Artificial intelligence (AI) holds significant potential in nursing education to create more sophisticated and complex simulations that help nursing students develop critical thinking skills and prepare them for real-world patient care situations. However, as with any new technology, it also presents concerns and controversies about its use in nursing education.
Dr. Hunter Cherwek is the vice president of clinical services and technologies at Orbis International, with a specific interest in how training and technologies can be used to eliminate avoidable blindness in low-resource communities around the world. In his role, Dr. Cherwek supports Orbis’ clinical training efforts and patient care programs.
Daily Nurse spoke with Dr. Cherwek about Orbis’ use of AI in their Cybersight program and AI’s role in nursing education.
What follows is our interview, edited for length and clarity.
Dr. Hunter Cherwek is the vice president of clinical services and technologies, Orbis International. Photo by Geoff Oliver Bugbee
How can AI be used to improve health on a global scale?
More people in the world have access to the internet than clean water. For example, 98% of adults in Kenya have a cell phone. There are more ways of reaching patients and offering them services than ever. AI has huge potential to diagnose and treat patients in areas where that was previously impossible.
Regarding global eye care and avoidable vision loss, AI can bridge the physical distance required for diagnosing eye diseases. Orbis has shown in places like Rwanda, Vietnam, and Bangladesh, where eye care clinics are few and far between, that AI can detect signs of serious eye conditions like glaucoma, diabetic retinopathy, and macular disease within seconds. This means patients can get treatment immediately or be referred to a specialist at the same appointment without undertaking more costly and sometimes arduous travel or taking time away from home and work obligations.
In eye health, we also see AI acting as an awareness and education tool. AI can better educate patients and health care providers, especially technicians in rural clinics.
AI is a tool in the doctor’s tool belt. It is not a replacement for the doctor. It is a way, say, for a healthcare worker in a rural clinic, often the only eye health provider for hundreds of miles, to diagnose and treat more efficiently the patients who need their help the most.
Does AI provide students with a convenient and accessible way to access information and practice clinical skills?
Yes, AI-assisted searches, AI-assisted education, and AI-assisted diagnosis are all valuable tools for a student. At Orbis, we have trademarked the term “machine mentoring.” Instead of just learning from a machine, we use machines and AI to mentor doctors, nurses, technicians, and patients. We see huge potential – when AI is properly supervised and studied – to help educate at all levels of eye care, from the patient to the surgeon.
Talk about how Orbis uses AI in its award-winning Cybersight program to expedite teaching, common diagnosis, and in-person training via its Flying Eye Hospital program.
Orbis’s robust telemedicine program, Cybersight, has been important in educating eye care professionals for over 20 years. It started at the dawn of the internet. The platform’s AI tool is only one of its features. Cybersight also connects healthcare workers in their home country with recognized experts from around the world to consult about specific patient cases, participate in live lectures, watch live surgeries, and take virtual courses in eye health. This method has proven to be successful not only in improving patient care but also in mentoring the next generation of eye care professionals.
Now, when a doctor logs on to Cybersight and requests a consult with a world-class expert, they can enable AI to help detect certain diseases by simply submitting a picture of a patient’s retina. The AI can give an immediate result when the patient’s data is submitted, and the image is uploaded. The doctor on the ground at their clinic can take action to treat the patient sitting in front of them before they even speak to the expert. The AI acts as a mentor because it shows the doctor how to recognize the patterns that are attributed to the disease it found. For example, the AI will highlight where the signs of glaucoma are located in the picture and how advanced the case is. Over time, the doctor will learn how to diagnose the condition on their own.
We use Cybersight before and during our Flying Eye Hospital programs. Orbis’s Flying Eye Hospital is the world’s only fully accredited ophthalmic teaching hospital on board an MD-10 aircraft. The Flying Eye Hospital is a state-of-the-art teaching facility with an operating room, classroom, and recovery room. On board, the Flying Eye Hospital, Orbis’s Volunteer Faculty, and clinical staff share their knowledge and expertise with local eye care teams. We use Cybersight to prescreen patients, often using AI, even before the plane has landed in a new country to begin a surgical training program. During the program, we use AI teaching, and we conduct workshops on AI.
What are the potential misuses of AI in nursing education?
AI, as an educational tool, can make a student’s learning faster, but it may not make it deeper unless it is used correctly. Like any tool, it can be used for good or bad. I worry that people will use AI to bypass knowledge that usually becomes hardwired through the learning process. So much of what we are trying to learn in medicine is judgment, critical thinking, and assessment workflows. If AI gives you the answer and you haven’t learned the why behind that answer, you could be doing yourself a disservice. AI can’t teach you how to think like a nurse. AI can’t teach you the human side of nursing. It can’t teach you how to get to a differential diagnosis, create a knowledgeable treatment plan, and build soft skills like communicating with patients and showing compassion.
Also, healthcare professionals would become dependent on AI without developing full competency. On the other hand, AI could be the best thing for a motivated self-starter student. With AI, they have more access to books and more synthesis of information and data. But someone uninterested in self-learning or self-development could quickly become dangerous.
What are some of the potential limitations and fallacies in the use of AI?
Technology is very good at amplifying the behaviors and systems that are already available. Simply throwing technology at a problem cannot solve the problem alone. It is going to enhance what is already there. AI can enhance a good system that is already in place or make a bad one worse.
We don’t know all of AI’s limitations or benefits yet. It’s a field in its infancy, and we are just starting. Orbis is leading the charge in developing AI in global eye health to find the potential benefits of this fascinating new technology.
Anything that can make the human experience better and improve human suffering is a technology I want to explore. I want to validate, test, research, and ensure it gets to the right people for the right purposes.
As AI continues to develop, will it replace educators in the future?
AI can make educators more powerful and more impactful. But there is an element of humanity in medicine and teaching that a machine can never duplicate. AI cannot teach the nuances of interviewing patients and how to show human kindness and compassion. A huge part of the medical field is not about science. Medicine is a very human experience. It is about listening to someone cry when they lose their loved one. It is the art of telling someone about a bad diagnosis while providing hope and a path forward. We can’t outsource humanity to a machine. There is no algorithm for compassion.
Does this mean that training critical thinking, rather than delivering the content of the class materials, becomes more important than ever?
A single lesson can give a student data, information, and knowledge. But the wisdom to use this data, information, and knowledge is where it counts. The hardest thing a surgeon needs to learn is judgment, not how to operate. My favorite professor in ophthalmology said the best surgery he ever did was the one he never started. The ability to evaluate risk and reward cannot be replaced. Technology will help us if we don’t lose sight of our humanity and use it to multiply the information at our disposal.
How should we evaluate students’ competency in acquiring knowledge in the classroom? For example, should we start implementing traditional paper and pencil formats for exams?
Traditional testing methods to measure knowledge remain critical. But also, it will become more important to evaluate students with oral exams and in role-playing scenarios with actors playing patients. These tests can assess students’ judgment and how much they have internalized the material.
While we are making concerted efforts to address health disparities and promote equity globally, do you see the advancement of technology further widening the digital divide across populations with various socio-demographic characteristics (e.g., age, socioeconomic status, and geographic locations)?
I worry about two divides: the digital divide and the data divide.
We are familiar with the digital divide, where modern technologies are inaccessible in low-resource regions. The data divide is less visible but equally as important. When data from specific populations or regions are not included in a data set that helps determine an algorithm, that algorithm becomes biased and less reliable. At Orbis, we are leading the way to closing both divides. Our goal is to leverage technology and training to connect doctors and eye health professionals with mentors and education, connect patients to the best care, and create a thriving community where eye care is prioritized and eye diseases are understood. It is the job of nonprofits, like Orbis, to globalize access to technology and education, which is exactly what Cybersight does. Cybersight is giving eye health professionals access to world-class training at no cost, no matter where they live.
Anything else to add?
There are thousands of nurses using Cybersight. I encourage your readers to log on and take a look around!
