In the first editorial in this series on the impact of the COVID-19 pandemic on medical education [¹] it was stated that ‘not so long ago […] during the creation of the continuous medical education National Accreditation System in 1999, the accreditation of distance learning was left for study at a later date, since reputable and well-known colleagues argued vehemently that distance training activities could not be accredited'. Later in the same editorial, it was noted that the colleagues who did not accept the accreditation of continuing medical education at a distance were not mistakenly defending what they believed and argued; indeed, if they were ‘guilty' of anything at all, it was their failure to foresee the future of information and communication technologies.

Already at the beginning of the COVID-19 pandemic face-to-face continuing medical education was brought to a halt for obvious reasons, but at the same time and just a few weeks later, events were starting to be held at a distance to replace those cancelled face-to-face activities. They were not new activities, they had already been scheduled. No new information and communication technologies were invented, those available were used. The conclusion is quite simple: we have been doing things simply because that's how we have always done them, without reflecting on whether they could and should be done in a different way. It is a fact that the pandemic has made us think, reflect and act. Couldn't we have thought about this and reflected on it earlier?

We should just make it clear at this point that face-to-face training will continue for many years to come and in some areas it will be irreplaceable. But let's not fool ourselves and let's give some thought to the important role that distance learning will play due to the sum of such diverse factors as the information and communication technologies that enable it, the optimisation of resources that lowers the costs, and improvements in the work-life balance, among surely many other factors.

The dilemma that we as medical educators want to pose is not whether or not to shift from face-to-face training to distance learning. The dilemma is not about using information and communication technologies because we did not have them before and now we do have them. The dilemma is not about optimising resources by live streaming a class and then making the recording of it accessible to students, arguing that this is for the students' convenience and perhaps also for that of the teacher.

The pandemic has brought a number of facts home to us. We have experienced how distance learning can be used to extents that we were completely unaware of. In general, we now have resources for distance learning. Now we know the what and the how. But the pandemic also places us before a dilemma to which we must respond by thinking and reflecting: what should we use distance learning for? And, in particular, is distance learning useful for continuing medical education?

It's not a matter of a shift in methodology or technique. It's not a matter of replacing our old incandescent light bulbs with leds just because they consume less electricity. The answer to the question as to ‘why' we should go deeper into distance learning is simple: we should use it, increase it, perfect it and optimise it, provided that by doing so it facilitates and improves the student's learning. The paradigm shift that should guide us – and to which we have already referred on several occasions – is that of switching from teacher-centred teaching to learner-centred teaching. The goal is to learn and therefore the methodology will be subsidiary to this. When an activity is submitted for accreditation, it should be accompanied by all the information that shows how the educational goals can be achieved with the new methodologies (objectives, skills to be acquired, evaluation systems, information and communication technologies to be used, etc.).

And what has happened up until now? Some figures can give us an idea. Between February and November 2020, the number of face-to-face continuing education activities in Spain fell by 78% and in the European Union the decline has been even greater, around 90%. These decreases was offset by the increase in distance continuing education activities. In Spain, they rose by 55% and in the European Union area the figure reached 85% (we are referring to international continuing education activities accredited by the UEMS-EACCME; we do not have separate data on continuing education activities for individual European Union countries). These data show that, in relation to the European average, we are slow to react.

In view of this drop in face-to-face continuing education activities, forced by the pandemic, we must urge all providers of continuing education to give some thought to the matter. It is necessary to rethink what changes should be introduced and what priorities should be set, what changes will be temporary and what changes are destined to remain. Conceptually, the decisions to be made are easy. The goal can be none other than to renew everything that can improve the learning process. The new methodologies are an incredibly effective tool, without losing sight of the fact that the focus is not on the methodology or the instrument, but on the learner. Programming a continuing education activity requires thinking about the programme, looking for the best teachers and, of course, determining the most effective methodology to ensure that those who have to learn do so.