Universities have one key principle in common, which is meeting the needs of the community by creation of knowledge-based wealth, and articulating entrepreneurship. In this regard, third-generation universities have opened up new horizons in the field of entrepreneurship, defining new career areas and creating wealth for the society [18, 19]. The results of the study showed that there are four different scenarios and challenges in Medical Education System in COVID-19 pandemic.
First Scenario: quick movement towards third-generation universities
In this scenario, the focus of teaching and learning is on nurturing entrepreneurial and creative students. This requires more collaborations between universities, and industries for research and development. In this case, universities will be creators of new ideas, new jobs, and profit. In this way the COVID-19 epidemic may represent an enduring transformation in medicine with the advancement of telehealth, adaptive research protocols, and clinical trials with flexible approaches to achieve solutions [20].
The Covid19 Pandemic Crisis has facilitated the digitization of universities. Under normal circumstances, this path toward achieving this goal has required more time and the complex administrative rules and bureaucracy. But in this special condition the potential to move universities towards digitalization and the importance of information technology has increased [21].
Some evidence suggests that students' attitudes toward e-learning are not positive. The most influential variables are learning environment, the degree of interactivity of the learning platform, students' knowledge and information about online communication. It seems that the growth of adopting approaches to correct these attitudes can be helpful [22].
The strategic actions for the success of this scenario are:
-
Reform in financing educational system, both private and public
-
Reform in recruitment of faculty members, on the basis of entrepreneurship and modern knowledge of electronic marketing
-
Re-design of the educational curriculum (specialized courses in entrepreneurship, creativity, critical thinking, innovation, marketing, project management)
-
Enhancing university internationalization
Second scenario: laying the foundation for e-learning and virtual Schools
This scenario focusing on expanding virtual health education into more diverse fields and with more advanced equipment and facilities. The university could then expand its virtual school and extensively collaborate with universities in other parts of the world to hold joint courses. This will enhance the opportunity for more enrolments, nationally and internationally, and enhance the exchange of knowledge and ideas. Expanding e-health courses are paramount due to emerging megatrends in health education, such as: expansion of borderless health care, improvement of health/bioinformatics information technology, development of fourth-generation smart hospitals with advanced intelligence and management systems in clinical and non-clinical settings. In this situation online education is a possibility that should be considered compatible with or replaced by face-to-face and physical education. Benefits such as the flexibility of online education, personalized and self-controlled learning, and cost savings cannot be ignored. Therefore, the implementation of smart universities will benefit all stakeholders. These smart universities will not only be more cost-effective than traditional one, but will also be more useful for students because a wider range of courses will be available compared to traditional universities and then different career paths are created [23]. Evidence suggests that the challenges of online education, especially in developing countries and low-income countries are lack of adequate Internet infrastructure, teachers’ lack of competency in online education, and students' low knowledge in this regard. Meanwhile, medical and clinical education has more challenges especially in teaching hospitals due to the health of patients that the constant presence of an observer is a basic need. This issue emphasizes the importance of conducting researches in this field and reducing administrative bureaucracy for an effective transition toward e-learning [24]. Potts in his study suggested that allow and foster greater use of tele supervision were adopted by the ACGME Board of Directors in February 2020 were to become effective July 1, 2020. As the pandemic unfolded in the US, it became clear that tele supervision of residents/fellows could positively affect the delivery of care to patients while mitigating the risks to those residents, fellows, and other healthcare providers [25].
The strategic actions for the success of this scenario are:
-
Changes in recruitment based on the expertise in e-health
-
Incorporate information communication literacy in the curriculum as well as investing in intelligence information systems
-
Increase online courses and support for the production of electronic curriculum content
Third Scenario: Turtle Movement
This scenario is similar to the current situation, including some main issues, such as: low motivation, inappropriate system of payment to educators, lack of evidence-based teaching and learning. This situation discourages those who are actually competent and scientific references in their own specialized fields to contribute to the area of policy-making and targeting (lack of meritocracy).
In this scenario, there will be an expansion of an industrial approach to medicine, which could have the following consequences: unbridled and non-expert use of new technologies; excessive increase in costs; harm to the spiritual relationship between physicians and patients; disregard for the spiritual dimension of human beings; lack of attention to ethics; violation of patients’ privacy; and lack of localization of new educational models, approaches and technologies will lead to the backward movement of the university in terms of achieving scientific authority in health education.
It is notable that even under these conditions, there can be opportunities to enhance the quality and improve the situation. with regard to the strategic geographical location of the universities in south of Iran and presence of experienced instructors in these universities, there will be proper conditions for growing and expanding medical tourism industry, which will lead to import of currency and improvement of financial support of the university.
The strategic actions for the success of this scenario are:
-
Society-based education tailored to the needs of community members and the use of indigenous models in education.
-
Improve the support and motivational system for distinguished students to maintain and reduce their migration (e.g., offering financial and intellectual support for converting innovative industrial-scale ideas; patent registration; international conferences attendance).
-
Monitoring the purchase and evaluation of advanced health and education technologies. The lack of proper rules and adequate supervision for the suitable application of advanced technologies or referrals tailored to the patient's treatment process causes a heavy financial burden on healthcare system, patients and families.
Fourth Scenario: Alert for Moving Backward to First-generation Universities
Along with the Covid-19 pandemic, unstable economic and political conditions, Universities will not be able to finance a new educational system, research projects, support staff and national/international students. University may be unable to establish the distance education in more diverse fields, and the inability to use more advanced teaching technologies. This process will lead to less collaboration among university and industries, less staff retention, and ultimately poor education, and ineffective future human resources. In this regard, a case study by WSB (Visa Skola Biznisa) proposed a model that is a product of the joint investment with the National Louis University. In this model, the key mission of entrepreneurial universities is to help create the opportunity and capacity for local and regional development, create a knowledge-based society, encourage the development of industry, commerce, services, urban development, and technological citizenship in an active and action-oriented form [26, 27]. Moreover, the results obtained by Etzkowitz showed that the goals of entrepreneurial universities will be realized when the results and achievements of some particular research or innovation are revealed. In addition, it was noted that value-adding occurs by the university itself operating the result of the research or innovation [28].