Gillan Caitlin, Hodges Brian, Wiljer David, Dobrow Mark
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Joint Department of Medical Imaging, Sinai Health/University Health Network/Women's College Hospital, Toronto, ON, Canada.
JMIR Res Protoc. 2021 May 19;10(5):e27340. doi: 10.2196/27340.
The emergence of artificial intelligence (AI) in health care has impacted health care systems, including employment, training, education, and professional regulation. It is incumbent on health professional associations to assist their membership in defining and preparing for AI-related change. Health professional associations, or the national groups convened to represent the interests of the members of a profession, play a unique role in establishing the sociocultural, normative, and regulative elements of health care professions.
The aim of this paper is to present a protocol for a proposed study of how, when faced with AI as a disruptive technology, health professional associations engage in sensemaking and legitimization of change to support their membership in preparing for future practice.
An exploratory multi-case study approach will be used. This study will be informed by the normalization process theory (NPT), which suggests behavioral constructs required for complex change, providing a novel lens through which to consider the agency of macrolevel actors in practice change. A total of 4 health professional associations will be studied, each representing an instrumental case and related fields selected for their early consideration of AI technologies. Data collection will consist of key informant interviews, observation of relevant meetings, and document review. Individual and collective sensemaking activities and action toward change will be identified using stakeholder network mapping. A hybrid inductive and deductive model will be used for a concurrent thematic analysis, mapping emergent themes against the NPT framework to assess fit and identify areas of discordance.
As of January 2021, we have conducted 17 interviews, with representation across the 4 health professional associations. Of these 17 interviews, 15 (88%) have been transcribed. Document review is underway and complete for one health professional association and nearly complete for another. Observation opportunities have been challenged by competing priorities during COVID-19 and may require revisiting. A linear cross-case analytic approach will be taken to present the data, highlighting both guidance for the implementation of AI and implications for the application of NPT at the macro level. The ability to inform consideration of AI will depend on the degree to which the engaged health professional associations have considered this topic at the time of the study and, hence, what priority it has been assigned within the health professional association and what actions have been taken to consider or prepare for it. The fact that this may differ between health professional associations and practice environments will require consideration throughout the analysis.
Ultimately, this protocol outlines a case study approach to understand how, when faced with AI as a disruptive technology, health professional associations engage in sensemaking and legitimization of change to support their membership in preparing for future practice.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27340.
人工智能（AI）在医疗保健领域的出现对医疗保健系统产生了影响，包括就业、培训、教育和专业监管。卫生专业协会有责任协助其成员界定与人工智能相关的变革并做好准备。卫生专业协会，或为代表某一职业成员利益而召集的全国性团体，在确立医疗保健专业的社会文化、规范和监管要素方面发挥着独特作用。
本文旨在提出一项拟议研究的方案，该研究旨在探讨面对人工智能这一颠覆性技术时，卫生专业协会如何进行意义建构以及使变革合法化，以支持其成员为未来实践做好准备。
将采用探索性多案例研究方法。本研究将以规范化过程理论（NPT）为依据，该理论提出了复杂变革所需的行为结构，为思考宏观层面行为体在实践变革中的作用提供了一个全新视角。将对4个卫生专业协会进行研究，每个协会代表一个工具性案例以及因其对人工智能技术的早期关注而选定的相关领域。数据收集将包括关键 informant 访谈、相关会议观察和文件审查。将使用利益相关者网络映射来识别个体和集体的意义建构活动以及针对变革的行动。将采用归纳与演绎相结合的混合模型进行同步主题分析，将新出现的主题与NPT框架进行映射，以评估契合度并识别不一致的领域。
截至2021年1月，我们已进行了17次访谈，涉及4个卫生专业协会。在这17次访谈中，15次（88%）已完成转录。文件审查正在进行，一个卫生专业协会的审查已完成，另一个协会的审查接近完成。在新冠疫情期间，观察机会受到相互竞争的优先事项的挑战，可能需要重新审视。将采用线性跨案例分析方法来呈现数据，突出对人工智能实施的指导以及NPT在宏观层面应用的意义。为人工智能考量提供信息的能力将取决于参与研究的卫生专业协会在研究时对该主题的考虑程度，因此取决于它在卫生专业协会内部被赋予的优先级以及为考虑或准备该主题所采取的行动。卫生专业协会和实践环境之间可能存在差异这一事实在整个分析过程中都需要加以考虑。
最终，本方案概述了一种案例研究方法，以了解面对人工智能这一颠覆性技术时，卫生专业协会如何进行意义建构以及使变革合法化，以支持其成员为未来实践做好准备。
国际注册报告标识符（IRRID）：DERR1-10.2196/27340。
