Undergraduate medical students’ perception of AI in Medicine

Introduction
The time period synthetic intelligence (AI) coined by John McCarthy in 1955 refers to “the flexibility of computer systems to carry out duties usually requiring human intelligence, however this doesn’t imply they function in the identical means as human considering and habits”. 1 The present state of AI is of technical performance whereas human-like capabilities are nonetheless in the longer term. AI is on the verge of having the ability to ship precision medication and well being.2 AI can elevate questions concerning the future of healthcare and the function of human physicians.3 AI is postulated to play a major function in bettering human decision-making and effectivity.4 It is already enjoying an vital function in a spread of well being specialties and illness circumstances, comparable to radiology, neurosurgical imaging, pores and skin lesions, tumors, chest ache, neurologic ailments comparable to Alzheimer’s illness, and likewise in the analysis of breast most cancers, drug discovery, remedy choice particularly in sufferers with comorbid circumstances and on a number of remedies, and stratified care supply.5,6
Physicians and well being programs leaders needs to be educated about the advantages and limitations of AI and machine studying (ML) as they could already be utilizing these or will probably be utilizing them quickly and are anticipated to play an vital function in their growth, testing, and integration into the medical workflow.7 An absence of data amongst physicians relating to AI and ML could translate into poorer affected person outcomes on account of a scarcity of understanding about deciding on instruments that add worth and integrating these into affected person care.8
AI will not be generally addressed throughout undergraduate medical training. Among attainable causes talked about have been present accreditation necessities don’t emphasize AI, medical colleges are already struggling below a heavy curriculum with periodic requests for brand new subjects and areas of examine to be added they usually lack college with the experience to show this matter.9 Another problem is that medical colleges and educators nonetheless have no idea the precise rising function of the doctor relating to AI and therefore are unable to plan instructing approaches.10 However, 5 main focus areas for AI in the medical curriculum have been instructed.3 Among these are working with and managing AI programs, exploring their moral and authorized implications, vital appraisal of AI programs, continued emphasis on the biomedical sciences, and studying to work with digital well being data. The growth of AI curricula would require collaboration amongst knowledge scientists, laptop scientists, working towards physicians, and consultants in medical training.11 As AI entails a number of abilities and data areas, a range of teaching-learning methods is recommended.
It is essential to familiarize medical college students with AI ideas and concepts in order that they’ll start to make use of these in caring for his or her sufferers, and don’t get slowed down by terminology and definitions.9 AI programs have solely lately been launched in a number of medical colleges in the developed world. The Carle Illinois College of Medicine in the United States has developed a curriculum with an emphasis on arithmetic and knowledge science.12 Queen’s University in The United Kingdom and the University of Toronto in Canada additionally provide programs. For AI to be extensively adopted in healthcare it should have regulatory approval, be built-in with Electronic Health Record programs, be standardized to a ample diploma, taught to clinicians and medical college students, be paid for by public or non-public payer organizations, and up to date over time.13 The few colleges which can be providing programs on AI use interactive lectures, small group classes, e-modules, and electives amongst different strategies.12 Embedding AI into pre-existing programs can cut back curricular overload and spotlight their medical purposes.13
Nepal is a creating nation in South Asia with a number of health-care issues. A current article mentions AI can provide low-cost options to completely different well being issues, assist in controlling the COVID-19 pandemic, and profit the nation.6 With the current penetration of AI in healthcare, it’s worthwhile getting ready the Nepalese healthcare system to accommodate future necessities of AI. AI might be thought of as a possible instrument to beat sure challenges dealing with the healthcare system as it’s anticipated to supply an economical enhancement of human capabilities, straightforward and correct interpretation of affected person knowledge, avenues for precision medication, save the time of the doctor, enhance radiology diagnoses, amongst others.13 Nepal’s well being and training system needs to be developed to use these developments and the nation ought to develop native experience. Health employees needs to be ready to deal with the potential challenges and threats posed by AI to reap the advantages of AI in Nepalese healthcare. Further, to develop a curriculum tailor-made to the nation’s wants it’s important that pupil perceptions on this matter be studied. Hence, the current examine was undertaken to check medical college students’ data of AI, their perceptions relating to the function of AI in medication, and preferences surrounding the combination of AI competencies into medical training.
Materials and Methods
Study Design
A cross-sectional examine was accomplished at KIST Medical College and Teaching Hospital amongst first 12 months to final-year medical college students and interns from eighth to thirty first July 2021.
Sampling Method
All college students have been invited to take part. The complete pupil inhabitants was 583 with a complete of 89 medical college students in the primary 12 months, 89 in the second 12 months, 90 in the third 12 months, 93 in the fourth 12 months, 119 in the ultimate 12 months, and 103 medical interns.
Inclusion Criteria
All college students from the primary 12 months to remaining 12 months Bachelor of Medicine and Bachelor of Surgery (MBBS) and medical interns.
Exclusion Criteria
Those college students who didn’t consent to take part and the Bachelor in Dental Surgery (BDS) college students have been excluded from the examine.
Ethical Approval
Ethical approval was obtained from the Institutional Review Committee of KIST Medical College and Teaching Hospital with a reference quantity of 2077/78/64.
Data Collection Methods
A questionnaire used in a Canadian examine was used after acquiring permission from the authors.11 The questionnaire was mentioned among the many authors for its suitability in the Nepali context and modifications in sure terminologies used in the demographic part have been accomplished. The questionnaire consisted of three sections. The first obtained sure demographic info from the contributors, the second half centered on their data about AI and the final half examined pupil perceptions about AI in medication. Each batch of the scholars has their class social media group which they use to share info. The college students have been knowledgeable concerning the examine by means of this social networking website and their emails have been collected.
Consent
The examine was administered on-line after acquiring knowledgeable consent. The examine was pretested amongst twenty alumni of the establishment. Those college students who offered their consent to take part in the examine have been requested to finish the questionnaire. Students have been additionally required to affirm an integrity pledge mentioning that they won’t contact others concerning the solutions to this examine and won’t discuss with any exterior sources whereas finishing the examine. Each pupil was contacted previous to the examine through e mail and consent was obtained. The written consent kind was designed and was despatched to the coed’s e mail.
Pilot Testing
The questionnaire was pretested by administering it to twenty previous college students (alumni). The Cronbach alpha worth was 0.6.
Data Management and Analysis
Data have been entered in Microsoft Excel and analyzed utilizing IBM SPSS Version 21 for Windows, Armonk, NY. Data have been offered in the shape of descriptive statistics and analyzed. Free textual content feedback have been collated.
The demographic traits have been tabulated. The median perception towards AI rating was calculated by noting the respondent’s diploma of settlement with a set of 5 statements. These have been scored as: strongly disagree = 1, disagree = 2, impartial = 3, agree = 4, and strongly agree = 5. The median scores have been in contrast amongst completely different subgroups of respondents in accordance with demographic and background traits. The different responses have been analyzed descriptively. For the perception in the areas of particular person affected person care, well being programs, and inhabitants well being respondents have been first requested the chance of AI performing a selected job after which the timeframe inside which the respondent thinks AI will change a mean human physician in performing this job.
Respondents’ perception relating to the impression of AI on ethics and on medical training was famous by learning their settlement with a set of statements. The quantity of respondents who chosen the responses as doubtless or extraordinarily doubtless was low in our examine. The authors determined solely to incorporate the evaluation of the time inside which the respondent thought AI will change a mean human physician in performing this job if greater than 20% of the overall respondents had answered doubtless/extraordinarily prone to the earlier query. The interval throughout which coaching in AI competencies ought to start was additionally famous. Free textual content feedback have been invited.
Results
A complete of 216 of the 583 college students (37%) participated. Female college students have been in majority, 125 (57.9%), adopted by males 91 (42.1%). Most contributors have been first-year college students, 83 (38.4%), adopted by interns 61 (28.2%).
The most quantity of college students, 170 (91.7%) had not attended or seen any talks or lectures on synthetic intelligence. No coaching in programming/coding was given to 206 (95.8%) college students. Most college students have been from the self-finance scheme, 196 (90.7%). Most college students, 115 (53.2%) understood the time period “synthetic intelligence”.
The time period “machine studying” was not understood by 92 (42.6%) of the contributors. Similarly, the time period “neural community” was acquainted to 89 (41.2%) of the contributors. Table 1 exhibits the demographic traits and the median data scores of the respondents. Table 2 exhibits the median scores of particular person statements about data.
Table 1 Respondent Demographics and Median Knowledge Toward AI Score Among Different Subgroups of Respondents

Table 2 Median Scores of Individual Statements Regarding Knowledge

Knowledge Toward AI
The median data towards AI rating was 11 (interquartile vary 4). The median rating was considerably greater amongst final-year college students. The rating was additionally greater amongst those that talked about they’d further coaching in AI. There have been no different variations in accordance with demographic and background traits.
Perception Toward AI in Individual Patient Care, Health Systems, and Population Health
Table 3 exhibits perception relating to AI in the areas of particular person affected person care, well being programs, and inhabitants well being. Of the respondents, 64.4% (n = 139) “strongly disagreed” AI can present sufferers with preventative well being suggestions. Similarly, 60.2% (n = 130), talked about “Extremely unlikely” that AI can analyze affected person info to succeed in diagnoses. Of the respondents, 56.5% (n = 122) felt it was “Extremely unlikely” that AI can formulate personalised remedy plans for sufferers. Regarding the applying of AI in well being programs, 48.1% (n = 104) felt “Extremely unlikely” that AI instruments can present documentation (eg, replace medical data) about sufferers. In relation to inhabitants well being, 69% (n = 149) thought of it “Extremely unlikely” that AI can conduct inhabitants well being surveillance and outbreak prevention.
Table 3 Perception Toward AI in the Areas of Individual Patient Care, Health Systems, and Population Health

Perception Regarding the Impact of AI on Ethics and Medical Education
Over 49% of respondents strongly agreed or agreed that AI will cut back the quantity of jobs obtainable to them. Over 65% believed the impression can be extra in sure specialties in comparison with others and have been additionally of the opinion that this may impression their selection of specialty. Nearly 90% agreed that AI will elevate new moral challenges. Over 70% agreed with the statements about AI elevating new social and well being fairness challenges. Nearly 90% of respondents believed that the Nepalese health-care system is ill-equipped to take care of the challenges of AI and over 75% felt their training doesn’t put together them adequately to work alongside AI. Over 80% opined each medical pupil/trainee ought to obtain coaching on AI competencies and 78% felt the coaching ought to start as a medical pupil. More particulars can be found in Table 4. Box 1 exhibits a range of free-text feedback made by the respondents.

Box 1 Free-Text Comments Made by the Participants

Table 4 Respondents’ Perception Regarding the Impact of AI on Ethics and on Medical Education

Discussion
Like most creating nations, the healthcare system in Nepal additionally faces challenges comparable to a scarcity of educated manpower, assets, uneven distribution of amenities, and restricted entry to healthcare. Even with these limitations, the nation has achieved important progress in the health-care indicators14 and integrated laptop expertise with most hospitals operating digital hospital databases to prepare affected person care and preserve digital medical file programs. The potential advantages of AI in Nepal have been reviewed by Teijlingen et al.6 Being key health-care crew members, physicians are anticipated to be key drivers of health-care transformations incorporating AI in the healthcare system of Nepal. They are additionally anticipated to resolve any anxiousness, questions, or confusion, sufferers could have relating to AI by offering reliable info.15 The current examine explored the medical college students, the longer term physicians’ data, and perceptions towards AI in healthcare. The findings confirmed much less understanding amongst medical college students of AI, machine studying, and neural networks, and a poor perception of the potential roles of AI in particular person affected person care and the healthcare system.
Of the examine respondents, solely barely over half understood the time period “Artificial intelligence”. In a Canadian examine involving medical college students, 83.3% both “agreed” or “strongly agreed” with the assertion “I understood the that means of AI”.11 Similarly, in the current analysis, solely 42.6% understood the time period ‘machine studying and solely 41.2% understood the time period “neural community”. Present examine findings are decrease than the Canadian examine whereby 65.9% knew about machine studying and 42.3% about “neural networks”.11 In a Spanish examine, 51.9% thought of themselves to not clearly perceive AI.16 In a survey from Germany involving three medical universities, 68% have been unaware of the applied sciences concerned in AI.17 Being a discipline initially extra associated to the applying of computer systems and good units, medical college students could have challenges in understanding the terminologies and technical background behind AI. It can also be price mentioning that the medical pupil curricula in Nepal at current don’t cowl AI.
Present analysis findings confirmed a poor perception among the many respondents of AI as demonstrated by decrease perception-related responses. The perceptions improved as college students progressed to the next 12 months of examine. A greater perception could also be linked with what college students hear and examine AI in social media, information, and different avenues.
The contribution of AI and machine studying in particular person affected person care involving analysis and remedy is properly documented in the literature.13 AI has confirmed advantages in many illness circumstances comparable to weight problems, GI ailments, oncology, cardiovascular circumstances, and so forth. It has additionally confirmed to be helpful in providing preventive well being suggestions.18 In the current analysis, solely one-tenth of the respondents felt that AI can present sufferers with preventative well being suggestions comparable to train, weight loss program, and wellness. Multiple printed proof helps AI purposes in these circumstances,19 which the responding college students weren’t conscious of. However, a overview on the function of AI in diabetic retinopathy screening emphasised numerous challenges together with medicolegal implications and moral points to be resolved in order to expedite the applying of AI in these conditions.20 Of the coed respondents, almost half felt AI can analyze affected person info to succeed in diagnoses whereas it’s clearly documented in the literature that AI can carry out in addition to or higher than human beings in diagnosing ailments.13 Students additionally had a poor perception of the truth that AI can analyze affected person info to determine prognoses. The analysis findings thus clearly display that the function of AI in the medical analysis of sufferers utilizing affected person info will not be properly understood by the scholars.
Another vital spotlight of the current analysis is that solely only a few (one-tenth) felt AI can learn and interpret diagnostic imaging. It is clearly documented that AI algorithms have made pathbreaking enhancements in image-recognition duties and are prone to impression the observe of radiodiagnosis.21 While, this department of medication is taken into account a quickly evolving discipline in incorporating AI, medical college students from Germany seen AI may detect pathologies in radiological examinations (83%) however not set up particular diagnoses (56%).17 In the current examine, solely one-quarter of the respondents felt that AI can formulate personalised remedy plans for sufferers and a low quantity of respondents felt that AI can formulate personalised treatment prescriptions for sufferers in addition to monitor affected person compliance to prescribed medicines, train, and dietary suggestions.
These findings clearly present a poor understanding among the many pupil respondents of the potential function of AI in precision medication. There are a number of items of literature confirming the function of AI in precision medication for cardiovascular medication,22 most cancers,23 and so forth. Robotic surgical procedure is a quickly advancing discipline with good precision and accuracy. Currently, robotic surgical procedure is managed by human surgeons who’re vulnerable to bodily, psychological, and technical variables, limiting the consistency of efficiency. On the opposite hand, surgical robots are proof against fatigue, and tremors and provide higher scalable movement and a excessive vary of axial movement24 resulting in higher precision and low morbidity charges.25 It is predicted that AI management algorithms can provide advantages to robotic surgical procedures by lowering errors, and time and in the end bettering outcomes by lowering human error.26 But, in the current analysis, solely 12% of the respondents talked about AI can carry out surgical procedure (eg, robotic surgical procedure).
In a examine from Saudi Arabia, 63.2% of medical college students demonstrated a optimistic perspective in the direction of robotic surgical procedure and felt it is going to enhance surgical outcomes although almost half of them felt sufferers wouldn’t conform to robotic surgical procedures.27 Similar to the Saudi examine, even in the current analysis most college students are unaware of robotic surgical procedure. Considering the fast development of robotic surgical procedures, even in a hospital in Nepal (KMC Hospital),28 you will need to educate medical college students. However, it has been talked about AI and robotics in healthcare could contribute to the dehumanization of medication in the longer term which may cut back the human contact in remedy. In a examine from Cyprus,29 54.5% of medical college students felt AI and robotics in healthcare is a kind of dehumanization. Though it’s troublesome at this level to foretell dehumanization on account of AI, one should contemplate the likelihood that such applied sciences could dehumanize care and undermine human rights requirements.30
Nearly half of the respondents felt that AI will cut back the quantity of jobs obtainable to them. A report from the UK means that 35% of jobs in the UK could possibly be automated in the following 10–20 years.31 There is an argument that the majority of the job loss in healthcare will probably be associated to those coping with digital info, radiology, and pathology and never those associated to direct affected person contact.32 This widespread perception of attainable risk to radiology and pathology jobs has led to postgraduate college students displaying reluctance in selecting these professions. In a Spanish examine, 36.7% (of the 341) medical college students surveyed expressed their considerations concerning the function of AI in selecting radiology as their specialty.18 In one other examine, 67.7% of Canadian medical college students agreed that AI would scale back the demand for radiologists, and one-sixth of respondents determined to not contemplate radiology because of the anxiousness associated to AI’s impression although it was in any other case their first selection.33 In one other examine from UK, 49% wouldn’t desire to think about a radiology profession on account of AI.34 However, additionally it is vital to notice that radiologists and pathologists do many different jobs different than simply studying and reporting radiology photos or biopsy slides. Hence, it could be too early to conclude concerning the attainable job risk posed by AI. Currently, in Nepal, these professions are flourishing and well-preferred by graduates whereas choosing their greater research. In the current examine, over one-third have talked about that AI will impression their selection of specialty choice. AI can also be anticipated to enormously affect dermatology observe by bettering the sensitivity and accuracy of screening pores and skin lesions because of the considerable availability of medical and dermatoscopic knowledge and pictures. AI has discovered main purposes in pores and skin most cancers, psoriasis, atopic dermatitis, and onychomycosis.35
It is seen {that a} excessive proportion of the respondents felt AI in medication will elevate new moral and social challenges and have an effect on well being fairness. The findings counsel college students’ understanding of AI in relation to moral elements. Ethical points comparable to accountability, transparency, permission, and privacy13 related to AI have been thought of a serious problem in incorporating AI into healthcare. There have been pointers governing moral points in AI comparable to Guidelines for Trustworthy AI issued by the European Union,36 and Ethics and governance of synthetic intelligence for well being by the WHO.37 The core rules on moral points by these organizations might be taught to medical college students.
Though the extent of the impression AI can have on healthcare will not be very clear, it’s nonetheless worthwhile for medical college students to have ample data of AI in healthcare. McCoy et al clearly described what physicians have to find out about AI in a medical context as ‘use it, ‘interpret it’ and ‘clarify it’.38 Colleges worldwide have carried out methods to show AI to medical college students. It is advisable that medical training authorities incorporate AI into medical college students’ curricula as quickly as attainable. In the current analysis, lower than 10% felt that their medical training is sufficiently getting ready them for working alongside AI instruments and over 85% wished medical coaching ought to embody coaching on AI competencies. Respondents additionally felt that it needs to be taught throughout the undergraduate degree (80%). The current examine discovering is in concordance with the Spanish and German research whereby most college students advisable together with AI in the medical college curriculum.16,17 An identical discovering was famous in a multinational survey involving 63 nations, medical college students confirmed a eager curiosity in studying about AI.39 A more in-depth have a look at the respondents’ willingness to find out about AI provides a optimistic signal that potential interventions will probably be simply accepted by the scholars. There might be additionally considerations about “who” and “how” to coach medical college students. This might be more difficult in Nepal the place medical colleges are sometimes understaffed, and the variety of human assets required to show and observe an interdisciplinary space like AI could also be absent.
Limitations
The current examine had a number of limitations. The examine included just one medical college and therefore the findings might not be consultant of your complete nation’s college students.
Recommendations
Based on the analysis findings, authors would advocate medical colleges incorporate AI into curricula. Since it may be difficult for medical colleges to coach college students on AI, the duty lies in the arms of universities and the medical council to develop a job power with consultants who can additional practice the trainers. While incorporating AI in the curriculum, moral points have to be given due significance. The ongoing pandemic has demonstrated the feasibility of providing coaching on-line enabling Nepalese medical schools to share scarce human assets.
Conclusion
The undergraduate medical college students had a low understanding of AI and its potential implications for healthcare and weren’t anxious concerning the impression of AI in healthcare. Though respondents thought of AI to have an effect on their particular person careers, they weren’t positive of AI’s impression on the person sufferers and the healthcare system. The current medical curricula in Nepal appear to offer very negligible or no inputs associated to AI. A delay in instructing AI to medical college students could make them ill-prepared to deal with the potential threats and challenges at a private {and professional} degree. A perceived willingness amongst college students to find out about AI might be thought of a optimistic signal to harness. To discover AI as a possible answer dealing with the healthcare system of Nepal, it’s crucial to teach future medical medical doctors on the topic with none additional delay.
Acknowledgments
The authors want to acknowledge Dr. Nishila Mehta from the University of Toronto, Canada for offering permission to make use of the questionnaire (Supplementary Material) developed by them for this examine.11 They thank Ajman University, United Arab Emirates, for paying the complete article processing fees. They thank all the scholars who participated.
Disclosure
The authors report no conflicts of curiosity in this work.
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