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without considering the work 3 Reiter HI, Salvatori P, Rosenfeld J, respect to the acquisition of
context into which that student will Trinh K, Eva KW. The effect of medical knowledge and skill. PLoS
transition. As leading Australian defined violations of test security One 2014;9 (2):e88606.
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Health Commissioner Professor Ian
2006;40 (1):36–42. work. J Organ Behav 2014;35
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4 Hausknecht JP, Halpert JA, Di (Suppl 1):41–60.
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deleterious culture of medicine Retesting in selection: a meta- conscientious workers adaptable?
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to which junior doctors [are] effects for tests of cognitive ability. 12 Aubusson K. She was eaten alive:
subjected’.12 J Appl Psychol 2007;92 (2):373–85. Chloe Abbott’ sister Micaela’s
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self-enhancement in medical doctors. Sydney Morning Herald 5
school applicants. Med Educ July 2017. http://www.smh.com.a
We need to know a great deal more on
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how, and if, medical training and the
6 Griffin B, Hu W. The interaction alive-dr-chloe-abbotts-sister-micaelas-
early, often challenging, experiences of
of socio-economic status and message-for-the-next-generation-of-
patient care contribute to inhibiting or
gender in widening participation doctors-20170704-gx4jt3.html.
limiting the expression of medical
in medicine. Med Educ 2015;49 [Accessed 18 July 2017.]
students’ positive qualities
(1):103–13. 13 Ferguson E, Lievens F. Future
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from 15 years of non-grades-based occupational and medical selection:
selection for medical school. Med myths, misunderstandings,
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(1):36–60. anxiety are detrimental with publication 13 September 2017

Learning from Dorothy Vaughan: artificial intelligence


and the health professions
Brian D Hodges

Art, literature and film provide the human condition. The racism, using her exceptional
powerful means of understanding remarkable film and book Hidden mathematical mind. Another
Figures1 portray three African pushes against prejudice to
Toronto, Ontario, Canada American woman scientists who, become a pioneering advocate for
against a backdrop of the 1960s black women engineers. However,
Correspondence: Brian Hodges, Wilson
Centre for Research in Education,
civil rights turbulence, helped to it is the third of the trio, a woman
University of Toronto, Toronto General advance the goals of the National named Dorothy Vaughan, who I
Hospital, 200 Elizabeth Street Suite 1ES565, Aeronautics and Space want to highlight.
Ontario M5G 2C4, Canada. Tel: +141 6340 Administration (NASA). One of
3079; E-mail: brian.hodges@utoronto.ca
the women prevails against a In 1961, NASA employed a large
doi: 10.1111/medu.13350 strong gradient of sexism and group of human computers: a job

ª 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education; 11
MEDICAL EDUCATION 2018 52: 3–11
commentaries

entailing sheer human force to education, testing organisations against the too easy claim that
calculate the complex formulae are poised to augment human what human professionals do is
necessary for space travel. test committees with computers too complex to be outsourced to
Hearing about the arrival of that generate test items3 and machines. What computer could
something called the IBM, a score examinations.4 compete with the wise counsel and
curious Dorothy Vaughan compassionate presence of an
surreptitiously read the operating experienced doctor, nurse or
manual and realised that the The imminent arrival of artificial pharmacist? Yet in reality, a great
need for human computers intelligence, deep learning and forms of many of our professional activities
would be short. Although she too automation such as robotics are about to are not very complex for AI.
transform health care and education,
had a brilliant mind and a Pattern recognition is one of
just as powerfully as the arrival of
forceful spirit, Vaughan machine computing at NASA them, and as AI systems get better
channelled her energies and better they will challenge our
differently. She shared what she claim to diagnosis, as a recent
learned about the coming study on deep learning and
Though it has been said that 47%
computer revolution with her detection of diabetic retinopathy
of jobs will disappear,5 it is more
colleagues and offered them demonstrated9. Further, we can
likely that AI and automation will
night courses. When the wheels scarcely imagine that affective
displace workers to new roles,
of the great new mechanical computing might also disrupt
rather than replacing them
computer began to turn, and domains such as communication
outright.6 Significant displacement
when the jobs of human and empathy, core competencies
will require helping our workforce
computers were set for of caring professionals.10
to develop new specialised skills.
elimination, Vaughan’s colleagues Nevertheless, as Susskind and
As Des Gorman writes in his
were prepared to assume new Susskind point out, health
article in this issue, ‘Matching the
roles as computer programmers. professionals often claim exclusive
supply of health workers to need is
license to empathy, but then
necessary if a health system is to
Health professions education is at provide it only during the
be sustainable, affordable and fit
exactly such a point today. The infrequent, short encounters made
for purpose’.7 Yet sadly I see our
imminent arrival of artificial possible in our harried,
professional organisations
intelligence, deep learning and underfunded institutions. People
concerned with clinging to their
forms of automation such as with high emotional needs, such
current scopes of practice,
robotics are about to transform as those with dementia, might be
replaying tired historical battles
health care and education, just as better supported by non-human
for control of little patches of
powerfully as the arrival of systems available at all times
professional turf, when they
machine computing at NASA. around the clock than trying to
should be decoding what human
Although there is disagreement reach a phone that doesn’t get
health professionals will be doing
about the speed of this answered at the hospital or clinic.
in an age of thinking machines.
development, there is no question Certainly, however, there are many
of its inevitability. At the hospital roles, such as ethical decision
where I work, we have just Though it has been said that 47% of making, which should probably
installed our first artificial jobs will disappear it is more likely that remain firmly in human hands
intelligence (AI) system for AI and automation will displace workers and hearts.
planning radiation therapy to new roles, rather than replacing
treatment. It can complete in just them outright
4 minutes a treatment plan that Significant displacement will require
only weeks ago took human helping our workforce to develop new
radiation therapists and physicists The Oxford-based authors Daniel specialised skills
over 2 hours. Plans are afoot to and Richard Susskind reveal what
integrate departments of radiology is coming in The Future of the
and pathology, recognising that Professions.8 They enumerate An important step is to introduce
AI will support pattern functions that are already being courses about AI, deep learning
recognition for diagnosis2. assumed by computers: analysing and automation into
Robotic drug-dispensing machines datasets, pattern recognition and undergraduate curricula. The
are replacing pharmacists just as scanning data for patterns among importance of metacognition,
bank machines replaced tellers. In them. However, they also warn situational awareness and other

12 ª 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education;
MEDICAL EDUCATION 2018 52: 3–11
commentaries

higher human cognitive functions planning, ‘better suited to the essay scoring and the future of
should also be enhanced in ‘‘needs’’ of the 19th century, and educational assessment in medical
medical schools and residency resistant to meaningful reform’. As education. Med Educ 2014;48
programmes to facilitate safe and a senior executive in an academic (10):950–62.
5 Frey CB, Osborne MA (2013)
productive computer–human health centre with over 15 000
The future of employment: How
interactions. I share the concerns employees, and 11 000 students
susceptible are jobs to
expressed by Gorman that today’s contemplating the changes ahead, computerization? Oxford Martin
health care workers are not easily this seems untenable. Educators Program on the Impacts of
retrained or redeployed. We must need to get in front of the changes Future Technology working
build admissions processes that that are coming, understand which paper. http://www.oxfordmartin.
select students adapted to role jobs will be transformed and what ox.ac.uk/downloads/academic/
flexibility and who can show new competencies will be required The_Future_of_Employment.pdf
leadership in changing contexts. and create forward-looking [Accessed February 14, 2017]
However, the dramatic shifts education programmes. Just like 6 Bessen B. Toil and technology:
ahead will also unmask one of the Dorothy Vaughan, we need to Innovative technology is displacing
workers to new jobs rather than
great weaknesses in health sneak in and read the manual for
replacing them entirely. Finance
professions education: the new IBM, recognizing that her
Dev 2015;16–19.
underdeveloped continuing story is about equity, advocacy and 7 Gorman D. Matching the
education. It is now urgent to generosity as much as it is about production of doctors with
create effective, enduring systems technological progress. I think it national needs. Med Educ 2018;52
for continuing education that link will serve us all to spend less time (1):103–13.
learning and adapting to our declaring how complex and 8 Susskind R, Susskind D. The Future
work.11 Neglect of this form of irreplaceable we health of the Professions: How Technology
education may have been less professionals are, and more Will Transform the Work of Human
salient in times of incremental adapting education for a radically Experts. UK: Oxford University
change, but in an era of profound different future. Press 2015.
9 Gulshan V, Peng L, Coram M et al.
transformation when we will need
Development and Validation of a
to retrain thousands of health care
Deep Learning Algorithm for
professionals, it will prove to be a It will serve us all to spend less time Detection of Diabetic Retinopathy
dangerous omission. declaring how complex and irreplaceable in Retinal Fundus Photographs.
we health professionals are, and more JAMA 2016;316 (22):2402–10.
adapting education for a radically 10 Marr B. What is Affective
The importance of metacognition, different future Computing And How Could
situational awareness and other higher Emotional Machines Change Our
human cognitive functions should be Lives? Forbes 2016;1–3. http://
enhanced in medical schools and www.forbes.com/sites/bernardma
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Most health care professionals in artificial intelligence. Radiologists
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Education. The Economist 2017;
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sponsored events and conferences 3 Pugh D, De Champlain A, Gierl
news/special-report/21714169-tec
M, Lai H, Touchie C. Using
(that are often more about hnological-change-demands-
cognitive models to develop
networking than learning) and a stronger-and-more-continuous-
quality multiple-choice question.
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weekend workshops. This approach [Accessed 22 June 2017]accepted
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to lifelong learning is, in the words for publication 13 September
A-P, De Champlain A. Automated
2017
of Gorman about workforce

ª 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education; 13
MEDICAL EDUCATION 2018 52: 3–13

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