RAPID advances in computing and artificial intelligence are forecast to change medical education. As part of the spectrum of medical education, continuing professional development (CPD) is likely to be similarly transformed over the next decade.
CPD is part of the medical education continuum between post-graduate medical training and transition to retirement. Arguably, CPD is the most important component of medical education as it covers all Australia’s medical practitioners working as clinicians (83 731 in 2015) for the many years of their professional practice, many more person-years of education than medical students and post-graduate trainees combined. Because of its long duration, CPD is more subject to change over time. CPD is increasingly recognised as an academic discipline with its own curriculum, evidence base, educators and governance structures. In Australia, the accrediting body for CPD is the Australian Medical Council (through accreditation of specialist medical colleges), the training organisation is the specialist colleges, and the training provider is health services, colleges and self-directed learning.
Computing power has been growing exponentially since Intel released the first microprocessor chip in 1971. The over 400 000-fold increase in computing power has enabled transforming advances in medical education and practice. For example, Microsoft HoloLens is a head-mounted self-contained holographic computer that enables mixed reality, where the user can interact with digital content and holograms. The smart glasses are available at a cost of $3000 each. Case Western Reserve University, in the United States, plans to use HoloLens to teach anatomy in the near future.
Computing power also enabled deep learning, the latest advance in artificial intelligence, a type of machine learning where networks are capable of unsupervised learning from data that are unstructured or unlabeled. Deep learning is now readily available from sources such as Google and is already being used in diagnosis, including photographic screening for diabetic retinopathy, where the results surpass human ability and speed. When coupled with big data analytics (extremely large datasets that may be analysed computationally to reveal patterns), with additional data sources, including the published medical literature, deep learning will offer significant improvement in health care decision making as well as a reduced cost of health care. My Health Record, Medicare and Pharmaceutical Benefits Scheme data, health care apps and smart wearables and patient collaboration via social media are all possible additional data sources.
In this rapidly changing environment, the role of medical professionals will change and CPD will be part of the change. Screening will be performed by machines rather than medical professionals or paramedical staff, and the role of doctors will be to interpret the machine-generated results. Arguably, humanistic aspects of medical care will become even more important in direct patient care. The curriculum of CPD will need to expand to include understanding of data analytics and deep learning. Medical professionals will need to control datasets and teach machines deep learning algorithms, keeping control of the process against “the rise of the machines”. Humanistic health care skills (“human ware”) will be highly valued and must be nurtured through appropriate CPD programs. Humanistic skills will also be necessary to avoid burnout in the new medical environment.
New surgical techniques and technologies continue to develop; many have a steep learning curve. New CPD programs will allow proceduralists to learn new technologies via mixed reality and patient avatars. Learning outcomes from CPD will be able to be assessed far more accurately by mixed reality assessment of competence (Moore’s level 4) instead of surveys of participation or satisfaction which are current practice.
Audit and feedback are thought to be critical in CPD-driven improvements in patient outcomes. Advances in data analytics will allow medical professionals to interrogate their patient records to understand patient outcomes and improve quality of their care. Likely, deep learning will detect patterns that doctors have not identified among their own patients.
Outcomes of CPD also ideally include measures of community health. Big data analytics will facilitate measurements of these outcomes but will require large and novel datasets to do so.
Medical regulatory bodies will also have access to advances in technology. The Medical Board of Australia, as part of its Professional Performance Framework, intends to “proactively identify […] doctors who are either performing poorly or are at risk of performing poorly, [and] assessing their performance […] [Age], professional isolation and multiple complaints are all risk factors for poor performance”. Such an approach will be facilitated by data analytics. Practising doctors will need excellent medical records and understanding of their patient population and comorbidities to ensure that external analysis of their data is accurate and interpreted correctly.
Thus, advances in technology will transform medical practice in ways that cannot as yet be clearly predicted. The role of CPD will expand to allow doctors to be experts in machine data and dataset interrogation, including much wider sources of data than today. Most importantly, humanistic aspects of medical care will become highly valued and CPD will play a critical role in allowing doctors to further develop these skills and prevent burnout.
Heather Mack is President-elect of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). She is an Honorary Senior Clinical Lecturer in the Department of Surgery (Ophthalmology), University of Melbourne. She practises in Melbourne and has a special interest in medical retina and retinal degenerations. She was Chair of the RANZCO CPD committee (2004–2011) and led the development of the current RANZCO CPD program.
I acknowledge Helena Prior Filipe, Chair of CPD for the International Council of Ophthalmology, my long term CPD collaborator.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
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