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Global cross-sectional student survey on AI in medical, dental, and veterinary education and practice at 192 faculties

Abstract

Background

The successful integration of artificial intelligence (AI) in healthcare depends on the global perspectives of all stakeholders. This study aims to answer the research question: What are the attitudes of medical, dental, and veterinary students towards AI in education and practice, and what are the regional differences in these perceptions?

Methods

An anonymous online survey was developed based on a literature review and expert panel discussions. The survey assessed students' AI knowledge, attitudes towards AI in healthcare, current state of AI education, and preferences for AI teaching. It consisted of 16 multiple-choice items, eight demographic queries, and one free-field comment section. Medical, dental, and veterinary students from various countries were invited to participate via faculty newsletters and courses. The survey measured technological literacy, AI knowledge, current state of AI education, preferences for AI teaching, and attitudes towards AI in healthcare using Likert scales. Data were analyzed using descriptive statistics, Mann–Whitney U-test, Kruskal–Wallis test, and Dunn-Bonferroni post hoc test.

Results

The survey included 4313 medical, 205 dentistry, and 78 veterinary students from 192 faculties and 48 countries. Most participants were from Europe (51.1%), followed by North/South America (23.3%) and Asia (21.3%). Students reported positive attitudes towards AI in healthcare (median: 4, IQR: 3–4) and a desire for more AI teaching (median: 4, IQR: 4–5). However, they had limited AI knowledge (median: 2, IQR: 2–2), lack of AI courses (76.3%), and felt unprepared to use AI in their careers (median: 2, IQR: 1–3). Subgroup analyses revealed significant differences between the Global North and South (r = 0.025 to 0.185, all P < .001) and across continents (r = 0.301 to 0.531, all P < .001), with generally small effect sizes.

Conclusions

This large-scale international survey highlights medical, dental, and veterinary students' positive perceptions of AI in healthcare, their strong desire for AI education, and the current lack of AI teaching in medical curricula worldwide. The study identifies a need for integrating AI education into medical curricula, considering regional differences in perceptions and educational needs.

Trial registration

Not applicable (no clinical trial).

Peer Review reports

Background

The popularity of artificial intelligence (AI) in healthcare has exponentially risen in recent years, attracting the attention of professionals and students alike [1, 2]. The emergence of large language models like ChatGPT has further expanded AI’s potential in medicine, offering new possibilities for clinical applications and medical training [3, 4]. AI has demonstrated expert-level performance in various medical domains, including breast cancer screening, chest radiograph interpretation, and prediction of treatment outcomes [5,6,7,8].

The increasing prevalence of AI in healthcare necessitates its incorporation into medical education. AI offers numerous potential benefits for medical training, such as enhancing understanding of complex concepts, providing personalized learning experiences, and simulating clinical scenarios [9,10,11,12]. Moreover, familiarizing medical students with AI tools and technologies prepares them for the realities of their future professional lives [13, 14]. However, the integration of AI also raises significant ethical challenges, including concerns about patient autonomy, beneficence, non-maleficence, and justice [9, 15, 16].

Existing literature has primarily focused on the technical aspects of AI in medicine or its potential applications in specific medical specialties [17]. Other studies have explored healthcare professionals' perceptions of AI, but these have been limited by small sample sizes and lack of geographic diversity [17]. This gap in the literature precludes a comprehensive understanding of how future healthcare professionals across different regions perceive and prepare for AI integration in their fields.

This multicenter study addresses this gap by investigating the perspectives of medical, dental, and veterinary students on AI in their education and future practice across multiple countries. Specifically, we examine: 1) students' technological literacy and AI knowledge, 2) the current state of AI in their curricula, 3) their preferences for AI education, and 4) their attitudes towards AI's role in their fields. By exploring regional differences on a large, international scale, this study offers a unique comparative overview of students' perceptions worldwide.

Methods

This multicenter cross-sectional study was conducted in accordance with the Strengthening the reporting of observational studies in epidemiology (STROBE) statement and received ethical approval from the Institutional Review Board at Charité – University Medicine Berlin (EA4/213/22), serving as the principal institution, in compliance with the Declaration of Helsinki and its later amendments [18, 19]. To ensure participant anonymity, the necessity for informed consent was waived.

Instrument development and design

Following the Association for Medical Education in Europe (AMEE) guide, this study aimed to develop an anonymous online survey to assess: 1) the technological literacy and knowledge of informatics and AI, 2) the current state of AI in their respective curricula and preferences for AI education, and 3) the perspectives towards AI in the medical profession among international medicine, dentistry, and veterinary medicine students [20]. To inform instrument development, a literature review of existing publications on the attitudes of medical students towards AI in medicine was independently performed by four reviewers (FB, LH, KKB, LCA), leveraging MEDLINE, Scopus, and Google Scholar databases in December 2022. Studies were selected for review based on the following criteria: 1) the publications were original research articles, 2) the scope aligned with our research objectives and targeted medical students, 3) the survey was conducted in English language, 4) the items were publicly accessible, 5) the measurement of perspectives towards AI was not restricted to a particular medical subfield. Following these criteria, five articles comprising a total of 96 items were identified as relevant to the research scope [21,22,23,24,25]. After a consensus-based discussion, items that did not match our research objectives or overlapped in content were excluded, resulting in 23 remaining items. These items were subsequently tailored to fit the context of medical education and the medical profession.

A review cycle was undertaken with a focus group of medical AI researchers and students, as well as an expert panel including physicians, medical faculty members and educators, AI researchers and developers, and biomedical statisticians (FB, LH, DT, MRM, KKB, LCA, AB, RC, GDV, AH, LJ, AL, PS, LX). The finalized survey consisted of 16 multiple-choice items, eight demographic queries, and one free-field comment section. These items were further refined based on content-based domain samples, and responses were standardized using a four- or five-point Likert scale where applicable.

The preliminary assessment was conducted through cognitive interviews with ten medical students at Charité – University Medicine Berlin to evaluate the scale's comprehensiveness and overall length. The feedback resulted in two rewordings and one item removal, finalizing the survey with 15 multiple-choice items and eight demographic queries supported by one free-field comment section. The final questionnaire items and response options can be viewed in Table 1.

Table 1 Questionnaire items and response options

Using REDCap (Research Electronic Data Capture) hosted at Charité – University Medicine Berlin, the English survey was subsequently disseminated through the medical student newsletter at Charité and deactivated after receiving responses from 50 medical students who served as the pilot study group and were not included in the final participant pool [26, 27]. After psychometric validation, participating sites distributed the REDCap online survey among medical, dental, and veterinary students at their faculty. Due to the large number of Spanish-speaking sites, a separate Spanish online version of the survey was employed using paired forward and backward translation with reconciliation by two bilingual medical professionals (LG, JSPO). Depending on their faculty location, participating sites distributed either the English or Spanish online survey via their faculty newsletters and courses using a QR code or the direct website link (non-probability convenience sampling). The survey was available for participation from April to October 2023.

Our data collection methodology was designed to mitigate several risks related to privacy, confidentiality, consent, transparency of recruitment, and minimization of harm, as highlighted before [28]. By using faculty newsletters and course distributions, we reduced the exposure of personal information on social media platforms, thereby maintaining a higher level of privacy. This method ensured that our participants' identities and responses were not publicly available or exposed to wider online networks. To further secure the data, the survey platform used was selected for its robust security features, including data encryption and secure storage. We explicitly informed participants about how their data would be used and protected, ensuring transparency and building trust.

Distributing the survey through official academic channels, such as faculty newsletters, implied a degree of formality and oversight, increasing the likelihood that participants were adequately informed of the study's intentions. By detailing the purpose of the study, the use of data and participants' rights on the first page of the survey, participants had to indicate their understanding and agreement by ticking an 'I agree' box before proceeding.

Using institutional channels for distribution provided a transparent and credible recruitment process that was likely to reach a relevant and engaged audience. We ensured that participants were aware that their participation was completely voluntary and that they could withdraw from the study at any time without penalty. We also provided contact details for participants to ask questions about the study, promoting openness and trust.

By avoiding the use of social media for recruitment, we eliminated the risk of participants' responses being exposed to their social networks, thereby protecting their privacy and reducing potential social risks. The content of the survey was carefully reviewed to ensure that no questions could cause distress or harm to participants. Participants were informed that they could skip any questions they felt uncomfortable answering, ensuring their well-being and autonomy throughout the survey process.

Inclusion and exclusion criteria

Inclusion criteria consisted of students at least 18 years of age, actively enrolled in a (human) medicine, dentistry, or veterinary medicine degree program, who responded to the survey during its open period and were proficient in either English or Spanish, depending on their faculty location. Participants had to confirm their enrollment in a relevant program and input their age to verify they were above 18 years old. Only those meeting these criteria could proceed with the survey. Respondents who started the survey but did not answer any multiple-choice items were excluded from the analysis. Partial missing responses to survey items resulted in exclusion from each subanalysis.

Statistical analysis

Statistical analyses were performed with SPSS Statistics 25 (version 28.0.1.0) and R (version 4.2.1), using the "tidyverse", "rnaturalearth", and "sf" packages [29,30,31,32]. The Kolmogorov–Smirnov test was used to test for normal distribution. Categorical and ordinal data were reported as frequencies with percentages. Medians and interquartile ranges (IQR) were reported for non-parametric continuous data. Variances were reported for items in Likert scale format. The response rate was derived from the overall student enrollment numbers at each faculty according to the faculty websites or the Times Higher Education World University Rankings 2024 due to the unavailability of official data on enrolled medical, dentistry, or veterinary students. In the pilot study group, item reliability was measured using Cronbach's α, with values above 0.7 interpreted as acceptable internal consistency. Explanatory factor analysis was used to examine the structure and subscales of the instrument, using an eigenvalue cutoff of 1 for item extraction. Items with factor loadings of 0.4 or higher were retained. Data suitability for structural evaluation was assessed using the Kaiser–Meyer–Olkin measure and Bartlett's test of sphericity. For geographical subgroup analysis, respondents were categorized based on their faculty location (Global North versus Global South) according to the United Nations' Finance Center for South-South Cooperation [33]. Additionally, participants were grouped into continents based on the United Nations geoscheme [34]. Due to the substantial number of European participants, students in North/West and South/East Europe were analyzed separately. Further subgroup analyses based on gender, age, academic year, technological literacy, self-reported AI knowledge, and previous curricular AI events can be found in the appendix (see Supplementary Tables 1–7). The Mann–Whitney U-test was employed for subgroup analyses of two independent non-parametric samples. For continental comparison, the Kruskal–Wallis one-way analysis of variance and Dunn-Bonferroni post hoc test were performed. To estimate effect size, we calculated r, with 0.5 indicating a large effect, 0.3 a medium effect, and 0.1 a small effect [35]. An asymptotic two-sided P-value below 0.05 was considered statistically significant.

Results

Pilot study

The median age of the pilot study group was 24 years (IQR: 21–26 years). 58% of participants identified as female (n = 29), 38% as male (n = 19), and 4% (n = 2) did not report their gender. The median current academic year was 2 (IQR: 2–4 years) out of 6 total academic years. Internal consistency for our scale's dimensions ranged from acceptable to good, as indicated by Cronbach's α. The section on "Technological literacy and knowledge of informatics and AI" registered an α of 0.718, while the section "Current state of AI in the curriculum and preferences for AI education" scored an α of 0.726, both displaying acceptable internal consistency. A Cronbach's α value of 0.825 for the "Perspectives towards AI in the medical profession" section denoted good internal consistency. The Kaiser–Meyer–Olkin measure for sampling adequacy was 0.801, confirming the sample's representational validity. Bartlett's test of sphericity returned a P-value of less than 0.001, validating the chosen method for factor analysis. Factor analysis yielded a structure comprising 15 items across three dimensions, collectively explaining 54% of the total variance. Factor loadings for individual items ranged from 0.495 for "Which of these technical devices do you use at least once a week?" to 0.888 for "What is your general attitude toward the application of artificial intelligence (AI) in medicine?".

Study cohort

Between the first of April and the first of October 2023, 4900 responses were recorded, of which 4345 (88.7%) were collected via the English survey and 555 (11.3%) via the Spanish survey version. Of these, 283 (5.8%) respondents reported degrees other than medicine, dentistry, or veterinary medicine or indicated that they had completed their studies, while 21 (0.4%) did not respond to any multiple-choice item or did not indicate their degree. The final study cohort comprised 4596 participants from 192 faculty and 48 countries, of whom 4313 (93.8%) were medical, 205 (4.5%) dentistry, and 78 (1.7%) veterinary medicine students. Of 5,575,307 enrolled students from all degrees at the 183 (95.3%) participating faculties in which the total enrollment number was publicly available, the survey achieved an average response rate of 0.2% (standard deviation: 0.4%). Most respondents studied in Southern/Eastern European (n = 1240, 27%) countries, followed by Northern/Western Europe (n = 1110, 24.2%), Asia (n = 944, 20.5%), South America (n = 555, 12.1%), North America (n = 515, 11.2%), Africa (n = 125, 2.7%), and Australia (n = 104, 2.3%). Please refer to Fig. 1 to view the distribution of participating institutions in relation to the number of participants on a world map. A detailed list of survey participants divided by country, faculty, city, degree, number of enrolled students, and response rate is provided in the appendix (see Supplementary Table 8). The median age of the study population was 22 years (IQR: 20–24 years). 56.6% of the participants were female (n = 2600) and 42.4% male (n = 1946), with a median academic year of 3 (IQR: 2–5 years). Full descriptive data, including items on technological literacy and preferences for AI teaching in the medical curriculum, are displayed in Table 2. Any free field comments of the survey participants are listed in the appendix (see Supplementary Table 9), with selected comments highlighted in Fig. 2.

Fig. 1
figure 1

The world map displays the geographical distribution of participating institutions (blue dots) in relation to the number of respondents per institution

Table 2 Descriptive data of the study population and results of the questions about tech-savviness and topic preferences for AI teaching
Fig. 2
figure 2

Diverse perspectives from medical students on the integration of artificial intelligence (AI) in healthcare education and practice. The selected quotes reflect a range of sentiments, from concerns about dehumanization and potential challenges in low-resource settings to viewing AI as a beneficial tool that complements rather than replaces the human touch in medicine

Collective perceptions towards artificial intelligence

Table 3 displays the survey results for Likert scale items. Students generally reported a rather or extremely positive attitude towards the application of AI in medicine (3091, 67.6%). The highest positive attitude towards AI in the medical profession was recorded for the item "How do you estimate the effect of artificial intelligence (AI) on the efficiency of healthcare processes in the next 10 years?" with 4042 respondents (88.4%) estimating a moderate or great improvement. Contrarily, 3171 students (69.4%) rather or completely agreed with the item "The use of artificial intelligence (AI) in medicine will increasingly lead to legal and ethical conflicts.". Regarding AI education and knowledge, 3451 students (75.3%) reported no or little knowledge of AI, and 3474 (76.1%) rather or completely agreed that they would like to have more teaching on AI in medicine as part of their curricula. On the other hand, 3497 (76.3%) students responded that they did not have any curricular events on AI as part of their degree, as illustrated on the country level in Fig. 3. Variability in responses was observed, ranging from 0.279 for the item "How would you rate your general knowledge of artificial intelligence (AI)?" —measured on a four-point Likert scale— to 1.372 for "With my current knowledge, I feel sufficiently prepared to work with artificial intelligence (AI) in my future profession as a physician.". Notably, the items capturing the trade-offs in medical AI diagnostics revealed that most students preferred AI explainability (n = 3659, 80.2%) over a higher accuracy (n = 902, 19.8%) and higher sensitivity (n = 2906, 63.9%) over higher specificity (n = 1118, 24.6%) or equal sensitivity/specificity (n = 524, 11.5%), as visualized in Fig. 4.

Table 3 Survey results of Likert scale format items on attitudes towards the medical degree, AI in the medical profession, AI education and knowledge
Fig. 3
figure 3

Pie charts illustrating student responses at the country level for the item "As part of my studies, there are curricular events on artificial intelligence (AI) in medicine.". A more filled, darker red chart indicates a higher proportion of students reporting no AI events, while a less filled, greener chart indicates fewer students reporting the absence of AI events. The missing portion of each chart displays the proportion of students who reported AI events, regardless of the duration. An all-white pie chart indicates that all students reported AI events in the medical curriculum. The absolute number of responses per country is shown above each chart. Analysis of the pie charts from countries with a representative sample of at least 50 respondents reveals that, among 28 nations, only four (Indonesia, Switzerland, Vietnam, and China) exhibited over 50% of students reporting the inclusion of AI events within their medical curriculum. Data from the USA displayed an equal proportion of students reporting the presence or absence of AI events in their curriculum (50% each). The residual 23 countries, encompassing Germany, Portugal, Mexico, Brazil, Poland, UAE, Austria, Italy, India, Argentina, Macedonia, Canada, Slovenia, Ecuador, Australia, Azerbaijan, Japan, Spain, Chile, Moldova, South Africa, Nepal, and Nigeria, had a lower proportion of students reporting the integration of AI in the medical curriculum. Abbreviations: UAE, United Arab Emirates; USA, United States of America

Fig. 4
figure 4

Gantt diagrams depicting medical students' preferences in AI diagnostics. a AI explainability (n = 3659, 80.2%) versus higher accuracy (n = 902, 19.8%) and b) higher sensitivity (n = 2906, 63.9%) versus higher specificity (n = 1118, 24.6%) or equal sensitivity and specificity (n = 524, 11.5%)

Regional comparisons

Please refer to Table 4 to view the results of the comparison of responses from the Global North and South for Likert scale format items. Perceptions between the Global North and South differed significantly for nine Likert scale format items. The highest effect size was observed for the item on AI increasing ethical and legal conflicts, with respondents from the Global North indicating a higher agreement (median: 4, IQR: 3–5) compared to those from the Global South (median: 4, IQR: 3–4; r = 0.185; P < 0.001). Notably, Global South students felt more prepared to use AI in their future practice (median: 3, IQR: 2–4) compared to their Global North counterparts (median: 2, IQR: 1–3; r = 0.162; P < 0.001) and reported longer AI-related curricular events (median: 1, IQR: 1–2; Global North: median: 1, IQR: 1–1; r = 0.090; P < 0.001). Conversely, Global North students rated their AI knowledge higher (median: 2, IQR: 2–3; Global South: median: 2, IQR: 2–2; r = 0.025; P < 0.001).

Table 4 Regional comparison of respondents from the Global North and South for Likert scale format items

For continental comparison, the Kruskal–Wallis one-way analysis of variance revealed significantly different Likert scale responses across all survey items (see Table 5). Subsequent Dunn-Bonferroni post hoc analysis displayed various significant differences in Likert scale responses for pairwise regional comparisons, while median and IQR remained largely consistent. Considering only medium to large effect sizes, the item "The use of artificial intelligence (AI) in medicine will increasingly lead to legal and ethical conflicts." yielded an r of 0.301 when comparing Northern/Western European (median: 4, IQR: 4–5) and South American participants (median: 4, IQR: 3–4; P < 0.001), and an r of 0.311 between South American and Australian participants (median: 4, IQR: 4–5; P < 0.001). Similarly, the statement "With my current knowledge, I feel sufficiently prepared to work with artificial intelligence (AI) in my future profession as a physician." displayed strong effect sizes in comparisons between North/West Europe (median: 2, IQR: 1–2) and Asia (median: 3, IQR: 2–4; r = 0.531; P < 0.001), South/East Europe (median: 2, IQR: 2–3) and Asia (r = 0.342; P < 0.001), and South America (median: 2, IQR: 2–3) and Asia (r = 0.398; P < 0.001).

Table 5 Regional comparison of Likert scale format items on the continental level

Discussion

Our multicenter study of 4596 medical, dental, and veterinary students from 192 faculties in 48 countries provides crucial insights into the global landscape of AI perception and education in healthcare curricula. The findings reveal a nuanced picture: while students generally express optimism about AI’s role in future healthcare practice, this is tempered by significant concerns and a striking lack of preparedness.

The educational basis of our study lies in addressing a critical gap in AI education within medical curricula, exploring how this deficiency varies across different regions, particularly between continents and the Global North and South. As AI rapidly advances and promises to reshape healthcare, the need for future physicians to be adequately prepared through comprehensive AI education becomes increasingly urgent. Our study goes beyond merely asserting the necessity of AI education by elucidating regional differences in perceptions and experiences related to AI among healthcare students.

Our findings extend previous research highlighting inadequacies in AI education in medical schools globally. Kolachalama and Garg [36] noted that AI is not widely taught in medical schools, with most curricula lacking substantial AI training modules. Chan and Zary [37] reinforced this, emphasizing the gap between recognizing AI’s potential benefits and actually integrating AI education into medical programs. Our study confirms these deficiencies on a larger, international scale, revealing that over three-quarters of students reported no AI-related events in their curriculum, despite strong interest in such education. Importantly, our research uncovers regional disparities in AI education and perception.

Students from the Global South were generally less likely to report having AI incorporated into their curricula compared to their counterparts in the Global North. This discrepancy underscores the need for tailored educational strategies that consider these regional differences to ensure equitable preparation for an AI-enhanced medical landscape. The observed differences in perceived preparedness for working with AI, particularly among Asian students, may reflect varying national AI policies, educational strategies, and macroeconomic factors [38, 39].

Depending on the study and item design, self-reported AI knowledge in the literature ranges from 2.8% of 2981 medical students in Turkey in 2022 who reported feeling informed about the use of AI in medicine to 51.8% of 900 medical students in Jordan in 2021 who indicated having read articles about AI or machine learning in the past two years [21, 40,41,42,43,44]. On the other hand, the reported prevalence of AI training in the medical curriculum ranges, for instance, from 9.2% in a 2020 survey of 484 medical students in the United Kingdom up to 24.4% in a 2022 study among 2981 medical students in Turkey, although variations in item designs and demographic contexts hinder a comprehensive longitudinal analysis [22, 40, 42, 43, 45]. In our study, less than 18% (n = 5) of countries with a sample size of 50 or more participants had a higher or equal proportion of students reporting any duration of AI teaching, pointing to a persistent deficit in medical AI education across various demographic landscapes. Overall, the incorporation of AI into medical education on a broader national or international scale is limited, and the adoption of frameworks, certification programs, interdisciplinary collaborations, modules, and formal lectures seems still to be at an early stage [14, 46,47,48, 49].

While our study design and varying sample sizes across regions complicate causal analysis, the fact that three of four countries with over 50% of students reporting AI training were in Asia suggests a potential link between educational exposure and perceived readiness.

Despite the overall positive outlook, our study reveals a pronounced concern among students about the ethical and legal challenges posed by AI integration in healthcare. This echoes findings from Mehta et al. and Civaner et al. [40, 50], highlighting the critical need for AI education to address not only technical skills but also ethical, legal, and societal implications.

In terms of educational preferences, most of the participants in our study indicated their interest in learning practical skills, followed by future perspectives and legal and ethical aspects of medical AI. This underscores the great potential of AI education to not only improve medical students' oversight, knowledge, and practical skills in using AI but also to educate about ethical, legal, and societal implications — topics that are also addressed in other AI education frameworks, such as the United Nations Educational, Scientific and Cultural Organization K-12 AI curricula report [51].

In our subgroup analysis of respondents across continents, two items displayed moderate to large effect sizes. First, participants from South America were less likely to agree that the use of medical AI will increase ethical and legal conflicts compared to participants from Northern/Western Europe and Australia. Yet, students' median responses in these regions were identical. Thus, the level of effect size primarily reflects outliers rather than a uniform regional disparity in opinion. Second, Asian students reported being better prepared to work with AI in their future careers. Although these differences in perceived preparedness could be driven by different national AI policies and educational strategies as well as macroeconomic factors, our study design and varying sample sizes across regions complicate a causal analysis [38, 39].

Finally, the strong preference for explainable AI systems over highly accurate but opaque ones underscores the growing emphasis on ‘Explainable AI’ in medicine, underlining the importance of transparency in fostering trust and acceptance among future healthcare professionals [52,53,54, 55].

This study has limitations. First, the uneven regional distribution of participants potentially biased results in favor of overrepresented regions. In addition, the online design and language availability in either English or Spanish, as well as the non-probability convenience sampling method, may have introduced selection bias by excluding students without internet access, students who were not proficient in either language, or students who did not wish to participate. Another potential source of selection bias could be that respondents with a specific interest in or experience with AI were more likely to participate in the survey. Furthermore, the calculated response rate appeared to be rather low due to the lack of data on the number of students enrolled in each medical discipline for most participating institutions. Consequently, we derived the response rate using the total student enrollment numbers, which significantly underestimated the true rate of participation among medical students as it assumes that all students within each faculty received an invitation to participate. Moreover, the presence of 20 institutions with fewer than 50 student respondents has skewed the response rate further downward.

Conclusions

In conclusion, our study -the currently largest survey of medical students’ perceptions towards AI in healthcare education and practice- reveals a broadly optimistic view of AI’s role in healthcare. It draws on insights from students with diverse geographical, sociodemographic, and cultural backgrounds, underlining the critical need for AI education in medical curricula around the world and identifying a universal challenge and opportunity: to adeptly prepare healthcare students for a future that integrates AI into healthcare practice.

Availability of data and materials

All data collected and analyzed as part of this study is available at figshare at: https://doi.org/10.6084/m9.figshare.24422422.

Abbreviations

AI:

Artificial intelligence

AMEE:

Association for Medical Education in Europe

ChatGPT:

Chat Generative Pre-trained Transformers

IQR:

Interquartile range

LLM:

Large language model

REDCap:

Research Electronic Data Capture

STROBE:

Strengthening the reporting of observational studies in epidemiology

USMLE:

United States Medical Licensing Examination

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Download references

Acknowledgements

Members of the COMFORT consortium (alphabetically listed by surname):

First name, middle initials (if applicable), last name

Affiliation

ORCID

Nitamar, Abdala

Department of Radiology, Federal University of São Paulo, São Paulo, Brazil

0000–0002-0421–0959

Álvaro, Aceña Navarro

Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

0000–0002-5975–5761

Hugo, J.W.L, Aerts

Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA; Department of Radiation Oncology and Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA; Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, The Netherlands

0000–0002-2122–2003

Catarina, Águas

Radiology Department, University of Algarve, Faro, Portugal

0000–0002-1575–6367

Martina, Aineseder

Radiology Department, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

0000–0002-8733–856

Muaed, Alomar

Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE

0000–0001-6526–2253

Salita, Angkurawaranon

Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

0000–0001-6211–5717

Zachary, G., Angus

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

0000–0003-3117–6116

Eirini, Asouchidou

Anatomy Laboratory, Aristotle University of Thessaloniki, Greece

-

Sameer, Bakhshi

Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

0000–0001-9367–4407

Panagiotis, D., Bamidis

Lab of Medical Physics & Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

0000–0002-9936–5805

Paula, N.V.P., Barbosa

Department of Imaging A.C.Camargo Cancer Center, São Paulo, Brazil

0000–0002-3231–5328

Nuru, Y., Bayramov

Department of I Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan

0000–0001-6958–5412

Antonios, Billis

Lab of Medical Physics & Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

0000–0002-1854–7560

Almir, G.V., Bitencourt

Department of Imaging, A.C.Camargo Cancer Center, São Paulo, Brazil

0000–0003-0192–9885

Antonio, J., Bollas Becerra

Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

0000–0003-4612–3949

Fabrice, Busomoke

Ministry of Health—Byumba Hospital, Byumba, Rwanda

0009–0002-2520–2488

Andreia, Capela

Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal

0000–0002-7576–6938

Riccardo, Cau

Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554 Monserrato, Cagliari, Italy

0000–0002-7910–1087

Warren, Clements

Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University Central Clinical School, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia

0000–0003-1859–5850

Alexandru, Corlateanu

Department of Respiratory Medicine and Allergology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

0000–0002-3278-436X

Renato, Cuocolo

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy

0000–0002-1452–1574

Nguyễn, N., Cương

Radiology Center Hanoi, Medical University Hospital Hanoi, Hanoi, Vietnam

0000 0001 8809 9583

Zenewton, Gama

Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil

0000–0003-0818–9680

Paulo, J., de Medeiros

Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal-RN, Brazil

0000–0002-2409–9944

Guillermo, de Velasco

Department of Biochemistry and Molecular Biology, School of Biology, Complutense University, Madrid, Spain; Instituto de Investigaciones Sanitarias San Carlos (IdISSC), Madrid, Spain

0000–0002-1994–2386

Vijay, B., Desai

Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE

0000–0003-3256–4778

Ajaya, K., Dhakal

Department of Pediatrics, KIST Medical College and Teaching Hospital, Kathmandu, Nepal

0000–0002-2881-655X

Virginia, Dignum

Department of Computing Science, Umeå University, Umeå, Sweden

0000–0001-7409–5813

Izabela, Domitrz

Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland; Bielanski Hospital, Warsaw, Poland

0000–0003-3130–1036

Carlos, Ferrarotti

Department of Diagnostic Imaging, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina

-

Katarzyna, Fułek

Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw Poland

0000–0002-1147-774X

Shuvadeep, Ganguly

Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

0000–0002-7296–6088

Ignacio, García-Juárez

Department of Gastroenterology and Unit of Liver Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

0000–0003-2400–1887

Cvetanka, Gjerakaroska Savevska

University Clinic for Physical Medicine and Rehabilitation, Ss Cyril and Methodius University, Skopje, Republic of North Macedonia

0000–0002-2328–4873

Marija, Gjerakaroska Radovikj

University Clinic for State Cardiac Surgery, Ss Cyril and Methodius University, Skopje, Republic of North Macedonia

0000–0003-4916–6178

Natalia, Gorelik

Department of Radiology, McGill University Health Center, Montreal, Canada

0000–0001-9672–6807

Valérie, Gorelik

Dawson College, Montreal, Canada

0009–0004-0184–2231

Luis, Gorospe

Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain

0000–0002-2305–7064

Ian, Griffin

Department of Radiology, University of Florida, Florida, USA

0009–0006-6565–4971

Andrzej, Grzybowski

Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznań, Poland

0000–0002-3724–2391

Alessa, Hering

Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Fraunhofer MEVIS, Institute for Digital Medicine, Bremen, Germany

0000–0002-7602-803X

Michihiro, Hide

Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

0000–0002-1569–6034

Bruno, Hochhegger

Department of Radiology, University of Florida, Florida, USA

0000–0003-1984–4636

Jochen, G., Hofstaetter

Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria

0000–0001-7741–7187

Mehriban, R., Huseynova

Department of I Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan

0000–0002-4040–5868

Oana-Simina, Iaconi

Research Cooperation Unit within the Research Department, National Institute of Research in Medicine and Health, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

0009–0003-3139–7004

Pedro, Iturralde Torres

Subdirección de Diagnóstico y Tratamiento, Instituto Nacional de Cardiología—Ignacio Chávez,

Mexico City, Mexico

-

Nevena, G., Ivanova

Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Cardiology, Karidad Medical Health Center, Plovdiv, Bulgaria

0000–0002-4213–8142

Juan, S., Izquierdo-Condoy

One Health Research Group, Universidad de Las Américas, Quito, Ecuador

0000–0002-1178–0546

Aidan, B., Jackson

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, St Vincent's Hospital Melbourne, Fitzroy 3065, Fitzroy, Australia

0000–0002-3809–8301

Ashish, K., Jha

Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India, Homi Bhabha National Institute—Deemed University, Anushaktinagar, Mumbai, India

0000–0001-5998–3206

Nisha, Jha

Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Kathmandu, Nepal

0000–0003-1089–6042

Lili, Jiang

Department of Computing Science, Umeå University, Umeå, Sweden

0000–0002-7788–3986

Rawen, Kader

Division of Surgery and Interventional Sciences, University College London, London, United Kingdom

0000–0001-9133–0838

Padma, Kaul

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada

0000–0003-2239–3944

Gürsan, Kaya

Department of Nuclear Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey

0000–0003-3157–5782

Katarzyna, Kępczyńska

Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland

-

Israel, K., Kolawole

Department of Anaesthesia, University of Ilorin/Teaching Hospital, Ilorin, Nigeria

0000–0001-5823–8685

George, Kolostoumpis

European Cancer Patient Coalition (ECPC), Brussels, Belgium

0000–0001-9768–9526

Abraham, Koshy

Department of Gastroenterology, Lakeshore Hospital, Kochi, India

0000–0002-9997–6569

Nicholas, A., Kruger

Orthopaedic Department, University of Cape Town, Cape Town, South Africa

0000–0002-8543–5745

Alexander, Loeser

Berlin University of Applied Sciences and Technology (BHT), Berlin, Germany

0000–0002-4440–3261

Marko, Lucijanic

Department of Hematology, Clinical Hospital Dubrava, Zagreb, Croatia, Department of Internal Medicine, School of Medicine University of Zagreb, Zagreb, Croatia

0000–0002-1372–2040

Stefani, Maihoub

Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary

0000–0002-3024–6197

Sonyia, McFadden

School of Health Sciences, Londonderry, Northern Ireland

0000–0002-4001–7769

Maria, C., Mendez Avila

Department of Imaging, University of Costa Rica, San Jose, Costa Rica

0009–0000-7124–2662

Matúš, Mihalčin

Department of Infectious Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Infectious Diseases, University Hospital Brno, Brno, Czech Republic

0000–0002-2946-658X

Masahiro, Miyake

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

0000–0001-7410–3764

Roberto, Mogami

Departamento de Medicina Interna, Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

0000–0002-7610–2404

András, Molnár

Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary

0000–0002-4417–5166

Wipawee, Morakote

Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

0000–0002-8670–7386

Issa, Ngabonziza

Ministry of Health—Byumba Hospital, Byumba, Rwanda

0000–0001-6092-166X

Trung, Q., Ngo

Department of Urology and Renal Transplantation, People's Hospital 115, Ho Chi Minh City, Vietnam

0000–0001-8044–6376

Thanh, T., Nguyen

Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

0000–0001-9379–6359

Marc, Nortje

Orthopaedic Department, University of Cape Town, Cape Town, South Africa

0000–0002-7737-409X

Subish, Palaian

Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE

0000–0002-9323–3940

Rui, P., Pereira de Almeida

Radiology Department, University of Algarve, Faro, Portugal; Comprehensive Health Research Center, University of Évora, Évora, Portugal

0000–0001-7524–9669

Barbara, Perić

Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

0000–0001-7228–8267

Gašper, Pilko

Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

0009–0003-0470–2034

Monserrat, L., Puntunet Bates

Unidad de Calidad, Instituto Nacional de Cardiología—Ignacio Chávez, Mexico City, Mexico

-

Mitayani, Purwoko

Medical Biology, Faculty of Medicine Universitas Muhammadiyah Palembang, Palembang, Indonesia

0000–0002-3936–3883

Clare, Rainey

School of Health Sciences, Londonderry, Northern Ireland

0000–0003-0449–8646

João, C., Ribeiro

Coimbra University and Medical School, Coimbra, Portugal

0000–0002-1039–6358

Gaston, A., Rodriguez-Granillo

Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina

0000–0003-0820–2611

Nicolás, Rozo Agudelo

Instituto Global de Excelencia Clínica, Bogotá D.C, Colombia

0000–0003-0409–2515

Luca, Saba

Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554 Monserrato, Cagliari, Italy

0000–0003-2870–3771

Shine, Sadasivan

Department of Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, Kochi, India

0000–0001-5676–5000

Keina, Sado

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

0009–0002-7596–4325

Julia, M., Saidman

Radiology Department, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

0000–0002-7626–7356

Pedro, J., Saturno-Hernandez

AXA Chair in Healthcare Quality, CIEE, National Institute of Public Health, Cuernavaca, Mexico

0000–0002-4991–5805

Gilbert, M., Schwarz

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria

0000–0001-6434–0520

Sergio, M., Solis-Barquero

Department of Imaging, University of Costa Rica, San Jose, Costa Rica

0000–0002-2513–0747

Javier, Soto Pérez-Olivares

Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain

0000–0002-0858–1394

Petros, Sountoulides

Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

0000–0003-2671-571X

Arnaldo, Stanzione

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy

0000–0002-7905–5789

Nikoleta, G., Tabakova

Medical University of Varna, Varna, Bulgaria

0000–0003-4177–3897

Konagi, Takeda

Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

0009–0004-3763–5701

Satoru, Tanioka

Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan; Charité Lab for Artificial Intelligence in Medicine, Corporate Member of Freie Universität Berlin, Charité—University Medicine Berlin, Berlin, Germany

0000–0002-4678–6163

Hans, O., Thulesius

Research and Development Department Region Kronoberg, Växjö, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden

0000–0002-3785–5630

Liz, N., Toapanta-Yanchapaxi

Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

0000–0002-1218–1721

Minh, H., Truong

Department of Urology and Renal Transplantation, People's Hospital 115, Ho Chi Minh City, Vietnam; Department of Nephro-Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam

-

Murat, Tuncel

Department of Nuclear Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey

0000–0003-2352–3587

Elon, H.C., van Dijk

Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Ophthalmology, Alrijne Hospital, Leiderdorp, The Netherlands

0000–0002-6351–7942

Peter, van Wijngaarden

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia

0000–0002-8800–7834

Lina, Xu

Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany

0009–0007-4119–1033

Tomasz, Zatoński

Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland

0000–0003-3043–4806

Longjiang, Zhang

Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

0000–0002-6664–7224

The authors want to thank Jaime Moujir-López, Javier Blázquez-Sánchez (Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain), Rubens Chojniak (Department of Imaging, A.C.Camargo Cancer Center, São Paulo, Brazil), and Dania Saad Rammal, Aya Mutasem Baradie, and Farrah Emad Elsubeihi (College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates) for supporting the data collection at their institutions. The authors acknowledge financial support from the Open Access Publication Fund of Charité—Universitätsmedizin Berlin.

Funding

Open Access funding enabled and organized by Projekt DEAL. This research is funded by the European Union (COMFORT (Computational Models FOR patienT stratification in urologic cancers – Creating robust and trustworthy multimodal AI for health care), project number: 101079894, authors involved: FB, MRM, LCA, PDB, AB, RC, GDV, VD, AH, LJ, GK, AL, PS, principal investigator: KKB, sponsors' website: https://www.comfort-ai.eu). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union. The European Union cannot be held responsible for them. The funding had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish.

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Authors

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Contributions

Conceptualization: FB, LH, DT, MRM, KKB, LCA, AB, RC, GdV, LG, AH, LJ, AL, JSPO, PS, LX; Project administration: FB, LH, KKB, LCA; Resources: FB, KKB, LCA, COMFORT consortium; Software: FB, LH, KKB, LCA; Data curation: FB, LH, KKB, LCA; Formal analysis: FB, LH, KKB, LCA, COMFORT consortium; Funding acquisition: FB, MRM, KKB, LCA, PDB, AB, RC, GdV, VD, AH, LJ, GK, AL, PS; Investigation: FB, LH, KKB, LCA; Methodology: FB, LH, DT, KKB, LCA; Supervision: FB, KKB; Validation: FB, LH, DT, EOP, MRM, KKB, LCA, COMFORT consortium; Visualization: FB, EOP, KKB; Writing – original draft preparation: FB, KKB, LCA; Writing – review & editing: FB, LH, DT, EOP, MRM, KKB, LCA, COMFORT consortium. All COMFORT consortia authors equally contributed to the data collection at their institutions, critically revised the final version of the manuscript for intellectual content, gave their final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Felix Busch.

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Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Board at Charité – University Medicine Berlin (EA4/213/22) in compliance with the Declaration of Helsinki and its later amendments. To ensure participant anonymity, the necessity for informed consent was waived.

Consent for publication

Not applicable.

Competing interests

KKB reports grants from the Wilhelm Sander Foundation and receives speaker fees from Canon Medical Systems Corporation. KKB is a member of the advisory board of the EU Horizon 2020 LifeChamps project (875329) and the EU IHI project IMAGIO (101112053). MA reports consultant fees from Segmed, Inc. The competing interests had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish. All other authors declare no financial or non-financial competing interests.

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Busch, F., Hoffmann, L., Truhn, D. et al. Global cross-sectional student survey on AI in medical, dental, and veterinary education and practice at 192 faculties. BMC Med Educ 24, 1066 (2024). https://doi.org/10.1186/s12909-024-06035-4

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