{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:22Z","timestamp":1790790802865,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/mep.21319.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000}}],"reference-count":51,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["mededpublish.org"],"crossmark-restriction":false},"short-container-title":["MedEdPublish"],"abstract":"<ns5:p>Background Artificial Intelligence (AI) is reshaping healthcare and medical education, with growing calls to embed it in medical curricula. However, evidence on first-year medical students, perceived benefits and limitations of AI, and views on ethics and professionalism is limited. Methods A qualitative study was conducted using semi-structured interviews to explore the experiences, attitudes, and perceptions of first-year students regarding AI. Convenience sampling yielded the participant cohort. Recruitment and analysis continued until thematic saturation was achieved. Transcripts were coded iteratively using NVivo software, and a reflexive thematic analysis was undertaken. Results Twenty participants were interviewed; 18 were AI users, to varying degrees, and two were non-users. Seven themes emerged: How AI is used; Benefits; Concerns and limitations; Ethical considerations; Advice for peers and professors; Attitudes toward and understanding of AI; and Participation in the project. AI users cited motivations like efficiency, personalization, and support. Benefits included faster access to information, organized content, and tailored explanations. Concerns included AI reliability, over-reliance, and ethical misuse, such as plagiarism. Most supported the inclusion of AI literacy in curricula for responsible, practical, and critical use of AI. Participants with AI literacy demonstrated a deeper understanding of AI. Conclusions We found that students in the medical school we studied are early adopters of AI, using it in various ways, and wish to utilize it effectively and ethically. The findings of this study align with other studies in other jurisdictions that call for early AI literacy.<\/ns5:p>","DOI":"10.12688\/mep.21319.2","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T10:14:07Z","timestamp":1771409647000},"page":"226","update-policy":"https:\/\/doi.org\/10.12688\/mep.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["AI Use or Non-use by First-Year Medical Students: A Qualitative Study of Perspectives, Usage, and Recommendations"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7486-9503","authenticated-orcid":false,"given":"Jennifer","family":"Simoni","sequence":"first","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0493-5167","authenticated-orcid":false,"given":"Elisa","family":"Mengual","sequence":"additional","affiliation":[{"name":"Dept. de Patologia, Anatomia y Fisiologia Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Aschenbrenner-Noriega","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Monforte-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1805-1483","authenticated-orcid":false,"given":"Marta","family":"P\u00e9rez-Merino","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4472-6742","authenticated-orcid":false,"given":"Gabriela","family":"Sawczyn","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4925-6254","authenticated-orcid":false,"given":"Roc\u00edo","family":"Zurita","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5974-7833","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Pereira","sequence":"additional","affiliation":[{"name":"Unidad de Educacion Medica Pamplona Navarre 31071 Universidad de Navarra Facultad de Medicina"},{"name":"Pamplona Navarre 31071 Universidad de Navarra Instituto de Cultural y Sociedad"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1186\/s12909-023-04700-8","article-title":"AI in medical education: medical student perception, curriculum recommendations and design suggestions.","volume":"23","author":"Q Li","year":"2023","journal-title":"BMC Med Educ."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"23821205211024078","DOI":"10.1177\/23821205211024078","article-title":"Are we ready to 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Imaging."}],"container-title":["MedEdPublish"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:19:08Z","timestamp":1784873948000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":51,"URL":"https:\/\/doi.org\/10.12688\/mep.21319.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/mep.21319.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/mep.23037.r45420","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/mep.23037.r45441","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/mep.23037.r45418","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/mep.23037.r45441","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/mep.23037.r45420","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/mep.23037.r45418","asserted-by":"object"}]},"ISSN":["2312-7996"],"issn-type":[{"value":"2312-7996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]},"assertion":[{"value":"Indexed","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/mep.22831.r44513, Suriyaarachchige Nishan Silva, Ochre health, Sydney, 24 Dec 2025, version 1, 1 approved, 1 approved with reservations, 2 not approved","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v1#referee-response-44513","order":0,"name":"referee-response-44513","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jennifer Simoni<\/b>; \n<i>Posted: 13 Jan 2026<\/i>; Thank you for your review and comments. They are much appreciated. We are encouraged by the overall assessment of it being a good and useful study. We believe that our research question was best addressed with a qualitative study. Our study goal was to explore, in more depth, why and how students are using AI for medical learning. Qualitative research methods are best suited to this. A survey would have been more appropriate if our goal were to assess the extent to which students use AI. However, with respect to a survey, our team feels that the results of our study support a future exploratory sequential design program of research on this topic,\n<b>&nbsp;<\/b>where the insights from the qualitative study inform the development of a larger survey more targeted toward generalizability.&nbsp; Regarding purposive sampling instead of convenience sampling, we&nbsp;considered&nbsp;it at first but decided against it due to concerns about introducing selection bias. Having said that, at the end, the participants&nbsp;included were,&nbsp;we believe, representative&nbsp;of the mixture of experiences and use of AI by students, as they&nbsp;included students using AI extensively, others using it to a lesser degree, and some not using it at all.&nbsp; We believe the results are presented appropriately as themes and, as is usual practice in qualitative research, are supported with illustrative quotes. The themes were identified by way of an iterative thematic analysis&nbsp;that is explained in the Methods section of the manuscript Thanks again. JS, JP, and EM","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-comment-3729","order":1,"name":"referee-comment-3729","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jennifer Simoni<\/b>; \n<i>Posted: 04 Feb 2026<\/i>; Additional comments  Thank you for your review and comments. They are much appreciated. We are encouraged by the overall assessment of it being a good and useful study. We believe that our research question was best addressed with a qualitative study. Our study aimed to explore in greater depth why and how students use AI for medical learning. Qualitative research methods are best suited to this. A survey would have been more appropriate if our goal were to assess how much students use AI. However, regarding the survey, our team believes the results of our study support a future exploratory sequential design program of research on this topic,&nbsp;in which the insights from the qualitative study inform the development of a larger, more generalizable survey. Regarding the sampling approach, we used a combination of convenience and purposive sampling to ensure that the views of students at various levels of AI use were included and explored. We have made this clearer in our revised manuscript (Methods Section: Participants and settings). Finally, we believe the results are presented appropriately as themes and, as is usual practice in qualitative research, are supported with illustrative quotes. The themes were identified through an iterative thematic analysis, as explained and further clarified in the revised manuscript (Methods Section: Data analysis).  Thank you again, JS, JP, EM, and the research team","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-comment-3735","order":2,"name":"referee-comment-3735","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/mep.23037.r45420, Waqar Naqvi, Datta Meghe Institute, Wardha, Maharashtra, 06 Mar 2026, version 2, indexed","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-response-45420","order":3,"name":"referee-response-45420","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/mep.22831.r45187, Ken Masters, Sultan Qaboos University, Muscat, 21 Jan 2026, version 1, 1 approved, 1 approved with reservations, 2 not approved","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v1#referee-response-45187","order":4,"name":"referee-response-45187","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jennifer Simoni<\/b>; \n<i>Posted: 04 Feb 2026<\/i>; We thank you for your review and comments. However, we respectfully disagree with the reasons given for recommending rejection of the manuscript. Below is our point-by-point response.&nbsp; &nbsp; &nbsp; \n<b>(1) Regarding including non-users in a study of usage.<\/b> The study goal was to explore why and how medical students are using or not using AI to support their learning. We applied the term \u201cuse\u201d to include varying levels of use, including non-use. We wanted to explore why and how students are using AI, and if not, why not. To this end, our interview questions, established before the interviews began, included questions relevant to non-users of AI. Therefore, we stand by our decision to include non-users. A clinical analogy could be the view of a community on vaccinations. It would be important to understand why some would not want to use it. We recognize that we could have been more explicit in our use of the word \u201cuse\u201d and our desire to include non-users. We have therefore modified the research goal statement in the revised manuscript to read \u201cThe study described herein aims to explore, in more depth, why and how first-year medical students currently use AI, or don\u2019t use it, in their medical training, including their motivations for using it or not using it, methods of use, and overall experiences\u201d&nbsp;&nbsp; We have also adjusted the title to read \u201cAI use or non-use by First-Year Medical Students: A Qualitative Study of Perspectives, Usage, and Recommendations\u201d, and made this more explicit in the Participants subsection.&nbsp; \n<b>(2) Regarding not defining AI.<\/b> &nbsp; We respectfully disagree with the reviewer. In phenomenology, when exploring a phenomenon, it is acceptable to use a broad term to examine how people interpret it differently.&nbsp; A clinical analogy would be to explore the concept of compassion and what it means to different patients and care providers. If we were to provide a definition of what that is up front, we would limit the exploration of that phenomenon. We deliberately asked them what they were using AI for (they were using for AI) and how they were using it (they were using it), to explore what they meant by it. In our study, we found that participants often referred to large language models when discussing AI and confirmed that they had some understanding of what AI is. Our impression is that this is a generation that is more informed about the digital world, including AI, than we may give them credit for.  &nbsp; \n<b>(3) Regarding including a disproportionate number of students from the AI UNAV Collaborative Team.&nbsp;&nbsp;<\/b> The reviewer is of the opinion that a disproportionate number of students from the AI UNAV Student Collaborative Team were interviewed. We ensured a balanced representation amongst the interviewees of those in the \n<i>AI UNAV Student Collaborative Team<\/i> and those not. In qualitative research, the goal is to reach thematic sufficiency, which is done by interviewing until saturation of codes and themes is reached. This occurred in both groups, and we therefore feel confident that the experiences of both groups (students in the \n<i>AI UNAV Student CollaborativeTeam<\/i> and students unrelated to the Team) were adequately captured. Moreover, not all the students in the \n<i>AI UNAV Student Collaborative Team<\/i> joined because of an interest in AI. Some joined because they were interested in developing their scholarship skills. Therefore, the assumption that all students in the&nbsp;AI\n<i> UNAV Student Collaborative Team <\/i>were there because of a special interest in AI is not correct. In addition, to mitigate bias, the students who were involved in the interviews and the analysis for this study were not interviewed (they were not study participants). We revised the Methods section of the original manuscript to state more clearly: \u201cThe five students who were part of the research team in this qualitative study did not participate as interviewees.\u201d &nbsp;Additionally, some students were not using AI much, and some were skeptical of it.&nbsp; Qualitative research explores a phenomenon in depth; in this case, it includes students who use AI and those who use it little or not at all. All these students have a valid contribution to make in terms of their experiences, and we captured these adequately. &nbsp; With reference to representing the student body, this is not a quantitative study examining generalizability.  &nbsp; \n<b>(4) In regard to the abstract being too broad.&nbsp;<\/b> The conclusions in the abstract of our revised manuscript now read \u201cWe found that students in the medical school we studied are early adopters of AI, using it in various ways, and wish to utilize it effectively and ethically. The findings of this study align with other studies in other jurisdictions that call for early AI literacy.\u201d&nbsp;&nbsp; Thank you again, JS, JP, EM, and the research team","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-comment-3737","order":5,"name":"referee-comment-3737","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/mep.23037.r45418, Alice Kam, University of Toronto, Toronto, 28 Feb 2026, version 2, indexed","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-response-45418","order":6,"name":"referee-response-45418","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jennifer Simoni<\/b>; \n<i>Posted: 23 Jul 2026<\/i>; We thank the reviewer for their time. We do, however, respectfully disagree with the reasons given for recommending rejection of the manuscript.  \n<b>Reviewer Comment:<\/b> \n<i>Authors placed all the bias concerns in the limitation sections. Yet the study would not be improved regarding its methodology state. It may be helpful to consider perspective publications if biases are the limiting factor.<\/i>  \n<b>Response:<\/b> We disagree that this study should be downgraded to a &quot;Perspective&quot; piece. A perspective piece is an opinion; this qualitative study is an empirical, reflexive thematic analysis of 20 in-depth interviews, coded systematically using rigorous research methods and documented in accordance with the Standards for Reporting Qualitative Research (SRQR), as explained in the Methods section. The reviewer\u2019s concern about &quot;bias&quot; assumes that qualitative research aims for generalizability.&nbsp; Malterud (Lancet 2001) highlighted that the researcher is the primary instrument in qualitative inquiry, a view echoed by other qualitative research experts such as Braun &amp; Clarke (2023). Rigor is achieved not through the elimination of the researcher\u2019s perspective, but through reflexivity, the systematic accounting for how our positions as medical educators and student-peers influenced the data. Malterud explains that the key to qualitative research is to be transparent about one\u2019s perspectives and that preconceptions are not a bias unless they are not disclosed. By documenting these dynamics in our Methods and Limitations sections, we adhere to the standards of trustworthiness required for empirical qualitative research, distinguishing this from a perspective piece.  \n<b>Reviewer Comment:<\/b> \n<i>The previous methodology was 2 non-AI users and rest with AI experiences from the author's lab. In this revision, the number of participants changed. The credibility of this study methodology is questionable at this stage, as research participant numbers should not be altered in a second revision.<\/i>  \n<b>Response:<\/b> The reviewer is incorrect. We did not change the number of participants (or their profiles). The total number of participants \n<b>(n=20) has remained constant <\/b>throughout the study and in both versions of the manuscript. In the revised manuscript, we simply described them in greater depth, as requested by the earlier reviews. This aligns with enhanced transparency, a standard practice in qualitative research (e.g., the Consolidated criteria for reporting qualitative research (COREQ) guidelines and the Standards for Reporting Qualitative Research (SRQR)). Regarding the inclusion of students from the &quot;author\u2019s lab&quot; (the \n<i>AI UNAV Student Collaborative Team<\/i>), we argue that this is a recognized qualitative approach known as &quot;insider research&quot; or \u201cco-research\u201d. &nbsp;In the literature, including one\u2019s peers in qualitative research has been documented as uniquely helpful, especially when it includes the very population with the experience the research question seeks to explore (Byrne et al., 2015). In medical education, involving students as co-researchers is highly valued and recognized as a way to mitigate power imbalances and ensure that student voices are accurately captured and interpreted, mitigating the risk of researcher-centric misinterpretation that often occurs when senior faculty analyze student behavior in isolation (Healey 2014). In addition, it ensures epistemic justice, meaning students have the right to contribute to the knowledge produced about them (Fricker 2007 and Walker 2019). &nbsp;  We therefore respectfully request that the reviewer reconsider their recommendation. JS, JP, EM, and the research team  NB:-&nbsp; Our response was submitted on March 4th.","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-comment-3771","order":7,"name":"referee-comment-3771","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/mep.23037.r45441, Helena Prior Filipe, Independent Researcher, Lisbon, 19 Mar 2026, version 2, indexed","URL":"https:\/\/mededpublish.org\/articles\/15-226\/v2#referee-response-45441","order":8,"name":"referee-response-45441","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":9,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}