{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:18:45Z","timestamp":1792070325154,"version":"4.4.0"},"reference-count":36,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Generative AI (GenAI) is increasingly integrated into clinical learning and practice. However, medical students often lack the competencies required for safe and critical use, including prompt design, output verification, and recognition of limitations. Educational interventions that integrate GenAI with clinical reasoning frameworks remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated a structured, theory-informed workshop integrating GenAI, prompt engineering, and clinical reasoning education to enhance medical students\u2019 self-perceived AI literacy and collaborative learning attitudes, and to assess whether patient-centered orientation changed following intensive AI exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single-group, pre-post, explanatory sequential mixed methods study with fifth-year medical students enrolled at an academic medical center between April 2024 and May 2025. The 3-hour workshop comprised 6 modules integrating clinical reasoning, cognitive-bias awareness, verification-oriented GenAI use, and hands-on prompt engineering and centered on ChatGPT (OpenAI). Quantitative outcomes were self-reported measures from a 20-item self-report AI-literacy questionnaire adapted from the Meta AI Literacy Scale and were examined with exploratory and confirmatory factor analysis, the 6-item Patient-Practitioner Orientation Scale-Short, and a modified Collaborative Learning Attitude Scale (CLAS). Pre-post change was assessed using 2-tailed paired\n                      <jats:italic>t<\/jats:italic>\n                      tests with Benjamini-Hochberg correction and Cohen\n                      <jats:italic>d<\/jats:italic>\n                      ; the Patient-Practitioner Orientation Scale-Short and CLAS were available for a subsample (n=46). Qualitative data from 6 interviews and 17 reflective narratives were analyzed using reflexive thematic analysis and integrated with the quantitative findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 150 eligible students, 139 (92.7%) completed paired AI-literacy assessments. Self-perceived AI literacy improved across all domains (Cohen\n                      <jats:italic>d<\/jats:italic>\n                      =0.69\u20100.93, all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001; all remaining significant after false discovery rate correction), and collaborative learning attitudes increased substantially (\n                      <jats:italic>d<\/jats:italic>\n                      =0.94,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). Patient-centered orientation showed no significant change (\n                      <jats:italic>d<\/jats:italic>\n                      =0.03); however, baseline scores were concentrated at the favorable end of the scale (a floor\/restricted-range effect), and the subsample analysis was underpowered (minimum detectable\n                      <jats:italic>dz<\/jats:italic>\n                      =0.42), so this null result is inconclusive rather than evidence of unchanged orientation. Gains did not differ by sex or across the sequential cohorts. Reflexive thematic analysis (interviews: n=6; reflections: n=17) identified five themes and one emergent theme describing a shift toward verification-oriented GenAI use: (1) understanding GenAI capabilities and limitations, (2) prompt-engineering skill development, (3) calibrated trust through verification, (4) GenAI-supported communication and collaboration, and (5) ethical considerations, with emerging reconceptualization of professional identity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A brief, theory-informed educational intervention integrating GenAI with clinical reasoning was associated with medium-to-large improvements in self-perceived AI literacy and collaborative attitudes. No detectable change in patient-centered orientation was observed; however, this finding should be interpreted as inconclusive, given measurement and power constraints. Embedding verification practices within clinical reasoning frameworks may offer a scalable approach for preparing physicians for responsible human-AI collaboration. Future studies should incorporate comparative designs, performance-based assessments, and longitudinal follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/94951","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:23:19Z","timestamp":1786645399000},"page":"e94951-e94951","source":"Crossref","is-referenced-by-count":3,"title":["Integrating Generative AI Into Clinical Reasoning Education for Medical Students: Mixed Methods Study"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3927-5621","authenticated-orcid":false,"given":"Cheng-Heng","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3556-5269","authenticated-orcid":false,"given":"Yu-Ting","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-0055","authenticated-orcid":false,"given":"Chiun","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4074-5838","authenticated-orcid":false,"given":"Huey-Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-0395","authenticated-orcid":false,"given":"Chih-Wei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"11","key":"R1","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1136\/bmjqs-2023-016690","article-title":"Generative artificial intelligence, patient safety and healthcare quality: a review","volume":"33","author":"Howell","journal-title":"BMJ Qual Saf"},{"issue":"4","key":"R2","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1136\/svn-2017-000101","article-title":"Artificial intelligence in healthcare: past, present and future","volume":"2","author":"Jiang","journal-title":"Stroke Vasc Neurol"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.53131","article-title":"The digital health competencies in medical education framework: an international consensus statement based on a Delphi study","volume":"8","author":"Car","journal-title":"JAMA Netw Open"},{"issue":"5","key":"R4","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1001\/jamainternmed.2024.0295","article-title":"Clinical reasoning of a generative artificial intelligence model compared with physicians","volume":"184","author":"Cabral","journal-title":"JAMA Intern Med"},{"issue":"10","key":"R5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.40969","article-title":"Large language model influence on diagnostic reasoning: a randomized clinical trial","volume":"7","author":"Goh","journal-title":"JAMA Netw Open"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-46411-8","article-title":"Systematic analysis of ChatGPT, Google Search and Llama 2 for clinical decision support tasks","volume":"15","author":"Sandmann","journal-title":"Nat Commun"},{"issue":"471","key":"R7","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aao5333","article-title":"Big data and black-box medical algorithms","volume":"10","author":"Price","journal-title":"Sci Transl Med"},{"issue":"8","key":"R8","doi-asserted-by":"publisher","first-page":"e589","DOI":"10.1016\/S2589-7500(24)00095-5","article-title":"Medical artificial intelligence for clinicians: the lost cognitive perspective","volume":"6","author":"Tikhomirov","journal-title":"Lancet Digit Health"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.3402\/meo.v16i0.5890","article-title":"An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory","volume":"16","author":"Pelaccia","journal-title":"Med Educ Online"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-016-0377-1","article-title":"Cognitive biases associated with medical decisions: a systematic review","volume":"16","author":"Saposnik","journal-title":"BMC Med Inform Decis Mak"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-022-03852-3","article-title":"Artificial intelligence in medical education: a cross-sectional needs assessment","volume":"22","author":"Civaner","journal-title":"BMC Med Educ"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04700-8","article-title":"AI in medical education: medical student perception, curriculum recommendations and design suggestions","volume":"23","author":"Li","journal-title":"BMC Med Educ"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-025-07177-9","article-title":"Integrating AI in medical education: a comprehensive study of medical students\u2019 attitudes, concerns, and behavioral intentions","volume":"25","author":"Duan","journal-title":"BMC Med Educ"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1258\/jhsrp.2007.007074","article-title":"The quality of mixed methods studies in health services research","volume":"13","author":"O\u2019Cathain","journal-title":"J Health Serv Res Policy"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"100014","DOI":"10.1016\/j.chbah.2023.100014","article-title":"MAILS - Meta AI Literacy Scale: development and testing of an AI literacy questionnaire based on well-founded competency models and psychological change- and meta-competencies","volume":"1","author":"Carolus","journal-title":"Comput Hum Behav Artif Hum"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/j.caeai.2021.100041","article-title":"Conceptualizing AI literacy: an exploratory review","volume":"2","author":"Ng","journal-title":"Comput Educ Artif Intell"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-022-03867-w","article-title":"A 4-factor perspective of the Patient-Practitioner Orientation Scale (PPOS): a deeper understanding of patient-centredness","volume":"22","author":"Jiang","journal-title":"BMC Med Educ"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.12604","article-title":"A short scale for measuring attitudes towards the doctor-patient relationship: psychometric properties and measurement invariance of the German Patient-Practitioner-Orientation Scale (PPOS-D6)","volume":"9","author":"Pauli","journal-title":"PeerJ"},{"issue":"10","key":"R19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0240835","article-title":"Attitudes of medical students towards interprofessional education: a mixed-methods study","volume":"15","author":"Berger-Estilita","journal-title":"PLoS One"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-022-03893-8","article-title":"Moving from tangibility toward digitalization: investigating team dynamics and facilitator support among medical students in conventional and digital small-group tutorials","volume":"22","author":"Chao","journal-title":"BMC Med Educ"},{"issue":"13","key":"R21","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","journal-title":"Qual Health Res"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: an experiment with data saturation and variability","volume":"18","author":"Guest","journal-title":"Field methods"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","journal-title":"J R Stat Soc Series B Stat Methodol"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"key":"R25","doi-asserted-by":"crossref","unstructured":"Braun V Clarke V . Thematic Analysis: A Practical Guide. SAGE; 2021. ISBN: 9781526417305","DOI":"10.4135\/9781036232078.n9"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","article-title":"Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher","volume":"24","author":"Braun","journal-title":"Int J Transgend Health"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1136\/amiajnl-2011-000089","article-title":"Automation bias: a systematic review of frequency, effect mediators, and mitigators","volume":"19","author":"Goddard","journal-title":"J Am Med Inform Assoc"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445385","article-title":"Designing AI for trust and collaboration in time-constrained medical decisions: a sociotechnical lens","author":"Jacobs","journal-title":"Proc CHI Conf Hum Factors Comput Syst"},{"key":"R29","doi-asserted-by":"crossref","unstructured":"Sweller J Ayres P Kalyuga S . Cognitive Load Theory. Springer; 2011. ISBN: 9781441981257","DOI":"10.1007\/978-1-4419-8126-4"},{"issue":"5","key":"R30","doi-asserted-by":"publisher","first-page":"371","DOI":"10.3109\/0142159X.2014.889290","article-title":"Cognitive load theory: implications for medical education: AMEE Guide No. 86","volume":"36","author":"Young","journal-title":"Med Teach"},{"key":"R31","unstructured":"Topol E . Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. Basic Books; 2019. ISBN: 9781541644649"},{"issue":"6","key":"R32","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1097\/ACM.0000000000000700","article-title":"A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators","volume":"90","author":"Cruess","journal-title":"Acad Med"},{"issue":"9","key":"R33","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1080\/0142159X.2019.1595557","article-title":"Artificial intelligence in medical education","volume":"41","author":"Masters","journal-title":"Med Teach"},{"issue":"6","key":"R34","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1027\/1015-5759\/a000460","article-title":"How performing PCA and CFA on the same data equals trouble","volume":"33","author":"Fokkema","journal-title":"Eur J Psychol Assess"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","DOI":"10.1002\/widm.1312","article-title":"Causability and explainability of artificial intelligence in medicine","volume":"9","author":"Holzinger","journal-title":"Wiley Interdiscip Rev Data Min Knowl Discov"},{"key":"R36","unstructured":"Editage. URL: https:\/\/www.editage.com\/ [Accessed 29-07-2026]"}],"container-title":["JMIR Medical Education"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:23:21Z","timestamp":1786645401000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededu.jmir.org\/2026\/1\/e94951"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":36,"URL":"https:\/\/doi.org\/10.2196\/94951","relation":{},"ISSN":["2369-3762"],"issn-type":[{"value":"2369-3762","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"v12i11e94951"}}