One urgent area that desperately needs national and global attention is disaster management. The World Health Organization defines a disaster as “a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community” [15]. In response to a pandemic, individuals and agencies, such as healthcare professionals, community workers, local governments, and nonprofit organizations share responsibilities for disaster management processes. The task involves more than understanding the pathophysiology of COVID-19. It involves education on how to address a pandemic—the creation of teams, leadership, resource and supply chain management, appropriate skills development, and communication with the community. Recent studies on the COVID-19 epidemic unanimously identified deficiencies in public health emergency preparedness, disaster coordination, interdisciplinary cooperation, and medical ethics in medical education [16,17]. Additionally, the public reluctance to vaccinate has been one of the critical barriers amid the epidemic.

One way to increase the effectiveness of disaster management is to invest in disaster preparedness, as constantly underscored by the United Nations and humanitarian organizations [18]. Disaster management is not new in medicine and other professional education but is rarely part of a medical curriculum [19]. Disaster preparedness requires not only having the requisite supplies on hand, but also having effective leadership and personnel cross-trained to contribute skills outside of their defined specialty during a disaster [19]. Contemporary medical education is aligned with health care systems that focus on field specialization. The exclusiveness of each specialty is limiting the basic and common functions and scope of medicine, and proves in the pandemic to be more self-serving than oriented to the societal need and good [13]. Physicians are capable within their specialties, but struggle serving as a generalist within a pandemic. This irony of specialization leaves the fundamental and general needs of the public potentially unaddressed.

There is an evident disconnect between what communities need and how health care professionals are trained [20]. In addition to technical proficiency, health professionals need to be both person and community-oriented to improve population health. Health professional schools have an ethical responsibility to their communities to produce practitioners who can address the public’s broad interests and specifically social issues relating to the public’s health and wellbeing, which are often full of complexity. Inherent within this responsibility is for the schools to identify societal needs and demonstrate results [5].

Despite these social priorities, there exists an inappropriate epistemology of competencies [21,22], whereby contemporary medical education has reduced the importance of complexity by defining competence with simplified and check-list driven tasks, predicated on linear knowledge development and performance assessments favoring clean and easily measurable learning objectives. The medical education curriculum has also historically been relatively weak on the complex themes of health equity and medical ethics, including indigenous health, minority health, migrant health, refugee health, care of sexual and gender minority groups, poverty, rurality, and mental health [23]. For example, despite incarceration being an epicenter for chronic illness, infectious disease, mental illness, and substance abuse, medical education programs rarely teach correctional health [24]. Students and residents are under-prepared to understand the multi-faceted impacts on health equity and local community health inherent in such subpopulations, particularly when government health directives are based solely on dominant population norms and fail to incorporate regard for minority and underrepresented communities [25].

Medicine is a complex social practice. The core competencies that the medical education curriculum teaches cannot be appropriately focused on performing over-simplified and sterilely itemized tasks detached from a community and relational context, but should navigate complexity in order to address community and population health needs. Humanities, social sciences, community health education, and ethics should be introduced early on in education to frame their importance, and should be embedded in the learning experiences of students across courses, allowing the student to grow in their “wisdom” and character-founded application of knowledge and technical skill. These topics should be put to use daily to solve problems, and not viewed as simply additional bits of isolated knowledge to be acquired or covered in curricular outlines.

Learning about communities by developing within communities themselves, embedded as a learner within the complexity and the diversity of their health care needs, should become a primary driver of curriculum in medical education. A lack of social accountability in contemporary medical education has occurred in part because of the lack of in-depth relationships between students, schools, and their surrounding communities, which is in fact required for the community to feel confident and invested in the medical school [26]. Without situation in a community, complexity can not become the teachable object in a medical education curriculum. It seems imperative for medical schools to work alongside communities, to learn how they might contribute to community initiatives and innovation. Medical schools need to demonstrate ongoing commitment and sustainability to their local constituencies. It is these stakeholders, after all, that constitute the patient body they need for training, and reflect their achievement of competency or lack thereof in healthcare outcomes. This evolution would help to ensure graduates have the clinical and cultural competencies necessary to be accountable to communities with the greatest needs, and to have the tools which will be necessary to proactively reduce inequities in future pandemics or other disaster environments [27].

Medical knowledge in the current medical education curriculum is typically dominated by a traditional biomedical paradigm (biochemistry, pathology, pharmacology, and so forth). The pandemic has reminded us of the nature of uncertainty in health care practice and the need for diverse paradigms in medicine [28]. Ilgen et al. [29] noted that experienced physicians tend to be more tolerant of uncertainty and accept the dynamic aspect of medicine where a contemporary diagnosis and treatment is an ongoing process for problem identification. COVID-19 is still a relatively poorly understood disease that has no proven, ubiquitously successful treatments at the time of this writing. What is more, the sudden flood of COVID-19 related publications has made it unmanageable to follow the research findings in the field. Additionally, there has been an associated diminished quality of the research findings published in high impact journals in the rush to provide current information, with an unprecedented number of retractions in this short period of time [30,31]. This uncertainty provides the profession an opportunity to self-reflect on our reliance on one specific medical paradigm in our education of future physicians [28].

There is more than one form of medicine and more than one way of teaching and practicing medicine [22]. Health and disease can be explained differently based on different medical paradigms. While biomedical treatments rely primarily on pharmaceuticals and surgery, complementary, alternative, and integrative medicine strategies similarly rely on internal (botanical medicine, nutraceuticals, mindfulness, and foods as medicine) and external manipulations of the body (acupuncture, massage, and body movements like yoga and tai chi) as tools in promoting health. For example, Qigong, one form of traditional Asian medicine focusing on mind-body exercise has been reported as effective for the prevention, treatment, and rehabilitation for respiratory illness including COVID-19 in China [32]. It is not that we are rejecting the current utilization of biomedicine, which has had profound effects on disease burden and life expectancy in recent decades. Indeed, the vaccination strategies derived from this model may be the most important measure that curbs the pandemic’s progress in the months to come. Rather, we are inviting and considering other views to broaden our therapeutic opportunities with an unknown disease, allowing us to address unprecedentally-complex health issues. Exploring paradigms that broaden the capacity of medical trainees to respond in uncertain environments with strategies to promote wholistic wellness, in a fashion complementary to pharmacologic and extirpative strategies, could expand the toolkit of our trainees as they navigate uncertainty. Included in this category would be the imperative highlighted by the pandemic to faciliatate and support trainees in building the character qualities and disciplines that correlate with high-reliability function in uncertain environments [33,34].

The recent movement to online learning in preclinical medical education does not simply indicate the migration of the curriculum to a virtual environment but creates the possibility of open lean medical education [36]. If lectures are delivered in an online format, why not share resources with learners in other schools, ideally taught and facilitated by the most competent instructors with reference to both content and educational skill? Why should all medical schools put time and resources to create and deliver the same content? As there is foundational medical knowledge that all medical learners should learn [37], preclinical medical education could evolve further toward “open” learning shared beyond the individual medical school boundaries. Moreover, the influx of new information is enormous in medicine and the information needs to be curated at a system level [20]. This problem is universal and shared by many medical schools.

Institutional collaboration to curate new information and provide an organized, standardized, and shared curriculum of foundational medical knowledge for all medical schools may open a new paradigm toward a lean medical education structure for preclinical medical education, including some of its interprofessional components. In some developing countries with a scarcity of resources and qualified faculty, these open online resources developed and curated by a collective set of institutions would be fundamentally helpful to address the shortage of healthcare providers [3,38]. This new method of medical education would de-monopolize preclinical medical education, and improve accessibility for all learners with less regard to socioeconomic status.

The ultimate added value of medical education is access to clinical practices and socialization into the healthcare system, which are not fully replaceable with online learning. Medical education should revisit the power of place, i.e., place-based pedagogy. Place-based pedagogy along with rooted experiential learning requires specific learnable objects tied to specific places and communities that would not be taught otherwise, such as free community clinic service learning and global health experiences [39].

A positive educational aspect during the pandemic has been that medical education expanded from a simulation lab, or a doctor’s office in clerkships toward real communities where authentic healthcare issues reside and in fact clamored for attention. As discussed in the earlier section, if social accountability is a desirable goal of medical education, how it is taught should be aligned with the context of the objective. Medical schools need to train physicians in their future environments including outside the four walls of the classroom and clinic. To do this, it seems imperative to extend the training environment beyond the campus and to build in-depth relationships with the community [26].

To facilitate students’ workplace learning [40,41], students’ roles should shift from learners to workers, which would change all social and environmental dynamics of their learning. In many countries there is an assumption that medical students should learn before working which excludes the educational value of working to learn. Why should medical education not allow students to take an appropriate level of responsibility in their clinical learning environments as a means of professional development, and allow them to experience the realities of professional commitment? On-the-job training is well-established in workplace learning [42]. Paid on-the-job training is available for firefighters’ and emergency medical technicians’ programs. Learning in the absence of work responsibilities can be unsatisfying, in that students may be relegated to remotely peripheral positions in the learning community [43]. The loss of opportunities to develop the skills of working in a healthcare system, interacting with peers, patients, healthcare teams, and communities, is critical [44]. As long as we can provide adequate oversight for medical learners, the integration of concomitant working and learning is something that medical education should revisit as a means to enhance student experience, engagement, and professional formation.

Interestingly, there is a movement, driven by the needs of coping with the current pandemic, to challenge the traditional notion of “learner only” student activity. In the United Kingdom, the Medical Schools Council has published very clear guidelines defining the role of medical students volunteering in the workplace [45]. In Portugal and Pakistan, medical schools started involving students as volunteer workers in response to the pandemic. Future evaluation of these initiatives will demonstrate the impact of volunteering on student learning and the development of professional identity. In the meantime, it is apparent that the pandemic is blurring the line between working to learn and learning to work in medical education, and this should be a very constructive tension for medical educators to manage both pedagogically and socially in the future.