Medical education

Beyond Memorization: AI Can Revolutionize Medical Education

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Tools like ChatGPT could catalyze the trend toward a “flipped classroom”

A photo of the ChatGPT application running on a smartphone over the OpenAI logo.

Since the release of ChatGPTopens in a new tab or window — an artificial intelligence (AI)-driven text generator developed by OpenAI — in November 2022, it has garnered status as the fastest-growingopens in a new tab or window web application in history. On a daily basis, users eagerly share newfound applications of the tool, from creating video gamesopens in a new tab or window to brainstorming holiday gift ideasopens in a new tab or window to writing musicopens in a new tab or window. Healthcare is no exception: physicians have experimented with tasking ChatGPT to summarize medical records, generate treatment plans, and even write letters seeking prior authorizations. On top of that, a studyopens in a new tab or window has reported the ability of ChatGPT to complete the U.S. Medical Licensing Examination (USMLE) with an accuracy near or at the passing threshold.

While ChatGPT and similar tools will not be replacing clinicians anytime soon, the technology does highlight the triviality of the memorization of medical facts. What does it mean for medical education if such an AI tool can, without any special training and in an infinitesimal fraction of the time, perform at a level that takes medical students 4 years and thousands of hours of dedicated study to attain?

The performance of ChatGPT on the USMLEopens in a new tab or window is a wake up call that the medical school curriculum and evaluations systems must change.

For years, leading medical educators like Charles Prober, MD, founding director of the Stanford Center for Health Education, have been advocating for a move away from traditional lectures and a memorization of facts. He advocatedopens in a new tab or window for a “flipped classroom” approach to medical education, where students can gather facts and lectures on their own time, and then come to the classroom to interact with professors and peers to practice problem-solving and data analysis. In this model, medical students learn to solve complex patient cases with their computers and every resource available to them — just like they will in the real world. This approach aims to de-emphasize the memorization of medical facts and focus on interacting with data and resources to develop critical thinking skills.

While this method of teaching is gaining tractionopens in a new tab or window in medical schools across the U.S., ChatGPT can further facilitate this approach. Without AI tools, finding relevant pieces of information can be time-consuming and frustrating, often requiring a search through multiple sources. ChatGPT and similar models provide an order of magnitude reduction in the time it takes to find, synthesize, and present relevant facts.

More than anything, ChatGPT epitomizes the effortlessness of information retrieval in the age of AI and machine learning. The medical education community must take proactive steps to take advantage of these technological advancements. While medical education has traditionally moved at a slow and measured pace — sticking to core concepts and deliberately incorporating new tools and information over time — ChatGPT is not simply another new tool but rather represents a paradigm shift in what it means to learn medicine.

How can AI and machine learning tools like ChatGPT be incorporated into medical training? Just as database searches are a part of medical education today, AI tools can also be introduced to medical trainees. While some may consider using these tools as “cheating,” it’s important for students to engage with and understand the strengths and limitations of this technology. What kinds of medical conditions can we trust ChatGPT to diagnose? What nuances to treatment plans is ChatGPT unable to appreciate? Finally, regardless of how physicians feel about it, patients now have access to ChatGPT; it is therefore the responsibility of clinicians to understand the capabilities of these AI tools so they may play an active role in interpreting and managing the consequences of easily accessible medical — and pseudomedical — information.

The growing adoption of AI tools further underscores the vital role of future physicians as leaders. Given that AI has demonstrated an incredible ability to follow protocols and find correct answers for straightforward medical conditions, we need to spend more effort training physicians to be team leaders. Physicians will likely be responsible for larger patient panels, assisted by interdisciplinary teams of technicians and other clinicians. In this context, physicians must learn better skills around management and communication.

Similarly, AI tools will, in conjunction with telemedicine, triage patients with simpler medical conditions into urgent care clinics or home-based solutions. In-person primary care visits will involve increasingly complex patients approaching inpatient severity, and physicians will need to become comfortable in applying fundamental knowledge in physiology to solve edge cases in medicine. In a similar vein, medical schools ought to acquaint students with exploring the full range of uncertainties and nuances of real-world medical scenarios.

Crucially, students should also focus on learning how to navigate complex social issues that go far beyond the diagnosis and basic treatment guidelines. Medical training should prepare students to tease out the preferences and values of a patient to better inform patient-centered care plans that integrate the medically “right” answer with the patient’s economic and psychosocial environment. This is where doctors of the future will show their worth and skill.

The performance of ChatGPT on the USMLE at the level of a graduating medical student demonstrates the significant potential of AI and machine learning to revolutionize medical education and practice. This revolution will be expedited through several means: competition from other technology such as Google’s Bardopens in a new tab or window and Baidu’s Ernieopens in a new tab or window; OpenAI’s ongoing efforts to improve its language models through GPT-4; and potential future neural networks specialized in medical topics. Although some may bristle at the prospect that these tools undermine the work of physicians, we believe they instead offer an unprecedented opportunity to augment what physicians can do — diagnose diseases with ever greater accuracy and efficiency — and enable what they do best — connect with patients at a human level and ultimately provide the best care possible.

Evolving Medical Education for a Digital Future

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Three major technology trends—mobile phone–enabled platforms, big data, and artificial intelligence (AI)—exemplify how new technologies are transforming conventional modes of healthcare delivery. Mobile applications are replacing activities previously requiring in-person visits, computers are using vast new data streams to personalize treatment approaches, and AI is augmenting disease diagnosis.

Physicians have an important role in deciding where and how these new tools might be best utilized in diagnosing, treating, and managing health conditions. As medicine undergoes a “digital transformation,” a foundational review of medical education spanning medical school, residency, and continuing medical education (CME) is needed to ensure that physicians at all stages of practice are equipped to integrate emerging technologies into their daily practice. By evolving medical education today, we can prepare physicians for medicine’s digital future.

Computers algorithmically diagnosing diabetes from retinal scans[1]; chatbots providing automated mental health counseling[2]; smartphone applications using activity, location, and social data to help patients achieve lifestyle changes[3]; mobile applications delivering surgical follow-up care[4]; and smartwatches passively detecting atrial fibrillation[5] are just a few examples in which technology is being used to augment conventional modes of healthcare delivery.

Many proposals to evolve medical training in a world of continuous technology transformation have focused on specific technologies, such as incorporating telemedicine into existing Accreditation Council for Graduate Medical Education (ACGME) competencies,[6] creating a new specialty of “medical virtualists,”[7] or better integrating data science into healthcare.[8]

Emerging Technologies Transforming Medicine

Looking beyond legacy health information technology platforms like electronic health records (EHRs), active venture capital funding provides a vision for where the community is placing its bets for emerging technologies. We highlight three areas drawing significant investor interest: mobile health ($1.3 billion raised in 2016),[9] big data enabling precision medicine ($679 million),[10] and AI ($794 million).[11]

Mobile health. In a 2015 national survey, 58.2% of smartphone owners reported having downloaded a health-related mobile application[12] from an estimated 259,000 available health-related applications.[13] These applications frequently help patients self-manage their health conditions by providing education, tracking tools, and community support between clinic visits.

Big data enabling precision medicine. Phone-based sensors, wearable devices, social media, EHRs, and genomics are just a few of the many new technologies collecting and transmitting clinical, environmental, and behavioral information. These new contextual data streams are facilitating personalized medical decision-making with treatments tailored to each individual patient.

AI. New computational methods such as AI, machine learning, and neural networks are augmenting clinical decisions via algorithmic interpretation of huge data sets that exceed human cognitive capacities. These new computational technologies hold great potential to assist with diagnosis (interpretation of ECGs, radiology, pathology), personalized treatment (tailoring treatment regimens for individual tumor genotypes), and population health (risk prediction and stratification), though for now they remain software innovations reliant on human clinician hardware to guide appropriate use.[14]

Knowledge Domains

Physicians have an important role in deciding where and how new tools might be best utilized in diagnosing, treating, and managing health conditions. A recent study by the American Medical Association (AMA) found significant physician interest in digital health tools, with 85% of physicians reporting that they perceived at least some benefit from new digital tools in improving their ability to care for patients.[15]

Integrating emerging technologies such as mobile applications, big data, and AI into regular practice will require providers to acquire new knowledge across ACGME educational domains such as Professionalism, Interpersonal & Communication Skills, and Systems-Based Practice.

From a foundational perspective, it is important that physicians understand their role and potential liability as related to these new technologies. This includes but is not limited to:

  • Understanding relevant laws, particularly state-based regulations concerning remote practice of medicine (ie, telemedicine). (Systems-Based Practice)
  • Compliance with HIPAA and other key privacy regulations when interacting with patient-generated data outside the bounds of the EHR. (Systems-Based Practice)
  • Evaluating potential malpractice implications, including assessing coverage scope. (Systems-Based Practice)
  • Awareness of emerging reimbursement codes for time allocated to new technology–enabled practice models. (Systems-Based Practice)

Outstanding questions remain regarding the clinical efficacy of many new technologies. With formal clinical trials still underway, physicians may feel unable to speak definitively regarding a specific technology’s potential risks and benefits. Yet, the increasingly broad use of these tools requires that physicians use their clinical expertise to help their patients understand the limitations of such technologies and steer them toward appropriate tools. Essential skills and roles that modern physicians must now adopt include:

  • Teaching patients how to identify trusted tools—those using evidence-based guidelines or created in conjunction with credible physicians, scientists, and hospitals (Medical Knowledge)
  • Setting clear expectations upfront about the extent of physician involvement in reviewing patient-generated data (particularly if there is no anticipated involvement) (Patient Care)
  • Assessing technology literacy in the social history and adapting patient education on the basis of digital attainment, including recommending websites, online video, and mobile apps when appropriate (Patient Care)
  • Advancing clinical knowledge by referring select patients to enroll in digital remote clinical trials (Systems-Based Practice)

Taking into account the rapidly increasing amounts of data inputs in clinical decisions, physicians must augment their statistical knowledge to become generally familiar with new data science methods:

  • Leverage data science tools such as visualization to more efficiently review large amounts of patient data, including identification of outliers and trends (Medical Knowledge)
  • Seek to understand the inputs and assumptions of advanced computational algorithms and not allow them to become a black box. Recognize that although deep-learning algorithms can deduce important patterns and relationships, physicians remain necessary as a critical lens in deciding how to apply findings to each individual patient. (Patient Care)

Implications for Physicians

For current medical students and trainees, many of whom are digital natives themselves, the educational domains outlined above may seem intuitive or obvious. In contrast, physicians currently practicing today are already burdened with countless administrative tasks that may make these future technologies feel overwhelming or irrelevant. Yet, the frustration and feelings of burnout that many physicians have as related to the use of EHRs exactly illustrates why it is critically important that physicians engage early in the dissemination of new technologies.

The first step for providers in the digital transformation of medicine is awareness. While providers may not be aware of, or are dismissive of, new technologies, these tools are already being used avidly by millions of patients around the world.[11] Mobile health, big data, and AI soon will become an integral part of medicine, much like EHRs (and stethoscopes).

The second step is for physicians to familiarize themselves with general categories of new digital tools. New journals such as the Journal of Medical Internet Research offer peer-reviewed manuscripts focused on “eHealth and healthcare in the Internet age.” Physicians may benefit from downloading and signing up for test accounts of new applications or connected health devices. Organizations should consider allowing physicians to spend a portion of their CME budgets on such “digital transformation” learning activities.

The third step is for physician leadership organizations to work with regulatory agencies like the FDA to help identify the most robust tools for physicians to adopt and recommend. A positive example of this is the AMA’s recently issued guidelines on the appropriate use of digital medical devices.[16]

By evolving medical education today, we can prepare physicians for medicine’s digital future. In the face of complex and rapid change, we may all be trainees in a world of ever-accelerating technological evolution.

Generational changes and their impact in the classroom: teaching Generation Me.

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Many faculty members believe that students today differ from those in the past. This paper reviews the empirical evidence for generational changes among students and makes recommendations for classroom teaching based on these changes. Generational changes are rooted in shifts in culture and should be viewed as reflections of changes in society.

 Methods This paper reviews findings from a number of studies, most of which rely on over-time meta-analyses of students’ (primarily undergraduates’) responses to psychological questionnaires measuring IQ, personality traits, attitudes, reading preferences and expectations. Others are time-lag studies of nationally representative samples of high school students.

 Results Today’s students (Generation Me) score higher on assertiveness, self-liking, narcissistic traits, high expectations, and some measures of stress, anxiety and poor mental health, and lower on self-reliance. Most of these changes are linear; thus the year in which someone was born is more relevant than a broad generational label. Moreover, these findings represent average changes and exceptions certainly occur.

 Discussion These characteristics suggest that Generation Me would benefit from a more structured but also more interactive learning experience, and that the overconfidence of this group may need to be tempered. Faculty and staff should give very specific instructions and frequent feedback, and should explain the relevance of the material. Rules should be strictly followed to prevent entitled students from unfairly working the system. Generation Me students have high IQs, but little desire to read long texts. Instruction may need to be delivered in shorter segments and perhaps incorporate more material delivered in media such as videos and an interactive format. Given their heightened desire for leisure, today’s students may grow into professionals who demand lighter work schedules, thereby creating conflict within the profession.

Medical educators face many of the same challenges as other faculty in trying to communicate with a generation they may not fully understand. Although Generation Me has many strengths, such as tolerance and a drive to succeed, its members may sometimes be tooconfident. Others crack under the pressure of sustaining high achievement and develop mental health problems. Their previous educational experiences have often not prepared them for the hard work and challenges required to succeed.

Educators can take several steps to better teach this generation. The first step is to understand its perspectives and realise that they are reflections of contemporary culture. Generation Me is doing exactly what it has been taught to by parents, teachers and media. The second step is to meet its members on their own ground by breaking lectures into short chunks, using video and promoting hands-on learning. However, standards for content and learning should remain the same, and should be fair to everyone. If one student asks for and receives special treatment, the rest of the class is short-changed, as is the ‘special’ student in the long run (the longer he receives special treatment, the more difficult he will find it to succeed in a world that does not confer special treatment just for asking). Educators cannot compromise on the material that must be learned. As students feel more entitled, more will demand better grades for less work, just as they received in high school. In medical education, however, allowing students to earn good grades when they do not learn the material is not only unfair but dangerous.

Today’s students frequently need the purpose and meaning of activities spelled out for them. Previous generations had a sense of duty and would often do what they were told without asking why. Most young people no longer respond to appeals to duty; instead, they want to know exactly why they are doing something and want to feel they are having a personal impact. This is an opportunity: if young people understand the deeper meaning behind a task, they can bring their energy and passion to bear on it. Medicine is a natural field for people who seek to have an impact, and this desire can be harnessed to improve medical education. Although self-esteem and narcissism do not necessarily help people succeed, narcissistic people’s desire for attention can potentially be harnessed to good ends, such as that of helping others through medicine. However, medical educators must make sure that students’ overconfidence does not lead to failure, and that the importance of less visible tasks is emphasised. Medical education resembles evolution in that it rewards by ensuring the survival of the fittest. When taught properly, the fittest of Generation Me will succeed, just as the fittest members of previous generations have done in the past.

 

Source: http://onlinelibrary.wiley.com