Dr. Anthony Chang

"The value of a college (any) education is not the learning of many facts, but the training of the mind to think."

Albert Einstein

Healthcare AI has rapidly evolved. The era of "computational" intelligence (Healthcare AI 1.0, 2010-2020), dominated by machine and deep learning in areas like medical imaging, has given way to Healthcare AI 2.0 (2020-2030). This current period, characterized by generative and agentic AI, can be termed "convolutional" intelligence due to increased human-AI engagement. We've transitioned from data processing and algorithmic computation to a time of generative models, agentic behaviors, multimodal synthesis, and human-machine collaboration. With the influx of "superinformation" from generative AI and large language models (LLMs) that seemingly "reason" and "think," it's crucial for humans to continually assess how we maintain cognitive relevance.

The next wave, Healthcare AI 3.0, promises even more "cognitive" elements, mirroring human cognition. To prepare for this future, we must define and elaborate on key human cognitive concepts: cognition, logic, clinical reasoning, clinical judgment, and critical thinking.

Cognition and logic in the age of AI

Cognition is the overarching process enabling clinical reasoning, judgment, and critical thinking, encompassing perception, attention, memory, language, problem-solving, decision-making, reasoning, and learning. Human cognition is dynamic, involving both explicit reasoning and often inexplicable tacit knowledge, always contextualizing information. While AI simulates aspects of cognition (perception via sensors, reasoning via algorithms, learning via models), it doesn't embody human cognition in its full, nuanced sense.

Logic, a rule-based system of thinking, forms the bedrock for clinical reasoning, clinical judgment, and critical thinking. In healthcare, logic allows us to draw conclusions, detect inconsistencies, make inferences, and apply deductive, inductive, and abductive reasoning to clinical data. While AI's logical processes can be opaque, human logic is typically more transparent and explainable.

The three "C"s of higher-order cognitive intelligence in healthcare

While often used interchangeably, clinical reasoning, clinical judgment, and critical thinking are distinct yet interconnected higher-order cognitive processes crucial for healthcare. All three necessitate a foundation of domain-specific knowledge, experience, and reflection.

• Clinical reasoning: This is a complex, multi-dimensional construct where a clinician identifies and prioritizes relevant clinical data to develop a hypothesis and a plan to confirm or refute it. A growing challenge (and opportunity) is the evolving concept of diagnosis as a collaborative effort involving clinicians, patients, and families. An example is forming a differential diagnosis for chest pain in a 67-year-old diabetic man.

• Clinical judgment: This is the process of reaching a conclusion and making a decision about patient care after applying reasoning and knowledge. It is a synthesis of reasoning, ethics, values, experience, and often, wisdom. Many of these dimensions are uniquely human. An example would be deciding whether to operate on a high-risk patient with multi-system failure.

• Critical thinking: Derived from the Greek "kritikos," critical thinking, if logic is the structure, is the discipline or philosophy. It's defined as a clinician’s capacity to engage in higher-level cognitive skills such such as analysis, evaluation, interpretation, inference, explanation, and self-reflection. These skills are often built upon logic, reasoning, and judgment. Critical thinking is essential for effective performance in all aspects of society, particularly healthcare. Logical cognitive frameworks will become even more critical with AI adoption. Human traits like curiosity, skepticism, and humility drive critical thinking, which is vital for managing medical uncertainty. An example is assessing the bias or reliability of a publication on an innovative diabetes treatment.

The Cognitive hierarchy and preserving humanity

These three "C"s are intricately linked within a cognitive hierarchy: Cognition enables logic, which structures critical thinking. Critical thinking, as an evaluative cognition applied in clinical reasoning, leads to clinical judgment and an actionable decision. These are not isolated concepts but deeply interconnected pillars of clinical practice in the coming decades. By preserving these cognitive dimensions, we can successfully retain the essence of our humanity in an increasingly artificially intelligent world.

AIMed25: shaping the future of AI in medicine

The vital topic of preserving human dimensions in the age of AI will be a key focus at AIMed25. Artificial Intelligence in Medicine (AIMed) is the longest-running conference (inaugurated in 2013) dedicated to AI in medicine and healthcare. Attracting over 1,000 clinicians from more than 50 subspecialties, along with healthcare leaders, data scientists, students, trainees, entrepreneurs, and investors from around the globe, the 3-day event covers a broad spectrum of AI-related topics. This includes generative AI, agentic AI, large language models, cybersecurity, and intelligent extended reality.

This year, AIMed25 features three special tracks: AI in pediatrics and neonatology, AI in health professional education, and AI and mental health of clinicians and patients. Special features include breakfast workshops on hot topics (chosen by attendees), afternoon subspecialty breakout sessions for over 20 different areas, an abstract competition with scholarships, and a popular one-day American Board of AI in Medicine (ABAIM) course. A special Chief AI Officer agenda will also be part of AIMed25.

See you there!