A modern healthcare system needs a modern training system. Yet, despite lessons in coding being introduced to primary schools in 2014, the medical training system lags far behind our primary school counterparts.
With the introduction of five new medical schools to the UK in the coming years, there is a real opportunity to start afresh and ensure that the doctors of tomorrow are trained for tomorrow.
Doctors clearly need to have an understanding of the classic triad of anatomy, physiology and pharmacology but also need to be encouraged to have a holistic approach to the patient. This will include developing an understanding of the various components of the medical system and how the structure of the NHS fits together. In an already packed curriculum, it is difficult to immediately see where a considerable syllabus for understanding technology data and ethical artificial intelligence could fit
Defining what an education in digital health should mean
Some medical schools have introduced technology training such as bedside ultrasound scanning, a modern and arguably diagnostically richer alternative to the traditional stethoscope. However, this is not ubiquitous and ultrasound is a comparatively ‘old’ new technology.
Perhaps more significantly, the words “artificial intelligence” and “digital health” do not appear as part of the GMC guidance for medical curricula for UK doctors, although the GMC does specify (PDF) more broadly that doctors should be able to “make effective use of decision making and diagnostic technologies”. Given their increasing ubiquity, the use of digital healthcare tools should be more explicit.
The term “education in digital health” is vague and the scope of the training required is a matter of discussion. It’s unrealistic to expect all doctors to be able to code but should digital health expertise be a specialist interest or is it a core skillset that should be required of future doctors? Is it now time for an undergraduate curriculum to be written? Indeed, there is a precedent for this work as evidenced by the Faculty of Medical Leadership and Management (PDF) who have developed an agenda for a similar “non-traditional clinical” curriculum.
The impact of digital health on the doctor-patient relationship
It’s clear that technology will play an increasing role in the working lives of doctors of today and of the future but it’s important also to note that junior doctors are already using technology as part of their daily practice, for example in the form of medical apps and calculators. While often these apps are produced by reputable sources and institutions, some are developed by well-meaning amateurs and the vast majority include a disclaimer, typically stating that calculator results should not be used to substitute clinical judgement. Might AI technologies escape the rigours of evidence-based medicine and regulation by providing similar disclaimers?
As these technologies become part of the treatment process, doctors should be able to apply the same rigour of evidence-based practice. But as commercial smart devices and wearables become ubiquitous, how should the doctor of the future respond to their results? How will these technologies affect the traditional doctor-patient relationship? Might they manifest as additional demands on the work of the doctor or might they reduce pressure on the system by mobilising a more digitally healthy public?
It’s clear that much work is needed to answer some of these fundamental questions. But what is obvious is that innovation requires innovation across all strands. And yet with innovation occurring at a much faster rate than curriculum development, how do we ensure the modern doctor has the skills to adapt accordingly?
One of the newly formed medical schools, the Kent and Medway Medical School, is developing nine vertical themes which will run throughout all five years of their programme. These focus on nine contemporary and innovative areas in which the NHS workforce must increasingly develop expertise. Each vertical theme has a champion who will ensure that the theme is represented throughout their programme. A champion for “health innovation in the 21st century” will particularly focus on digital health.
However, this challenge is not limited to undergraduate medicine. After graduating, doctors undergo a comprehensive postgraduate training scheme in their chosen specialty. This builds on undergraduate learning to support junior doctors in becoming specialists in a chosen field.
Postgraduate training has not always evolved to that of a modern doctor. Seemingly, there is a point at which technology becomes accepted and then incorporated into curricula. Clearly, this will be driven partly by standards and regulation.
The health secretary, Matt Hancock, has announced that technology is the future of the NHS but much work is needed in the community to move digital health and AI from a niche interest of a few doctors to the widespread use and acceptance. There is hope that the creation of NHSX can aid in facilitating this but the question remains: what are the core skills doctors will need to practice digital medicine?
A specialty training programme for digital health
Junior doctors and clinicians may take a fellowship year out of training to gain additional skills and expertise. These fellowships exist in order to up skill the workforce, but they remain a choice solely for interested physicians and will only go some way to addressing the need for widespread knowledge and expertise in this new area of medicine.
It will be fascinating to see where this new field of medicine will take us. Could we see a future specialty training programme, much as doctors are trained in general medicine or surgery, in digital medicine, creating consultants in digital health and AI for example?
It’s important to consider also, particularly in medicine, that education is a wider issue than training the future workforce. Our own public engagement work identified education as a key theme for citizens too. Education is needed to inform the public regarding choices and options in digital health and simply to make them aware of what products are available to them. Education is also imperative in allowing the public to make informed decisions and consent about the use of these technologies in their own healthcare, just as this applies to any other more traditional treatment.
This education requires ongoing dialogue, trust and support for their use in homes, particularly for citizens who may find their use particularly challenging. Therefore educating, and engaging with, patients should be seen as part of a seamless process. How might this additional demand impact on a workforce which is already working at full capacity and how might it be perceived by staff?
Digital health and NHS understaffing
We perhaps need to start seeing technology as part of the solution of an under-resourced workforce. Opponents to digital health rightly point out other priorities in healthcare such as understaffing and poor working conditions. It is important therefore to ensure the message regarding digital health is clear: that digital health can help, not by replacing staff, but by facilitating productivity in other areas which allows staff to concentrate on those areas which absolutely require human interaction.
We must work closely with those who raise valid concerns about the priorities of digital health. This will be vital for staff and patients alike and form part of the educational work that is required. It will be exciting to explore, for example, how digital health might impact a future workforce in a positive way. Might they assist in reducing burn-out in doctors and therefore make medicine an attractive career prospect again?
This work needs to be done in a transparent and ethical manner with a national conversation, not technology evangelists working in silos. Fortunately, organisations such as the All-Party Parliamentary Group on AI have set up task forces specifically to assist with this work with a focus on citizen participation and education.
There is no question that AI and digital health are here to stay. We need to ensure that the doctors of tomorrow are not faced with a working world that bears no resemblance to the world they trained for and that the public is ready to benefit from these technologies. It’s time to become healthcare professionals and citizens of tomorrow and learn together.
Dr James Hadlow is a visiting Darzi Fellow at the University of Kent. Dr Chris Farmer is a professor at the University of Kent. Professor Chris Holland is Dean at Kent and Medway Medical School (KMMS).