Medium access in 5G systems was tailored to accommodate diverse traffic classes through network resource slicing. 6G wireless systems are expected to be significantly reliant on Artificial Intelligence (AI), leading to data-driven and goal-oriented communication. This leads to augmentation of the design space for Medium Access Control (MAC) protocols, which is the focus of this article. We introduce a taxonomy based on push-based and pull-based communication, which is useful to categorize both the legacy and the AI-driven access schemes. We provide MAC protocol design guidelines for pull- and push-based communication in terms of goal-oriented criteria, such as timing and data relevance. We articulate a framework for co-existence between pull and push-based communications in 6G systems, combining their advantages. We highlight the design principles and main tradeoffs, as well as the architectural considerations for integrating these designs in Open-Radio Access Network (O-RAN) and 6G systems.

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