Shortly after the summer of 2022, while trying to come up with some ideas for a lecture I had been asked to give on The physician of the future , I browsed through the book published by the Fundación Educación Médica (FEM) in 2009 with the same title ‘ El Médico del Futuro ’ (The Physician of the Future). This is neither the time nor the place to dwell on the lack of progress made on the proposals put forward by the authors of the FEM in the above-mentioned monograph. Yet, on rereading the text, I was struck by two things. One concerns the ongoing validity of its proposals. The other was an appreciation of the lack of insight into the relevance that new technologies would have for medicine in general and more particularly for medical education.

Perhaps this can be justified by the fact that, in the 14 years since the publication of the monograph, technological development has advanced at a dizzying pace. Talking about new technologies 14 years ago referred to the use of computers, and artificial intelligence (AI) was not on the agenda. Today, we speak of digital transformation, digital signatures, the metaverse, avatars and AI without remembering that up until very recently we were still using typewriters, some of which were very modern with a built-in correction key!

In this introduction I must stress one more issue. A look at the archives of the main Spanish national newspapers in the last quarter of 2022 shows few references to AI, but if we repeat the exercise in the first quarter of 2023, the number of times AI is mentioned increases exponentially. Nowadays, we can find quotes about AI every day in newspapers, on radio and television, and especially on social media. Led by ChatGPT, but accompanied by many other competing programs (Frase.io, Salesforce Einstein, NetBase Quid, Synthesia, Sembly and Grammarly, among others), everybody is talking about AI.

I should make it clear that I am no expert in AI and therefore am not qualified to delve into its inner workings. I am a professor emeritus of medicine, and I consider that my years of experience do allow me to give my opinion on the teaching/learning process. This editorial is therefore not intended to address what AI is, but rather to explore its possibilities as a tool or technique for enhancing doctors’ professional practice, as well as for improving the processes by which medicine is learnt.

The future of medicine, as has always been the case, lies in its capacity to adapt to changes of both a technological and a social nature. And I would like to underline the importance of that ‘both’, which in no way subordinates one set of changes to the others, but instead puts them on an equal footing.

There is no need to insist on the importance of the transformation of technology or to draw the reader’s attention to the technological revolution. Back in 1936, in his film Modern Times , Charlie Chaplin humorously reflected on what technology is capable of and the importance of technology adapting to people rather than people adapting to technology. The evolution of technology in general and especially biomedical technology has not only surpassed Charlie Chaplin and Jules Verne, but is in an exponential phase very, very close to its asymptote. What surprises us today because of its novelty will be outdated tomorrow and no longer news.

The other revolutionary component, the social one, also deserves some reflection. The social revolution seems less spectacular, less exponential, perhaps slower, more intermittent in time, but no less dramatic. Among other easy examples, we can recall the French revolution, or perhaps the beginning of the film 1900 , in which the characters in the oil painting The Fourth Estate come to life on their way to the strike - a symbol of the industrial revolution. The members of rural communities, after the famine, looked for work in the city and found themselves exploited by the proletariat: ‘Out of the frying pan and into the fire’. Not only did the technological revolution fail to improve the differences between social classes, it actually widened the gap between them. Announcing a new social revolution is neither the stuff of doomsayers nor a pipe dream. Make no mistake: we have been slow to accept the evidence on climate change. It is now time to strive to reconcile technological development, AI and social peace.

While it may seem that the digressions of this introduction are leading us away from AI and medical education, we are in fact about to connect the two scenarios. The metaverse is no longer just a word - it is a reality. And neither undergraduate medical training nor specialised training or continuing medical education take this reality seriously into account. With today’s techniques we train doctors to practise yesterday’s medicine and, in the best of cases, we think of tomorrow’s methodologies to educate doctors for today’s medicine. Is anyone thinking about training doctors for the future?

Physicists, specialists in bioinformatics and mathematicians formulate equations to anticipate the evolution of tumours in the Department of Integrated Mathematical Oncology at the Moffitt Center (Florida, USA). You don’t have to go that far either: Professors Ben Lehner and James Sharpe are leading a predictive biology project at the Ciutadella-Barcelona Science Cluster. The Hospital del Mar, in Catalonia, just one example among many other Spanish hospitals, is implementing machine learning tools to plan brain irradiation, that is, it is incorporating AI into therapy. These two examples, although there are many more, show that AI is already being used in Spain in both the diagnosis and treatment of patients. It can be argued that this is true, but on a small scale. It could be said that these practices are real, but in very specific pathologies or situations. But the reflection we must make is that in a short period of time these special or infrequent situations will become generalised and recognised as the norm. The presence of AI in different aspects of medicine (learning/practice) is not a prophecy, it is a reality.

At this point, we might ask ourselves a thought-provoking question. If, in a few years (maybe a decade?), AI makes it possible to diagnose and to determine the therapy that is best suited to a patient, what will be left for the doctor to do?

The physician of the future will have a lot of things left to do. Fortunately, doctors will not find themselves out of a job. The patient will continue to be offered the caring hand of a person and not a machine. And the community will still have a care team leader. If we reread and believe the corpus hippocraticum (surely, more Galenic than Hippocratic) and take up the most transcendental aspects of its legacy, in a nutshell we could say that the values of the physician are based on the simultaneous incorporation of two concepts: philotechníe and philanthropíe.

Doctors belong to the group of professionals who love science and technical knowledge, the téchnē , but they do not use their techniques freely and haphazardly. Rather, they use them in accordance with the ethical principles proper to their profession. Medical practice is based both on knowledge of science (love of science/technique), philotechníe , and on ethical principles and respect for humanity (love of the person/man), philanthropíe.

The Hippocratics (and we must ‘hippocratise’ ourselves) do not regard the physician as just another professional, as a téchnitēs , but as an investigator of human nature. The consequence is simple: both technical and human aspects are essential in doctors who, if they pursue excellence, must display both of them. The medical professional will only move towards excellence if, in addition to demonstrating the best knowledge (specific competencies), he or she is aligned with the three universal principles recognised by medicine in the 21^st century: i) the principle of the primacy of patient welfare, ii) the principle of patient autonomy, and iii) the principle of social justice.

But where are these principles, these values (Aristotle would speak of virtues)? Who teaches them? How are they practised? The codes of professional ethics and the guidelines that the English-speaking world has introduced to us hold the keys to ‘Medical Professionalism’. But what we should really be concerned about, now that AI is living alongside us, is how to reconcile the technological revolution of AI with professionalism. That is, how do we harmonise philotechníe with philanthropíe ? Adela Cortina warned us that morality is an article of prime necessity in advanced, deeply demoralised societies, in which we feel overwhelmed by any challenge that arises. It is therefore urgent, before the technological revolution ploughs on and ‘technologises’ all doctors, that we go a step further and reconstruct the Hippocratic Oath and update it not only to the 21^st century, but with a vision that goes beyond into the future. Today we no longer swear to the gods, but instead we enter into contractual relationships based on the three principles mentioned earlier. It is time to bring to light a hitherto unspoken social contract, a contract between doctor and patient or, if you prefer, between the medical profession and the community. It is time for professionals, preoccupied by the technological and social revolutions - the former exponential and the latter menacing - to rise up to face another revolution: the professional revolution, the revolution of professionals.

Undergraduate, specialised and continuing education must be committed to both philotechníe and philanthropíe . The values - the virtues - can be formulated and described in the classroom or in a book, but the pupil does not learn to live out the values of the profession just in the classroom or in a book. The undergraduate, specialised or continuing education student or companion learns from what they experience in their professional setting and therefore role modelling takes on a special relevance in the learning of values, in medical professionalism. The revolution of professionals will begin when we believe that excellence requires both technical and human components.

The revolution of professionals is to believe that the best way to train good professionals is to be good professionals. It is to believe that the influence of our professional activity will produce better doctors. It is to want to be ‘influencers’ for our peers. The revolution of professionals is not to abandon ourselves to the mercy of technology and social change (which we will of course incorporate as appropriate). The revolution for professionals is to be and to train ‘influencers’. It is to practise in a professional manner by following Codes, Social Contracts, Medical Principles and Values that are the basis of the revolutionary commitment that will allow AI to be incorporated into the culture of physicians.

[To be continued: Artificial intelligence and medical education (II): patients’ well-being].