Rethinking medical education in times of AI – Part 4: “When the half-life of medical knowledge shrinks.”

Being a teacher’s son provides you with a masterclass in cheating.

Everyone knew about my mum’s golden rule: “I don’t mind students trying to cheat. They just need to accept the consequences if I manage to bust them.”

And that she did a lot. At times it almost seemed like it had become a guilty pleasure of hers. Decades of practice had made her a detective someone like Columbo would have looked up to.

At dinner she used to tell us about her latest “coup”. Euphoria in her eyes. Victory in her voice. “Passing on a piece of paper… I mean please! Did he think I was born in the Stone Age?” Sometimes I wondered if they even had a chance.

Seeing other people get burnt on a daily basis, naturally I didn’t even consider playing with fire. I was an eager-to-please student learning everything by heart.

…until Medical School. That’s when things changed.

Doctors are used to eating Books

Studying Medicine is fundamentally different from school. First there are your new classmates. If you want to stay a teacher’s pet, then you better be a piranha.

Because competition is fierce: Here everyone is eager-to-please, learning everything by heart. These things no longer make you exceptional. They make you normal.

I’m not saying it’s impossible. But striving for the spotlight requires true grit. Even for the superbrains. And you’ll definitely meet some.

And then there’s the absurdity of the mountains you have to climb. Even if your ambition is to really climb all of them. Everyone eventually has to accept that you have to make some compromise.

Medical knowledge is basically endless. And the “Everest” is getting larger every day.

It’s a tough Battle to win

Now it’s hard to overstate this: We are talking about a collective of people who are generally really good at taking in lots of information. They’re used to it. They even kind of crave it.

Yet, they’re starting to get overwhelmed. Just look at the numbers:

According to estimates, the doubling time of medical knowledge was 50 years in 1950. If you went to medical school back then, education-wise you basically were set for life. Aside from an occasional refresher perhaps. A little bit of “I might as well” and “Sure, why not”.

“50 years in 1950”. I mean come on. Even that’s easy to remember.

In 1980, however, the doubling time already sped up to 7 years. That’s about when my father finished medical school. Sure, you had to visit a conference every couple of years. Maybe even buy the latest version of your specialty’s favorite textbook.

But other than that, your expertise as a seasoned doctor was sort of bulletproof.

Fast-forward to 2010 and the doubling time of medical knowledge shrunk to 3.5 years. Now it’s starting to get spicy. The first few sheep are starting to fall behind, growing the distance to their flock.

This is pretty much when I started studying medicine. After your second or third internship you already started to notice that “seniority” alone didn’t guarantee anything.

The Myth of the all-knowing Mastro

Patients still aspired to receive treatment from the Chief physician. Understandably so. Sometimes silver hair can really seem like the silver lining.

But on the quiet, nurses or assistant physicians would occasionally hint that they personally would much prefer the deputy (or whoever else was the team’s favorite all-star). Not always of course. But more often than you’d like to think.

Suddenly, seeing lots of medical books in the shelves of someone’s office started having the exact opposite effect. “Is this the ancient source of his knowledge or does he also have internet access?” Great relief when you then noticed the router and it worked.

Of course you might think I’m exaggerating. But take a BMJ study from 2017, evaluating the “physician age and outcomes in elderly patients” within US hospitals.

Here the adjusted 30-day mortality rate was 1.3 percentage points higher for physicians older than 60 compared to physicians age 40 and under.

Now before you consider “divorcing” your favorite GP: This is just one study and there are always (many!) exceptions to the rule.

And today?

In 2020 the doubling time of medical knowledge was estimated to be 0.2 years. That is 73 days.

This means medical students who started their studies in 2020 will roughly experience four doublings in medical knowledge until they are allowed to practice medicine.

Just in contrast: Do you know how long it takes to publish a book? Basically ages!

I hope by now it should have become obvious why our approach to medical education must fundamentally change.

I know the prior part alone can be a lot to take in. But there’s an additional “grain of salt” you still have to consider:

Evidence can be a jungle

In 2005 Stanford Professor John Ioannidis shocked the scientific community with his famous paper “Why Most Published Research Findings Are False”. Something he’s only been able to double down on since then (doing similar analyses for numerous different research areas).

Most researchers‘ dire reality to only get “significant results” published has clearly taken a toll on what statisticians would call – well – accurate.

Now the snap judgment might be: “But if a large chunk of publications is shaky, the whole knowledge acceleration isn’t too bad, right?”

Unfortunately, no. Even though most studies might have little or no impact (and even 82 % of doctors feel “that fewer than half of studies they read actually had an impact on how they practice medicine”).

Highly important findings (from accurate studies!) do emerge constantly and increasingly cause entire paradigm shifts in medicine.

These are the ones you really don’t want to miss.

Yesterday’s “Gold Standard” can be tomorrow’s “Malpractice”

So is there a solution in sight?

The answer is “yes”. It’s called cheating. Or more specifically: What my mom (or most teachers) would have called cheating.

Because for whatever reason, back in school it was frowned upon to use a cheat sheet. That’s why cautious kids like me had to learn everything by heart.

But now times have changed. Even the smartest cookie in the box won’t be able to memorize everything.

And even if there’s currently somebody out there who’s actually able to study medicine in 73 days… Then let’s talk again in 2030 or 40. I’m confident that I’ll get my money back.

“But doesn’t that mean that they don’t really ‘know’ things anymore?” (My mom)

Well, of course modern doctors still need to know both the basics and the essentials. That alone can be quite the climb. But beyond that they most of all have to be quick learners… and therefore effectively “cheat”.

By that I mean looking things up, whenever they’re unsure about the current state-of-the-art diagnostic or treatment approach. Which will occur (increasingly) often.

And more than that: They have to understand new concepts really fast.

Ultimately, only an entirely new approach to medical education can be the solution for that.

Continue with part 5 of our series to find out what impact “YouTube, TikTok & Co” have on all of this.

Sebastian Szur is a writer and medical doctor. After completing his medical studies, he went into health-tech where he focused on refining diagnostic algorithms and communicating digital innovation. He’s also worked at a clinic for internal medicine and psychosomatics studying the connection of mental and physical health. Writing has always been an essential part of his life. He’s the Head of Medical Writing at Medudy, a dynamic platform dedicated to enhancing medical education.

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