As I See It

As a medical educator, it’s been tough to avoid conversations regarding the potential impact of generative artificial intelligence (Gen-AI) and machine learning (ML) in healthcare education and delivery. A PubMed search of “generative artificial intelligence medical education” this past month revealed that annual publications on this topic jumped exponentially in the past few years, from less than 50 prior to 2018, to 416 in 2022, and 519 so far in 2023. I offer this “As I See It” perspective with the knowledge that many of you may be way ahead of the game in this area than I am. For those who are latecomers to the conversation, like me, I hope that I can convince you that the time has come to jump onto the train or be left at the station. We need knowledge-informed input, as educational leaders and as care providers, to ensure that Gen-AI and ML facilitate learning, and ethical and equitable care of patients.

Students are already ahead of us in this content area. Last spring, I was chatting with a premedical student with a background in computer science, lamenting the inefficiencies of my clinical environment. I expressed my longing for technology that will help me create treatment plans without repeating costly testing, summarize my conversations with patients, and collate in milliseconds the medical data that took me hours to collect from the EMR. The student politely let me rant, and then shared that this technology already exists. And sure enough, during an AI summit a few weeks ago, a leader from a health system outlined the technology that is currently in place and under development for their providers. This company has created a “Responsible Use of AI” program and a “Machine Learning Review Board”, to review AI tools, assess the “risk for harm” and establish “review processes for vendor-acquired AI”. The company is using AI-enhanced virtual assistants to help direct calls from patients and enhance personalized care, and utilizes data analytics, natural language processing, and ML to analyze patient outcomes. While this was the only healthcare company presenting at the summit, I suspect that healthcare companies worldwide are utilizing similar systems and approaches, to optimize and improve care. The challenge is that health professions students may not be learning about this technology (including the opportunities and limitations) during their educational programs and may not be well-prepared to contribute to initiatives and conversations ensuring ethics and avoidance of potential bias.

To be clear – I am not suggesting that we endorse computer science or technology education at the expense of learning the science, communication skills, and teamwork that are fundamental to the education of a healthcare provider. Indeed, it is possible to incorporate Gen-AI and ML in our education programs in ways that facilitate learning and prepare students for a changing healthcare environment without sacrificing the critical knowledge and skills that they must learn; these tools may actually facilitate learning for students at a time when the volume of information to be learned and the competing demands on their time contribute to stress.

A recent IAMSE (International Association of Medical Science Educators) series* brought thought leaders from around the country together in this area, highlighting the opportunities and obligations of medical educators to learn, embrace, and incorporate AI in our teaching. The IAMSE Fall 2023 Webcast Audio Seminar Series, called “Brains, Bots & Beyond: Exploring AI’s Impact on Medical Education” included five sessions addressing the opportunities and challenges that we must address as medical educators. Each of the sessions in this series was extraordinary - exciting, invigorating, expertly delivered - and just a bit overwhelming. Such sessions can serve as a guidepost for healthcare education, to help us with the innovation and reform required to prepare our students to be the “humans in the loop” to ensure equity, ethics, and holistic analyses. By incorporating these into health sciences education, we can prepare students for their roles as providers, researchers, and leaders who will ensure that patients remain at the center of these developments. We need to prepare our students not only to be aware of what is possible but to contribute as informed advocates for our patients, who are entrusting us with this responsibility. This is not going to be easy – curricula need to be adapted, and we need to support our already busy educators in doing so in an interdisciplinary and collaborative fashion. Fortunately, the IAMSE sessions provided a compelling overview to help us understand why this is important, and what we need to do.

These are exciting times, not only for healthcare education but also for clinical care. With our engagement as educators, we can properly position our future healthcare providers to help inform the implementation of AI in ways that increase health equity and ensure that the application of these technologies supports the patient-provider connection, enhances our interprofessional engagement and relationships, removes bias, and ensures that we are serving all populations of patients with ethical advocacy.

Sonia Nagy Chimienti, MD FIDSA, Senior Associate Dean for Medical Education Dartmouth’s Geisel School of Medicine

*IAMSE Fall 2023 Webcast Audio Seminar Series

1. “An Introduction to Artificial Intelligence and Machine Learning with Applications in Healthcare”, presented by H. Valafar, University of South Carolina

2. “Artificial Intelligence: Preparing for the Next Paradigm Shift in Medical Education”, presented by C. James and E. Otles, University of Michigan

3. “Transforming Healthcare Together: Empowering Health Professionals to Address Bias in the Rapidly Evolving AI-Driven Landscape”, presented by S. Bessias, Duke University School of Medicine, and M.P. Cary Jr, Duke School of Nursing

4. “AI Tools for Medical Educators”, V. Capaldi, D. Kurzweil, and E. Steinbach, Uniformed Services University of the Health Sciences

5. “ChatGPT and Other AI Tools for Medicine and Medical Education”, presented by B. Hersh, Oregon Health & Science University.