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

Medicine has evolved toward rationalization since the Enlightenment, favour ing quantitative measures. Now, a paradigm shift toward control through for malization can be observed in health care whose structures and processes ar e subjected to increasing standardization. However, educational reforms and curricula do not pet adequately respond to this shift. The aim of this art icle 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 organizationa l decision making in the project's instructional design is shown. Evaluatio n results of intrinsic learning motivation are demonstrated: intrinsic lear ning motivation depends upon students' perception of their competence exhib iting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational fo rmat, called 'evidence-based learning (EBL)' is deduced from these findings and described here. Effects of formalization consist of structuring decisi on making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formaliz ation such as implementation problems and bureaucracy are discussed. Formal ized tools for designing medical education are available. Specific instruct ional designs influence students' learning motivation. Concept maps are sui table for controlling educational quality, thus enabling the paradigm shift in medical education.