Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2023;13(1):e2023035 1 Attitudes Towards Artificial Intelligence Among Dermatologists Working in Saudi Arabia Fatima Al-Ali1, Sam Polesie2,3, John Paoli2,3, Mohammed Aljasser4, 5, Louai A Salah6 1 Department of Internal Medicine, King Hamad University Hospital, Muharraq, Bahrain 2 Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden 4 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 5 Division of Dermatology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 6 Dermatology Department, East Jeddah General Hospital, Ministry of Health, Jeddah, Saudi Arabia Key words: dermatologists, artificial intelligence, attitudes Citation: Al-Ali F, Polesie S, Paoli J, Aljasser M, Salah LA. Attitudes Towards Artificial intelligence Among Dermatologists Working in Saudi Arabia. Dermatol Pract Concept. 2023;13(1):e2023035. DOI: https://doi.org/10.5826/dpc.1301a35 Accepted: June 17, 2022; Published: January 2023 Copyright: ©2023 Al-Ali et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Louai A Salah, Dermatology Department, East Jeddah Hospital, 2277 King Abdullah Rd, Al Sulaymaniyah, Jeddah 22253, Makkah, Saudi Arabia. Tel: 012 232 7555 E-mail loai.salah@gmail.com Introduction: Artificial intelligence (AI) and its applications are among the most discussed modern technologies today. Despite the rapidly expanding use of AI in medicine, and specifically in dermatol- ogy, only a few studies have studied the attitude of physicians toward AI. Objective: To recognize the attitudes towards AI among dermatologists in the Kingdom of Saudi Arabia. Methods: A cross-sectional survey was done among dermatologists in Saudi Arabia. Questionnaires were distributed through several online channels. Results: Overall, 103 dermatologists filled out the survey. The majority saw very strong or strong potential for AI in the automated detection of skin diseases based on dermatological clinical images (50.9%), dermoscopic images (66.6%) and within dermatopathology (66.6%). In regard to results of attitudes towards AI, 56.6% and 52. 8% agreed that AI will revolutionize medicine and dermatology, respectively. However, many of the respondents disagreed that AI will replace physicians (41.5%) and human dermatologists (39.6%) in the future. Age did not impact the overall attitude of dermatologists. Conclusion: Dermatologists in Saudi Arabia showed an optimistic attitude towards AI in dermatology and medicine. However, dermatologists believe that AI will not replace humans in the future. ABSTRACT 2 Original Article | Dermatol Pract Concept. 2023;13(1):e2023035 Introduction With the current advancement of technology, algorithms have taken on a huge role in the field of medicine and dis- placed much of the work of physicians. Artificial intelligence (AI) and its application in various fields are considered one of the most talked about modern technologies today. Experts in medicine have described AI as the stethoscope of the 21st century [1]. AI is a revolution that can help optimize any job. A recent review showed a promising impact on the sensitivity and accuracy in the screening of skin lesions and skin cancer detection [2]. Multiple recent studies demonstrated the ben- efits of AI. Worldwide, there is an increasing number of im- pressive attempts at the rapid leveraging of this technology in dermatology [3]. With the rapidly expanding use of AI in medicine and specifically in dermatology, there are only a few studies that discussed the attitude of physicians towards AI. In order to understand the attitudes, an online survey was prepared. Objective The goal of the current study is to understand the attitudes towards AI among dermatologists in the Kingdom of Saudi Arabia. To our knowledge, this topic has never been investi- gated through research in Saudi Arabia. Materials and Methods A cross-sectional survey was prepared. Survey forms were disseminated electronically through the Saudi Society of Dermatology and Dermatologic Surgery mailing group and a Saudi dermatologists’ WhatsApp group during the months of September 2020, March and July 2021. Included in the study were dermatologists (consultants and specialists) working or having worked in Saudi Arabia at the time of the survey and who had online access. The survey was adapted from the form used in an orig- inal study by two of the authors [4]. It contained 30 ques- tions including socio-demographic data (gender, age, main practice setting, and years of working in Saudi Arabia), their background knowledge and sources of AI and, lastly, their feelings and attitudes towards AI in dermatology. Analysis and data management were done using IBM SPSS software version 23 (IBM Corp., Armonk, N.Y., US). Results were presented as counts and percentages for cate- gorical variables while numerical variables were presented by mean and standard deviations. Also, the General Linear Re- gression Model (GLRM) was used to determine the relation of sex and group with attitudes using scores for the answers. P-values <0.05 were considered statistically significant. Results Among the 103 dermatologists who responded to the survey, 87 (84.5%) were practicing dermatology in Saudi Arabia and 9 (9.4%) were not, at the time of the study (Table 1). The majority of the respondents were male (n=33, 67.3%), mostly between the ages of 31 to 40 years old (n=17, 34.7%) and had 6-10 years (n=14, 28.6%) experience in dermatol- ogy. In regards to their main practice setting, most of the Table 1. Socio-demographic characteristics of respondents in the study (n = 103). Variables n Percentage(%) Practicing in Saudi Arabia Yes 87 84.5 No 9 8.7 Skipped 7 6.7 Distribution of answers to the questions below: Answered 49 47.6 Skipped 54 52.4 Gender Female 16 32.6 Male 33 67.4 Age 21-30 years 2 4.1 31-40 years 17 34.7 41-50 years 7 14.3 51-60 years 8 16.3 61-70 years 15 30.6 Main practice setting University hospital 12 24.5 Military hospital 5 10.2 Public teaching hospital 8 16.3 Public non-teaching hospital 8 16.3 Private clinic 10 20.4 Private hospital 4 8.2 Other 2 4.1 Years of working in dermatology 0-5 years 5 10.2 6-10 years 14 28.6 11-15 years 6 12.2 16-20 years 4 8.2 21-25 years 8 16.3 26-30 years 2 4.1 31-35 years 5 10.2 36-40 years 4 8.2 40 above years 1 2 Original Article | Dermatol Pract Concept. 2023;13(1):e2023035 3 respondents practiced in University hospitals (n=12, 24.5%) followed by private clinics (n=10, 20.4 %), public teaching hospitals (n=8, 16.3%) and public non-teaching hospitals (n=8, 16.3%). Answers regarding background knowledge in AI revealed that 46 (63.9%) knew about AI as a topic in dermatology. However, 11.1% (n=8) had excellent knowledge when it comes to AI in dermatology and the majority (n=20, 27.8%) had only heard about it but not more (Table 2). Meanwhile, when asked about their source of AI information, 68.8%, 65.6%, 42.2% and 32.8% heard about AI from social me- dia, media, friends, and lectures, respectively (Table 3). In regard to potential applications of AI in dermatology, respondents believed that AI has a strong potential in the au- tomated detection of skin diseases based on clinical derma- tological images (n=20, 35.1%), on dermatoscopic images (n=28, 49.1%) and on dermatopathology images (n=23, 40.4%) (Table 4). More than half of the respondents considered themselves as well-educated regarding the use of modern technology (n=28, 52.8%). The majority of respondents had read med- ical publications regarding AI within dermatology (n=25, 51%) while most had not used AI as a diagnostic aid in real life (n=34, 69.4%) (Table 5). Results of attitudes towards AI revealed that age did not affect the attitudes of dermatologists toward AI overall. In general, 56.6% (n=30) and 52.8% (n=28) agreed that AI will generally revolutionize medicine and dermatology, re- spectively. Twenty-six (49.1%) agreed that dermatology and medicine become more exciting to them with the increased use of AI. More than half agreed that AI will improve der- matology (n=30, 56.6%) and medicine in general (n=27, 50.9%) and almost half (n=24, 45.3%) agreed that AI must be part of medical training. However, most respondents expressed disagreement regarding AI replacing physicians Table 2. Distribution of answers regarding background knowledge of artificial intelligence. Count Percent (%) AI is a topic that has become of interest to the Dermatology community. Were you already aware of this topic in Dermatology? Yes 46 63.9 No 26 36.1 Which degree of knowledge would you say you have when it comes to AI within Dermatology? Excellent Knowledge 8 11.1 Good Knowledge 14 19.4 Basic Knowledge 19 26.4 I have heard about it, but not more 20 27.8 I have never heard about it 11 15.3 *72 (69.9.%) participants answered this part Table 3. Distribution of answers regarding sources of knowledge on artificial intelligence. Sources Count Percent (%) Media Yes 42 65.6 No 22 34.4 Social Media Yes 44 68.7 No 20 31.2 Lectures Yes 21 32.8 No 43 67.2 Friends Yes 27 42.2 No 37 57.8 *64 (62.1%) participants answered this part Table 4. Distribution of answers regarding the potential of artificial intelligence in dermatology*. Question Choices Very strong potential Strong potential Moderate potential Low potential No potential I don’t know Automated detection of skin diseases based on dermatological clinical images? 9(15.8%) 20(35.1%) 16(28.1%) 10(17.5%) 1(1.7%) 1(1.7%) Automated detection of skin diseases based on dermatoscopic images? 10(17.5%) 28(49.1%) 13(22.8%) 5(8.8%) 0(0%) 1(1.7%) Automated detection of skin diseases based on dermatopathology images? 15(26.3%) 23(40.3%) 11(19.3%) 6(10.5%) 0(0.%) 2(3.5%) *57 (55.3%) participants answered this part 4 Original Article | Dermatol Pract Concept. 2023;13(1):e2023035 Table 5. Distribution of answers regarding attitudes towards artificial intelligence among dermatologists in Saudi Arabia. Section 1* Question Choices Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree I don’t know AI will revolutionize Medicine in general. 16(30.2%) 30(56.6%) 4(7.5%) 2(3.8%) 0(0.0%) 1(1.9%) AI will revolutionize Dermatology 16(30.2%) 28(52.8%) 4(7.5%) 3(5.7%) 0(0.0%) 0(0.0%) AI will revolutionize Dermatology more than other medical specialties in general. 6(11.3%) 15(28.3%) 16(30.2%) 10(18.9%) 2(3.8%) 4(7.5%) In the foreseeable future, all physicians will be replaced by AI. 2(3.8%) 4(7.5%) 5(9.4%) 22(41.5%) 17(32.1%) 3(5.7%) The human dermatologist will be replaced by AI in the foreseeable future. 2(3.8%) 3(5.7%) 5(9.4%) 21(39.6%) 18(34%) 4(7.5%) A development with an increased use of AI in Dermatology frightens me. 3(5.7%) 6(11.3%) 9(17%) 23(43.4%) 12(22.6%) 0(0.0%) A development with an increased use of AI in Dermatology makes Dermatology more exciting to me. 14(26.4%) 26(49.1%) 12(22.6%) 1(1.9%) 0(0.0%) 0(0.0%) A development with an increased use of AI makes Medicine in general more exciting to me. 13(24.5%) 26(49.1%) 11(20.7%) 1(1.9%) 2(3.8%) 0(0.0%) AI will improve Dermatology. 15(28.3%) 30(56.6%) 5(9.4%) 1(1.9%) 2(3.8%) 0(0.0%) AI will improve Medicine in general. 16(30.2%) 27(50.9%) 7(13.2%) 1(1.9%) 1(1.9%) 1(1.9%) AI should be part of medical training. 21(39.6%) 24(45.3%) 5(9.4%) 2(3.8%) 0(0.0%) 1(1.9%) Section 2** Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree I don’t know I consider myself well informed about the use of modern technology, especially computers. 13(26.5%) 28(52.8%) 3(6.1%) 5(10.2%) 0(0.0%) 0(0.0%) Yes No Would you consider yourself to be someone who enjoys technology? 47(95.9%) 2(4.1%) Have you read any medical publications regarding AI within Dermatology? 25(51.1%) 24(49%) Have you used AI as a diagnostic aid in real life within Dermatology? 15(30.6%) 34(69.4%) *53 (51.5%) participants answered this part ** 49 (47.6) participants answered this part (n=22, 41.5%) and human dermatologists (n=21, 39.6%) in the future. In addition, 43.4% (n=23) were not frightened about the increased use of AI. The majority of respondents were neutral regarding the proposal that “AI will revolu- tionize dermatology more than other medical specialties” (n=16, 30.2%). Discussion In this cross-sectional study, dermatologists in Saudi Arabia showed a positive attitude towards AI. Most of the respondents had not used AI in diagnosis in real settings but generally agreed that AI will revolutionize dermatology and medicine. While 63,9% of the respondents were aware of AI as a topic in dermatology, the majority of them had only heard about it (n=20, 27.8%) and only 11.1% had excellent knowl- edge. Although the awareness of AI among dermatologists was lower compared to the report of Polesie et al. [4], respon- dents viewed AI as having strong potential in the detection of skin diseases. Dermatologists saw a stronger potential of AI in detection using dermatoscopic images and within dermatopa- thology than with dermatological clinical images [4]. Original Article | Dermatol Pract Concept. 2023;13(1):e2023035 5 In our study, although respondents were optimistic about the increased use of AI in the development of dermatology and medicine in general, the majority (n=21, 39.6%) dis- agreed that AI will replace doctors. Only 3.8% strongly agreed while 5.7% agreed with this hypothesis. This is con- sistent with other studies about AI. Polesie et al. reported similar results in which only 5.5% of the participants agreed that human doctors will be displaced by AI [4]. Krittanawong also concluded that although AI may become more effective in diagnosis and image recognition, it cannot replace physi- cians [5]. In a 2017 survey in the United States, the majority of the respondents were worried about computers replacing humans in the future [6]. This was not the case in Korea, in which only 35.4% of the participants agreed that AI will displace physicians in the future [7]. In this study, the relationship between sex and age was determined and examined. The findings revealed that derma- tologists’ attitudes toward AI were unaffected by their age. Similar results were found in the study of Polesie et al. [4]. The current study has some limitations. First, since this is a cross-sectional survey, selection bias and social desirability biases are possible. Due to the selected method of distrib- uting the survey, the response rate could not be calculated. Participants may be more optimistic than those who did not participate. Second, not all the questions in the survey were answered by the participants, some were skipped, resulting also in possible selection bias. Conclusion Dermatologists in Saudi Arabia showed an overall positive at- titude towards AI in dermatology. Overall, age did not affect the attitudes of dermatologists about AI. Furthermore, results showed that most dermatologists were aware of the poten- tial of AI in the automated detection of skin diseases using dermatoscopic, histopathological and clinical dermatologi- cal images. Moreover, they agreed that AI will revolutionize dermatology and the development of AI within our specialty seemed exciting to them. However, most participants believed that AI will not replace physicians in the future. References 1. Mesko B. The role of artificial intelligence in precision medicine. Expert Rev Precis MedDrug Dev. 2017 2017/09/03;2(5):239- 241. doi: 10.1080/23808993.2017.1380516. 2. De A, Sarda A, Gupta S, et al. Use of Artificial Intelligence in Dermatology. Indian J Dermatol. 2020 Sep-Oct;65(5):352-357. doi: 10.4103/ijd.IJD_418_20. PubMed PMID: 33165383; PubMed Central PMCID: PMCPMC7640800. eng. 3. Negnevitsky M. Artificial intelligence. 2nd ed. Essex, England: Addison-Wesley; 2002. 4. 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