Virtual reality, augmented reality and digital simulations are increasingly being integrated into medical education. From anatomy training to procedural practice, these technologies promise to make clinical education more accessible, scalable and standardized. Yet a new correspondence suggests that one of the most important elements of medical expertise may remain difficult to replicate digitally: the tacit knowledge acquired through hands-on experience.
The paper, led by Professor Orly Lewis of the Hebrew University of Jerusalem, argues that while digital technologies can effectively teach procedural steps and clinical reasoning, they struggle to convey the physical intuition that clinicians develop through direct patient care and supervised practice. To illustrate the problem, the researchers turned to an unlikely source: the work of Galen of Pergamum, the influential Roman physician whose anatomical teachings shaped medicine for centuries. The paper was recently published in Nature Medicine.
A 2,000-year-old experiment
As part of the interdisciplinary ATLOMY project, Lewis and colleagues attempted to recreate a dissection procedure described in the second-century text Anatomical Procedures. The team followed Galen’s detailed instructions for dissecting the abdominal wall and peritoneum of a female pig specimen.
The ancient physician’s descriptions are remarkably precise. Readers are instructed, for example, to make superficial incisions around the navel until the underlying tissue appears lighter in color. Yet when the researchers attempted to replicate the procedure, they encountered a challenge familiar to many medical educators today: the written instructions described the steps, but not the skill required to perform them.
Questions quickly emerged. How deep is “superficial”? How much pressure should be applied with a scalpel? How should the hand respond when tissue resistance changes? These decisions depend on sensory perception, motor skills and clinical judgement developed through experience rather than explicit instruction.
According to Lewis, the findings reveal a limitation that extends beyond ancient medical texts. “Even Galen’s highly detailed written instructions were not sufficient to guide us,” she noted. “Modern simulations face a similar challenge. They can replicate visible actions, but they often struggle to transfer the physical intuition of an experienced physician.”
The limits of digital training
The issue has become increasingly relevant as medical schools expand their use of virtual and augmented reality platforms while opportunities for cadaver dissection, bedside teaching and supervised clinical exposure decline in some settings. Modern competency-based education often breaks procedures into measurable steps that can be taught and assessed. While this approach supports standardization, the authors argue that it may overlook elements of expertise traditionally transmitted through observation, mentorship and repeated hands-on practice.
Clinical competence depends not only on knowing what to do, but also on understanding how to do it safely. Whether inserting a catheter, making an incision or palpating tissue, healthcare professionals rely on subtle sensory cues that are difficult to describe and even harder to digitize. This form of embodied knowledge often develops gradually through direct interaction with patients and guidance from experienced clinicians.
The next generation of simulations
The authors are not questioning the value of digital innovation in healthcare education. Instead, they argue that future training technologies should be designed with a deeper understanding of how clinical expertise is acquired. If virtual reality and simulation platforms are expected to complement, or partially replace, traditional training methods, they must move beyond visual instruction and incorporate aspects such as touch, resistance, pressure, timing and tactile feedback. Advances in haptics and immersive technologies may help bridge that gap, but significant challenges remain.
The lesson drawn from Galen’s 2,000-year-old text is surprisingly relevant to modern healthcare. Medical knowledge has never been transmitted through words and images alone. While digital tools can teach anatomy, workflows and decision-making with increasing sophistication, the development of clinical judgement still depends heavily on experience.
As medical education continues its digital transformation, the challenge will be ensuring that future clinicians acquire not only knowledge, but also the practical intuition required to translate that knowledge into safe and effective patient care.
AI and XR medical training
Last year researchers at Mount Sinai developed an AI-powered surgical training system that enables medical students to learn complex procedures with minimal human supervision. The platform combines artificial intelligence with an extended reality (XR) headset that provides step-by-step guidance, live video instruction and real-time feedback during training.
In a pilot study involving 17 medical students, all participants successfully completed a simulated partial nephrectomy using a realistic 3D-printed “phantom kidney” model. The AI continuously analyzed their actions and delivered corrective guidance, achieving 99.9% accuracy during a critical surgical step. Researchers believe the technology could help address shortages of experienced surgical trainers, reduce training costs and improve consistency in surgical education. Future development will focus on simulating complete operations rather than individual procedural steps.
