• • This letter to the editor highlights the stagnant progress in undergraduate ENT education post–coronavirus disease 2019 (Covid-19), despite promising technologies discussed in the original study.

• • New technology in clinical education needs to be cautiously approached to not overcompromise the theoretical basis of clinical teaching.

Dear Editors,

We read with concern the article by Davies et al., “Have we made any undergraduate medical education improvements since Covid-19? A systematic review of undergraduate ENT teaching,” which highlights a lack of progress in ENT education despite the pandemic’s potential to spur innovation.Reference Davies and Hampton¹ The review identifies promising interventions like mixed reality and cadaveric teaching but notes persistent limitations in clinical exposure. This is a critical gap given that 20–30 per cent of general practice consultations involve ENT conditions.Reference Griffiths² This study also further highlighted by the fact that General Practice is the most preferred specialty amongst medical students.Reference Ferreira, Collins, Handscomb, French, Bolton and Fortescue³

Traditionally a specialty that lacks undergraduate exposure, ENT requires innovative approaches to ensure future doctors are equipped to manage ENT issues given how common they are epidemiologically.

The review’s findings, based on six low-quality studies, reveal minimal curriculum advancement, despite opportunities for reform during the coronavirus disease 2019 (Covid-19) pandemic.Reference O’Hagan and Sunnucks^4, Reference Malik, Abbas, Jayarajah, Bruce and Tolley⁵ Technologies like mixed reality and cadaveric teaching mentioned in the review offer an excellent opportunity to further education. They align with paradigms of education, fir example, Experiential Learning Theory, providing concrete experiences (e.g., virtual endoscopy) and reflective observation through feedback.Reference Kolb⁶ Similarly, Vygotsky’s constructivism supports active learning using the above, scaffolding students within their “zone of proximal development.”Reference Vygotsky⁷ Perhaps the budding artificial intelligence (AI) -driven platforms could be further developed to enhance the learning experience by offering adaptive case simulations, fostering active experimentation and memorable learning experiences.

One significant limitation of technological advancements in education is it does not serve as a complete parallel to patient interaction - Osler’s “sea”. Educators should be wary that technology should not take precedence over learning in a clinical environment, which may have been tempting during the pandemic. Learning technologies lack the fidelity to emulate the art of patient interaction, conducting history and examination with patients, which is the cornerstone of medicine.Reference Lave⁸ The exposure of clinical interaction and clinician role-modelling which may be unique in ENT, can provide opportunities for students to learn the art of medicine. Hands-on experiential learning is undoubtedly the heart of medical education.

There is a lack of long-term data given how novel technological advancements are in clinical education, but students’ active participation has repeatedly shown to be a driver of good educational outcomes and memory retention.Reference Bingen, Aamlid, Hovland, Nes, Larsen and Skedsmo⁹ Further research is needed to evaluate long-term outcomes and cost-effective dissemination of these technologies. This review is a call to action to enhance ENT education, ensuring future doctors are prepared for clinical practice and maintain the professionalism of our field.

Sincerely,

Dr. Adan Chew