人工智能在医学教育中的应用

人工智能在毕业后医学教育中的应用与挑战

  • 谢文加 ,
  • 王筝扬
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  • 1浙江大学医学院附属邵逸夫医院眼科,杭州 310016;
    2浙江大学医学院附属邵逸夫医院教育办公室,杭州 310016

收稿日期: 2024-07-15

  网络出版日期: 2025-03-04

基金资助

国家重点研发计划(2023YFE0204200);浙江大学AI For Education系列实证教学研究项目(重点项目序号3);浙江大学AI For Education系列实证教学研究项目(一般项目序号5)

Applications and challenges of artificial intelligence in postgraduate medical education

  • Xie Wenjia ,
  • Wang Zhengyang
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  • 1Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
    2Department of Education Administration, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

Received date: 2024-07-15

  Online published: 2025-03-04

Supported by

National Key R & D Program of China (2023YFE0204200); “AI for Education”Teaching Research Project of Zhejiang University (Key Project No. 3); “AI for Education”Teaching Research Project of Zhejiang University (General Project No. 5)

摘要

人工智能(artificial intelligence, AI)技术的引入正在逐步重塑医学教育的面貌。近年来,以辅助诊断AI和生成式AI为代表,AI技术在毕业后医学教育中得到了日益广泛且深入的应用。本文介绍了AI在毕业后医学教育中辅助教学实施、辅助自主学习和辅助评估与反馈的应用进展,展示其提升教学效率与质量,促进临床能力的精准培训与个性化培养,推动医师从传统学习向人机协同新模式过渡的能力和潜力。本文还对AI技术带来的伦理问题、数据安全、教育公平性、技术接受度和“医学+AI”交叉人才培养等一系列挑战进行了探讨。

本文引用格式

谢文加 , 王筝扬 . 人工智能在毕业后医学教育中的应用与挑战[J]. 中华医学教育杂志, 2025 , 45(3) : 187 -193 . DOI: 10.3760/cma.j.cn115259-20240715-00736

Abstract

The integration of Artificial Intelligence (AI) technology is progressively reshaping the medical education. In recent years, represented by diagnostic assistance AI and generative AI, AI technology has been increasingly and extensively applied in various aspects of postgraduate medical education. This review introduces the progress of AI applications in postgraduate medical education, including assistance in teaching implementation, self-directed learning, and assessment and feedback. The review demonstrates the ability and potential of AI to enhance teaching efficiency and quality, promote precise and personalized clinical competence development, and facilitate the transition of physicians from traditional learning to a new model of human-computer collaboration. The review also discusses the challenges generated by AI technology, such as ethical issues, data security, educational equity, technology acceptance, and the cultivation of “medicine + AI” interdisciplinary professionals.

参考文献

[1] 方晏红, 张扬, 李航, 等. 毕业后医学教育的现状和思考[J]. 中国继续医学教育, 2020,12(14):85-87. DOI: 10.3969/j.issn.1674-9308.2020.14.032.
[2] 阮恒超, 樊立洁, 耿晓北, 等. 住院医师规范化培训基地评估结果的分析与思考[J]. 中华医学教育杂志, 2021,41(6):563-566. DOI: 10.3760/cma.j.cn115259-20210113-00064.
[3] Xu Y, Jiang Z, Ting D, et al. Medical education and physician training in the era of artificial intelligence[J]. Singapore Med J, 2024,65(3):159-166. DOI: 10.4103/singaporemedj.SMJ-2023-203.
[4] Lancet T. AI in medicine: creating a safe and equitable future[J]. Lancet, 2023,402(10401):503. DOI: 10.1016/S0140-6736(23)01668-9.
[5] Masters K. Artificial intelligence in medical education[J]. Med Teach, 2019,41(9):976-980. DOI: 10.1080/0142159X.2019.1595557.
[6] Cooper A, Rodman A. AI and medical education — a 21st-century pandora′s box[J]. N Engl J Med, 2023,389(5):385-387. DOI: 10.1056/NEJMp2304993.
[7] Klar R, Bayer U. Computer-assisted teaching and learning in medicine[J]. Int J Biomed Comput, 1990,26(1-2):7-27. DOI: 10.1016/0020-7101(90)90016-n.
[8] Pei L, Ak M, Tahon N, et al. A general skull stripping of multiparametric brain MRIs using 3D convolutional neural network[J]. Sci Rep, 2022,12(1):10826. DOI: 10.1038/s41598-022-14983-4.
[9] Suk HI, Lee SW, Shen D, et al. Hierarchical feature representation and multimodal fusion with deep learning for AD/MCI diagnosis[J]. Neuroimage, 2014,101:569-582. DOI: 10.1016/j.neuroimage.2014.06.077.
[10] Wang S, Li C, Wang R, et al. Annotation-efficient deep learning for automatic medical image segmentation[J]. Nat Commun, 2021,12(1):5915. DOI: 10.1038/s41467-021-26216-9.
[11] Suk HI, Lee SW, Shen D, et al. Latent feature representation with stacked auto-encoder for AD/MCI diagnosis[J]. Brain Struct Funct, 2015,220(2):841-859. DOI: 10.1007/s00429-013-0687-3.
[12] Feng Y, Li J, Zhang X. Research on segmentation of brain tumor in MRI image based on convolutional neural network[J]. Biomed Res Int, 2022,2022:7911801. DOI: 10.1155/2022/7911801.
[13] Shen J, Zhang C, Jiang B, et al. Artificial intelligence versus clinicians in disease diagnosis: systematic review[J]. JMIR Med Inform, 2019,7(3):e10010. DOI: 10.2196/10010.
[14] Wu J, Yuan Z, Fang Z, et al. A knowledge-enhanced transform-based multimodal classifier for microbial keratitis identification[J]. Sci Rep, 2023,13(1):9003. DOI: 10.1038/s41598-023-36024-4.
[15] Esteva A, Kuprel B, Novoa RA, et al. Dermatologist-level classification of skin cancer with deep neural networks[J]. Nature, 2017,542(7639):115-118. DOI: 10.1038/nature21056.
[16] Pandey PU, Ballios BG, Christakis PG, et al. Ensemble of deep convolutional neural networks is more accurate and reliable than board-certified ophthalmologists at detecting multiple diseases in retinal fundus photographs[J]. Br J Ophthalmol, 2024,108(3):417-423. DOI: 10.1136/bjo-2022-322183.
[17] Chaddad A, Peng J, Xu J, et al. Survey of explainable AI techniques in healthcare[J]. Sensors (Basel), 2023,23(2):634. DOI: 10.3390/s23020634.
[18] Altintas L, Sahiner M. Transforming medical education: the impact of innovations in technology and medical devices[J]. Expert Rev Med Devices, 2024,21(9):797-809. DOI: 10.1080/17434440.2024.2400153.
[19] Sato Y, Takegami Y, Asamoto T, et al. Artificial intelligence improves the accuracy of residents in the diagnosis of hip fractures: a multicenter study[J]. BMC Musculoskelet Disord, 2021,22(1):407. DOI: 10.1186/s12891-021-04260-2.
[20] Fang Z, Xu Z, He X, et al. Artificial intelligence-based pathologic myopia identification system in the ophthalmology residency training program[J]. Front Cell Dev Biol, 2022,10:1053079. DOI: 10.3389/fcell.2022.1053079.
[21] Burke OM, Gwillim EC. Integrating artificial intelligence-based mentorship tools in dermatology[J]. Acad Med, 2024,99(6):e4. DOI: 10.1097/ACM.0000000000005705.
[22] Meetschen M, Salhofer L, Beck N, et al. AI-assisted X-ray fracture detection in residency training: evaluation in pediatric and adult trauma patients[J]. Diagnostics (Basel), 2024,14(6):596. DOI: 10.3390/diagnostics14060596.
[23] Aldeman N, de Sá Urtiga Aita KM, Machado VP, et al. Smartpath(k): a platform for teaching glomerulopathies using machine learning[J]. BMC Med Educ, 2021,21(1):248. DOI: 10.1186/s12909-021-02680-1.
[24] Tabuchi H, Engelmann J, Maeda F, et al. Using artificial intelligence to improve human performance: efficient retinal disease detection training with synthetic images[J]. Br J Ophthalmol, 2024,108(10):1430-1435. DOI: 10.1136/bjo-2023-324923.
[25] Retamero JA, Gulturk E, Bozkurt A, et al. Artificial intelligence helps pathologists increase diagnostic accuracy and efficiency in the detection of breast cancer lymph node metastases[J]. Am J Surg Pathol, 2024,48(7):846-854. DOI: 10.1097/PAS.0000000000002248.
[26] Muntean GA, Groza A, Marginean A, et al. Artificial intelligence for personalised ophthalmology residency training[J]. J Clin Med, 2023,12(5):1825. DOI: 10.3390/jcm12051825.
[27] Ricotta DN, Richards JB, Atkins KM, et al. Self-directed learning in medical education: training for a lifetime of discovery[J]. Teach Learn Med, 2022,34(5):530-540. DOI: 10.1080/10401334.2021.1938074.
[28] Desai SV, Burk-Rafel J, Lomis KD, et al. Precision education: the future of lifelong learning in medicine[J]. Acad Med, 2024,99(4S Suppl 1):S14-S20. DOI: 10.1097/ACM.0000000000005601.
[29] Boscardin CK, Gin B, Golde PB, et al. ChatGPT and generative artificial intelligence for medical education: potential impact and opportunity[J]. Acad Med, 2024,99(1):22-27. DOI: 10.1097/ACM.0000000000005439.
[30] Alhur A. Redefining healthcare with artificial intelligence (AI): the contributions of ChatGPT, Gemini, and Co-pilot[J]. Cureus, 2024,16(4):e57795. DOI: 10.7759/cureus.57795.
[31] Laohawetwanit T, Apornvirat S, Kantasiripitak C. ChatGPT as a teaching tool: preparing pathology residents for board examination with AI-generated digestive system pathology tests[J]. Am J Clin Pathol, 2024,162(5):471-479. DOI: 10.1093/ajcp/aqae062.
[32] Lee P, Bubeck S, Petro J. Benefits, limits, and risks of GPT-4 as an AI chatbot for medicine[J]. N Engl J Med, 2023,388(13):1233-1239. DOI: 10.1056/NEJMsr2214184.
[33] Gordon M, Daniel M, Ajiboye A, et al. A scoping review of artificial intelligence in medical education: BEME Guide No. 84[J]. Med Teach, 2024,46(4):446-470. DOI: 10.1080/0142159X.2024.2314198.
[34] 梁菊, 李瑛. 模拟医学教育:医学教学发展的必然趋势[J].肾脏病与透析肾移植杂志, 2015,24(3):266-269.
[35] Gendia A. Cloud based AI-driven video analytics (CAVs) in laparoscopic surgery: a step closer to a virtual portfolio[J]. Cureus, 2022,14(9):e29087. DOI: 10.7759/cureus.29087.
[36] Hisey R, Camire D, Erb J, et al. System for central venous catheterization training using computer vision-based workflow feedback[J]. IEEE Trans Biomed Eng, 2022,69(5):1630-1638. DOI: 10.1109/TBME.2021.3124422.
[37] Mirchi N, Bissonnette V, Yilmaz R, et al. The virtual operative assistant: an explainable artificial intelligence tool for simulation-based training in surgery and medicine[J]. PLoS One, 2020,15(2):e229596. DOI: 10.1371/journal.pone.0229596.
[38] Baloul MS, Yeh VJ, Mukhtar F, et al. Video commentary & machine learning: tell me what you see, I tell you who you are[J]. J Surg Educ, 2022,79(6):e263-e272. DOI: 10.1016/j.jsurg.2020.09.022.
[39] Siyar S, Azarnoush H, Rashidi S, et al. Machine learning distinguishes neurosurgical skill levels in a virtual reality tumor resection task[J]. Med Biol Eng Comput, 2020,58(6):1357-1367. DOI: 10.1007/s11517-020-02155-3.
[40] Knudsen JE, Ghaffar U, Ma R, et al. Clinical applications of artificial intelligence in robotic surgery[J]. J Robot Surg, 2024,18(1):102. DOI: 10.1007/s11701-024-01867-0.
[41] Okuda Y, Bryson EO, DeMaria S Jr, et al. The utility of simulation in medical education: what is the evidence?[J]. Mt Sinai J Med, 2009,76(4):330-343. DOI: 10.1002/msj.20127.
[42] McGaghie WC, Issenberg SB, Petrusa ER, et al. A critical review of simulation-based medical education research: 2003-2009[J]. Med Educ, 2010,44(1):50-63. DOI: 10.1111/j.1365-2923.2009.03547.x.
[43] Muthusami A, Mohsina S, Sureshkumar S, et al. Efficacy and feasibility of objective structured clinical examination in the internal assessment for surgery postgraduates[J]. J Surg Educ, 2017,74(3):398-405. DOI: 10.1016/j.jsurg.2016.11.004.
[44] Ginsburg S, van der Vleuten C, Eva KW. The hidden value of narrative comments for assessment: a quantitative reliability analysis of qualitative data[J]. Acad Med, 2017,92(11):1617-1621. DOI: 10.1097/ACM.0000000000001669.
[45] Yilmaz Y, Jurado NA, Ariaeinejad A, et al. Harnessing natural language processing to support decisions around workplace-based assessment: machine learning study of competency-based medical education[J]. JMIR Med Educ, 2022,8(2):e30537. DOI: 10.2196/30537.
[46] Wood EA, Ange BL, Miller DD. Are we ready to integrate artificial intelligence literacy into medical school curriculum: students and faculty survey[J]. J Med Educ Curric Dev, 2021,8:1967551794. DOI: 10.1177/23821205211024078.
[47] Civaner MM, Uncu Y, Bulut F, et al. Artificial intelligence in medical education: a cross-sectional needs assessment[J]. BMC Med Educ, 2022,22(1):772. DOI: 10.1186/s12909-022-03852-3.
[48] Banerjee M, Chiew D, Patel KT, et al. The impact of artificial intelligence on clinical education: perceptions of postgraduate trainee doctors in London (UK) and recommendations for trainers[J]. BMC Med Educ, 2021,21(1):429. DOI: 10.1186/s12909-021-02870-x.
[49] Naamati-Schneider L. Enhancing AI competence in health management: students′ experiences with ChatGPT as a learning tool[J]. BMC Med Educ, 2024,24(1):598. DOI: 10.1186/s12909-024-05595-9.
[50] Hswen Y, Voelker R. New AI tools must have health equity in their DNA[J]. JAMA, 2023,330(17):1604-1607. DOI: 10.1001/jama.2023.19293.
[51] Recai Y, Alexander W, Nykan M, et al. Continuous monitoring of surgical bimanual expertise using deep neural networks in virtual reality simulation[J]. npj Digital Medicine, 2022,5(1):54. DOI: 10.1038/s41746-022-00596-8.
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