Can you imagine a future where a person is endorsed as fully qualified to serve as a medical doctor without ever going to college or medical school? If we look back far enough in history, we know that this was commonplace, even the standard. Today, such an idea seems reckless or absurd to most people. How could someone possibly gain all the knowledge, skill, and experiences necessary to do that job at the standard that we expect in healthcare today? How could someone reach that level of competence without going through a formal curriculum, studying from several hundred dollar textbooks, attending countless seminars and lectures, doing the carefully crafted hands on learning, being carefully assessed and vetted, and going through the entire sequences of learning experiences created for future doctors as they progress through college and medical school? Would you want a brain surgeon to work on you who never went to medical school? It is hard to even imagine a modern world work someone could reach that level of expertise, be recognized as such, be highly qualified, and receive a job as a doctor.
Yet, as a thought experiment, imagine that you had to propose and then create two or three alternative models for people becoming doctors. Suppose that you had to create a system for equipping tens of thousands of highly qualified and competent future medical doctors, but you had to do it without college or medical school. Where would you start?
Many instructional designers would probably begin by conducting a careful analysis of exactly what knowledge, skills, dispositions, and mindsets are necessary to do the work of a general practitioner today. You might interview people, do a careful and in-depth study of doctors in the workplace, examine the problems and procedures commonplace in that line of work, and whatever else it takes to create this initial list. Then, given the importance that people attribute to this particular work, you would probably establish ways to further vet, verify, and refine that list.
Once you know what is needed, then what? Again, the traditional instruction designer might jump to the end. What is the best possible evidence that someone embodies all of the competencies and/or proficiency that you identified? Given the importance attributed to this line of work, you would work hard to make sure that whatever plan you devised would provide a high level of confidence that people were truly competent.
After that, you might delve into research on the best way to help someone move from novice to expert in terms of the competencies and/or proficiencies listed. Perhaps you would examine a blend of teaching and learning strategies, maybe even looking at how to design adaptive learning software that constantly monitors performance and adjust to optimize learning.
Not doing this in the context of formal college and/or medical school, you don’t have any of the limitations established by these structures. Time, place, pace, and the learning pathway are completely flexible. One person might demonstrate competency in a short time, while another might work on it over a decade or two. There are no rules about who is allowed to study or not. There are no rules about how much it would cost. There are not requirements about who is in charge of the learning. The only requirement is that there is a clearly defined set of competencies and proficiencies, and that there are valid and reliable measures of learning that have an incredibly high level of predictive power with regard to future performance as a medical doctor. You can also be free to design multiple learning pathways, even ones that are constantly adapting and learning how monitor and maximize the learning of each person.
We talk about the unbundling of higher education today, and there are ample examples of it. Most are with competencies related to less regulated jobs and professions. However, thinking about a highly regulated and largely unquestioned learning pathway like medical school might be a helpful thought experiment. It is an exercise in imagining alternatives to the current system, the potential affordances of such alternatives, as well as the limitations.
As it stands, much policy and practice is based upon an unquestioning acceptance of the current system. As I’ve mentioned before and drawing from a Henry Ford quote, our attempts at educational innovation are most often the faster horse sort of solution. We assume that the system that we have is the one that we should have or will always have. Or, we are too worried about the potential losses to consider something that might completely disrupt the current system. Yet, there is benefit in sometimes stepping away from the current structures and allowing ourselves to truly imagine the breadth of possibilities. Perhaps we will discover truly promising options that were largely hidden from us before.