A participatory design approach was utilized to conduct a scenario analysis workshop in October 2024 to address Trinity College Dublin’s School of Medicine’s (TCD) strategic concerns. The qualitative approach was selected because of its effectiveness in offering insights into complex and multifaceted experiences, particularly when the primary aim of the study was to achieve a detailed and nuanced description [19,20].

Participatory design is an approach that actively raises the voices of all stakeholders and brings everyone to an equal level [21]. Scenario analysis is a process of evaluating and understanding possible future events by considering how key factors can lead to various feasible scenarios [16]. It is a method used in strategic planning to help anticipate uncertainties and develop strategies to address them.

Scenario analysis was used to generate visions of the future wherein medical education would need to take place, while participatory design was used as a means to engage participants in in-depth exploration of each future narrative and approach to co-creation of the required competencies and mindsets that might be needed in the future. TCD was used as an instrumental case; the focus of instrumental case studies is on gaining understanding of the phenomenon rather than on the case itself [22].

TCD is one of the oldest medical schools in Europe and is in the process of upgrading its Medicine degree. TCD’s reform is facing the challenge of creating a program that would prepare HCPs for the world of tomorrow. TCD’s current strategic concerns are (1) ensuring curricula remain cutting-edge and globally relevant, (2) balancing the push toward digitization with hands-on clinical training, and (3) addressing the increasing importance of environmental and social responsibility in medical practice.

The objective was to develop an understanding of potential future scenarios for TCD and formulate strategies to address challenges and capitalize on opportunities for the Medicine degree program.

An email invitation was sent to senior staff members at TCD, policy makers at the Health Service Executive, and selected medical students. Purposive sampling was used to ensure that the sample was rich for analysis. The sampling was based on several factors such as background, age, and years of experience, among other factors.

The ESPAS “Global Trends to 2030” report [13] identifies the following megatrends:

Deliberations took place in the form of structured group discussions with TCD’s executive leadership team in order to determine the most relevant drivers for TCD, reflecting the most pressing concerns and anticipated external pressures relevant to future curriculum design. The aim was to align scenario construction with institutional foresight rather than explore low-probability, high-uncertainty events. After deliberation, Digital Connectivity and Climate Change were identified as the two key drivers for this session as these factors fundamentally influence technological adoption, health care delivery models, and sustainability challenges. Once these drivers were selected, the team developed a scenario matrix, mapping out four distinct future scenarios based on high and low variations of each driver.

To bring these scenarios to life, the team employed ChatGPT for narrative generation, using detailed prompts to craft scenario descriptions that were specific to the strategic needs of the study. The narratives were designed to immerse participants in each possible future, emphasizing the elements and contexts relevant to the discussion. To create further engagement with the scenarios, MidJourney was used to create compelling visual representations, ensuring that the abstract concepts were visually evocative and memorable. Finally, the narratives were transcribed using Murf.AI, an AI voice generator, and played during the workshop sessions to create an immersive experience that helped participants conceptualize the future as a lived reality.

The use of AI was deliberate to explore how these tools might support scenario planning. All outputs were reviewed and refined by human facilitators. While each scenario presents distinct challenges and opportunities, overly dystopian or utopian framings were avoided to ensure balance.

The event was held in a dedicated off-site innovation space, such that participants could have the opportunity to break free from the everyday, to gain a fresh mindset and to use collaborative tools to reframe their thinking.

The session employed various interactive methods, including presentations, group discussions, and hands-on activities, to foster an environment of collaboration and shared learning. Participants were presented with information from the ESPAS report, were introduced to the scenario analysis methodology, and were then presented with four plausible future scenarios of what the world and Ireland would look like in the year 2035.

An ad hoc set of materials was designed to facilitate data collection and effectively guide participants through the participatory design workshop. Recognizing that scenario analysis can be complex and unfamiliar to many, we developed a structured board that visually organized the process, breaking it down into clear, digestible steps. This served as a focal point for participants, ensuring they could navigate the method intuitively. In alignment with embodied cognition theory [23,24], physical cards were created to make abstract concepts more tangible. These cards represented essential future mindsets and skills for HCPs, derived from relevant literature [25-29]. Blank cards or wildcards were also included to allow participants to introduce new mindsets and skills that were not represented in the provided cards.

Additionally, we prepared printout slides containing the different scenario descriptions, providing key details such as the overarching narrative, global context, and defining features of each scenario.

Participants were divided into 4 groups of up to 7 people, each focusing on a separate scenario. Each group participated in timed sessions that transitioned from passive immersion to active engagement with the scenarios.

Throughout the session, data was systematically captured through notes, photographs, and sticky notes, ensuring that discussions, insights, and decision-making processes were well-documented for later analysis.

A group sorting approach combined with thematic analysis was utilized to systematically examine the insights generated during the workshop. The analysis incorporated multiple data sources (sticky notes, facilitator notes, photographs, notes from participants’ presentations). Thematic analysis was conducted in an iterative and inductive manner [30], allowing key concepts and patterns to emerge organically from participant contributions rather than being imposed by predefined frameworks.

The collected materials were categorized and sorted into broad thematic clusters, focusing on competencies, mindsets, and structural needs for future health care education. The discussions and presentation notes were transcribed and analyzed for recurring themes, divergences, and underlying assumptions. In order to help triangulate findings across different data points, structured outputs from scenario discussions and the more fluid, reflective insights from open conversations were integrated. The approach allowed for the capture of consensus areas and areas of debate and uncertainty. Triangulation was achieved by cross-referencing themes that emerged across the multiple formats (eg, sticky notes, verbal group summaries, facilitator observations), allowing validation of recurring patterns and identification of unique contributions across the different data types. Shenton’s guidelines were followed [31] to help ensure the integrity of the content analyses and generate an audit trail.

Researcher reflexivity was critical throughout the case: the lead author is a digital health expert with training in applied strategic foresight and ample experience in participatory design, and the facilitators brought expertise as HCPs and experienced strategy consultants. This positionality shaped both the design and execution of the workshop, influencing how scenarios were framed, how discussions were guided, and how emerging insights were interpreted. Our backgrounds allowed us to provide depth in discussions on digital transformation, health care systems, and future competencies but also required constant self-awareness to mitigate bias, ensuring that we did not unintentionally steer conversations toward predefined narratives or overlook alternative perspectives. To foster participant-driven insights, we emphasized an open-ended, exploratory approach, where diverse voices were prioritized and deliberation was structured around materials that encouraged co-creation rather than facilitator-led direction. The facilitators adopted an observational stance during the workshop sessions to minimize bias in participant interaction. By reflecting on our roles throughout the process, we remained mindful of how our expertise might shape participant interactions and interpretations, striving to balance guidance with openness, allowing emergent themes to be driven by the collective experience of the group rather than our own professional frameworks.

The work was carried out in accordance with the ethical principles of research with human participants and ethical review in the human sciences in Finland [32]. The ethical review process was not required for the present study as it involved participants in their capacity as experts. The activities conducted were designed for knowledge sharing within a professional setting, participants were informed about the purpose and objectives of the session and consented to participate.

The event gathered 28 participants ranging from medical students, HCPs, academicians, and policy makers. Table 2 presents some descriptive characteristics of the participants.

Participants were divided into groups of 7 individuals, ensuring that there would be a mixed variety of backgrounds in each group. Each group received a printout of the scenario (Figure 2) and was assigned a structured board (Figure 3). The groups moved through timed segments from discussing the scenario and its implications for common people to more specific health care issues and needs for medical education. Sets of physical cards containing competencies and mindsets were provided to trigger conversation (Figure 4), as well as wildcard cards that could be used to represent unknown or unaccounted elements.

The activity concluded by outlining strategic training actions that medical schools would need to take now to be ready for that future. At the end of the session, all groups presented their work, and the floor was opened for free exchange.

Across all four scenarios, the competencies and mindsets were selected as essential for HCPs of the future (Textbox 1).

There was a clear interest and motivation in improving medical education with a strong desire to be involved in the process. The session highlighted the need for a long-term vision and strategic planning; however, there were actionable steps that could be further defined to create short-term to medium-term actions. These are presented in Textbox 2.

This study makes contributions to the field of medical education and strategic foresight by employing a participatory design approach to explore the implications of global megatrends on the future of medical training. Through scenario analysis, it provides a structured framework for envisioning potential futures and identifying the key competencies and mindsets essential for future HCPs. By integrating stakeholder engagement, including policymakers, educators, clinicians, and students, the study ensures that its findings are grounded in diverse perspectives. Moreover, it offers actionable strategies for medical education reform, emphasizing adaptive learning models, sustainability integration, digital health training, and patient-centered approaches. By advancing a future-oriented, systems-thinking approach, this work equips medical schools with the tools to proactively navigate uncertainty and drive curriculum innovation in response to an evolving health care landscape. This study also offers a novel application of AI tools (eg, ChatGPT, MidJourney, Murf.AI) in foresight-driven educational planning.

The use of future studies to understand the implications for health care has been adopted by institutions such as the World Health Organization [33], the European Commission [13], and the United Kingdom’s National Health Service [16]. Scenarios, as part of strategic analysis, allow organizations to envision multiple futures, preparing them for a range of possibilities rather than a fixed trajectory [34]. They are useful in a rapidly changing world, enabling proactive rather than reactive strategies. Scenarios are widely acknowledged as an effective tool for enabling communities of practice to generate critical insights into the future and have been used in the past to prepare health care systems like National Health Service in the United Kingdom [16].

While the scenarios explored qualitatively different futures, many of the competencies and mindsets selected by the participant groups converged, suggesting that certain capabilities are seen as universally necessary. However, nuances in action prioritization did emerge across scenarios (eg, scenarios with low connectivity emphasized community-based solutions, while high-tech scenarios emphasized digital adaptability).

Participatory design has been used in health care in many instances for creating digital health solutions and educational content and experiences [17,18,21,35-37] and is generally aligned with the vision for public and patient involvement [38-40]. The approach allows stakeholders to have a voice in the systems, services, or processes that are relevant to them, advocating for a combination of backgrounds and experiences. Bringing in HCPs, policy makers, academicians, and medical students provided an opportunity for them to express their views. However, studies bring to light how power dynamics in participatory sessions may influence mixed group interactions [41-43]. Utilizing physical elements like cards to represent abstract concepts is an established practice in education in alignment with embodied cognition theory [23,24].

The findings from this study are aligned with overall concerns regarding medical education as the health care sector navigates through the complexities of the 21st century [44]: the need for enabling cooperation between HCPs and AI-enabled tools [29,45], promotion of empathy and personal resilience [46], and understanding of the impact of climate change and its implications on health care [47].

The application of AI tools to facilitate rapid development and visualization has been gaining traction in recent years [48,49]; however, this approach has raised concerns and questions around transparency, authorship, and potential bias issues [49-51].

The findings from this scenario-based participatory process inform the ongoing curriculum redesign discussions at TCD. These findings can help contribute to theoretical models of competency-based medical education by providing examples of how foresight methodologies can uncover both core and context-contingent educational needs. Furthermore, the study supports the emerging field of educational future literacy, which advocates for anticipatory capacity building in higher education institutions.

There is also interest in replicating this methodology at other institutions within and beyond Ireland to further validate its utility and adaptability. Finally, the study raises an important scientific and pedagogical question: How can medical education systems build internal foresight capacity, not just to anticipate future needs but to adapt in real time? This shifts the conversation from “what future to prepare for” to “how to maintain curriculum resilience in the face of uncertainty,” a shift that aligns with complexity theory and systems-based approaches to organizational learning.

This study employed qualitative research methods to explore future competencies and mindsets for medical education. While this approach provides rich, contextual insights, several limitations must be acknowledged.

The driver selection process, while institutionally relevant, did not follow a formalized Social, Technological, Economic, Environmental, and Political (STEEP) process, which may have introduced framing effects or excluded other impactful variables (eg, political instability). The findings emerged from a single workshop with 28 participants, representing a specific institutional and geographic context (TCD in Dublin). While key themes align with broader global trends in medical education, findings are not universally generalizable. A larger and more diverse participant pool, cross-institutional studies, and longitudinal follow-up research would help validate and refine these insights.

The background of the research team may carry implicit biases in scenario selection, discussion facilitation, and data interpretation. While open-ended prompts and participant-led discussions were designed to mitigate undue influence, facilitator expertise may have subtly shaped the direction of the conversations.

As the groups were mixed, the workshop environment inherently carries risks of groupthink and social desirability bias, where participants may align their views with dominant perspectives or the opinions of more vocal group members. No patient representatives were present in the session, and medical students’ voices could have been influenced by unexplored power dynamics. Efforts to counteract this included structured activities and diversified discussion formats, but the possibility of power imbalances or self-censorship remains.

The analysis relied on thematic coding of qualitative data from sticky notes, discussions, and participant presentations. Qualitative data is subject to researcher interpretation, making findings inherently subjective. The selection of key scenario drivers was expert-driven, based on foresight methodologies. While these drivers are highly relevant to the future of health care, alternative drivers could have led to different scenario framings and insights. Despite these limitations, this study provides valuable foresight into the future of medical education and demonstrates the utility of participatory methods in shaping strategic curriculum design.

Due to the nature of the workshop design, participant contributions were captured primarily via sticky notes, presentation summaries, and facilitator notes. While this allowed for triangulation of themes, the absence of direct transcriptions limits the depth of participant voice that can be directly quoted.