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AI Scribes Should Aid Notes, Not Replace Trainee Assessments

Should residents and med students get access to AI scribes? Or does it risk critically de-skilling them? My 7 thoughts: 1/ Students are increasingly using scribes in all aspects of their life. I’m not in school anymore but I suspect many are using scribes in university classes and med school too. The shift to AI note taking is already happening pre-clinical training. Our future workforce is just going to be less experienced at taking notes in general. 2/ I don’t think anyone worries about future doctors being bad at taking notes - but we worry they won’t be good at doing an assessment and plan without practice. Eventually AI scribes will evolve to drafting assessments and plans too to save clinicians time - THAT part of a future AI scribe needs to be turned off for trainees. Automate the history taking, but make sure trainees draft the A/P. 3/ Let trainees interact with an AI co-pilot to get feedback on their A/P but only after drafting. Trainees are already using UpToDate, OpenEvidence or just plain old books to do their A/P anyways - this is just the next generation of self-learning. You can’t stop unmotivated students who don’t want to actually learn, but motivated students who would use AI to learn shouldn’t be penalized. 4/ In the age of AI, the preceptor - trainee teaching relationship is even more important. You can still get trainees doing oral presentations and back-and-forth on patient cases - no one can hide behind AI when you are face-to-face. Hopefully you can go even deeper in these conversations because trainees master the basics faster with AI. 5/ AI scribes should/will provide tools for helping trainees improve - eg grading the clinical encounters and giving feedback on whether trainees missed important questions, how they could have been more empathetic, etc. Faculty should look for ways to use AI scribes to improve clinical training. 6/ At some point, as trainees get closer and closer to independent practice, they should be allowed full AI scribe access - including draft A/P, draft orders and all the other automation that is inevitable. There will be an appropriate gradual increase in access that faculty will have to decide. 7/ The OSCE / live examination process will have to evolve to work in the AI era. AI scribes becoming an acceptable tool in OSCEs will be inevitable - it will be a messy path to getting there but expect it.