-based medicine and critical appraisal skills
Interprofessional Education	Minimal emphasis on interprofessional education and interdisciplinary collaboration	Focus on teamwork and collaboration among healthcare professionals
Technology Integration	Limited use of technology in education	Integration of advanced medical technologies, simulation tools, digital resources, virtual learning, and telemedicine.
Lifelong Learning	Limited emphasis on continuous professional development and lifelong learning	Emphasis on continuous professional development and lifelong learning
Diversity and Inclusion	Lack of diversity in medical schools	Focus on diversity, inclusion, and cultural competency
Global Health Perspective	Limited focus on global health and public health issues	Emphasis on global health awareness and understanding of health disparities
Assessment and Evaluation	Summative, high-stakes exams	Competency-based and performance-based assessments and evaluation (formative and summative), including continuous feedback and reflection
Research	Limited emphasis on research	Greater emphasis on evidence-based medicine and research opportunities

Table 2. Evolution of the WWW from Web 1.0 to Web 4.0.

Web Version	Learning Paradigm
Web 1.0 (1990–2000: Information Centric Static Web)	Traditional Content was primarily static and text-based, with limited interactivity. Medical education websites served as information repositories, providing course materials, lecture notes, and references. Online medical journals became accessible, allowing researchers and students to access scientific publications. Web 1.0 lacked dynamic engagement and collaboration, offering mostly one-way communication.
Web 2.0 (2000–2010: People-Centric Social Web/ Read-and-Write Web)	Social Learning The advent of Web 2.0 brought interactivity and user-generated content to the web. Social media platforms emerged, enabling medical professionals to connect, share knowledge, and engage in discussions. Medical education shifted toward more interactive learning experiences through multimedia content, online forums, blogs, wikis, and collaborative learning.
Web 3.0 (2010–2020: Machine-Centric Semantic Web)	Personalized Learning Web 3.0 aimed to make the web more intelligent, context-aware, and personalized. In medical education, this phase focused on incorporating smarter search engines and improved knowledge retrieval. Learning platforms used semantic technologies to deliver personalized learning pathways and recommendations based on learners’ preferences and performance. VR and AR are integrated into e-learning for immersive experiences.
Web 4.0 (2020–2030: Agent-Centric Symbiotic Intelligent Web)	Immersive Learning Web 4.0 is an extension of the concept that envisions a more intelligent, autonomous, and adaptable web. In medical education, Web 4.0 leverages artificial intelligence (AI), machine learning, and big data analytics to deliver advanced learning experiences. AI-driven virtual tutors and conversational agents help guide learners, answer questions, and provide personalized feedback. Virtual and augmented reality technologies create immersive simulations for medical training, enhancing practical skills and decision-making. IoT-enabled devices create a pervasive learning environment that allows for seamless integration of digital and physical learning spaces.

Figure 1. Evolution of the Web, education and healthcare.

Table 3. Major traits of the four educational generations.

Elements	Education 1.0	Education 2.0	Education 3.0	Education 4.0
Teaching Methods	Teacher-centered instruction	The transition toward student-centered learning	Learner-driven and personalized learning	Integration of emerging technologies and data-driven insights
Pedagogical Differences	Rote learning and memorization	Increased emphasis on collaboration and communication	Shift towards critical thinking, problem-solving, and creativity	Personalized and adaptive learning experiences
Technology Integration	Limited use of technology	Integration of multimedia resources and interactive tools	Online resources, open educational resources, MOOCs	AI, VR, AR, gamification
Curriculum Design	Fixed curriculum	Blended format of traditional and digital methods	Flexible and self-paced curriculum	Blended and flipped classroom models
Assessment and Evaluation	Standardized exams and assessments	Multiple formats of assessments including multimedia projects	Project-based assessments, portfolios	Learning analytics, performance-based formative assessments, and competency-based evaluation. Simulation-based assessments, electronic portfolios (ePortfolios), longitudinal integrated clerkships (LIC)

Table 4. Differences between traditional 2D content and 3D Web-based content.

Characteristics	Traditional 2D Content	3D Web-Based Content
User Interface	Text-based interfaces	Immersive and realistic environments where users can interact with objects, avatars, and the environment in a more natural and intuitive manner.
Remote Learning and Collaboration	Collaboration through learning management systems, which is 2D technology-enhanced learning (e.g. asynchronous participation in discussion board activities, completing assignments, online forums, video conferencing)	Remote collaboration and global knowledge sharing (e.g. learners from different locations or countries collaborating in a 3D virtual anatomy lab)
Engagement and Motivation	Low level of engagement or motivation (e.g. reading case descriptions in a textbook)	Higher level of engagement and motivation through immersion and hands-on learning (e.g. an interactive 3D scenario where learners diagnose and treat virtual patients, and/or interact with objects and scenarios for physical manipulation and exploration)
Accessibility and Flexibility	Universal accessibility of educational content from anywhere with an Internet connection (e.g. self-paced learning, and accessible to certain disabilities)	Customizable 3D modules for different learning needs, including simplified interfaces
Personalization	Less adaptable due to standardized curriculum with fixed progression	Adaptable to individuals’ learning preferences and paces through an adaptive learning platform adjusting difficulty based on a learner’s performance
Spatial Visualization	Limited depth and perspective (e.g. 2D anatomical diagram of the heart)	Enhanced 3D representation for accurate spatial understanding and visualization skills (e.g. 3D interactive model of the human heart, allowing learners to rotate, zoom, and dissect for detailed spatial understanding of complex structures or concepts.)
Interactivity	Limited interactivity and graphical fidelity (e.g. static images illustrating surgical steps, text-based materials, video lectures, educational animations, interactive slides, interactive quizzes, and online assessments)	Interactive exploration, manipulation, and simulations such as virtual surgery simulation with haptic feedback where learners can perform steps of a procedure in a realistic virtual setting and observe outcomes in real-time Use of conversational agents, also known as chatbots, that simulate human interactions through text or verbal communication
Realism	Limited realism and graphs representing medication effects	Realistic simulations and procedures such as simulating a patient’s response to medication with physiological changes visible in a 3D model
Dynamic Processes	Lack of dynamic representation of dynamics (e.g. series of 2D images depicting muscle contraction)	Effective representation of dynamic processes over time such as an animated 3D representation of muscle contraction and relaxation during the cardiac cycle
Depth and Perspective	Limited angles and perspectives (e.g. a flat diagram of a neuron and its connections)	Multi-angle views for complex structures when exploring a 3D model of a neuron to understand synapse connections from multiple angles
Holistic Understanding	Limited to specific views (e.g. viewing isolated 2D images of blood vessels)	Comprehensive view of structures and scenarios (e.g. exploring an immersive 3D environment of the human circulatory system)
Complexity	Simpler, quicker representation (e.g. simplified 2D diagram of brain structures)	In-depth and complex learning experiences (e.g. virtual 3D dissection of a complex anatomical structure like the brain)
Familiarity	Familiar format for many learners (e.g. traditional textbooks and diagrams)	Transitioning from traditional 2D textbooks to 3D interactive modules, requires adjustment for learners accustomed to 2D

Table 5. Immersive technologies.

Technology type	Description	Medical applications
Virtual Reality (VR)	VR creates a completely immersive digital environment that isolates users from the physical world. Users wear VR headsets to be fully immersed in a simulated 3D environment. An immersive virtual reality system tracks a learner’s movement and projects it onto the virtual environment. The three-dimensional virtual environment that offers real-time visual, aural, haptic, and/or kinesthetic input is interacted with by the learner [^40]. VR provides a sense of presence, making users feel as if they are physically present in the virtual world. VR is primarily used to create immersive experiences, training simulations, gaming, and entertainment where users can interact with the digital environment and with each other.	Anatomy Visualization: Learners can explore 3D anatomical models in a fully immersive environment, allowing them to understand complex structures better than traditional 2D methods [36]. Training Simulations: VR enables trainees and surgeons to practice surgeries in a controlled and risk-free environment, enhancing their skills and decision-making. This VR environment also provides learners with real-time feedback regarding their performance and techniques applied [45]. Patient Interaction: Medical trainees can engage with virtual patients, gaining experience in (collaborative) diagnostic reasoning, patient communication, and empathy.
Augmented Reality (AR)	AR overlays digital information to enhance the real world by adding digital elements such as text, images, or 3D objects, to the user’s surroundings. Users experience a blend of the physical and digital worlds while still being aware of their real-world surroundings [38]. AR is often experienced through smartphones, tablets, smart glasses, or other devices with cameras [15].	Anatomical Learning: AR can project virtual images onto physical models or cadavers, providing additional insights and annotations during dissections. Medical Imaging: AR can be used to display 3D images from medical scans directly onto a patient’s body, aiding in visualization and surgical planning. Training for Medical Procedures: AR can guide medical students through procedures by overlaying step-by-step instructions onto the patient or medical equipment.
Mixed Reality (MR)	MR combines elements of both VR and AR, allowing digital objects to interact with the real world and vice versa [15]. Users can interact with and manipulate both real and virtual objects. MR headsets, like Microsoft’s HoloLens, enable users to see and interact with digital content as if it exists in the same space as the real world.	Hybrid Simulations: Combining physical simulators or mannequins with virtual elements allows for complex and realistic medical scenarios and procedural training Team Training: VR and AR can simulate scenarios that involve coordination among medical teams, promoting teamwork and communication skills, such as emergencies.

Table 6. Benefits and challenges of the use of metaverse.

Categories	Benefits	Challenges
Learner Engagement	Increasing engagement and interaction with dynamic, interactive content material Allowing the use of active learning through gamification, simulations, and interactive scenarios	Maintaining the educational quality of the content Taking measures to prevent overstimulation
Immersive Learning Experiences	Providing hands-on experience with realistic fully immersive 3D environments Developing skills through experiential learning	Financing high initial costs for producing immersive media Dealing with technical problems, such as incompatibility of equipment
Personalized Learning	Allowing virtual practice of skills in a safe environment Creating personalized educational opportunities	Overcoming the learning curve for some learners Maintaining security and privacy of data
Assessment and Evaluation	Obtaining personalized feedback and real-time data collection Monitoring and analyzing learning analytics (intelligent data) to identify areas for improvement	Maintaining data privacy and ethical considerations Ensuring the accuracy and consistency of the data
Collaboration Opportunities	Promoting global collaboration and a range of viewpoints among medical students, practitioners, and experts Having access to experts worldwide	Removing language and cultural barriers Adapting or managing time zone differences
Cost Efficiency	Providing remote training at a reasonable cost Reducing the need for physical presence	Providing all learners with access and affordability Keeping cost-effectiveness through careful management of institutional IT support and quality in balance
Technical Limitations and Access	Enabling access for remote or underserved areas Tailoring to varying learning needs and preferences	Having access to high-quality hardware and a reliable network Helping users who are not familiar with the new technology
Content Quality and Accuracy	Having access to an extensive collection of up-to-date medical content and resources	Ensuring the quality and accuracy of educational materials and resources
Faculty and Learner Training	Offering training opportunities for faculty and staff Teaching learners how to use digital technology effectively	Handling reluctance to modify conventional teaching approaches Providing faculty with sufficient training and support
Existing Curricula and Resistance to Change	Embracing innovation in both teaching methods and content Integrating metaverse applications into the curriculum	Overcoming resistance from educators and institutions Combining cutting-edge technology with traditional teaching techniques
Lack of Human or Physical Interaction	Reducing the need for physical infrastructure Fostering a sense of community and social interaction	Dealing with the shortcomings of virtual interactions Responding to worries or concerns about possible isolation and disconnection
Data Privacy and Security Concerns	Keeping learner data private and secure Complying with legal and ethical guidelines for managing data	Preventing possible data breaches and cyberattacks Building and maintaining secure metaverse platforms
Learner Data Accuracy and Reliability of AI Algorithms	Generating data-driven insights for personalized learning that contribute to better model training	Eliminating biases by ensuring accurate data collection and analysis
Legal and Ethical Issues	Adhering to ethical standards and best practices Assessing compliance with data protection and privacy regulations	Navigating complex legal and ethical frameworks Resolving potential conflicts between stakeholders
Maintenance and Updates	Preserving continuous improvement of educational content Keeping current with the most recent advancements in medical research and information	Managing updates without disrupting ongoing education Balancing the workload of content creators and faculty
Cost Implications	Reducing the need for physical infrastructure costs Exploring cost-effective metaverse platforms	Assuring sustainable long-term financing structures for education and training Providing funding for the implementation of the metaverse

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