Many things have changed since I started my medical training but at least one of them is as valid today as it was 30 years ago: being a doctor is a lifetime commitment to learning. During my medical training the transfer of knowledge was almost exclusively one-directional: from professors to students. Limitations in technology, the characteristics of the students and of the socio-cultural environment made the professor the center of the education. Knowledge was important, but mentorship even more: even in those times, mentorship was essential for obtaining the ability to integrate theory into practice and for developing the skills and experience for the ever-changing challenge that is meeting the patient.

By providing a model, the good professors were able to plant the seed of continual self-education; and, reconsidering it now, with my lifetime experience, I believe that seed gradually sprouted to the current student-centered education concept.

Today, a student-centered medical educationimplies a better understanding of the neo-millennial generation (our current students, born between 1982-2000). This generation is used to learning more from the virtual reality than from the classical exposition instruction and searches more knowledge application than knowledge acquisition; they are confident, higher in self-esteem and assertiveness than most of the members of their teachers’ generation and are particularly achievement-focused. Compared to the X generation and the baby boomers, who constitute the majority of the universities staff, they are more tolerant, enjoy more working in teams, need a better work-life balance and are highly dependent on technology.¹Desy et al. have summarized the main characteristics of the millennials in relation to the medical training as follows:² the millennials need explicit and specific goals, personalized and self-directed teaching methods, a variety of assessment tools, emotional intelligence skills development, explicit feedback based on specific targeted behavior and public accountability.

How should we better adjust our medical training to meet these goals? There is no easy answer, but one of the solutions gaining more and more adherents is active learning, an umbrella term that covers "case-based learning, experiential learning, peer problem solving, and project-based learning”, facilitated by technologies including "audience response, podcasts, virtual patient simulation, and online games”.³More and more, the quality of education moves from a process-driven to an outcome-driven adjustment.⁴ More integration of basic science to the clinical practice⁵ is part of the evidence-based medicine we all want to achieve.

A concrete example of an active learning process is the project "Participative learning: integrating pathophysiology knowledge in drafting a scientific article" conducted by the Association for Increasing the Visibility of Scientific Research, in collaboration with the Students’ Medical Research Association. The project was supported by the editorial team of the Journal of Contemporary Clinical Practice and by the volunteer participation of some of the staff members of the chair of Pathophysiology 2 from the Carol Davila University of Medicine and Pharmacy, Bucharest. The project aimed to facilitate the understanding of the mechanisms of disease in a specific clinical context through the preparation of a case presentation manuscript to be submitted to a medical journal. The participation was open to any medical student after the completion of the third year of training and was supervised by one of the members of the pathophysiology chair. The first steps were choosing the case, the discussion with the treating physician and obtaining patient consent. These were followed by the analysis of the symptoms and of the paraclinical data in relation to the possible pathophysiological mechanisms. At the end, the student was supposed to draft the manuscript and integrate the authors’ comments. The final manuscript was edited with the direct supervisor, approved by all authors, and the student had to submit it and to receive the comments from the peer-review process. The answers to these comments were discussed and authorized by all authors.

There were 14 initial participants, some of them working individually, others already organized in a team. One team has changed the focus from a case-based analysis to a review article, a change that I approved in order to maintain the basic philosophy of the project, which was the personalized learning. Not all of them completed the task and this was due either to the volunteer, extra hours activity, or to the inefficient collaboration with the treating physician, that may not always be used to the medical papers writing process. These are main lessons learnt for future continuation of similar projects and for the necessary improvements to be done.

But there were also remarkable achievements. Not surprisingly, writing has proven to be an excellent process of clarifying ideas for the students. It was a learning by doing example of teaching and the results testify for it. By now, 5 papers were submitted and one is under final discussions between the authors prior to submission. The articles that were already published gave great satisfaction to the students and they expressed their wish to continue. By accomplishing the task of drafting the manuscript, they focused their readings differently than in the traditional exam-oriented way; reading medical literature driven by their internal motivation to solve the case. This also gave them a sense of being more "in control” of their education, as some of them confessed to me.

As initiator of the project, it was an honor for me to coordinate 4 of the students’ achievements and to see their growing interest for the subject they have chosen, their dedication in studying the medical literature, their perseverance in understanding the subtle specificities of the case that would have been otherwise ignored. Different personalities, different working styles, and for me, a challenge to adapt to the diversity of questions that are far beyond my daily teaching activity. During this supervision process, I had an intense feeling that this is the way to integrate basic and clinical science and so was the students’ feedback. I was also happy to involve medical practitioners in the learning process, and to create the communication opportunity with the reality of medical practice for the students who participated. A leaning process for us all, encompassing both the beauty and the difficulty of teaching millennials.

In the present issue of the Journal of Contemporary Clinical Practice we present 2 cases that were the results of this project. The articles illustrate the diversity of the topics covered by the project: one refers to the sepsis mechanisms in the neutropenic context of myelodysplasia and the other presents a dermatological condition that is very frequently associated with metabolic dysfunctions (diabetes, dyslipidemia) and autoimmune disease.^6,7 The cases are presented in a comprehensive perspective that takes into account the mechanisms of disease and their relation to the clinical evolution and to the response to treatment. Discussions are based on a comprehensive literature review, that was one of the main learning objectives of the project. Both are complex medical cases, in which multiple comorbidities contribute to the immunodepression (in the first case) and to a complex pathogeny in the second.

I am taking this opportunity to gratefully thank all contributors to this project: the organizations that made it possible, the medical doctors that gave their time and expertise to discuss the cases, the editorial team who agreed to support us, my colleagues who mentored the students and of course the students who showed so much engagement, enthusiasm and maturity.

1.Smith TJ, Nichols T. Understanding the Millennial Generation. J Bus Divers 2015;15:39-47.

2.Desy JR, Reed DA, Wolanskyj AP. Milestones and millennials: A perfect pairing competency-based medical education and the learning preferences of generation Y. Mayo Clin Proc 2017;92:243-50. [Crossref]

3.McCoy L, Pettit RK, Kellar C, Morgan C. Tracking active learning in the medical school curriculum: A learning-centered approach. J Med Educ Curric Dev 2018;5:2382120518765135. [Crossref]

4.Association of Program Directors in Internal Medicine, Fitzgibbons JP, Bordley DR, Berkowitz LR, Miller BW, Henderson MC. Redesigning residency education in internal medicine: a position paper from the Association of Program Directors in Internal Medicine. Ann Intern Med 2006;144:920-6. [Crossref]

5.5, Kadirvelu A, Gurtu S. Integrated learning in medical education: Are our students ready? Med Sci Educ 2015;25:549-51. [Crossref]

6.Dugăeșescu M, Popescu RS, Săndulescu O, Otelea MR. Recurrent sepsis with P. aeruginosa in a patient with myelodysplastic syndrome and multiple comorbidities – case report and review of physiopathological mechanisms. J Contemp Clin Pract 2019;5(1):40-5. [Crossref]

Nedelcu R, Balaban M, Zurac S, Popp C, Stinga P, Turcu G, Brînzea A, Antohe M, Popescu R, Popescu C, Ion D, Oțelea MR, Balasescu E, Postelnicu A, Grecu A. Disseminated granuloma annulare associated with systemic disorders: a case report and review of the literature. J Contemp Clin Pract 2019;5(1):31-5. [Crossref]