Secondary Logo

Journal Logo

Letters to the Editor

In Reply to Guragai

Sam, Amir H. MBBS, PhD; Millar, Kate R. MBChB; Lupton, Martin G.F. MBBS, MA, MEd

Author Information
doi: 10.1097/ACM.0000000000003799
  • Free

We were delighted to read Mandeep Guragai’s letter, which is a timely reminder of the inequality of technological and educational access across the world. Guragai makes important points, and we wish to comment on 2. The first point is the position of the Nepal Medical Council in relation to not allowing substitution for hands-on training. In normal circumstances, we would be in agreement; however, we are not in normal circumstances. Training programs across the world are having to make numerous adjustments to cope with the challenges of the COVID-19 pandemic. The consequences of effectively pausing training need to be balanced against the anxiety that new technological solutions, such as digital clinical placements, are somehow not as good. This anxiety is legitimate, which is why it is important that the introduction of any new educational technology be subject to rigorous academic appraisal and formal validation. In addition, as clinical teaching is gradually reintroduced, clinical educators will face new challenges. We need to decide in advance what instruction should be face-to-face and what should remain online—and get the balance right—while protecting students and staff. At our institution, our planning process has allowed us to reflect on what is core medical knowledge and has provided an opportunity to review how we teach aspects of our medical curriculum.

The second point is that access to mobile data and the Internet is unequal across the world, which is illustrated by Guragai’s experiences. The Pew Research Center in 2019 estimated that more than 5 billion people have mobile devices, and while the median smartphone ownership is about 45% in emerging economies, it is higher among young adult populations (e.g., 74% in the Philippines). 1 Furthermore the number of mobile phone owners continues to grow. This increased access to smartphones presents medical educators with an extraordinary opportunity, and we must learn from first-hand experiences, such as Guragai’s. Medical schools such as the Imperial College School of Medicine, in collaboration with students and doctors from countries like Nepal, will be able to innovate and validate new technological solutions to the challenges of delivering affordable and accessible high-quality medical education in both West London and Kathmandu.


1. Silver L. Smartphone ownership is growing rapidly around the world, but not always equally.Pew Research Center. Published February 2019. Accessed October 5, 2020.
Copyright © 2020 by the Association of American Medical Colleges