Navigating medical education in the era of generative AI

所以我觉得AI带来的变化会很类似，我们不该仅仅因为惯性就死守传统的医学专科划分。

So I think AI will look very similar and we should not hold on to this notion of classical medical specialties simply out of convention.

对。

Right.

明白了。

All right.

你现在刚开始住院医师培训吧？

So now you're starting your residency.

你其实正在一家顶级风投机构牵头负责医疗和生命科学领域的投资。

You're, you know, basically leading a charge in health and life sciences for leading venture firm.

我想让你预测一下，两年后、五年后、十年后，医疗行业会变成什么样？

I'd like you to predict what the world of health care is going to look like, you know, two years from now, five years from now, ten years from now.

为了说得更具体点，作为医生兼投资人，你觉得两年后、五年后、十年后，你能做些什么现在根本做不到的事？

And and to frame that, to make it a little more specific, you know, what do you think will be possible that you, as a doctor and an investor, will be able to do two years from now, five years from now, ten years from now that you can't do today?

两年内，我乐观地认为，临床医生会更广泛地使用AI，不只是用于后台事务。

Two years from now, I'm optimistic we'll have greater adoption of AI by clinicians, both for back office use cases.

不管是用AI助手自动生成病历用于报销，还是现在开始拓展到直接面向患者的场景，

So whether that's the scribe and the generation of the note for billing purposes, but also now thinking about that for patient facing applications.

我们已经在用AI草拟病历了。

We're already doing this with drafting of notes.

我觉得未来两年，这类明显有用的应用会迅速普及，不只是在资金雄厚的大型学术医院，而是真正渗透到社区医院、乡村医院和资源匮乏的基层机构。

I think we'll see greater proliferation of those more obvious use cases over the next And two hopefully, we're seeing that across hospital systems, not just large, well funded academics, but really reaching our community hospitals, our rural hospitals, our under resourced settings.

希望到时候，采用率能大幅提升。

I think, hopefully, we'll see greater conversion.

现在我们最大的问题就是‘试点综合症’，对吧？

Right now, we have this challenge of pilotitis, right?

很多人在试，但数据表明，只有三分之一的试点项目能真正落地应用。

Lot of people are but trying the data shows that only one in three pilots are really converting to production use.

所以咱们得把真正有效的推下去，把没用的赶紧砍掉。

So hopefully, we'll move things forward that are working and pare back on those that are not.

对。

Mhmm.

未来两年内，我们解决不了支付模式的问题。

We will not solve the problem of payment models in the next two years.

这是我个人的判断。

That is a prediction I have.

未来五年，我猜在监管机构的帮助下，我们会找到更合适的支付方式来推动AI的应用——毕竟不能光靠让医院和医疗系统自己掏钱来支撑。

Over the next five years, I suspect that with the help of regulators, we will identify better payment mechanisms to support the adoption of AI because it cannot and will not sustain itself simply by asking health systems and hospitals to pay for it.

没错。

Yes.

这办法根本没法大规模推广。

That is not a scalable solution.

对。

Yep.

事实上，如果要求医护人员更多地采用新技术，那就得有新的激励机制，让他们能从中获益。

In fact, I think there have to be new revenue positive incentives if providers are asked to to do more in the adoption of technology.

完全同意。

Absolutely.

对。

Mhmm.

但正如我们所知，AI最有前景的一些应用根本跟收入无关，比如给某人做个诊断——这可能会促使进一步干预，也可能不会。

But as we appreciate, some of the most promising applications of AI have nothing to do with revenue and might simply be providing a diagnosis to somebody, you know, for whom that might drive additional intervention, but may also not.

我们得接受这一点，因为这才是该做的事。

We have to be okay with that because that's the right thing to do.

作为医生，我们有道德责任，在能为患者带来价值的地方就去应用它。

It's our moral imperative as clinicians to implement this where it provides value to the patient.

未来十年，作为技术乐观派，我希望看到的是，医疗服务和医学研究之间的那道墙逐渐消失。

Over the next ten years, what I, again, being a techno optimist, am hopeful we start to see is a dissolving of the barrier that exists between care delivery and biomedical discovery.

这正是十多年前提出的‘学习型医疗系统’的愿景。

This is the vision of the learning health system that was written over ten years ago.

但现实中我们还没实现它。

And we have not realized it in practice.

我强烈主张，每个进入我们医疗系统的患者，不仅要得到最好的治疗，我们还要从他们的经历中学习，去帮助下一个患者。

I'm a big proponent of ensuring that every single patient that enters our health care system not only receives the best care, but that we learn from the experiences of that individual to help the next.

但在我们现在的体系里，根本不是这么运作的。

And in our current system, that is not how it works.

而有了人工智能，这一切现在变得可能了。

But with AI, that now becomes possible.

我觉得把医疗体验和医学研究联系起来，这个未来愿景真的太棒了。

Well, I think connecting healthcare experiences to medical discovery, I think that that is really such a great vision for the future.

我也同意，人工智能真的给了我们希望，让我们有可能实现它。

And I do agree AI really gives us real hope that we can make it true.

摩根，我觉得我们还能再聊几个小时都不够。

Morgan, this I I think we could talk for a few hours more.

你现在做的这些，真的太了不起了。

It's just incredible, what you're up to nowadays.

非常感谢你这次的对话。

Thank you so much for this conversation.

和你聊了这么多，我学到了很多。

I I I've learned a lot talking to you.

彼得，太感谢你抽出时间了。

Peter, thank you so much for your time.

我肯定会好好珍藏这本亲签的《AI在医学中的革命》很多年。

I will be clutching my signed copy of the AI revolution in medicine, for many years to come.

摩根显然不是个普通的医学院毕业生。

Morgan obviously is not an ordinary med school graduate.

在之前的节目中我们看到，那些走在AI医疗前沿的人，往往既是临床医生，又是技术开发者。

In previous episodes, one of the things we've seen is that people on the leading edge of real world AI in medicine oftentimes are both practicing doctors as well as technology developers.

摩根就是这种通才的又一个例子——既是医学生，又是风险投资人。

Morgan is another example of this type of polymath, being both a med student and a venture capitalist.

让我特别印象深刻的是，摩根特别爱动手实践。

One thing that struck me about Morgan is he's just incredibly hands on.

他会主动去寻找最前沿的工具和技术，哪怕这些还处于实验阶段，他也直接用到自己的学习和临床实践中。

He goes out, finds leading edge tools and technologies, and often, these things, even though they're experimental, he takes them into his education and into his clinical experiences.

我觉得这对医学院来说是个很重要的启示：我们真得给学生提供支持，更要真正允许他们去接触和使用这些新工具、新技术。

I think this highlights a potentially important point for medical schools, and that is it might be incredibly important to provide the support, and let's be serious, the permission to students to access and use new tools and technologies.

说实话，每次和摩根交流，我都觉得在医学AI的早期阶段，亲自动手实验是无可替代的，而最好的时机就是在医学院读书的时候。

Indeed, the insight for me when I interact with Morgan is that in these early days of AI in medicine, there is no substitute for hands on experimentation, and that is likely best done while in medical school.

接下来是我的对话，嘉宾是丹尼尔·陈。

Here's my interview with Daniel Chen.

丹尼尔，很高兴你来参加。

Daniel, it's great to have you here.

是的。

Yeah.

不是。

No.

能来这儿我很荣幸。

It's a pleasure being here.

我通常在访谈开头会问一个问题：你平时都干啥？怎么跟妈妈解释？

Well, you know, I normally get started in these conversations by asking, you know, how do you explain to your mother what you do all day?

之所以这么问，是因为我们节目里的很多人头衔都挺高，工作也挺特别。

And the reason that that's a good question is a lot of the people we have on this podcast have fancy titles and unusual jobs.

但我猜，你妈妈对医学生每天做什么，早就有了自己的想法。

But I'm guessing, that your mother, would have already a preconceived notion of what a medical student does.

所以我换个角度问你：你妈妈不知道你上学时每天实际都在忙些什么？

So I'd like to twist the question around a little bit for you and ask, what does your mother not realize about how you spend your your days at school?

还是说，她其实都懂？

Or does she get it all right?

我知道。

I know.

她特别细心。

She is very observant.

这点我先说清楚。

I'll say that off the bat.

但我觉得她可能没意识到，我花在课堂和医院之外的时间有多少。

But I think something that she might not realize is the amount of efforts spent kind of outside the classroom or outside the hospital.

她总说：‘你医院里待那么久，早上那么早就去了。’但她不知道，我从医院回来根本不是说‘好了，今天完事了，躺平睡觉’，而是还得继续：刷题、补没看完的书、把手上那个研究项目收个尾，赶紧发给导师。

Know she is always like saying oh you have such long days in the hospital, you're there so early in the morning but what she doesn't realize that maybe when I come back from the hospital it's not just like oh I'm done for the day, just wind down, go to bed but it's more like okay I have some more practice questions I need to get through, I didn't get through my studying, let me write on, like wrap up this research project I'm working on, get that back to the PI.

从某种程度来说，这些事没完没了，但都是她不知道的。

It's never ending to a certain extent that those are some things she doesn't realize.

对，我觉得大家都知道医科大二的学生总在学习，这好像是大家都能想到的事。

Yeah, I think you know all the time studying I think is something that people expect of second year medical students.

就算是现在，咱们这种顶尖医学院里，大家也都默认要参与科研项目。

And even nowadays at the top medical schools like this one, being involved in research is also expected.

但有一点挺少见的，就是你才读大二，居然已经去临床帮忙了。

I think one thing that is a little unusual is that you are actually in clinic as well as a second year student.

那你目前处理得怎么样？

How has that gone for you?

对，说实话这个过程真的挺有意思的。

Yeah, I mean it's definitely interesting.

主要是这一年来，我的时间基本都花在三件事上。

I would say I spend my time, especially this year, it's kind of three things.

一件是前期的临床基础学习，就是大家印象里那种啃书本的内容——不过说实话，我们现在好像都没什么人用实体教材了。

There's a preclinical stuff I'm doing that's your classic, know, you're learning from the books though I don't feel like many of us do have textbooks anymore.

还有临床部分，你刚才提到的，我们有个挺特别的模式，叫连续整合式临床轮转，这个可以聊聊。

There's the clinical aspect which you mentioned which is we have an interesting model, longitudinal integrated clerkships, we can talk about that.

最后一个部分就是研究了，算是课外活动吧。

The last component is the research aspect right, the extracurriculars.

但我觉得作为二年级学生这么早就开始临床轮转，真的挺特别的，尤其是我们这种模式——通常医学生有两年时间慢慢啃书、打基础，我们可没这待遇。

But I think starting out as a second year and doing your rotations pretty early on in kind of the medical education has been really interesting especially with our format because typically med students have two years to read up on all the material and like get some foundational knowledge.

我们呢？才刚学了一年，就被扔去面对病人了，‘去，这个病人脚踝疼，你去看看’——可课堂上连‘脚踝疼’都还没讲到呢！我该从哪儿下手？

With us it's a bit more we have maybe one year under our belt before we're thrown into like okay go talk to those patients they have ankle pain, right, but we might have not even started talking about ankle pain in class, right, where do I begin?

所以刚开始的时候，真像对着消防栓猛喝水，还特别尴尬：跟病人聊着聊着，自己心里直打鼓——我根本搞不清状况啊！诊断思路乱成一团麻。

So I think starting out it's kind of like you know the classic drinking from a fire hydrant but you also kind of have that embarrassment of you're talking to the patient like I have no clue what's happening or you might have my differentials all over the place right?

但好处是，因为是连续轮转，现在到了最后一个季度，所有东西突然串起来了：哦，原来你说的症状是这样，体检发现是那样，我慢慢能理出几个可能的诊断了，比如最可能的前三项，还能顺带想到下一步该做啥检查，慢慢就能聚焦到最可能的病因了。

But I think the beauty of the longitudinal aspect is that now that we're like in our last trimester everything is kind of coming together like okay I can start to see you know here's what you're telling me, here's what the physical exam findings are, I'm starting to form a differential like okay I think these are the top three things but in addition to that I think these are the next steps you should take so we can really focus and hone in on what exact diagnosis might be.

明白了。

All right.

那我们接下来想聊聊AI。

So, of course, what we're trying to get into is about AI.

说来有趣，我和凯莉、扎克合写的那本书，其实一开始没怎么考虑医学教育的事儿，虽然书里确实有几处我们猜过，医学生应该会觉得AI挺有用的。

And you know, the funny thing about, AI and the book that Carrie, Zach, and I wrote is, we actually didn't think too much about medical education, although we did have some parts of our book where we well, first off, we made the guess that medical students would find AI to be useful.

我们还设计了一些例子，比如弄个虚构的病人案例，然后让AI假装成那个病人。

And we even had some examples, you know, where, you know, you would have a vignette of a mythical patient, and you would ask the AI to pretend to be that patient.

接着你跟它互动，模拟一次问诊过程。

And then you would have an interaction and have to have an encounter.

所以我特别想聊聊，现在这些事儿到底有没有在发生，有多真实。

And so I wanna delve into whether any of that is happening, how real it is.

不过在聊这个之前，咱们先说说你个人跟AI的接触情况。

But before we do that, let's get into, first off, your own personal contact with AI.

我先问个简单的问题。

So let me start with a very simple question.

你平时会用像ChatGPT这样的生成式AI工具吗？

Do you ever use generative AI systems like ChatGPT or similar?

用得可频繁了，几乎每天都会用。

All the time, if not every day.

每天都用，嗯。

Every day, okay.

那你是从什么时候开始用的？

And when did that start?

我觉得是刚推出GPT-3.5那会儿，我有点好奇。

I think when it first launched with GPT 3.5, I was curious.

我身边朋友全是搞科技的，工程师、产品经理，都跟我说：‘丹尼尔，你试试这个。’

All my friends work in tech, software engineers, PMs, they're like, hey Daniel, take a look at this.

一开始我还以为就个高级点的搜索引擎罢了。

And at first I thought it was just more of a glorified search engine.

我后来翻了翻记录，第一次问ChatGPT的问题居然是：‘下周天气怎么样？’

I think I was actually looking back, my first question to chat GPT was what was the weather going to be like the next week?

这种问题随便搜一下谷歌或者手机APP不就有了嘛，对吧？

Like something easily you could have looked up on Google or your phone app, right?

对。

Right.

我当时就想

I'm like

哦，这玩意儿还挺厉害的，但后来我想到在医学院第一次用它的时候。

oh this is pretty cool but then kind of fast forwarding to I think the first instance I was using it in med school.

真正帮到我的第一件事，其实是个编程问题。

I think the first thing that really helped me was actually a coding problem.

我当时在搞科研项目，想用 SQL。

As far as research projects I was trying to use SQL.

我压根没上过任何 SQL 课，就问 ChatGPT：‘你能帮我写段代码，把两列数据合并一下吗？’

Obviously I've never taken a SQL class in my life so I asked Chat like, hey can you write me this code to maybe morph two columns together, right?

这种事我本来得花好几个小时去 Google、看 YouTube 教程，或者啃文档，但 ChatGPT 不仅把代码给我写出来了，还一步步教我：‘你先打开 SQL，点这个菜单，把代码粘到这里，记得文件名别搞错’——结果真跑通了。

Something that might have taken me hours to maybe Google on YouTube or like try to read some documentation which goes through my head, but ChatGPT was able to not only produce the code but like walk me through like okay you're gonna launch SQL, you're gonna click on this menu, put the code in here, make sure your file names are correct and it worked.

所以它在我没受过专业训练的领域，给了我特别强的助力。

So it's been a very powerful tool in that way in terms of like giving me expertise in something that maybe I traditionally had no training in.

那你这么用的时候，身边应该也有同学、朋友在用吧？

And so while you're doing this, I assume you had fellow students, friends, and others.

那你有没有注意到他们是怎么用AI的？

And so what were you observing about their contact with AI?

我猜你也不是一个人在这么用吧。

I assume you weren't alone in this.

是的。

Yeah.

对。

Yeah.

刚推出那会儿我也不太清楚别人怎么用，但要说现在，很多做法其实跟你们书里讲的特别吻合。

I think when I'm not too sure in terms of what they were doing when it first came out, but I think if we were talking about present day, a lot of it's kind of really spot on to what you guys talked about in the book.

那种私人导师、私人教练的模式，现在真的到处都能看到。

I think the idea around this personal tutor, personal mentor is something that we're seeing a lot.

就算上课时老师在讲，对吧？

Even if we're having in class discussions, the lecturer might be saying something, right?

我或者我朋友就会马上打开ChatGPT或者其他模型，去查一个问题。

And then I might be or I see a friend in ChatGPT or some other model looking up a question.

你们还提到，AI能用不同层次解释一个概念，说实话，遇到复杂话题时，我常问ChatGPT：‘你能不能像给我六岁小孩那样讲明白？’把难点拆解清楚。

And then you guys talk about how it can explain a concept at different levels right, but honestly sometimes if there's a complex topic I ask Chad GPD like can you explain this to me as if I was a six year old, breaking down complex topics.

我觉得这种现象在临床前的课堂上很常见，但就连临床阶段，AI也在大量参与教学。

So I think it's something we see in the preclinical space in lecture, but also even in the clinical space there's a lot of teaching as well.

有时候导师正忙着看病人，我有问题也不好意思打扰，就干脆跟ChatGPT聊聊：‘你对这个怎么看？’

Sometimes if my preceptor is busy with a patient but I had maybe a question I would maybe converse with CHADGBT like hey what are your thoughts about this?

还有个特别常见的事——医生特别爱用缩写，而且很多缩写只有他们那个小领域才懂。

Or like a common one is like medical doctors love to use abbreviations and these abbreviations are sometimes only very niche and unique to their specialty right?

我之前读过一位泌尿妇科医生的笔记，第一句话里居然有十个缩写。

And I was reading this note from a urogynecologist and I thought the entire first sentence I think there were like 10 abbreviations.

我直接列了个清单，问ChatGPT：‘在泌尿妇科的语境下，这些缩写可能是什么意思？’

Obviously I compiled lists and asked Chad GP like hey in the context of urogynecology can you define what these could possibly mean, right?

总比在Google里瞎搜，或者不好意思去问导师强多了。

Instead of hopelessly searching in a Google or maybe embarrassingly asking the preceptor.

所以在这些情况下，AI真的帮了大忙。

So in these instances, it's played a huge role.

是的。

Yeah.

当你做这些事的时候，AI 也可能出错。

And when you're doing things like that, it can make mistakes.

那你觉得生成式 AI，比如 ChatGPT，靠不靠谱？

And so what are your views of the reliability of generative AI, at least in the form of ChatGPT?

在医学领域，我们确实很担心这些模型会编造信息，每次和同行聊这个，我都会特别留意这一点。

Yeah, think into the context of medicine, we fear a lot about the hallucinations that these models might have and it's something I'm always checking for when I talk with peers about this.

我们觉得最有用的时候，是模型能给出来源，让我们能追溯回去。

We find it most helpful when the model gives us a source, linking it back.

现在医学界公认的金标准是 UpToDate，这是临床医生写给临床医生看的，但有时候查 UpToDate 耗时太长，信息太多，得慢慢筛。现在很多人改用 Open Evidence，它也是个大模型，但每次都会标注引用的文献，这点特别好。

I think the gold standard nowadays in medicine is using something called UpToDate that's written by clinicians for clinicians and but sometimes searching on UpToDate can be a lot of time as well because it's a lot of information to like sort through but nowadays where a lot of us are using something called Open Evidence which is also an LLM but they always cite their citations with like published literature right?

我觉得，能意识到这些模型的缺陷，同时又能批判性地分析原始文献，这种双重能力，我们现在已经越来越熟练了。

I think being able to be conscious of the downfalls of these models and also being able to have the critical understanding of like analyzing the actual literature, I think double checking is just something that we've been also getting really good at.

你觉得医学生们对 AI 的态度怎么样？

How would you assess student attitudes, med student attitudes about AI?

你这么说，好像这已经是生活中很自然的一部分了。

Is the way you're coming across is it's just a natural part of life.

但大家对AI，尤其是AI在医学中的应用，有明确的立场吗？支持还是反对？

But do people have firm opinions, you know, pro or con when it comes to AI and especially AI in medicine?

我觉得现在大家的看法还挺分裂的。

I think it's pretty split right now.

有一半人像我们一样，对AI的潜力持谨慎乐观的态度。

I think there's the half kind of like us where we're very cautiously optimistic about the potential of this.

它能给我们提供额外的信息，像个辅导老师，还能快速给出答案。

It's able to give us that extra information being that extra tutor, It's also able to give us information very quickly as well.

但另一方面，很多学生担心的——我也同意——是这种依赖会削弱我们独立思考的能力。

But I think the other flip side of what a lot of students hesitate to, which I agree, is this loss of the ability to critically think.

你只要把病人的病史输入进去，让它给你列个十项鉴别诊断清单，这事儿太容易了。

Something that you can easily do is give these models relevant information about the patient history and be like, give me a 10 list differential, right?

作为学生，很容易就觉得‘这太难了，不如直接用AI给的答案吧’，然后就照着做了。

And I think it's very easy as a student to you know this is difficult let me just use what the model says and we'll go with that, right?

我觉得关键是要分清楚，医学院正是你学习如何成为一名好医生的时候，而这离不开敏锐的观察力和批判性思维。

So I think being able to separate that, medical school is a time where you're learning to become a good doctor and part of that requires the ability to be observant and critically think.

要是这些模型一直陪着，反而可能削弱你培养这些能力的机会。

Having these models simultaneously might hinder the ability to do that.

所以我觉得下一步是，这些工具确实很棒，非常有用，但怎么确保它们不会妨碍你发展批判性思维呢？

So I think the next step is like these models can be great, a great tool, absolutely wonderful, but how do you make sure that it's not hindering these abilities to critically think?

对。

Right.

那你做长期临床实习、在门诊的时候，会掏出手机来问AI吗？

And so when you're doing your LIC work, these longitudinal experiences and you're in clinic, are you pulling the phone out of your pocket and consulting with AI?

肯定会啊。

Definitely.

我给自己定的规矩是，为了防止依赖，每天晚上我提前看第二天的病人名单时，都会先自己认真想一遍。

And I think my own policy for this to kind of counter this is that the night before when I'm looking over the patient list, the clinic of who's coming, I'm always giving it my best effort first.

比如，儿科门诊有个小孩，主诉就是流鼻涕，我会先自己琢磨琢磨。

Like, okay, the chief complaint is maybe just a runny nose for a kid in a pediatric clinic.

这到底可能是什么，对吧？

What could this possibly be, right?

这时候我们见得多了，心里大概有数了——可能是上呼吸道感染，病毒性的，也可能是细菌性的。我会先自己仔细过一遍病史什么的，尽量做到位。但要是碰到特别复杂、以前没怎么见过的病例，我也会先自己琢磨个初步鉴别诊断，虽然不一定完美，然后才问ChatGPT：‘除了这些，你觉得还有啥可能？’

At this point we've seen a lot like okay, it could be a URI, could be viral, it could be bacterial, know and then I go through the, know, I try to do my due diligence of like going through the history and everything like that, But sometimes if it's a more complex case, something maybe a presentation I've never seen before, I'll still kind of do my best coming up with maybe a differential might not be amazing, but then I'll ask you know, chattypety like, okay, in addition to these ideas, what do you think?

我是不是漏了什么？

Am I missing something?

通常它给的回复都挺靠谱的。

You know, and usually it gives a pretty good response.

说实话，这种‘找人帮着看看’的想法，我和Carrie、Zach以前觉得现在早该遍地都是了，但实际观察下来没那么普遍。

You know, that particular idea is something that I think Carrie, Zach, I thought would be happening a lot more today than we're observing.

就是让别人帮你再看一遍你的工作。

And it's the idea of a second set of eyes on your work.

至少我们感觉，现在这种做法远没有我们当初预想的那么常见。

And somehow, at least our observation is that that isn't happening quite as much by today as we thought it might.

但说实话，这明明是最安全、最有效的用法之一。

And it just seems like one of the really safest and most effective use cases.

当你观察自己和其他二年级医学生时，你觉得大家在‘第二套思路’这件事上做得怎么样？

When you go and you're looking at yourself and other fellow medical students, other second year students, what do you see when it comes to this second set of ideas idea?

我觉得很多学生确实会用ChatGPT来辅助，毕竟从一开始我们就被教导，千万别漏掉那些警示信号。

I think like a lot of students are definitely consulting ChatGPT in that regard because, you know even in the very beginning we're taught to be like never miss these red flags right.

这些警示信号我们总会在鉴别诊断里考虑，但有时候真不好判断该给它们多大权重。

So these red flags are always on our differential but sometimes it can be difficult to figure out where to place them on that right.

所以除了自己列鉴别诊断，我最近发现特别有用的是跟这些工具聊一聊，看看它们是怎么推理的。

So I think in addition to coming up with these differentials, something I've been finding a lot of value is just chatting with these tools to get their rationale behind their thinking.

我觉得特别有帮助的一点是，这其实也是医学艺术的一部分——搞清楚该开什么检查，比如该做哪些化验。

Something I find really helpful, I think this is also a part of the kind of arts of medicine is figuring out what to order, right, what labs to order.

当然，急诊室里有些标准流程是自动化的，某些症状该做哪些影像检查也有共识，但你要是去问十个医生下一步该怎么做，他们能给你十个不同答案，可我从来搞不懂他们为啥这么选，总说‘我培训这么多年都是这么干的’或者‘我老师就这么教的’。所以我常问ChatGPT：‘为啥这一步该这么做？’‘这主意靠谱吗？’看看它的利弊分析，对我学习帮助特别大。

Obviously you have your order sets that automate some of the things like in the ED or like there are some gold standard imaging things you should do for certain presentations but then you chat to like 10 different physicians on maybe the next steps after that and they give you 10 different answers but there's never, I never understand exactly why, it's always like I've just been doing this for all my training or that's how I was taught so asking ChatGPT like why would you do this next or like is this a good idea and seeing the pros and cons has also been really helpful in my learning.

是的，这真太有意思了。

Yeah, wow that's super interesting.

那现在我想聊聊你接受的教育。

So now know, I'd like to get into the education you're receiving.

你知道，我觉得凯撒医疗在课程设计上真的非常前沿，一直在努力走在时代前列。

And, you know, I I think it's fair to say Kaiser Permanente is very progressive and and really trying to be very cutting edge in how the whole curriculum is set up.

对没听过这个的听众说一下，我从学校创立之初就一直在校董事会任职。

And for the listeners who don't know this, I'm actually, on the board of directors of the school and have been since the founding of the school.

我觉得当初他们邀请我加入董事会，可能就是因为学校想在技术方面超前布局。

And I think one of the reasons why I was invited to be on the board is the school really wanted to think ahead and be cutting edge when it comes to technology.

从我这个位置看，我一直觉得学校在课程里融入的技术还不够多。

So from where I've sat, I I've never been completely satisfied with the amount of tech that has made it into the curriculum.

但另一方面，我也安慰自己，毕竟学生本来就对技术特别敏感，这股潮流挡不住。

But at the same time, I've also made myself feel better about that just understanding that it's sort of unstoppable, that students are so tech forward already.

不过我想听听你们和同学们的真实想法：你们觉得现在的医学教育，有没有足够系统地教你们人工智能这类技术？

But I I I wanted to delve in a little bit here into what your honest opinions are and your fellow students' opinions are about, whether you feel like you're getting adequate training and background formally, as part of your medical education when it comes to things like artificial intelligence or other technologies.

你怎么看？

What think?

你希望课程能做些调整吗？

Do Would you wish the curriculum would change?

这问题问得真好。

Yeah, think that's a great question.

从技术角度来说，学校在为我们创造学习机会方面做得挺到位的。

I think from a tech perspective the school is very good about implementing opportunities for us to learn.

比如学怎么用Epic，对吧？

Like for example, learning how to use Epic, right?

还有凯撒医疗那边叫Health Connect的电子病历系统，对吧？

Or Kaiser Permanente, they call Health Connect, right these electronic health records.

据我所知，好多学校可能都没教这些。

That my understanding is a lot of schools maybe don't teach that.

我们每年大概有一两次培训，告诉你怎么在系统里设快捷方式之类的。

That's something where we get training sessions maybe once or twice a year like hey here's how to make a shortcut in the environment right.

所以从这点来看，学校确实很主动，而且资源也特别好找。

So I think from that perspective the school is really proactive in providing those opportunities and they make it very easy to find resources for that too.

我觉得你毕业的时候，肯定能成为Epic高手。

Yeah I think you're pretty much guaranteed to be an EPIC black belt by the time you finish

是的，不过说到人工智能这块，学校的态度还是比较谨慎乐观的。

Yes, your but then I think in terms of the aspects of artificial intelligence, I think the school's taken a more cautiously optimistic viewpoint.

他们现在还在观望阶段。

They're just kind of looking around right now.

目前课程里还没正式涉及这方面的内容。

Formally in the curriculum there hasn't been anything around this topic.

我听说去年高年级的学生自己组织过一场关于这个话题的讲座。

I believe the fourth year students last year got a student led lecture around this topic.

但跟其他学校的同学聊了聊，发现这东西其实是在慢慢加进课程里的，而且大多是学生推动的。

But talking to other peers at other institutions it looks like it's something that's very slowly being built into the curriculum and it seems like a lot of it is actually student led.

我有个朋友在芬伯格医学院说，他们在临床实习前刚办过一场讲座，教大家怎么用这些工具更高效。

My friend at Feinberg was like we just got a session before clerkship about best practices on how to use these tools.

我另一个朋友在匹兹堡大学说，他们正在试着把一个大语言模型整合进自己的教学系统——学生不用再满网站找课件了，直接问它：‘那天上课讲了啥？能再详细说说吗？’它就能自动调出相关内容。

I have another friend at Pitt talking about how they're leading efforts of maybe incorporating some sort of LLM into their in house curriculum where students can instead of clicking around the website trying to find the exact slide, they can just ask this tool like okay we had class this day, they talked about this but can you provide more information and it can pull from that.

所以我觉得，这些进展很大程度上都是学生带头搞起来的，这其实挺让人兴奋的，因为它也引出一个问题：现在的医生们，是不是也没怎么掌握这些新工具呢？

So I think a lot of this is a lot of it is student driven which I think is really exciting because it begs the question I think you know current physicians maybe not be very well equipped with these tools as well right?

所以他们可能也不太清楚接下来该怎么做，课程到底该是什么样子。

So maybe they don't have a good idea of what exactly is the next steps or what does the curriculum look like.

我觉得未来AI课程的发展，还是得靠学生推动。

So I think the future in terms of this AI curriculum is really student led as well.

是的，这确实挺有意思的。

Yeah, yeah, that's really interesting.

我觉得出现这种情况，不光是因为课程跟不上， accreditation标准也拖了后腿。

I think one of the reasons I think also that that happens is it's not just necessarily the curriculum that lags, but the accreditation standards.

accreditation对医学院特别重要，毕竟得保证拿到MD的人真是合格的医生。

Accreditation is really important for medical schools because you want to make sure that anyone who holds an MD is a bona fide doctor.

在大多数国家，包括美国， accreditation标准都管得特别严。

And so accreditation standards are pretty strictly monitored in most countries, including The United States.

依我看， accreditation机构在理解和接纳AI方面，反应也挺慢的。

I think accreditation standards are also, my observation, are slow to understand how to adopt or integrate AI.

这可不是在批评他们。

And it's not meant as a criticism.

这还是个大未知数。

It's a big unknown.

没人清楚到底该怎么做。

No one knows exactly what to do and how to do.

所以特别有意思的是，据我观察，我和你看到的一样，关于如何把AI融入医学教育，大部分创新其实都来自学生自己。

And so it's really interesting to see that as far as I can tell, I went through the same thing that you just have seen, that most of the innovation in this area about how AI should be integrated into medical education is coming from the students themselves.

我觉得，嗯，这应该是个好现象。

It seems, I think I'd like to think it's a healthy development.

我总觉得，学生可能更擅长用这些工具。

I I something tells me maybe the students are are a bit better at using these tools as well.

我常和我的带教老师聊，因为凯撒医疗也有他们自己的版本。

You know, I I talk to my preceptors because KP also has their

带教老师？也许我们该解释一下。

own version.

嗯，带教老师？也许我们该解释一下。

A preceptor maybe we should explain.

哦，对不住啊。

Oh yeah, sorry.

带教老师就是已经完成住院医师培训、拿到执照的主治医生，他们在临床环境中 basically 就是你的导师。

A preceptor is an attending physician, fully licensed, finished residency and they are essentially your kind of teacher in the clinical environment.

所以KP也有他们自己的那种环境记录设备，我老喜欢问他们：‘你觉得这些工具怎么样？’结果不管哪个专科，意见都特别两极分化。

So KP has their own version of some ambient documentation device as well and something I always like to ask like hey what are your thoughts on these tools right and it's always so polarizing as well even among the same specialty.

比如精神科，我觉得这工具特别适合用在那儿——可我的带教老师死活不喜欢，隔壁的带教老师却爱得不行。看来还是像你说的，很多地方都充满未知。

Like if you ask psychiatrists which I think is a great use case of these tools right, my preceptor hates it, another preceptor next door loves So I think a lot of it is still like a lot of unknowns like you were mentioning.

对。

Right.

说起来真好，你提到这个，因为之前来的嘉宾老提一件事，就是AI在临床里做‘环境录音’，比如自动帮你整理或生成病历。

Well, fact, I'm glad you brought that up because one thing that we've been hearing from previous guests a lot when it comes to AI in clinic is about ambient listening by AI, for example, to help set up a clinical note or even write a clinical note.

另一个特别火的用法，是用生成式AI来回复病人消息。

And another big use case that we heard a lot about that seems to be pretty popular is the use of generative AI to respond to patient messages.

咱们先聊聊病历自动生成这个事儿吧。

So let's start with the clinical note thing.

首先，你对这项技术有什么看法吗？

First off, do you have opinions about that technology?

我觉得这 definitely 挺好的。

I think it's definitely good.

尤其是在家庭医学或者儿科这种跟病人耗时间特别多的环境里，这种工具真的特别有用，对吧？

I think especially where you know if you're in the family medicine environment or pediatric environment where you're spending so much time with patients, note like that is great, right?

从医学生角度来说，说实话有这工具当然好，但写病历本身其实学的东西特别多。

I think coming from a strictly medical student standpoint, I think it's honestly it'd be great to have but I think there's a lot of learning when you write the note.

你知道的。

You know.

我所有带教老师都说过，你写的病历得让我看得出你的思考过程，等到了评估和计划部分，思路要慢慢收拢到一两个最可能的诊断上，这本事得靠长期练出来的。

There's a lot of you know all my preceptors talk about like when I read your note it should present it in a way where I can see your thoughts and then once I get to the assessment and plan it's kind of funneling down towards a single diagnosis or a handful of diagnosis and that's I think a skill that requires you to practice over time right.

所以吧，如果我刚上一年级就有个工具直接给我生成病历，那这种成长体验就没了，你知道吧。

So a part of me thinks like if I had this tool where I can just automatically give me a note as a first year then it takes away from that learning experience you know.

我们一年级的时候，教授和医生们经常给我们反馈病历，那反馈真是多到爆。

Even during our first year throughout school we frequently get feedback from professors and doctors about these notes and it's a lot of feedback.

我觉得你不该把那段写在那里，那部分内容应该归到这一块，比如病历或者SOAP格式里——主观部分是病人告诉你的，客观部分是体检发现的，然后是你对病情的判断，最后才是处理方案。

It's like I don't think you should have written that, that should be in this section, you know, like a medical note or a SOAP note where you know subjective is like what the patient tells you, objective is what the physical findings are and then your assessment of what's happening and then your plan.

这种格式特别讲究，而且医学本身就很结构化，大家都这么干，对吧？

Like it's very particular and then I think medicine is so structured in a way that's kind of like how everyone does it right.

所以回到你刚才的问题，我觉得这工具确实很棒，但不适合医学生用。

So kind of going back to the question, think it's a great tool but I don't think it's appropriate for a medical student.

是的。

Yeah.

听你这么说，真有意思。

It's so interesting to hear you say that.

我们之前请过一位嘉宾，是Epic公司研发部的负责人，赛斯·海恩。

I I was one of our previous guests is the head of r and d at Epic, Seth Hayne.

她说，彼得，医生其实很多思考都是在写病历时完成的。

She said, you know, Peter, doctors do a lot of their thinking when they write the note.

当然，Epic现在也在推那种环境感知的自动记笔记工具。

And, of course, Epic is providing ambient, you know, clinical, you know, note taking automation.

但他一直在提醒我们要谨慎，因为你虽然说这是学习的好机会，但实际上，作为医生，写病历时也是在思考病人的情况。

But, you know, he was urging caution because, you know, you're saying, well, this is where you're learning a lot, but actually it's also a point where as a doctor, you're thinking about the patient.

我们确实得小心，别把这部分工作轻易自动化了。

We do probably have to be careful with how we automate parts of that.

好吧，那你现在正在准备美国医师执照考试的第一步。

All right, so you're gearing up for step one of the USMLE.

那是个大大的多选题考试。

That'll be a big multiple choice exam.

第二步也差不多，特别侧重于高级临床知识。

And then step two is similar, very, very focused on advanced clinical knowledge.

第三步就稍微互动一点了。

And then step three is a little more interactive.

所以大家一直有个疑问：我们该怎么规范AI在医学中的使用？

And so one question that people have had about AI is, you know, how do we regulate, the use of AI in medicine?

有一篇很有名的论文，来自学术界和产业界，提出可以把AI当作人来对待，让它通过同样的执照考核。

And one of the famous papers that came out of, both academia and industry was the concept that you might be able to treat AI like a person and have it go through the same licensing.

这一点在我们写书的时候，Carrie、Zach 和我都认真考虑过。

And this is something that Carrie, Zach, and I contemplated in our book.

写书那会儿，我个人是不认同这个想法的，但现在我觉得它依然有生命力。

In the end, at the time we wrote the book, I personally rejected the idea, but I think it's still alive.

所以我一直在想，你对AI在你未来工作中能用、不能用，到底该设什么标准，有什么看法吗？

And so I've wondered if you have any, you know, any for first off, are you opinionated at all about what should the requirements be for the allowable use of AI in the kind of work that you're going to be doing?

这确实是个难题，界限到底该怎么划呢？

Yeah, think it's a tough question because where do you draw that line?

如果按人类的标准，能通过考试就算合格，那理论上AI也能当医生。

If you apply the human standards of it's passing exams then yes, in theory it could be maybe a medical doctor as well.

AI的共情能力说不定比有些医生还强呢。

It's more empathetic than medical doctors right?

那这道线，到底该画在哪里？

So where do you draw that line?

我觉得，可能正是那种人性的温度，才是病人真正想要的吧。

I think you know part of me thinks it's maybe it is that human aspect that patients like to connect with right?

也许这些工具真的只是帮我们减轻一些认知负担的辅助手段，对吧？

And maybe this really is just like these tools are just aids in helping maybe load off some cognitive float, right?

但另一部分我觉得，得想想那些从小就在这种技术环境中长大的下一代。

But I think the other part of me I'm thinking about this is the next generation who are growing up with this technology, right?

他们整天跟各种应用打交道，不是在平板上滑来滑去，就是跟聊天机器人说话，用着ChatGPT。

They're interacting with applications all day, maybe they're on their iPads, they're talking to chatbots, they're using ChatGPT.

这可是他们成长的日常环境。

This is kind of the environment they grew up with.

那这意味着，他们会不会比我们这一代，或者上一代，更信任这些工具，反而不太看重人与人之间的连接？

Does that mean they also have increased like trust in these tools that maybe our generation or the generations above us don't have that value that human connection?

他们会更不重视人与人之间的联系吗？

Would they value human connection less?

说实话，我觉得这些想法挺让人担忧的——没错，说到底我可能没这些工具聪明，但我至少还能给人安慰；可万一将来那代人根本不在乎这个，觉得这些工具就是最靠谱的，因为他们从小接触的就只有这些，那医生的价值还剩多少？

Know I think those are some troubling thoughts that you know, yes at the end of the day maybe I'm not as smart as these tools but I can still provide that human comfort but if at the end of the day the future generation doesn't really care about that or they perfectly trust these tools because that's all they've kind of known, then where do human doctors stand?

我觉得在某些专业领域，人与人之间的连接可能还是特别关键。

I think part of that is there would be certain specialties where maybe the human connection is more important.

建立这种信任的长期性，我觉得特别重要。

The longitudinal aspect of building that trust I think is important.

全科医学就是个很好的例子。

Family medicine is a great example.

比如血液肿瘤科，癌症治疗这种事，谁都不想听到确诊消息，但我觉得，屏幕冷冰冰地弹出结果，和医生当面跟你聊，感觉完全不一样——这种时候，人与人之间的温度，真的特别关键。

I think hematology oncology with cancer treatment obviously I think anyone's not going to be thrilled to cure cancer diagnosis but something tells me that seeing that on a screen versus maybe a physician prompting you and telling you about that tells me that maybe in those aspects you know the human nature, the human touch plays an important role there too.

是啊，我觉得真正决定未来五十年走向的，可能就是你们这一代人。

Yeah you know I think it it strikes me that it's going to be your generation that really is going to set the pattern probably for the next fifty years about how this goes.

这事儿特别有意思，因为很多事最终都取决于你们怎么反应。

And it's just so interesting because I I think a lot, will depend on your reactions to things.

比如现在已经有病人带着诊断清单来就诊了，你知道的，就是他们自己用ChatGPT查出来的可能病因。

So for example, you know, one thing that is already starting to happen are patients who are coming in armed, you know, with a differential.

我知道他们完全是靠ChatGPT自己搞懂了一堆东西。

I know that they've developed themselves with the help of Chad GPT.

你肯定也想过这些吧。

So let me, you must have thought about these things.

所以，实际上在你的临床工作中，这种情况已经发生了吗？

So, in fact, has it happened, in your clinical work already?

是的，我值急诊班的时候，真见过病人跑来就说，我脖子疼，这是ChatGPT告诉我的一堆可能性，你觉得呢？要不要查这个血、那个血？

Yeah I've seen people come into the ED during my ED shift like emergency department and they'll be like oh I have neck pain and here are all the things that you know Chad told me, Chad GPT told me, what do you think, do I need, I want this lab ordered, that lab ordered.

我第一反应其实是挺好的，也许真该这么做。

And I think my initial reaction is great, maybe we should do that.

但另一方面，你也得明白，不是每个人都有足够的临床背景，知道哪些才是关键，哪些必须优先排除掉，对吧？

But I think the other reaction is understanding is that not everyone has the clinical background of understanding what's most important, what do we need to absolutely rule out, right?

所以我觉得，ChatGPT有时候可能偏向保守，会给病人列出一堆极端可能性，就是为了确保不漏掉任何危险信号。

So I think in some regards I would think that maybe a chat GPT airs on the side of caution giving maybe patients more extreme examples of what this could be just to make sure that it's a way is not missing any red flags as well.

对。

Right.

不过我觉得，我们学到的最重要的一点就是，得跟病人一起做决定，对吧？

But I think a lot of this is what we've been learning is it's all about shared decision making with the patient, right?

你得承认，他列的那些确实都挺有道理，但可能他没考虑到这个症状——

Being able to acknowledge like yeah that list, most of the stuff is very plausible but maybe you didn't think about this one symptom you

你有。

have.

所以。

So

我觉得这其中一部分，可能算是个题外话，就是关于提示词的问题，对吧？

I think part of it, maybe it's a sidebar here, is the idea of prompting, right?

你知道，大家总在说那些提示词工程师，到底该怎么给模型上下文，才能让它答对你的问题？

You know they've always talked about all these prompt engineers, know, how well can you give it context to answer your question?

我觉得关键是要给模型提供准确、相关的信息，而什么该给、什么不该给，这恰恰体现你的临床经验——什么才算真正相关。

So I think being able to give these models the correct information and the relevant information and keyword relevant because relevant is I guess where your clinical expertise comes in, like what do you give the model, what do not give.

所以，我觉得医疗专业人员和普通患者之间的区别，本质上就在这里。

So I think that difference between a medical provider versus maybe a patient's is ultimately the difference.

我想再深入聊聊这一点，因为你提到了信任问题，而信任对患者来说至关重要，直接影响他们对医疗的安心感。

Let me press on that a little bit more because you brought up the issue of trust, and trust is so essential for patients to feel good about their medical care.

我可以想象，你作为一个医学生，第一次见病人，还没建立起信任关系，结果病人反而更相信ChatGPT，而不是你。

And I can imagine, know, you're a medical student seeing a patient for the first time, so you don't have a trust relationship with that patient and the patient comes in maybe trusting ChatGPT more than you.

很有道理。

Very valid.

不，说实话，我经常遇到这种情况。

No, I mean I get that a lot surprisingly you know.

有时候你就会想，哎呀，患者不想见医学生，毕竟我们总是给病人选择权，对吧？

Sometimes like you're like, oh I don't want to see the medical student because we always give the patient an option right?

不管是门诊还是其他就诊，这都是他们的权利，我觉得这完全能理解。

Like it's their time whether it's a clinic visit but yeah those patients I think it's perfectly reasonable.

如果我知道有个二年级医学生要负责给我问病史，我也会有点担心——他问的问题全不全？有没有把信息准确传给主治医生？

If I heard a second year medical student was going to be part of my care team taking that history I would be maybe a little bit concerned too like are they asking all the right questions, are they relaying that information back to their attending physician correctly.

所以从医学生的角度来说，很多事关键在于怎么跟病人解释清楚：这其实是个学习机会。我经常跟病人说，你放心，我做的每一件事，最后都有人复核。

So I think a lot of it is, at least from a medical student perspective, is framing it so the patient understands that this is a learning opportunity for the students and something I do a lot is tell them like hey, at the end of the day there is someone double checking all my work.

但遇到那些带着清单来的病人，我有时候会坐下来，跟他们好好聊聊。

But for those that come in with a list, I sometimes sit down with them and we'll have a discussion honestly.

我觉得你不可能是脑膜炎，因为你没发烧，我们做的那些体格检查也都是阴性的，所以你真没必要太担心。

I don't think you have meningitis because you're not having a fever, some of the physical exam maneuvers we did were also negative so I don't think you have anything too worried about that.

所以我觉得，跟病人开诚布公地聊一聊，是建立最初信任的关键。

So I think it's having that very candid conversation with the patient that helps build that initial trust.

跟他们说清楚

Telling them

听到你对这件事这么上心，真让人佩服。

like you It's impressive to hear how even killed you are about this.

我知道，你这么谦虚，说‘我只是一个二年级医学生，病人当然可能不太信我’，这没错。

You know, I think, of course, and you're being very humble saying, well, you know, as a second year medical student, of course, someone might not, you know, have complete trust.

但我觉得，未来不管医生经验多老、技术多牛，都没法躲开这个问题。

But I think that we will be entering into a world where no doctor is going to be, no matter how experienced or how skilled, is going to be immune from this issue.

咱们时间快到了，我想再提一两个有挑战性的问题。

So we're starting to run toward the end of our time together, and I'd like to end with one or two more provocative questions.

那我先问第一个。

And so let me start with this one.

你这么贴近科技和数字医疗，肯定听说过图灵和诺奖得主们的预测——说有一天，某些医学专科，尤其是放射科，会被机器彻底取代。

Undoubtedly, I mean, you're close enough to tech and and digital stuff, digital health that you you're undoubtedly familiar with famous predictions by Turing and Nobel laureates that someday certain medical specialties, most notably radiology, would be completely supplanted by machines.

最近，像马斯克这样的人还预测，也许某些类型的手术也会被机器取代。

And more recently there have been predictions by others like Elon Musk that maybe even some types of surgery would be replaced by machines.

你怎么看？

What do you think?

你有什么看法吗？

Do you have an opinion?

我觉得‘取代’这个词太重了，对吧？

I think replace is a strong term, right?

说医生会完全过时，我觉得不太可能。

To say that doctors are completely obsolete I think is unlikely.

更可能的是，医生这个角色本身的含义会发生变化，对吧？

If anything, I think there might be a shift maybe in what it means to be a doctor, right?

毫无疑问，放射科医生的需求可能会下降，因为很多简单的工作真的可以自动化了，对吧？

Undoubtedly maybe the demand of radiologists are going to go down because maybe more of the simple things can truly be automated, right?

到时候可能只需要一个监督型的放射科医生，就能顶得上十个普通放射科医生的工作量。

And you just have a supervising radiologist whose output is maybe 10 times as maybe 10 single radiologists right.

所以我确实觉得，未来某些专科的需求可能会下降。当我谈到医生角色的转变时，可能不再那么依赖诊断了——如果这些模型能超强地处理海量信息，那未来医生的核心能力反而会变成：深刻理解这些模型的局限，知道什么时候该介入，这才是下一代医生的关键。

So I definitely see a future where the demand of certain specialties might go down and when I think when I talk about a shift of what it means to be a physician maybe it's not so much diagnostic anymore, If these models get so good at like just taking in large amounts of information but maybe it pivots to being really good at understanding the limitations of these models and knowing when to intervene is what it means to be the kind of the next generation of physicians.

说到手术，我觉得确实是个问题，但可能五十年内还不会发生。

I think in terms of surgery, yeah I think it's a concern but maybe not in the next fifty years.

达芬奇机器人确实挺厉害的。

Like those da Vinci robots are great.

梅奥诊所之前展示过一些视频，那些机器人用计算机视觉来缝合腹腔镜的小切口——这事儿我每天在手术室都干，现在咱们人类和机器人水平差不多了。但问题在于，万一出状况怎么办？机器人能应对突发意外吗？

I think out of Mayo Clinic they were demoing some videos of these robots leveraging computer vision to like close portholes like laparoscopic scars and that's something I do in the OR right and we're at the same level at this point so at that point maybe, but I think robotics still has to address the understanding of like what if something goes wrong, right?

出了事，谁来负责？

Who's responsible?

我觉得短期内，机器人还做不到在突发危险时灵活应对。

And I don't see a future where a robot is able to react to these dangerous situations when maybe something goes wrong.

关键时刻，还是得靠外科医生接手。

You still have to have a surgeon on board to kind of take over.

所以从这点来看，我觉得未来大概就是这个走向。

So in that regard that's kind of where I see maybe the future going.

最后一个问题。

So last question.

你知道，说到时间分配，我们之前采访的嘉宾都提到，越来越多的医生开始搞技术，比如写代码之类的。

You know, when you are thinking about the division of time, one of the themes that we've seen in the previous guests is more and more doctors are doing more technology work, like writing code and so on.

同时，越来越多的技术人员也开始深入学习临床和基础医学知识。

And more and more technologists are thinking deeply and getting educated in clinical and preclinical work.

所以对你来说，咱们展望一下十年后吧。

So for you, let's look ahead ten years.

你觉得自己那时候的工作分工会是什么样子？

What do you see your division of labor to be?

或者说，你那时候怎么跟妈妈解释你每天都在忙些什么？

Or, you know, how would you what would you tell your mom then about how you spend a typical day?

我觉得吧，技术这块我肯定想继续参与，不管是做AI，还是用技术提升医疗质量。我理想的状态是，既能看病人，又能抽时间做些更高层面的大项目。

Yeah I mean I think for me technology is something I definitely want to be involved in my line of work whether it's you know AI work, it's improving quality of healthcare through technology, my perfect division would be maybe still being able to see patients but also balancing some maybe more of these higher level kind of larger projects.

我觉得这样分担一下，挺好的。

I think having that division would be something nice.

是啊，就我对你这点了解，我觉得你肯定特别棒。

Yeah, well, I think you would be great just from the little bit I know about you.

丹尼尔，跟你聊真的特别开心。

And Daniel, it's been really great chatting with you.

祝你 upcoming 的考试顺利，熬过这一两年的医学生涯。

I wish you the best of luck with your upcoming exams and getting past this year or two of your medical studies.

说不定哪天，我就成你的病人了。

And perhaps someday I'll be your patient.

太感谢你了。

Thank you so much.

说起来，我这份工作挺幸运的，经常能跟各个阶段的学生聊天，从高中生到研究生都有。

You know, one of the lucky things about my job is that I pretty regularly get to talk to students at all levels, spanning high school to graduate school.

尤其是跟医学生聊的时候，我总是被他们的聪明、认真和充沛的精力打动。

And when I get to talk, especially to med students, I'm always impressed with their intelligence, just how serious they are, and their high energy levels.

丹尼尔就是这一切的完美体现。

Daniel is absolutely a perfect example of all that.

说老一辈对新技术没年轻人那么在行，听起来有点老生常谈，但说实话，这事儿还真有道理。

Now it comes across as trite to say that the older generation is less adept at technology adoption than younger people, but, actually, there probably is a lot of truth to that.

和丹尼尔聊天的时候，我觉得他挺有分寸的，但也明确表达了：他和同学们并不指望医学院的教授们对AI的理解能跟他们一样。

And, in the conversation with Daniel, I think he was actually being pretty diplomatic, but also clear that he and his fellow med students don't necessarily expect the professors in their med school to understand AI as well as they do.

我毫不怀疑，医学教育必须大改，才能帮未来的医生和护士准备好迎接AI时代。

There's no doubt in my mind that medical education will have to evolve a lot to help prepare doctors and nurses for an AI future.

但这种变革会从哪儿开始呢？

But where will this evolution come from?

回想起我和摩根、丹尼尔的对话，我越来越觉得，改变最可能来自学生自己。

As I reflect on my conversations with Morgan and Daniel, I start to think that it's most likely to come from the students themselves.

只要见过摩根和丹尼尔这样的人，你就没法不对下一代医生充满希望。

And when you meet people like Morgan and Daniel, it's impossible to not be incredibly optimistic about the next generation of clinicians.

再次衷心感谢摩根和丹尼尔抽出时间跟我们分享他们的经历。

Another big thank you to Morgan and Daniel for taking time to share their experiences with us.

也感谢各位听众的收听。

And to our listeners, thank you for joining us.

我们只剩最后两期了，一期讲AI对公共卫生部门和医疗系统运作的影响，另一期是合著者圆桌讨论。

We have just a couple of episodes left, one on AI's impact on the operation of public health departments and health care systems, and another co author roundtable.

希望大家继续关注。

We hope you'll continue to tune in.

我们下期再见。

Until next time.