S.A. Wartman is president and CEO, Association of Academic Health Centers, Washington, DC. C.D. Combs is vice president and dean, School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia.
Acad Med. 2018 Aug;93(8):1107-1109. doi: 10.1097/ACM.0000000000002044.
Noteworthy changes coming to the practice of medicine require significant medical education reforms. While proposals for such reforms abound, they are insufficient because they do not adequately address the most fundamental change-the practice of medicine is rapidly transitioning from the information age to the age of artificial intelligence. Increasingly, future medical practice will be characterized by: the delivery of care wherever the patient happens to be; the provision of care by newly constituted health care teams; the use of a growing array of data from multiple sources and artificial intelligence applications; and the skillful management of the interface between medicine and machines. To be effective in this environment, physicians must work at the top of their license, have knowledge spanning the health professions and care continuum, effectively leverage data platforms, focus on analyzing outcomes and improving performance, and communicate the meaning of the probabilities generated by massive amounts of data to patients, given their unique human complexities. The authors believe that a "reboot" of medical education is required that makes better use of the findings of cognitive psychology and pays more attention to the alignment of humans and machines in education and practice. Medical education needs to move beyond the foundational biomedical and clinical sciences. Systematic curricular attention must focus on the organization of professional effort among health professionals, the use of intelligence tools involving large data sets, and machine learning and robots, all the while assuring the mastery of compassionate care.
值得注意的是,医学实践的变化要求进行重大的医学教育改革。虽然有很多这样的改革建议,但它们还不够充分,因为它们没有充分解决最根本的变化——医学实践正迅速从信息时代过渡到人工智能时代。未来的医学实践将越来越具有以下特点:无论患者身在何处,都能提供医疗服务;由新组建的医疗团队提供护理;越来越多地使用来自多个来源和人工智能应用程序的大量数据;以及熟练管理医学和机器之间的接口。为了在这种环境中取得成效,医生必须在其执照规定的最高范围内工作,具备跨越医疗保健专业和护理连续体的知识,有效地利用数据平台,专注于分析结果和提高绩效,并向患者传达大量数据生成的概率的含义,考虑到他们独特的人类复杂性。作者认为,需要对医学教育进行“重新启动”,更好地利用认知心理学的研究成果,并更加关注人类和机器在教育和实践中的一致性。医学教育需要超越基础的生物医学和临床科学。系统的课程必须关注医疗保健专业人员之间的专业工作组织、涉及大数据集的智能工具的使用以及机器学习和机器人,同时确保掌握富有同情心的护理。