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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 147-153

The metaverse: A new avatar in medical educational ecosystems?


Department of Neurology, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Submission17-Nov-2022
Date of Acceptance20-Nov-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Prof. Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Yenepoya (Deemed to be) University, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_267_22

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How to cite this article:
Shelley BP. The metaverse: A new avatar in medical educational ecosystems?. Arch Med Health Sci 2022;10:147-53

How to cite this URL:
Shelley BP. The metaverse: A new avatar in medical educational ecosystems?. Arch Med Health Sci [serial online] 2022 [cited 2023 Feb 6];10:147-53. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/147/364975



“Education is the foundation upon which we build our future”

–Christine Gregoire

I have been involved in academia for three decades actively engaging with medical students (learners) across the generational span ranging from Gen X, Gen Y (Millennials) to Gen Z (digital natives). This enriching passage of time for me has underscored the relevance of the differences among generational group of not only the students but also the teaching and learning skills practices among generational groups of teachers.


  The 21st-Century Teacher Top


Why did I begin my conceptualization of Educational Metaverse and Technology Enhanced Learning (TEL) with the “Teacher”? Can technology replace teachers in future classrooms? Is the need for human teachers being eliminated? These were perhaps some of the crucial concerns that rushed through my mind. Technology in education, in my opinion, would enhance deep learning and enrich the learning process, but it cannot replace the role of a teacher.

Future students cannot be taught in a modern classroom without access to human intelligence, human skills, and social interaction. Human innovations on teaching and learning practices as well as innovations for promotion of digital education and workforce development of educators are quintessential for future learning and educational innovation in the era of AI and Metaverse education. 21st century education won't be defined by any new technology. With the 4th Industrial Revolution, Education 4.0 does ring true with the words of the Irish poet William Butler Yates “Education is not to fill the bucket, but to ignite it.' In the end, I would underscore that there must be a seamless fusion of pedagogy and technology, and pedagogies should be tied to educational technologies. I tend to agree with the educationist Dr. Michael Fullan's wisdom quote “pedagogy is the driver and technology is the accelerator”. The educational metaverse, in this context, is a completely new realm, an alternative education space, with enormous implications for the future of teaching and learning, and indeed could serve as the “virtual runway” for augmented reality in education and enriched teaching-learning processes. Therefore, the goal should be towards 'innovating medical education and educating for innovation' in order to facilitate the professional development of 21st century teachers on digital skills and the educational perspective of the metaverse.

Teachers of the 21st century have to create future learners by taking into account rapid advances in technology and the era of the digital world we live in. Educational metaverse would transform the “Next Gen” learning environment to virtual classrooms. Therefore, a critical facet of the 21st-century teacher would be to develop and evolve as “life-long learners” to become effective educators.[1] I am reminded by the words of Albert Einstein that reiterates the role and challenges of the 21st century teacher – “Intellectual growth should commence at birth and cease only at death” portraying a cradle-to-grave perspective, and another by him “Once you stop learning, you start dying.” Teachers should not only engage and educate students to become lifelong learners (innovative learning), but also effective and progressive teachers should invariably harness the mindset and human maturity of lifelong learners to keep abreast of the evidence-based effective pedagogies (innovative teaching) in the context of the rapidly evolving digital and virtual world as the key to innovative and inclusive medical education in 21st-century educational ecosystems.

Like technology, the field of education has also evolved quite fast where pedagogical techniques, skills, and educational technologies do become obsolete within decades. Technologies and digital literacy are now critical components of education today. The argument, I would say is “for how long would teachers survive their future in a rapidly changing era of TEL and Educational Metaverse?” Teachers must be knowledgeable about TEL, adopt a lifelong learning mindset, and should not be intimidated by the rapid changes in the digital world educational ecosystem. To learn, unlearn, and relearn should therefore be the “teacher's human maturity” to survive, thrive, and mediate effective teaching–learning practices, and to be the avatar for being successful in the 21st-Century Next Gen classroom. The art, science, and theatrics of teaching should not be a static educational process; instead, educators must constantly challenge themselves by embracing the new and evolving aspects of TEL. The evolving role of the 21st-century teacher is quintessential as a creator and conductor of new effective and multiple pedagogies, enhanced, engaging and enriched learning, personalized learning, soft and flexible skills development, masterly learning, problem-solving, fostering critical thinking, creative thinking, and to encourage collaborative learning, and also adopt the role of a mentor, roles that cannot be replaced by technology of any kind. A new era in medical education would be governed by hybrid pedagogies, wherein the opportunities of the digital era could be blended into and throughout the traditional medical curriculum. This innovative medical education strategy would indeed be conducive to creating a truly transformative learning ecosystem. In addition, the innovative educators of today should emphasize “mediated learning” and the need to be curious, flexible, and forward-thinking. This would undoubtedly inspire and empower students for 21st-century sustainable learning.


  Teachers as Lifelong Learners: The Pedagogical Trajectory to 2040 and Beyond Top


“No one is born fully-formed: It is through self-experience in the world that we become what we are”

–Paulo Freire

Let me reflect on the words echoed by the educator, Peter Drucker “We now accept the fact that learning is a lifelong process of keeping abreast of change. And the most pressing task is to teach people how to learn.” Hence, at the outset of this editorial, I would reiterate medical educators should be actively engaged in being lifelong learners in their role in the educational process. This undoubtedly would galvanize educators to incorporate new tools and strategies into the learning process to boost their students' learning development and learning outcomes. Teachers need to reimagine the very concept of learning, create a learner-centered classroom, and develop a specific skill set for adaptability toward TEL as the current cohort of students belongs to Generation Z and Generation Alpha. This teaching–learning ideology has been elegantly put forward by the words of Alvin Toffler, “The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” Nevertheless, I would emphasize that the pearl in the Oyster of TEL is not the technology per se, but instead the creative, dynamic role of the 21st-century teacher knowledgeable in digital and metaverse literacy, and their use of the right technology coupled with innovative and effective pedagogies. Technologies do not teach or learn instead they mediate and augment teaching and learning. This has been enshrined in the words of George Couros, the principal of Innovative Teaching and Learning, Canada: “Technology will not replace great teachers but technology in the hands of great teachers can be transformational.

I have witnessed the shift in re-inventing the curricular content from the structured and standardized, discipline-based traditional curriculum based on the Flexnerian approach to one of an integrated curriculum that inculcates and implements a horizontal and vertical integration that epitomizes the competency-based medical education in the current era of a modern medical curriculum.[2] The teaching–learning culture in medical schools also witnessed a transformation from a teacher-centered learning to a student (learner)-centered learning philosophy. The challenging role of the 21st-century teacher does not resonate with “what” we deliver; it is about “how well” the innovative teacher could deliver novel teaching–learning practices. I believe this has certainly galvanized, promoted, and positively influenced self-regulated learning. During this passage of my time as a teacher, it has become apparent to me the relevance of “teacher characteristics” that would harness improved student learning and ultimately effective and patient-centered care. In the context of three different generations, namely Gen X, Gen Y (Millennials), and Gen Z (digital natives), it is crucial to recognize their varied learning needs and learning styles. An innovative teacher and an effective teacher should therefore possess a blend of excellent characteristics that will be conducive to creating a positive learning environment.

I have realized the absolute need for teachers to adapt to the current needs of 21st-century learners, to recognize the different needs of students, as well as their learning preferences all of which would empower and optimize their learning potential. Once teachers (facilitators) understand these fundamental generational differences, teachers need to have tripartite characteristics that resurrect their roles as “the competence-centered teacher,” “the empathetic teacher,” and “the innovative teacher.”[3] Having seen the evolution in the student–teacher dynamics through the passage of Generations X, Y, and Z, recognizing the evolving medical educational ecosystem, a teacher's role is certainly not limited to imparting classroom learning. Instead, the current generation of teachers should foster a new understanding between the educator and the learner. The “effective teacher” of the 21st century would need to wear different hats, one of a facilitator, a counselor, a mentor, a pedagogical weaver well versed in educational paradigm rooted in critical pedagogy, the Socratic inquiry/elenctic method, as well as to formulate pedagogies of the future that support deeper learning, personalized learning strategies, collaborative learning, and informal learning.

Twenty-first-century teachers should be “restless,” innovative, creative, and learn–unlearn–relearn to chart the pedagogical path to 2040 for the philosophy of sustainable learning and education. Such teachers should be enshrined in brain-based learning that is well integrated into TEL. Medical education has been under a constant state of “challenge for innovation” to reconfigure, remodel, re-imagining, and re-inventing medical curriculum for the 21st century during the span of the past several years. This is especially so relevant during the “era of the Coronavirus (COVID-19) Pandemic” that has undoubtedly disrupted the well-established structure of medical education.

The COVID-19 pandemic made us realize the value of remote education. The pandemic has brought out human ingenuity and novel adaptations. The pandemic has thus spurred a revolution in telehealth. It has also enforced disruptive innovations to springboard remarkable innovations in tech-based medical education, hybrid learning, and enriching the teaching–learning process by steering through the “Connectivist, Cognitivism, and Constructivist Models” of learning and instructional design.

The 21st-century teaching–learning process should involve innovative pedagogical practices and instructional strategies for sustainable learning and transferrable skills. This endeavor could be realized through the blending of collective fields of digital technology (technology-based pedagogy), brain-based education, adult and active learning theories, learning styles, and multiple intelligence theory. To my mind, undoubtedly the “student–educator interaction' is pivotal to enable a harmonious amalgamation of both the concepts of “brain-based teaching” and “evidence-based learning” which could be the reality with metaverse-oriented medical training. The evolution of a truly immersive educational metaverse by 2040 could indeed be the next avatar of medical education for the next generation of medical students, doctors, and health-care workers.


  The Metaverse-Creation of “Homo Technologicus” Top


“Change is inevitable, and that abides by reality. Metaverse is evolving by nature. Change makes saints sinners and vice versa. Similarly, dust becomes men, men become gods, and gods turn to dust”

–Robert Charles Wilson

Homo sapiens are entering a vital era in which the human–technology link is an inexorable trend. Humans have an instinct for creation, and this creativity is an important factor that distinguishes humans from other animals. Perhaps, the zenith of human creation coupled with the revolution in technologies in computers, genetics, nanotechnology, neural interfaces, reverse brain engineering, robotics, artificial organs and systems, and artificial intelligence (AI) could be fathomed when one reads the 2006 book by the American inventor and futurist, Ray Kurzweil “The Singularity is near: When humans transcend biology,” and the 2012 movie “The Singularity is Near: A True Story About the Future” based on this book. AI will reach human levels by around 2029. The singularity is the point at which machines' intelligence and human intelligence would merge by 2045, a spellbinding future of posthumanism and transhumanism (“transhumanism singularity”). A new era for humanity is also portrayed by a community of researchers dwelling on the “2045 Initiative” Here, the roadmap for cybernetic immortality as well as creation of an avatar controlled by a “brain–computer” interface, and ultimately transference of human consciousness, and brain–computer model to holographic bodies is being researched and a work in progress.

Turning back to re-inventing the educational arena, I believe that the advances in emerging technologies do present new pedagogies, environments, challenges, possibilities, and tensions across learning spaces. In recent years, virtual reality (VR) technologies have become increasingly accessible. Medical institutions have now adopted simulation-based medical teaching and training that has certainly enhanced the ability to objectively assess technical skill competencies in a competency-based medical education framework. Taking the cues from the aviation industry, there seems to be a promise to re-invent medical teaching and training in the next generation of health-care professionals with the introduction of a virtual world of an educational environment, located within the so-called “Metaverse in Medicine.” I would recall that the interest in the idea of the metaverse leapt in 2021–2022, which was prompted in part by Facebook's decision to rebrand itself as “Meta.” However, the word was coined by sci-fiction author Neal Stephenson in 1992 in his novel “Snow Crash.” This new buzzword in 2022 ascribes to “meta” meaning “virtual, transcendence” and “verse” a backformation from “universe.” The metaverse lexicon is the realm of computer-generated, networked extended reality, with a collection of a set of emergent technologies such as 5G, AI, VR, augmented reality (AR), mixed reality (MR), digital twins, blockchain, holography, or Internet of Things (IoT). The COVID-19 global pandemic has indeed awakened the sleeping “lion” (metaverse). The metaverse of the future is likely to fully support augmented and VR, AI, and the connectivity to link all worlds. From the educational perspective, the metaverse will serve as one of the most significant applications with great potential in the coming future. The metaverse-based education environment will be enhanced by metaverse-related technologies which fuse with the elements of the virtual and the real-world educational settings unlocking a variety of fantastic learning experiences for learners.


  COVID-19 Pandemic: A Springboard to the Digital Era and Virtual Ecosystem in Medical Education Top


“The secret of change is to focus all your energy not into fighting the old but building of the new”

–Socrates

The COVID-19 pandemic has had an unprecedented impact on medical education worldwide. The global pandemic has been a major inflection point in digital innovation where online learning and virtual platform has undoubtedly emerged as a disruptive and important tool for the future of medical education. As the digital age continues to take hold of our post-COVID-19 world, education is about to enter another dimension with 5G and metaverse. Metaverse (including Multiverse and Omniverse) is being touted as the next big thing in the digital world that will bring revolutionary changes to the entire digital ecosystem.

Indeed, metaverse is poised to be an exciting, futuristic technology that could be specifically harnessed for the enhancement of medical education, to augment the preexisting learning curriculum, and add another dimension to competency training. With this prologue, I am quite intrigued by how one would reimagine the myriad possibilities, effectiveness, and the future of medical education ecosystem through the immersive digital environments of XR. The adoption and potential role of medical AI/ML in health care and the practice of “P4” Medicine (predictive, preventive, personalized, and participatory), medical/health humanities, technological mediation of health care, the unique human vulnerabilities, and therefore various ethical concerns of “human-centered AI” in clinical ecosystems (health AI) and meta-hospitals is another facet that will not be addressed here. Medical IoT, blockchain technology, AI, AR, and VR are the pioneers of the metaverse in the field of medical education. In the metaverse, a virtual world that transcends reality is created by the convergence of blockchain technology and AI, also a convergence of virtual and physical space. Will metaverse applications become a reality in medical training, in particular surgical training and interventional cardiology? We will see the answers later.

I wonder if this human creative innovation and rise of “homo technologicus/homo virtualis” would translate to potential humanities contributions to the emerging intersections with AI, and the versatile platform of “5G metaverse-based education” and if it would be able to revolutionize learning ecosystems and medical education in the future. Will this immersive and interactive virtual world of the educational metaverse be able to change the future of learning and expand the horizons of “hands-on” medical training experiences in the future? I wonder if medical education could evolve from “medical universities” to “metaversity” in a 5G powered metaverse medical educational ecosystem in future.

The fourth industrial revolution (4IR) has arrived.[4] The 4IR is defined by its interconnectivity, intelligent automation, and a confluence between the physical, digital, and biological universes. Therefore, it would be right to emphasize that the 4IR (Industry 4.0 or 4IR) has indeed given teachers what might be the greatest responsibility of our time: to evolve teaching strategies so they can unlock individual student potential and prepare students with the skills needed to shape the future through innovation supported by technology.


  Metaverse-Oriented Medical Training Top


“Today, I think we look at the internet. But I think in the future you're going to be in the experience”

–Mark Zuckerberg

The metaverse has now officially become the future to look forward to. There's no denying that metaverse-based education does promise an enhanced “learner-centered” curriculum, decreased educator burnout, personalized learning, boosts learner confidence, lessens the cognitive load, and maximizes engaged learning through cybergogy to heutagogy.[5],[6],[7] The main appeal of the metaverse is the idea of redesigning learning spaces, “blending” worlds, and immersion for enriched personalized learning skills (medical and surgical training) and outcomes. The educational metaverse is probably here to stay, and as once remarked by Professor Enrico Coiera Director of the Centre for Health Informatics, Australian Institute of Health Innovation, and the founder of Australian Alliance for AI in Healthcare “What is the fate of medicine in the time of AI? Our fate is to change” in Lancet 2018 while discussing the fate of medicine in the time of AI. The metaverse is becoming a reality, and we need to adapt to meet it and embrace it. Are we ready for it? I would reiterate that medical educationists should need to work together with technologists that power the metaverse platform to form a “think tank” to reappraise the opportunities, risks, ethics, and policy implications. As educators, we need to engage students to use metaverse-based education safely, confidently, and ethically navigate these learning spaces.

The metaverse uses AI and blockchain to create a digital virtual world that transcends the limits of the real world. AR-, MR-, and VR-based technologies along with head-mounted devices (HMDs) would allow for an immersive learning experience that enables the teaching and learning of complex medical curricular content. HMDs make the learning content more accessible, engaging, and enjoyable, reduce the cognitive load, and increase students' motivation for learning too. This has been evidenced by a systematic review from a global perspective that considered the XR-based HMDs as at least noninferior to the traditional teaching methods, as far as the effectiveness of knowledge, skills, and attitudes is concerned.[8] This is especially so for teaching and learning of complex three-dimensional (3D) spatial structures in the fields of anatomy[9] (VR-based HMD neuroanatomy training; Virtual Cadaver-AR app “HoloHuman” replacing the SynDaver model) and surgery (360° virtual learning, not in 2D), but also including other disciplines such as pathology, ophthalmology (VR Ophthalmology Simulator-OculAR SIM AR program), emergency medicine, gynecology, and dentistry. Virtual-reality technology will indeed be the logical next step for enhanced 3D and interactive learning, especially in the context of the spatial understanding of neuroanatomy that is essential to neurologic-based medical and surgical specialties, including interventional cardiology, neurology, neurosurgery, and psychiatry.

In the discipline of cardiology, the adoption of metaverse learning and skill training could be through a virtual laboratory for virtual heart attack training, and a virtual cardiac magnetic resonance imaging room and cardiac surgery theater. VR spaces will also augment diagnostic and interventional radiology practice and competency training in 3D spaces. In surgical training, the VR-based cadaver training sessions can have a performance-enhancing effect on surgical trainees' technical capabilities, such as precision and decision-making skills, yet prove to be cost-effective. Being a neurologist, virtual technologies and metaverse classrooms would be an effective strategy to mitigate the problem of “neurophobia” that plagues undergraduate students and would facilitate effective and enriched learning outcomes in neurology and neurosurgery trainees.[10] The virtual and 3D brain models in the virtual-reality environment would empower students to engage in immersive learning, and improve their spatial and 3D neuroanatomy learning, thus increasing neuroanatomical knowledge, motivation, and retention of neuroanatomy knowledge.

VR does allow the surgical trainee to create a patient-specific 360° reconstruction of the anatomy and explicate their surgical plan of operation. This VR-based approach does “humanize” the understanding of treatment and ensures the trust of patients. Immersive learning through metaverse is transforming surgical planning outside the operation theater, and is indeed a valuable learning strategy to improve surgical skills and accuracy, and at the same time reducing human errors and guaranteeing high patient satisfaction and positive surgical outcomes. The surgeon's skills, preparedness, and competency in the operating theater could be boosted and trained using tools that range from VR headsets to haptic gloves to mimic real surgical procedures (digital surgery). The 3D printing technology used for robotic surgery training in urology may substitute for live animals and cadaver training. VR with AR simulators can train a wide range of psychomotor and basic robotic surgery skills. This Metaverse in Medicine technologies will promote access to hands-on practice to gain experience and to successfully bridge the gap between education and medical practice. Evidence also showed that through XR-based virtual patients via VR-based avatars, the attitudes, communication, empathy, and problem-solving skills of doctors could be enhanced and trained. This would indeed guarantee patient-centeredness without losing the “personal touch” in VR-based training. XR-based HMDs implementing medical teaching and skills training also do take into consideration the progression from knowledge to skills as evaluated by the four levels of competencies as per Miller's Pyramid of professional competence.

VR and AR technologies will enable everyone to use digital avatars for face-to-face communication in the virtual world and metaverse classrooms. From a student's perspective, AR-based learning does indeed achieve a highly stimulating learning environment and hands-on immersive experience, promotes the acquisition of practical and social skills, augments their learning outcomes, and facilitates remote learning and interactive simulations. Virtual lecture rooms will facilitate remote learning, and training, and participate in metaverse classrooms and workshops. Through the adoption of holographic construction and holographic emulation technology and technologies for virtuality–reality interconnection, it would revolutionize pedagogical strategies to improve the efficiency of education and training for medical practice. Leveraging the high technologies of the Metaverse in Medicine, doctors and patients can enter the metaverse with their digital twin, and practice metaverse medicine through virtuality–reality interconnection.

In the metaverse, both learners and teachers can break free from the restrictions of time and location. Metaverse-based education would also assist in blended learning, virtual experiment learning in a virtual laboratory, competency-based education, and inclusive education. As compared to traditional lecture-based classes, the metaverse-based environment certainly does augment creative learning and promotes inquiry-based and problem-solving tasks. Medical schools must incorporate technology-enhanced novel learning approaches and active learning techniques into their graduate medical education. One such approach should include gamification and game-based learning (GBL). Metaverse platforms would make it easy for learners to develop higher-order thinking skills (Bloom's taxonomy of learning objectives) during the whole learning process. In the metaverse, with the support of learning logging and learning analysis (using learning analytics techniques), teachers would be able to assess learners' performance, extract the real learning flow undertaken by students in the virtual world, and learner growth more comprehensively based on both formative and summative data.

The revolution in cognitive and computational neurosciences, and the reverse engineering of the human brain (decryption of the human brain's spatial memory networks; human consciousness), would hold huge promises and opportunities for reproducing AI which could potentially further guide the evolution of the metaverse environment in the next few decades. The field of AR certainly does offer opportunities for educators in the field of medical education to create a rich and engaging curriculum, offering students the opportunity to not only learn but also experience the learning content by simplifying the complexity of information.


  Futuristic Learning-Educational Metaverse – A New Avatar? Top


Just when you think you know something, you have to look at in another way. Even though it may seem silly or wrong, you must try

–Robin Williams (as John Keating in Dead Poets Society)

In conclusion, the COVID-19 pandemic has undoubtedly disrupted the well-established, traditional structure of medical education. It would not be wrong for me to state that the COVID-19 pandemic has certainly pushed medical educators to rethink how we teach and learn. There has been a shift from face-to-face to online teaching of medicine, engaging learning opportunities through blended/hybrid learning, invigorated with timely introduction of alternative student formative and summative assessment methods.[11] The pandemic has ushered a rapid transition from the conventional more “analog” approach to a more “digital” model and perhaps a hybrid environment, as innovative educational strategies. Online platforms emerged as the most appropriate way for teaching via teleconferencing to engage students in lectures, interactive sessions, and students' topic/case presentations. The dissemination of knowledge rapidly escalated via non-face-to-face methods of communication through webcast, video-conferencing, virtual Zoom-based and/or ENGAGE platforms for classes/tutorials, virtual conferences, and workshops. The dawn of a truly digital era has been set in motion in the post-COVID period which also guarantees faster and more efficient learning with improved engagement, a more immersive, interactive, realistic, and collaborative learning experience and reach.

As an extension to the existing digital learning experience, I would unhesitatingly state that the burgeoning, and emerging metaverse platform, a 3D digital space mixed with the real world and the virtual world, would certainly be heralded as a trend of future education with great potential. Researchers from backgrounds of computer science (metaverse-related technologies – AR, Lifelogging, Virtual Worlds, and Mirror Worlds; designing metaverse models for educational framework) and educational technology would need to work in tandem to study the challenges and opportunities of a metaverse in medical education. Although I see a vast ocean of opportunity with its innovative perspectives by adopting metaverse-based medical education, it is quintessential to be cognizant and vigilant about the set of challenges (SWOT analysis of Edu-Metaverse) of the metaverse technologies in the educational ecosystems. These challenges would be in the realms of technological advancements (hardware, wearable devices specifications to obviate cybersickness, and cost economics), learners' privacy (digital identities of students and metaverse avatars) and physical security, system security, operational security, management security as well as data cybersecurity issues, the ethical and moral issues, and the digital addiction and mental health issues related to the metaverse.

It is also imperative to conduct comparative research on learners' performance (cognitive and noncognitive aspects) between in-person learning and different metaverse platforms to find out the relatively effective educational environments for teaching and learning. Educational researchers would need to propose and dissect various methodological and pedagogical models (pedagogical theories, technology-enhanced pedagogy, embodied and extended cognitive theories, and cognitive load theory) in line with the metaverse-based medical education. Another challenge of the educational metaverse platform would be to extrapolate the formative and summative learners' assessment framework. There have been studies that explicated the students' perspectives and opinions from the UAE medical institutions about the educational use of metaverse.[12] Their Structured Equation Modeling factored Perceived Enjoyment, Personal Innovativeness (PI) where the PI included Perceived Usefulness (PU) and its Perceived Ease of Use (PEOU) that was integrated with the Technology Acceptance Model. The study finds that PI closely influences the students' intentions to use metaverse. The PI was further affected by PEOU and PU. This study underscores that students were able to overcome the metaverse technological uncertainty (user-friendliness) and do develop a positive inclination to use metaverse technology that does translate to meaningful impacts on teaching and learning.[13]

Nonetheless, the presence of the metaverse is a brand new concept compared to existing educational technologies that are worth exploring and to something medical schools and universities should adapt, adopt, and embrace. The metaverse in medical education is indeed thought-provoking and certainly does hold great promise and is potentially pivoted in time to bring about great opportunities and innovations in the direction of future medical education. Twenty-first-century innovative teachers, as lifelong learners themselves, should be knowledgeable and be trained in the virtual educational ecosystem to promote up-to-date and high-quality student-centered constructivist learning and education. I would reiterate that 21st-century teachers must be equipped with technology. Educators should harness willingness for change imposed by the digital and metaverse ecosystems beyond the traditional classroom walls. Educators should be geared toward embracing and learning new-age technology. However, no matter how advanced technologies are, teachers are still the best educators. Teachers should be knowledgeable about how to harness the different educational technologies in the virtual ecosystem to effective use. This epitomizes the undeniable fact that pedagogy should always be the engine, the 21st century teacher as the pedagogical weaver, and where educational technology is the accelerator.

Would metaverse be the Next Gen classroom or “Virtual campus” in the medical educational ecosystem? Would the virtual ecosystem be a blessing, tech hype, hope for future reality, or a curse (from a moral, ethical and legal perspective)? Will the metaverse continue to be the center of attraction for educationists? Major hurdles stand in the way of making the metaverse possible. Significant barriers include usability, affordability, and accessibility. Will the LMICs be able to adopt and adapt to metaverse-based education or be a curse for those that suffer from poor infrastructure, especially in developing countries? Concerning the United Nations Sustainable Development Goals (SDGs), especially SDG4 which governs quality education, it is important to investigate how the metaverse could be designed to be inclusive and accessible to all students worldwide. I wonder whether this new promising revolutionary “avatar” in our medical educational ecosystems can transform into a positive and immersive “metaverse” school of learning or “metaworse.” I think the denominator that will determine that trajectory would be decided by how we take advantage of the metaverse to overcome the limitations of current education, address the potential challenges and limitations of metaverse educational technologies, and ultimately maximize its positive, experiential, immersive, and personalized experiences for the future learners in medical education. Humanity should have a critical reflection on the relevance of the educational metaverse, as an alternative tool to augment the existing effective pedagogy and educational strategies, by adhering to a reality-oriented and human-centered philosophy of the teaching–learning experience, ultimately translating to societal goodness. Educational technology is merely an augmentation to the teacher. It can help the process of learning, but it certainly cannot replace the role of the effective and innovative 21st-century teacher for sustainable learning.

“A vision is not just a picture of what could be; it is an appeal to our better selves, a call to become something more”

–Rosabeth Moss Kanter



 
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