European Journal of Cardiovascular Medicine

Artificial Intelligence (AI) refers to the stimulation of human intelligence in machines programmed to think, learn, and problem solve like humans. AI is a rapidly evolving field with applications across industries like healthcare, finance, transportation, and more, aiming to enhance efficiency, automation, and problem-solving capabilities. AI covers a wide range of academic areas and it is an extraordinarily complex sub-division of information technology. In recent years, it has been observed that there was an exponential rise in day-to-day use of AI in practice of medicine. It was also noted that the use of robotic interventions, patient management navigation and imaging technology have been progressively aiding surgical practice. [1,2]. These AI tools draw from various approaches to simulate human intelligence, including supervised machine learning (ML), neural networks, and deep learning [3].

AI has helped in treating a number of diseases and reduced several errors in diagnosis and follow-up in medicine [4,5]. In recent times, AI has grown rapidly and has improved from research to implementation of AI in various departments of medicine [4, 6]. Significant use of AI has been seen in high-income nations as there was high financial support for research in AI. In contrast there was no significant intention in application of AI in low-income nations [4]. According to WHO, there would be shortfall of 12.9 million workers in health care globally by 2035 [4,7].

Various other research studies have indicated that AI plays a vital role in many medical specialities like radiology, pathology, and others [4].

The "quadruple aim" of healthcare-improving population health, improving patient and caregiver experiences, and lowering the rising cost of care-presents formidable obstacles for healthcare systems worldwide.

Global healthcare expenditures, the burden of chronic diseases, and aging populations are making it harder for governments, payers, regulators, and providers to develop and change healthcare delivery models. Furthermore, healthcare systems are forced to "perform" (provide efficient, high-quality care) and "transform" care at scale by incorporating real-world data-driven insights into patient care in the context of the current global pandemic [8].

Increasing healthcare expenditures, the burden of chronic diseases, and more population in the geriatric group are making it harder for governments of various countries, payers, regulators, and providers to develop and change healthcare delivery models worldwide. Furthermore, healthcare systems are forced to "perform" (provide efficient, high-quality healthcare) and "transform" care at scale by incorporating real-world data-driven insights into patient care in the context of the current global pandemic [8].

With the recent advances world-wide and increase in demand of quality of health care facilities by the general population, it is essential to learn newer and advanced techniques. This study aims to assess the knowledge and various methods of artificial intelligence used by medical undergraduate students which aid in their learning process.

This was a cross-sectional study was conducted among undergraduate medical students of a tertiary care teaching hospital in Southern India. This study was conducted for a period of two months, between September and October 2023. All the students from first to final years during the study period were included in the study. Study population contains all medical undergraduate students pursuing their course in that tertiary care teaching hospital.

Sample size was calculated from the previous estimated prevalence study on the Knowledge of AI conducted in India [9].

n= (z² pq)/d² 

Where n = Sample size

p = Estimated prevalence from previous study = 62.5%

q = 100 - 62.5 = 37.5

d = 10% relative precision = 6.25

By substituting these values in the above equation the sample size (n) = 230.5 which was rounded off to 250.

The medical undergraduate students who attended on the day of the study and willing to participate were included in the study. Students who were not present on the day of study, and who had participated in workshops and took part in any training program in the use of AI in various fields of medicine were excluded from this study. A self-designed, semi-structured questionnaire was used as a study tool in this study which was formulated from literature of the previous research studies in this study area. The questionnaire includes the basic details of the undergraduate students, questions regarding the knowledge of the students regarding artificial intelligence, various forms of AI and their use in the medical field and their education; and questions regarding the practice of artificial intelligence by under graduate students.

This study was conducted after acquiring ethical clearance from Institutional Ethics Committee (F. No IEC/KMCH/2023/39) and informed consent was obtained from all the study subjects that were included in the study.

The study sample of 250 medical students was selected from the first year through final year students by using convenience sampling. All the medical students who were present on day of the study, and willing to participate and who had met the inclusion and exclusion criteria were taken into the study. The students included in the study were provided with the printed format of questionnaire which includes questions on the knowledge and practice of artificial intelligence in the medical field. These questions include details on knowledge on various AI tools, types of AI tools used and purpose of use of AI tools in the medical field by undergraduate students.

All the data collected from this questionnaire was compiled into Microsoft Excel sheet and the analysis was done using Statistical Package for Social Sciences (SPSS) Version20. Frequencies or percentages were used to express the findings from the analysis of different variables in this study.

Among 250 under graduate students included in the study between 18 to 25 years of age, The mean age of the study population was 20.66 ± 1.37 years.

Table 1: Age distribution (n=250)

Table 1 represents the age distribution of the study subjects, which shows that 136(54.4%) of students were between 20 – 21 years of age followed by 64(25.6%) between 22-23 years of age.

Table 2 Gender distribution. (n=250)

Table 2 shows that among 250 undergraduate students in this study, 139 (55.6%) were female and 111 (44.4%) were male.

In this study of 250 medical students, 101(40.4%) were in Final MBBS part 1 followed by 74(24.6%) in First MBBS, 55(22%) in Second MBBS and 20(8%) in Final MBBS part 2.

Table 3 Know about Artificial Intelligence (n=250)

Table 3 shows that, among the study population of 250 medical under graduate students, 70 (28%) have no knowledge or not aware of artificial intelligence.

Table 4 Knowledge on use of artificial intelligence in medical field (n=250)

Table 4 shows that 158(63.2%) of the undergraduate students have knowledge on the use of AI in medical field in gaining knowledge in various techniques and clinical methods.

Table 5 Knowledge on machine learning, algorithm, neural network (n=250)

Table 5 shows that among 250 students, 79(31.6%) had knowledge on various modalities of AI in medical practice like machine learning, algorithm and neural network etc.

Table 6 Knowledge on chat GPT (n=250)

Table 6 shows that 83.2% medical students have knowledge on chat GPT and 42(16.8%) does not have knowledge on any AI modalities.

Table 7 Other AI tools other than Chat GPT (n=250)

Table 7 shows that 34(13.6%) of undergraduates have knowledge on other AI tools and majority, 216(86.4%) do not have knowledge.

Table 8 Perception of students on use of AI in medicine (n=250)

Table 8 represents the perception of undergraduate medical students on use of AI in medicine, which shows that 103(41.2%) think that AI is essential in medical field. It also shows that study subjects think that AI will replace various tasks done by physician at varying degree.

Table 9 Used chat GPT (n=250)

Table 9 shows that, among 250 study subjects 135(54%) have used chat GPT while 115(46%) have not used AI.

Table 10 Purpose of using various AI tools (n=250) (multiple responses)

Table 10 shows that majority of undergraduate students 64.4% use AI for studying followed by 28.8% for assignments, 25.2% for research work, 23.2% for assessing the signs and symptoms of patients, and 17.6% for different treatment methods.

Among the 250 medical undergraduate students who were included in the study, 136 (54.4%) were between 20 - 21 years of age and 139 (55.6%) were females.

Previous knowledge on of artificial intelligence:

In our study, among 250 under graduate students, 180 (72%) students have knowledge on previous use of artificial intelligence. Similar results were seen in study conducted in Syria where 70% have previous knowledge of AI [4]. A study done in Pakistan showed 68% students have knowledge on AI [10]. Another study in India shows similar results where 62.5% had heard about AI [9].

Knowledge on the use of artificial intelligence in medical field:

In this study, 158 (63.2%) under graduate students have knowledge on the use of artificial intelligence in medical field. Whereas only 23.7% students know the application of AI in medical field in a study conducted by Swed S et al and in a study conducted in Pakistan also showed that 27.3% doctors and 19.4% medical students were aware of application of AI in medical field [10]. A multicentric study conducted in UK showed that 80% of medical students think that AI will have a vital role in healthcare [11]. Study conducted among French paediatricians showed that 86% were in favour of implementing AI tools in Paediatrics [12]. An online survey conducted on Knowledge and practice of AI showed that 68.4% students believe that it is Compulsory to have knowledge on AI among medical students [13].

 A systematic review done among health care students showed that 76% students had positive attitude towards AI in the clinical profession [14]. A systematic review study on Acceptance of clinical artificial intelligence among physicians and medical students showed that five out of eight studies have 65% or higher awareness regarding application of AI in clinical practice [15].

Knowledge on various types of artificial intelligence tools:

In current study, 79 (31.6%) students were aware about machine learning, algorithm and neural network. 208 (83.2%) were aware of chat GPT and 34 (13.6%) have knowledge on various other forms of artificial intelligence tools. A study conducted by Perrier E et al showed that 40%

have knowledge on deep learning and 5% have received specific training in AI [12].

Perception on use of artificial intelligence in medical field:

Among 250 medical students, 103 (41.2%) students think that AI is essential in the field of medicine and 76 (30.4%) think that AI will replace the role of physician in creating the personalised treatment plans and in giving psychiatric counselling to the patient. Study conducted by Swed S et al in Syria, showed that 45.7% students strongly agree and 41.7% students have positive attitude towards necessity of AI in medical field [4]. A web based survey conducted among the surgeons showed that 61.5% of them thought that AI is useful to support in training and education, 59.5% thought that AI was useful in perioperative decision making and 53% thought it was useful for obtaining surgical vision in emergency surgeries [1]. A study conducted by Ahmed Z et al showed that 76.7% medical students support the inclusion of AI in curriculum, 78.3%, 59.8% and 57.2% addressed the importance and need of AI technology in radiology, pathology and COVID-19 pandemic respectively [10]. A study conducted Jindal A et al showed that 89.1% medical students were optimistic about scope of integration of AI in medicine [9]. A multi-centric study conducted in UK showed that 89% of students believed that having knowledge in various AI tools would be advantageous for their future, and 78% agreed that students should receive training in AI as part of their medical degree [11]. In a study conducted among medical students in Nepal believed that over 49% strongly agreed or agreed that AI will reduce the number of jobs for doctors [16]. A study conducted by Civaner MM et al showed that 58.6%,45.5% and 42.7% thought that using AI in medical field could devalue medical profession, damage trust and negatively affect patient-physician relationships respectively [17]. A study conducted among French Paediatricians showed that 50% of study subjects opinionated AI as a risk to the security of medical data and 35% stated AI as risk to different ethical aspects of medicine in humans. In study by Perrier E et al., 39% of the participants had fear of losing clinical skills because of AI, and 6% feared losing their job because of AI [12]. In an online survey conducted by Al Saad MM et al, showed that 68.4% of the students consider that it is essential for medical students to receive knowledge of AI [13]. Another systematic review including 37 articles identified the 3 primary uses of AI were learning support (n=32), assessment of students’ learning (n=4), and curriculum review (n=1) [18]. A systematic review conducted by Mousavi Baigi et al showed that 29 (76%) of healthcare students had a positive and promising attitude towards AI in the clinical profession and its use in the future; however, in nine of the studies (24%), students considered AI a threat to healthcare fields [14]. A systematic review by Chen M et al showed that 77% were optimistic about prospect of clinical AI, 68% disagreed that AI would become a surrogate physician, but believed it should assist in clinical decision-making [15].

Practice of various artificial intelligence tools:

In present study, 135 (54%) students in the study have used Chat GPT. Majority of the students taking part in the study, 161 (64.4%) used various AI tools for studying. 72 (28.8%) used them for writing assignments. 63 (25.2%) used them for research work. 23.2% and 17.6% used various AI tools for diagnosis and to know various treatment modalities respectively. A study conducted among 19 medical schools of UK showed that 45 out of the 484 responses have received any teaching on AI [11]. In study by De Simone B et al., 25% surgeons out of 200 were trained, robotic surgeons and can perform it but only 19 (9.5%) were currently performing it [1]. A study conducted in Syria showed that residents and assistant professors had 2.371 and 4.422 times higher practice of AI than students [4]. In a study conducted by Perrier E et al 5% paediatricians have received specific training in AI and those who received training in AI had significantly better knowledge and a higher probability of having encountered AI tools in medical practice [12]. A systematic review with cross sectional survey including 60 studies showed that 10-30% had actually used AI [15].

In our study among 250 undergraduate medical students, 72% had knowledge on artificial intelligence but only 63.2% had knowledge on the use of artificial intelligence in medical field. Among 250 study subjects, 31.6% had knowledge on various modalities of artificial intelligence tools in medicine like machine learning, algorithm, neural network. 83.2% have knowledge on Chat GPT which is the major form of AI tools used these days among the students, but only 54% of them use Chat GPT. Among students these are mainly used for studying (64.4%). Even though there is some knowledge of artificial intelligence in medical field, there is a huge gap found in training the medical students about the uses and implementation of AI in medical field. Although AI acts as a double-edged sword, the use of AI in the medical field should be encouraged with proper training and developing various techniques that will be useful for the future generations which helps in giving both preventive and therapeutic care to the needy at their reach.

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