Medical education splits into two worlds. You’ve got preclinical years – classroom-based, theory-focused. Then clinical years – hospital-based, patient-focused. This separation made sense when medical knowledge evolved at roughly the same pace as continental drift. Evidence-based guidelines could sit unchanged for decades. Surgical techniques passed down like family recipes.
That’s not today’s reality.
Evidence-based guidelines, surgical techniques, and treatment protocols can change within months now. Three mechanisms are shifting this landscape: individual practitioners holding dual clinical-teaching appointments, simulation companies developing tools that replicate clinical workflows for classroom use, and medical societies building policy frameworks that enable practitioner involvement. Evidence from nursing, orthopaedic, and cardiovascular programmes shows measurable improvements in knowledge retention and practical skills. Yet resource intensity and practitioner time constraints present genuine barriers to universal adoption.
When the Surgeon Becomes the Professor
Responding to this shift, some medical institutions are creating formal dual appointments where practising clinicians also hold teaching positions. This approach matters because a surgeon who operated yesterday can explain not just textbook techniques but also judgment calls, complications management, and patient communication – elements that textbooks struggle to capture.
This approach manifests in formal dual clinical-teaching appointments at medical schools. Dr Timothy Steel, a Sydney-based neurosurgeon at St Vincent’s Private and Public Hospitals, exemplifies this model as an Adjunct Clinical Associate Professor at the University of Notre Dame. Since 1998, he’s maintained an active surgical practice while teaching Masters in Medicine students. Steel’s dual commitment allows him to translate immediate neurosurgical and spine surgery experiences into educational frameworks. Students learning complex surgical decision-making from an instructor actively engaged in those decisions gain instruction grounded in current practice rather than historical interpretation. Of course, juggling theatre schedules with lecture prep isn’t exactly a recipe for work-life balance, but it demonstrates how practitioner-educators translate immediate clinical judgment into educational frameworks.
However, dual-role practitioners face significant time challenges. Balancing clinical schedules with teaching preparation limits how many can adopt this model. Time constraints and geographical limitations mean most students can’t learn exclusively from active clinicians. To address this scalability challenge, simulation technology companies have developed systems that replicate clinical workflows in classroom settings.
Simulation as Clinical Translation
Medical simulation technology has moved from basic mannequins to high-fidelity systems that recreate complex clinical scenarios. These systems let students practise procedures and decision-making before they encounter real patients. Effective simulators need design input from active clinicians who understand authentic clinical workflows, physiological responses, and decision points. They’re bringing practitioner expertise directly into the technology itself.
Medical simulation companies tackle this by developing high-fidelity training systems with clinician input. Alf-Christian Dybdahl, CEO of Laerdal Medical based in Norway, shows this approach in action. Laerdal works on simulation technology that connects academic instruction with clinical practice. Laerdal’s high-fidelity simulators include MamaAnne and NeoBeat for neonatal care and resuscitation training, plus collaborations like SIMCharacters that enhance simulators such as ‘Paul’ and the forthcoming ‘Emily’. Students can practise complex clinical procedures in controlled classroom environments designed to replicate authentic clinical conditions.
It’s an ambitious goal. Recreating clinical chaos in a perfectly controlled setting.
Still, these systems enable classroom-based procedural practice at scale that individual practitioner oversight simply can’t match. Laerdal’s mission to save one million additional lives annually by 2030 through improved training reflects how simulation technology scales hands-on learning beyond what any number of individual practitioner-teachers could provide.
This design approach shows how simulation technology scales the practitioner-educator principle. It embeds clinical authenticity into tools that enable classroom-based hands-on learning when direct patient access is limited. Like Steel’s translation of surgical expertise into educational frameworks, Laerdal’s simulators translate clinical workflows into training tools. Both approaches recognise that effective medical education needs continuous input from those engaged in active practice.
Both individual practitioners maintaining dual appointments and simulation technology enabling classroom-based clinical skills need institutional support to function effectively. Dual appointments need compensation structures that recognise both clinical and teaching contributions, while simulation equipment requires substantial capital investment. Medical societies and policy leaders increasingly recognise this reality, creating frameworks that value and sustain practitioner involvement in education.
Building the Infrastructure for Integration
Systemic policy frameworks are necessary to enable practitioner-led education by structuring compensation, protecting teaching time, and designing programmes that assume clinical practice and education are intertwined rather than separate career tracks.
Medical societies and policy organisations address this by creating institutional frameworks that structure compensation and protect teaching time. Gene M. Ransom III, CEO of MedChi (The Maryland State Medical Society), provides an example of this policy-building work. Under his role, MedChi is involved with developing programmes like the Episode Quality Improvement Programme and the Maryland Primary Care Programme. His work includes chairing the Maryland Loan Repayment Advisory Commission and serving on cost management committees, creating systemic support for physicians combining patient care with teaching and mentorship. His work on developing state programmes and contributing to health policy publications demonstrates how medical society leadership creates the systemic frameworks necessary for practitioner-educator models.
This systemic support demonstrates that practitioner-led education requires more than individual initiative – it demands policy frameworks that structure compensation, protect teaching time, and design programmes assuming clinical practice and education are intertwined rather than separate career tracks. While Steel demonstrates the practitioner-educator model at an individual level and Laerdal shows its technological scaling, Ransom’s policy work addresses systemic requirements: neither individual dual appointments nor simulation technology investment occurs without institutional frameworks that recognise their value.
Evidence of Impact
Empirical evidence from controlled studies demonstrates measurable improvements in both knowledge retention and practical skill acquisition when students learn through approaches maintaining connection between classroom instruction and clinical practice.
Research at Peking University Third Hospital in China compared training approaches among 30 orthopaedic residents. The study found that combined training integrating virtual simulation experiments with traditional teaching methods produced superior outcomes, with the combined group achieving theoretical knowledge scores of 92.1 and practical skills scores of 92.7. This demonstrates that blending classroom-based clinical simulation with conventional instruction creates more effective learning than either approach alone.
A study involving 140 undergraduate nursing students examined the integration of artificial intelligence into clinical education by enhancing the Mini-Clinical Evaluation Exercise (Mini-CEX) with automated performance analysis of video-recorded clinical skills and patient interaction transcripts. AI-assisted evaluation provided more consistent feedback and led to more rapid skill acquisition, demonstrating how technology can extend practitioner oversight by providing standardised clinical assessment at scale – relevant when practitioner time for individual assessment is limited.
These outcome improvements validate approaches exemplified by Steel (direct practitioner teaching), Laerdal (simulation technology), and supported by Ransom’s policy work (institutional frameworks) – all share the common principle of maintaining connection between classroom instruction and current clinical practice.
Institutional Commitment at Scale
When measurable learning improvements are documented, institutions respond with substantial capital investment. Major institutional investment in infrastructure enabling clinical training within educational settings demonstrates confidence that practitioner-led education represents a fundamental shift rather than a temporary pedagogical trend.
East Carolina University’s Brody School of Medicine received a $1 million award from the Golden LEAF Foundation to support the construction of a seven-storey, 195,000-square-foot building equipped with high-tech classrooms, anatomy labs, and simulation suites. Completion is expected in 2027. The project will increase class cohorts to 120 students and add 89 residents and fellows.
This represents substantial institutional investment in facilities specifically designed to enable clinical training within educational environments. Institutions planning multi-year construction projects must expect the practitioner-educator model to persist long enough to justify expenditure at this scale.
Short-term pedagogical experiments get pilot funding for temporary equipment. They don’t get permanent buildings.
The decision to expand capacity to 120 students and add 89 additional residents indicates institutions are treating practitioner-led education as foundational rather than supplementary. They’re building permanent capacity, not testing feasibility. Dr Michael Waldrum, dean of the medical school and CEO of ECU Health, indicated the facility’s particular importance for rural healthcare education.
Major infrastructure investment at this scale demonstrates institutional confidence that classroom-based clinical education through simulation and practitioner involvement represents the future of medical training. The decision to increase cohorts and fellowship positions within this facility validates institutions view practitioner-educator models as scalable, not merely supplementary.
The Limits of Integration
Resource intensity, time constraints, simulation limitations, and infrastructure costs present genuine barriers preventing universal adoption of practitioner-led education, suggesting the model will likely complement rather than replace traditional academic-only teaching. Turns out money and time aren’t unlimited – who knew?
Sure, evidence supports practitioner-led education and institutions are investing significantly. But real constraints limit how widely this model can scale. Practitioners maintaining dual clinical-teaching roles face competing demands. Clinical schedules are often unpredictable. Teaching preparation is time-intensive. Academic appointments typically pay less than pure clinical practice, creating financial disincentives for practitioners to take teaching roles unless institutions structure compensation to recognise both contributions.
High-fidelity simulators replicate many clinical scenarios effectively. They can’t fully capture the complexity of patient care though.
Think about it: simulators can replicate vital sign changes and anatomical responses but struggle to replicate the stress of a patient’s family member asking difficult questions while the clinical situation deteriorates. They miss the unexpected complications, patient psychology, and cognitive load of managing multiple simultaneous demands.
These limitations don’t invalidate the practitioner-educator model but suggest it’ll likely exist alongside rather than replace traditional academic-only teaching positions. This hybrid reality frames understanding of the model’s trajectory.
The Emerging Hybrid Model
Medical education is bringing clinical practice back to the centre of teaching. Three mechanisms work together to make this happen. Individual practitioners maintain dual roles – Steel’s neurosurgery practice informs his Notre Dame teaching. Simulation technology replicates clinical environments – Laerdal’s high-fidelity tools enable classroom-based procedural practice. Institutional frameworks support practitioner involvement – Ransom’s policy work creates structures for physicians who combine care with teaching.
This model won’t replace everything. Resource constraints make that impossible – practitioner time costs money, compensation structures need reworking, simulation technology isn’t cheap. But it’s not going anywhere either.
The evidence backs this up. Measurable learning improvements show up in nursing and orthopaedic training. Substantial institutional investment like ECU’s simulation centre suggests practitioner-led education represents a permanent shift in medical training’s fundamental approach. It’s not just another pedagogical trend.
Medical knowledge moves fast these days. Treatment protocols change. Surgical techniques evolve. Evidence-based guidelines shift within months. The pressure to keep education grounded in current practice will only intensify.
The historical separation between classroom instruction and clinical practice made sense when knowledge moved slowly. It doesn’t now. Whether through individual dual appointments, simulation technology, or policy frameworks supporting both, medical education is rediscovering something apprenticeship training knew centuries ago. Sometimes the best classroom is wherever the real work gets done.
