Attitudes towards artificial intelligence within dermatology: an international online survey

Abstract

Dear Editor, Artificial intelligence (AI) has emerged as a hot topic within dermatology, and during recent years several studies have demonstrated its benefits in a research setting. While this development is unravelling rapidly and has also been made available to consumers, little is known about the attitudes towards AI among dermatologists. To increase our understanding of dermatologists’ attitudes towards AI within dermatology we prepared an anonymous and voluntary online survey including 29 questions. The survey was distributed to dermatologists through several online channels, including mailing lists, to members of the International Dermoscopy Society. The survey was set up using SurveyMonkey® (SurveyMonkey, San Mateo, CA, U.S.A.) and was open from January to June 2019. The complete survey text and aggregated survey responses are available online.1,2 Linear regression models were used to correlate answers to sex and age group using a score for the answers. All tests were two sided and P‐values < 0·05 were considered statistically significant. In total, 1271 surveys were completed and further analysed. Overall 55·4% of respondents were female, and the median age was 46 years (interquartile range 37–56); 92 countries were represented. Most of the respondents worked in Europe (69·8%, n = 887), and the majority (53·5%, n = 680) mainly worked in a hospital setting. While 85·1% of respondents were aware of AI as an emerging topic in dermatology, only 23·8% had either good or excellent knowledge about AI within dermatology. The respondents were asked about three applications for AI within dermatology. The strongest potential was considered for dermatoscopic images, which was significantly higher than the potential seen for clinical or dermatopathological images (data not shown). Only 5·5% (70 of 1271) of the respondents agreed or strongly agreed that the human dermatologist will be replaced by AI in the foreseeable future. Among dermatologists working in a hospital setting, 17·1% (116 of 680) expressed fear towards increased use of AI within dermatology. The corresponding figure for dermatologists working in a private office group was 18·7% (100 of 535; P = 0·43). For the entire group, 77·3% agreed or strongly agreed that AI will improve dermatology, and 79·8% thought that AI should be a part of medical training. Increasing level of knowledge of AI within dermatology was correlated with a positive attitude (P < 0·001). Men showed more excitement and less fear about the use of AI within dermatology, as well as within medicine in general. An overview of the specific questions relating to attitudes is presented in Table 1. Distribution of answers for questions regarding attitudes and feelings about artificial intelligence (AI) Data are n (%) unless otherwise stated. CI, confidence interval. The five possible answers were transformed into a numerical score (from 1, ‘strongly disagree’ to 5, ‘strongly agree’), which was used as the dependent variable. A linear regression model with both sex and age group as predictors was used. The age groups (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and ≥ 75 years) were used as numerical values in the regression model (i.e. numbers ranging from 1 to 7). All ‘I don't know’ answers were excluded from the regression model. aFemale was used as the reference. The results from this survey suggest that AI is well received within the field of dermatology. Despite the overall optimistic responses, it is still too early to predict how AI will be implemented and used in everyday clinical practice. In a recent editorial, the pros and cons of putting an AI model either before or after the clinician were discussed.3 Moreover, in a neighbouring perspective article, Lim and Flaherty argued that AI must be judiciously integrated into mainstream clinical practice only after dermatologists have received training in its use.4 A recent survey demonstrated that German undergraduate medical students are not concerned that AI will replace human radiologists, and they are aware of the potential applications and implications of AI in radiology and medicine in general.5 Another general survey including 669 Korean physicians and medical students demonstrated that, while only 6·0% of the respondents agreed or strongly agreed that they had a good familiarity with AI, 73·4% thought that it has useful implications in the medical field.6 Recently, the overall attitude towards AI in diagnostic pathology was positive among 487 respondents from 54 countries. In fact, 73·3% of respondents expressed either interest or excitement about the integration of AI tools. Only a minority of the respondents reported being concerned (17·6%) or extremely concerned (2·1%) that AI tools would displace human jobs.7 The majority of respondents received the survey invitation via their interest in dermatoscopy. Therefore, dermatologists with a special interest in this field were more likely to have received the invitation. On the other hand, diagnosis of skin tumours is currently the most appealing target for AI within dermatology. Furthermore, setting up an online link rather than solely inviting dermatologists from a predetermined mailing list voided the possibility to obtain a survey response rate. Finally, the possibility of selection bias is real and it can be speculated that physicians with positive attitudes were more likely to have answered and completed the survey. Our results demonstrate an overall optimistic attitude towards AI among dermatologists. The majority of surveyed dermatologists believe it will improve our diagnostic capabilities. A minority of respondents were concerned about being replaced by AI in the foreseeable future. Funding sources: none. Conflicts of interest: P.T. reports personal fees from Silverchair and grants from MetaOptima Technology Inc. outside the submitted work.

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