The rise of artificial intelligence will bring changes...

Gustavo Tolchinsky

During 2017, the exhibition "David Bowie is" passed through Barcelona, which reviewed the life and all the creative facets of one of the musical geniuses of the 20th century and personally, author of some of my most beloved songs, such as Changes. One of the curiosities that visitors could discover in it was the Verbasizer, a computer program that offered random combinations of words to generate new opportunities to create phrases, as a creativity assistant. Bowie was avant-garde in many ways and he demonstrated this by risking not only with groundbreaking designs but with the incorporation of technological tools. 

Eric Topol is also at the avant-garde of medicine and the engine of precision medicine. He has just published Deep Medicine: How Artificial Intelligence can make medicine human again, a book with a appealing title and that we will surely have to read carefully. I introduce this, because the AMA Journal of Ethics of February 2019 precisely dedicates a whole monograph to artificial intelligence. I recommend you to spend some time reviewing the articles in this issue, such as the role of virtual patients, ethical aspects of facial recognition or the possible reduction of disparity in access to general medicine and mental health with artificial intelligence.

However, particularly one has caught my attention; I must confess that probably because of the classic confirmation bias: Reimagining Medical Education in the Age of AI, written by Steven A. Wartman and Donald Combs. This article addresses the emergence of artificial intelligence from the competence and training perspective of the medical profession. It highlights obvious aspects of the paradigm shift, going from the acquisition of information to the ability to use rationally in a context of information overload. And it does so in contrast to crucial aspects such as decision making, highlighting the support that artificial intelligence can suppose to the understanding, interpretation and communication of risk. The article also adds that the psychology of decision making is vital in our role in the practice of medicine, along with empathy and communication skills. Therefore, the doctor of the future will have to know how to deal with the tools that put the information at his disposal, but the most important task will be the ability to properly manage that information to convert it into useful information that fits the preferences and needs of our patients Finally, it emphasizes that these competencies will be even more necessary for the greater the role of personalized medicine in the future. 

Another aspect, being far from banal, related to artificial intelligence is, who governs decision-making and its ethical consequences. Who makes the decisions? Who is made responsible? Even applying the appropriate means, the response to treatments is very variable, so we are reminded that as doctors we’ve got to be able to make decisions, but also know how to deal with suffering and be compassionate. We must remember that “medicine is in the means, not in the outcomes", that is, that our responsibility is to apply the indicated means, not to guarantee the results. But it must be added that, in doing so, we must respect the patient's values.

Therefore, facing the challenge of curricula redesign is essential, and not in an "incremental" way. The authors criticize that no curricular modification has changed the contents, only added more and that in the end the retention capacity is evaluated. Therefore, they propose a radical change in the curricula. The proposal is: to change the retention of information by the ability to capture it at the right time, learn to collaborate and use artificial intelligence tools, a better understanding of the probability and know how to apply it sensibly to decision-making and, finally, cultivate compassion and empathy. Criticism reaches its climax by naming all organizational structures that stand in the way of these changes.

In the meantime, we continue to train professionals of the future without addressing changes in the curricula. Our administration and our medical schools also have fixed structures, also the chairs' weight, position's demands and agenda’s challenges continue to resist to change, less based on the amount of information stored and more based on how to manage it and, above all, on how we can share it with our patient. I’m not saying that these contents are taught poorly (though sometimes they are), it’s only that their extension, as the authors say, should not be what long. In the meantime, lessons dedicated to ethics and communication are seen as a side dish and not as a main course. Nevertheless, they are requisite for the practice of medicine, but they are not reflected in many medical school curricula, while we repeat class hours on concepts that will expire several times during our professional practice.

I take the opportunity to post the Changes video live 1973 in honour of the changes that, I hope, will also occur in our healthcare system and medical schools.