Do we face a fourth paradigm shift in medicine--algorithms in education?

Medicine has evolved toward rationalization since the Enlightenment, favouring quantitative measures. Now, a paradigm shift toward control through formalization can be observed in health care whose structures and processes are subjected to increasing standardization. However, educational reforms and curricula do not yet adequately respond to this shift. The aim of this article is to describe innovative approaches in medical education for adapting to these changes. The study design is a descriptive case report relying on a literature review and on a reform project's evaluation. Concept mapping is used to graphically represent relationships among concepts, i.e. defined terms from educational literature. Definitions of 'concept map', 'guideline' and 'algorithm' are presented. A prototypical algorithm for organizational decision making in the project's instructional design is shown. Evaluation results of intrinsic learning motivation are demonstrated: intrinsic learning motivation depends upon students' perception of their competence exhibiting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational format, called 'evidence-based learning (EBL)' is deduced from these findings and described here. Effects of formalization consist of structuring decision making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formalization such as implementation problems and bureaucracy are discussed. Formalized tools for designing medical education are available. Specific instructional designs influence students' learning motivation. Concept maps are suitable for controlling educational quality, thus enabling the paradigm shift in medical education.