Every year, COMSEP gives me a few days to set aside the noise of the broader world and reconnect with a community of dear friends that cares deeply about pediatric medical education.
This year felt different.
I didn’t leave with a single big headline or takeaway. Instead, I left with a quieter but more meaningful realization: something important is changing—not in what we're talking about, but in how we’re thinking about learners, teaching, and our roles as educators in a rapidly shifting world.
Here's what's stayed with me.
I attended a session on “AI in the Residency Match” expecting the usual discourse. Instead, what struck me most was a newly elevated tone. No one was asking whether AI belongs in this process. What I heard instead was: How do we all use AI appropriately? How do we authentically guide students through it responsibly?
This shift from skepticism to shared practical application is important. And it wasn’t limited to AI. Across sessions, there was a broader pattern: a deeper focus on what actually works in day-to-day teaching and learning. Educators weren’t looking for new ideas as much as they were looking for student-focused approaches that fit into complex workflows, with growing real-world constraints.
At one point, I raised what felt like a slightly uncomfortable question:
“If students are already using AI, and we know they are, and we’re using it too, and they know we are, what does it mean if we tell them not to?”
The group leaned in rather than pushed back. The conversation moved toward something more productive: how to use moments like this to build trust with learners, rather than create friction.
That's the reframe I keep coming back to: AI as a point of connection rather than tension. Meeting students where they are, because frankly it’s where we are, too. Being authentic about our own use, our own uncertainties, and turning what could be a confrontation into an opportunity for a more honest relationship. That's not a policy. It's a new position, and I think it's the right one.
If there was one theme that consistently surfaced across sessions and conversations, it was this: supporting all learners as individuals is becoming more necessary—and more complex.
There was deep engagement around expanding accommodations, revising the definition of ‘dis’ability, and addressing the neurodiversity among our learners. I witnessed a genuine curiosity and desire for improving support for all types of learners and their unique potential as future clinicians. This is not a theoretical challenge. It shows up every day in clinical education, where variability in learning needs intersects with variability in clinical experiences.
This resonates with me personally. Early in my career, I worked with a student who is profoundly deaf as she progressed through medical school, residency, and into a pediatric neurology fellowship. Adapting the learning and clinical environments required significant intention and effort, and the experience has stayed with me. It was genuinely rewarding because she brought something unique to her peers, our team and her patients, precisely because of who she was. We all grew because of her.
The same principle applies now, even as the complexity increases. Neurodiversity, in particular, asks more of us as educators because it is not always visible. But the underlying principle is the same: we need to see our student's true potential first, then ask what needs to change in the environment—not in the student—to best support their unique contributions. As pediatricians, this approach extends meaningfully to our patients and their families as well.
I also think it's important, even when it's uncomfortable, to bring our personal lives into this conversation. Many of us are closely connected to people who navigate neurodiversity. That personal experience should inform our professional practice. Perhaps one of the places we're becoming more sophisticated as educators is in recognizing that integrated authenticity makes us better.
The future of clinical education, for all learners, is individualization. And AI is what makes that possible at scale.
COMSEP has long been a pioneer in EPAs and milestones, the competency frameworks that define what graduating medical students need to be able to do before entering residency. That work has laid the foundation for something even more powerful: AI-driven, competency-based feedback systems that personalize learning for every student. At this year’s meeting, I talked with educators grappling with new ways to evaluate students. Sessions focused on narrative assessment, real-time clinical reasoning evaluation, and frameworks for identifying and supporting struggling learners early in clerkships.
This is what we've created at Aquifer. Every learner, regardless of ability or learning style, receives feedback on their clinical reasoning. And they receive this feedback in a virtual environment where they can engage at their own pace, repeat encounters without judgment, and arrive in live clinical settings prepared and confident. For all learners, and neurodiverse learners especially, removing the pressure of real-time clinical environments creates a safe space to build clinical reasoning and diagnostic thinking skills before those skills are ever visible to others. Our PracticeSmart and Calibrate assessments are aligned to support this growth by giving students and educators the data they need to identify strengths and weaknesses early and by providing tools to close gaps and advance each learner’s individual progress.
It's no longer aspirational to imagine broader competency-based, personalized feedback at scale. We are building it today. And COMSEP, with its history of leading on competency frameworks, is exactly the community that can help us create this new model.
I co-led a workshop with some of my more seasoned peers where we shared our career paths with younger faculty and witnessed a certain undercurrent. Many of the younger educators were quietly questioning whether the paths we described are still accessible to them. The landscape has changed. The pressures are different, and in many ways, greater. The pandemic, budget pressures, geopolitical uncertainty, the additional demands of individualized education—it can feel overwhelming even on the good days.
And yet what I saw in that room was a group of people who, despite everything, are still showing up with a genuine commitment for the role and, yes, even joy. What clearly continues to ground this work, for all of us, is the learners themselves. The energy, the optimism, even the naivety that emerging clinicians bring to their learning is its own kind of antidote to burnout. Engaging with that energy is what elevates us past the hardest days.
In many ways, early-career educators may be better positioned for what comes next. They're closer to today's learners. They are navigating similar shifts. And they may be more ready to rethink long-standing approaches in ways that this moment requires.
Stepping back, what struck me most is that the core challenges Aquifer set out to address 25 years ago are still very much present.
Educators are still working to:
Provide consistent clinical experiences across varied settings
Support increasingly diverse learners and their unique needs
Teach and assess clinical reasoning in meaningful ways
Prepare students for what comes next
Our core mission hasn't changed: help educators deliver the COMSEP curriculum through a clinical reasoning framework to all of their learners, smoothing over the inevitable gaps that arise across different clinical sites, different times of year, and different learner starting points—and do this through content and assessment continuously built and maintained by the peers they most trust.
What's new is the opportunity to address these challenges in more scalable and personalized ways, regardless of abilities or faculty availability.
At Aquifer, we see this in how educators are using our cases and assessment tools—not just to deliver content, but to create space for learners to practice, reflect, and build confidence before stepping into clinical environments. Importantly, these tools are most powerful when they are used in ways that align with how educators actually teach—not as add-ons, but as integrated parts of the learning experience.
And what makes Aquifer uniquely positioned to do it? Trust. This community built Aquifer. We've always been by COMSEP educators, for COMSEP educators, and that cannot be replicated outside of our community. We were created in rooms just like the ones at this conference, over decades of shared commitment to this work.
I watched as one of my colleagues used Aquifer's AI-supported educator tools during a break. She quickly reviewed our new virtual patient experiences and stood up the framework for a new custom course for her fourth-year students. She turned to me afterward, grateful and trusting what we'd built that advanced her own teaching vision. That was the moment that said it all. That's the relationship. That's what we're here to protect and to build on.
The future of medical education isn’t being defined by a single innovation or idea. It’s being shaped by educators working together, and with our learners, toward more thoughtful, more individualized, and more practical approaches to teaching and learning.
The formula, as I see it, is simple: collaborate to design and support the specific individual needs of every learner, do that well, and the educational outcomes will follow. That’s a stabilizing principle we can all embrace together in these changing times.
See you at COMSEP 2027.