Review article: Impact of Artiﬁcial Intelligence in Medical Education

Cutting edge educational technologies such as AI and virtual reality are widely utilized in higher education to develop virtual learning resources. Therefore the application of artiﬁcial intelligence in clinical practice is considered a promising area of expansion in medical education. This study aimed to explore the current use of artiﬁcial intelligence in medical education. The researcher highlighted gaps and the area of future research. Majority of articles published on the role of AI in medical education highlight the demand for curriculum reforms based on the latest technologies in education. computer-based decision support systems will make a diﬀerence in the traditional medical curriculum and changes in the student's knowledge, problem-solving, and information-seeking skills. These articles highlight the challenges related to the implementation of AI in medical education for its sustained growth. There is apprehension that e-learning may impact negatively the students who beneﬁt from human-human interaction. However, faculty training, seminars, and workshops can enhance the faculty and students' perspectives about the role of AI in medicine.


Introduction
In the current era, artificial intelligence (AI) is playing an extraordinary role in medical education to improve the quality of training. AI, machine learning, and associated new technologies assist in big data management and eventually improves educational aspects in medicine. AI is commonly referred to as machine intelligence and it is defined as the use of machines that have some of the qualities which the human mind carries, such as the ability to With the accelerating level of health digitalization, AI tools and applications have escalated due to heightened demand among the medical educators, educational organizations, and industries associated with the medical field. However, it is worth stating that there has been little known about the impact of AI in medical education. Besides, an in-depth investigation is desirable to comprehend the user's experience and apprise guidelines in medical education (Aboueid et al., 2019). For instance, the usage of AI in medical education can support learners mostly through its capability to deliver individualized feedback.
Few studies determined the advantages and challenges that are encountered when AI is incorporated into medical education (Bhhatarai et al., 2019). However, little stress is noticed on the curriculum review and assessment of students' learning due to the lack of digitalization and the complex nature of examinations, respectively (Chan and Zary, 2019). This study aimed to explore the current use of artificial intelligence in medical education. The researcher will highlight gaps and the area of future research. Findings will help medical experts, educators, and policymakers to integrate AI in medicine for the optimum training of health through enhancing the concept of digital health.

Method
In this literature review, we utilized the PRISMA systemic review guidelines to collect information, analyze, and present data. To identify relevant research, we used academic databases including; Cochrane Library, Medline, PubMed Central, Web of Science, and Google Scholar. Besides reference searching was done in an attempt to recognize further relevant studies. The following keywords were used to find published articles: Artificial intelligence, machine intelligence, medicine, medical education. Then we narrowed down our research to be more precise and used the following keywords Artificial intelligence, medical education.
Three authors independently reviewed the article search results to select peer-reviewed, English language articles, determining the role of artificial intelligence in medical education in a diverse context of the studies and different fields of medicine. Our study included the original articles (Peer-reviewed published & approved), commentaries, editorials, and conference news in medical education. This strategy ensured that the information obtained is vast and non-ambiguous. To ensure that the information that is incorporated into the research is not outdated, the researchers stick to academic papers that were published between the years January 2019 and July 2020.

Results
For this review article, we found 4355 articles identified published from January 2010 to May 2020 using keywords: Artificial intelligence, machine intelligence, healthcare system, medical education. 4067 articles were excluded after title review (Clearly irrelevant) and were not matching to initial keywords and we read 288 abstracts. 256 articles were excluded as three reviewers commented that these articles were more focused on the role of AI in the Iqbal S, Ahmad S, Akkour K, Wafa A, AlMutairi H, Aldhufairi A MedEdPublish https://doi.org/10.15694/mep.2021.000041.1 Page | 3 healthcare system and advanced technologies in hospital setups. Figure 1 presents the flowchart of the research based on inclusion criteria of keywords (Artificial intelligence; machine intelligence; medicine; Medical education). We included 46 articles for full manuscript study and these articles were mentioning different types of intelligent information systems in medical education and digital tools assisting medical educators. These studies stated the challenges linked to the implementation of AI in medical education and debate on key areas to contrivance AI in medical education. Table 1 presents the summary of themes discussed in 30 articles on the role of AI in medical education. Table 2 showed the author's details, the title of articles context/method of study, and the conclusion of each article. Curriculum reforms in medical education 8 2.
Deep learning models in medical education 7 3.
Virtual Reality in medical education 5 4.
Challenges for implementation of AI 6 5.
Future predictions and apprehensions about AI 4 Suggest adopting a hybrid educational approach using visual rating scales in an operative environment, supplemented by simulated sessions to uncover potentially problematic surgical techniques.

AI assistance in the educational learning environment
Majority of articles published on the role of AI in medical education highlight the demand for major curriculum reforms based on the cutting-edge technologies in education. In the future, computer-based decision support systems will make a difference in the traditional medical curriculum and changes in the student's knowledge, problemsolving, and information-seeking skills (Berner and McGowan, 2010). Mostly published articles highlight the challenges related to the implementation of AI in medical education for its sustained growth. Medical instructors may use this AI-assisted authoring tool to generate their diverse characters that will interact efficiently with the students in the e-learning environment (Alepis and Virvou, 2011).
These days, educational technologies such as AI and virtual reality are widely utilized in higher education to develop virtual learning resources (VLRs). These tools are found to be very effective to enhance the learning experience for learners (Birbara, Sammut, and Pather, 2019). Therefore the application of artificial intelligence in clinical practice is considered as an auspicious area of expansion, especially for diagnostic medicine, teleconsultation, and genomics (Briganti and Le Moine, 2020). Additionally, the concept of using the Chatbots can help the medical students by engaging in pedagogically sound discussion, evaluating students, and giving instant feedback (Chan and Pawlina, 2020).
There is apprehension that in the future e-learning may impact negatively the students who benefit from humanhuman interaction. To determine the attitudes of undergraduate medical students regarding AI, the majority of studies do not support that AI will replace human physicians (Pinto Dos Santos et al., 2019). However, faculty training, seminars, and workshops can enhance the faculty and students' perspectives about the role of AI in medicine. Medical educators could find the chance to use this tool to create their way to interact effectively with their students (Alepis and Virvou, 2011).

Research Gaps & Areas for Further Inquiry
In this review, we ended with a lot of questions that need to be answered by medical educators in the modern medical education era.
Should AI be a compulsory part of medical education at undergraduate and postgraduate training?
How AI can be embedded in the undergraduate medical curriculum?
Will diverse currulum models need different approaches to amalgamate AI?
Will medical educators adapt to AI tools and virtual reality environments through enhancing the knowledge are skills required for AI in medical education?
How can medical educators prepare and proact swiftly to future evolutions in AI-oriented medical education?
Whether machines will achieve the insight and intelligence of human educators?
Should we arrange workshops and awareness campaigns for the rapid adaptation of AI in medical education?
Although virtual reality and simulation have been developed in medical education, how can engagement of AI in the real education system be sustained?
How will faculty development progress in the AI era?
An issue that saturates most of these questions is: will the next generation of medical students remain the same as that of now?
These questions challenge a considerable schema for future research and advance an open debate among medical professionals and educators. A quote from Ray Kurzweil (American inventor and futurist 2020) is appropriate: "Artificial intelligence will reach human levels by around 2029. Follow that out further to, say, 2045, and we will have multiplied the intelligencethe human biological machine intelligence of our civilization -a billion-fold."

Limitations
The article represents the rational and thoughtfulness of 3 independent reviewers and interpretation may differ. However, the conclusive comments are agreed upon by all authors.

Conclusion
Cutting edge educational technologies such as AI and virtual reality are widely utilized in higher education to develop virtual learning resources. Therefore the application of artificial intelligence in clinical practice is considered a promising area of expansion in medical education. Majority of articles published on the role of AI in medical education highlight the demand for major curriculum reforms based on the latest technologies in education. computer-based decision support systems will make a difference in the traditional medical curriculum and changes in the student's knowledge, problem-solving, and information-seeking skills. These articles highlight the challenges related to the implementation of AI in medical education for its sustained growth. There is apprehension that in the future e-learning may impact negatively the students who benefit from human-human interaction. However, faculty training, seminars, and workshops can enhance the faculty and students' perspectives about the role of AI in medicine.

Take Home Messages
Artificial intelligence (AI) has an extraordinary role in medical education. There is an intense demand for curriculum reforms based on the latest technologies in education. The diverse challenges related to the implementation of AI in medical education need to be understood by medical educators. Faculty development programs can enhance the perspectives about the role of AI in medicine.

Notes On Contributors
Dr. Shazia Iqbal is working as an assistant professor and director of the medical education unit at Alfarabi College of Medicine, Riyadh, Saudi Arabia. She is the author of this article and developed the study concept/design. She assists in the undergraduate curriculum development with a special interest in innovative educational technologies in medical education. ORCID ID: https://orcid.org/0000-0003-4890-5864