By: Nathan Baggett, MD and Felix Ankel, MDWe are living in exponential times.
Our relationship with knowledge, professional identity, and structure is rapidly changing. In the data to information to knowledge to wisdom transition, a clinician’s value proposition was often in the information to knowledge space. Patients would come in for a visit, they would share information, something magic would happen, and the clinician would share knowledge which would provide value to the patient clinician encounter. With the increased fingerprint of artificial intelligence, more of the data to information to knowledge transition will be automated. The value proposition of the clinician of the future will be in the knowledge to wisdom space. That space is a shared space: it is shared with patients, families, members of the healthcare team, and the public. It is more human, less machine.
What will be the skills and competencies needed in the knowledge to wisdom space? Will these skills be more focused on the afternoon classes of sociology, economics, management, and communication sciences rather than the morning classes of biology, chemistry, and physics? How will we assess skills that are more human, less machine? How will we assure that these assessments are fair, valid, and reliable and free of bias? What forcing function well these assessments have for certification, licensure, and medical education curriculum delivery? If clinicians are changing their relationship with knowledge, identity, and structure, should core competencies be updated to incorporate the growing influence of artificial intelligence and the need for fusion skills?
The following is a first-person account of a journey as both a patient and a clinician, a patient and medical educator, and a patient and family member that may help frame a discussion on what clinician skills and competencies are important for the 21st century.
In a few weeks, I will be finishing my residency in emergency medicine and starting a fellowship in medical education. My path to residency and a career in medical education took a detour when I needed a liver transplant just a few months before medical school graduation. What followed was more complications and setbacks than I could imagine which required two additional liver transplants, hundreds of days in the hospital, dozens of surgeries and procedures, and an incredibly uncertain, and ever shifting, prognosis.
As I reflect on both my formal education and my experience as a patient, I am grateful to my donors, doctors, nurses, and the entire team who cared for me when I was sick. Now as I move into a career in education, I also think about the skills and qualities that my team possessed which were instrumental in helping me and my family through a long, and at many times, perilous journey as a patient.
Core competencies such as medical knowledge and patient care and procedural skills were clearly integral to the provision of my care. But as complications mounted1, what stands out now is how the complexity of modern care – with ever expanding options for intervention and treatment – the human aspect of medicine will always be imperative to patient care even as disruptive technologies promise a new era of medicine. Medical education needs to reconsider what constitutes the core competencies of a 21st century physician.
In the coming years, we will quickly become facile with AI generated prompts about our patients’ risks, unrecognized diagnoses, and other clever insights. Just as an order set for the management of diabetic ketoacidosis helps to standardize and minimize the risk of error, AI models have the potential to transform medicine and improve patient outcomes. But the application of AI in modern medicine will require a more nuanced approach to how the physician interacts with and synthesizes insight from an algorithm with their own expertise. At the core of these models will be probabilities and patterns that have meaning at scale but may be meaningless to your individual patient.
In my case, how might an algorithm suggest an individual system or health system proceed in the face of improbable outcomes? An algorithm lacks the creativity and imagination that is inherent to addressing complex patient care scenarios. At multiple points after my transplants, my chances of survival were grim, so in an era of artificial intelligence, would the machine, after crunching the numbers and analyzing existing patterns, predict a zero chance of survival? Would I be labeled a hopeless cause? The future of medicine will exist in how physicians wield these tools while cultivating the wisdom to prevent the artificial intelligence from taking away from the genuine care of their patient.
Questions to consider?
As we move towards a post-AI medical education and assessment world. How will we standardize educational outcomes and personal education. How will we standardize patient outcomes and personalize care? How will we assess competencies such as breaking bad news,
conflict management and negotiation, patient-centered communication, priority setting, procedural competencies and troubleshooting.
References:
Chan TM, Thoma B, Finnell JT, Gordon BD, Farrell S, Pusic M, Cabrera D, Gisondi MA, Caretta-Weyer HA, Stave C, Ankel F. Precision medicine within health professions education: Defining a research agenda for emergency medicine using a foresight and strategy technique (FaST) review. AEM education and training. 2024; 8(S1). S5-S16.
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