From Flexner to artificial intelligence: a century of transformation in global medical education.

Abstract

Over the past century, medical education has undergone a profound transformation, evolving from unregulated apprenticeships into a highly structured, competency-based continuum of lifelong learning. This review delineates the centenary changes in global medical education, highlighting the structural, pedagogical, and philosophical milestones that have shaped the modern healthcare workforce. A comprehensive narrative review of historical and contemporary medical education literature was conducted. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed articles, policy declarations, and historical texts published between 1910 and 2025. Search strategies utilized Medical Subject Headings and keywords such as "history of medical education," "competency-based education," "social accountability," "curriculum reform," and "artificial intelligence." The 1910 Flexner Report established the biomedical university-based model, which dominated the 20th century but inadvertently created rigid departmental silos. Subsequent reforms dismantled these silos in favor of integrated, problem-based learning. The 1988 Edinburgh Declaration and the 2010 Lancet Commission catalyzed a paradigm shift toward social accountability, systems-based practice, and Competency-Based Medical Education. Concurrently, regional trajectories in India, Africa, Asia, and Latin America highlight the post-colonial push for standardized, socially responsive curricula. Today, the integration of artificial intelligence and immersive simulations offers unprecedented opportunities for personalized learning, though it presents socio-technical challenges, including the digital divide and algorithmic bias. Additionally, academic medicine faces a crisis in preserving the physician-scientist identity amidst shifting evaluation metrics. To produce an agile workforce capable of meeting the complex epidemiological demands of 2050, medical education must harmonize relentless technological innovation with the humanistic imperative of socially accountable, equitable patient care.