International Medical Education

The integration of artificial intelligence (AI), particularly large language models (LLMs), into education, marks a profound shift in how knowledge is accessed, processed, and applied. These tools offer clear advantages—including improved efficiency, immediate support, and high productivity—but it may simultaneously weaken foundational skills. This Perspective examines the dual impact of AI on education, arguing that over-reliance on AI may displace essential cognitive processes that reinforce professional competence. Emerging evidence points to troubling associations between frequent AI use and diminished critical reasoning. We propose a model of critical alliance, in which AI augments but does not replace core intellectual processes. Unlike existing AI competency or digital literacy, this model centers on preserving human cognitive agency, judgment, reflection, and intellectual ownership, as primary educational outcomes. This framework not only emphasizes cognitive independence, but also equitable access, ethical vigilance, and faculty development as cornerstones of AI literacy. Addressing these questions is essential to safeguard both intellectual growth and educational equity in an AI-augmented era. Unlike existing digital literacy or AI competency frameworks, the critical alliance explicitly centers on preserving human cognitive agency and intellectual ownership as educational priorities, particularly in environments increasingly shaped by high-performing generative systems.

Simulation-based learning experiences (SBLE) are widely used in health professions education to enhance clinical skills, confidence, and decision-making in a safe environment. In Doctor of Physical Therapy (DPT) programs, peer simulation offers a cost-effective alternative to high-fidelity simulation and standardized patients, though its effectiveness across different instructional formats remains underexplored. This study examined the differences in student confidence in outpatient physical therapy between cohorts of students from three educational delivery methods, which included face-to-face (F2F), virtual instruction (VI), and F2F combined with integrated clinical experiences (F2F + ICE), prior to their first clinical experience. Using a three-group comparative design, 107 students across three academic years (2019, 2020, and 2022) completed pre- and post-course surveys assessing confidence in four domains and interest in outpatient care. A two-way ANCOVA, controlling baseline interest, revealed significant differences in confidence across all cohorts between pre- and post-course assessment time periods (p < 0.001), with no significant differences between cohorts under the various delivery formats at post-course assessment. While the F2F + ICE group demonstrated higher baseline confidence, this difference was not found post-course. Findings suggest that peer simulation effectively improves perceived confidence in outpatient physical therapy regardless of delivery mode. These results support the integration of SBLE in DPT curricula to prepare students for clinical practice and highlight the need for further research across multiple programs.

While the distribution of those underrepresented in medicine (URiM) varies across US medical specialties, it remains unclear whether residency website diversity messaging influences these patterns by specialty and geographic region. This study investigates residency diversity messaging from different specialties and assesses factors that influence URiM recruitment. The 2024 AAMC Report on Residents identified the three specialties with the highest and lowest URiM representation (Integrated Thoracic Surgery, Otolaryngology, Interventional Radiology, Public Health and General Preventive Medicine, Obstetrics and Gynecology (OBGYN), and Family Medicine). Using FREIDA™, all residency programs were reviewed between December 2024 and March 2025. Websites received diversity indicator scores based on the presence of a nondiscrimination statement, a diversity and inclusion message, a program-specific diversity section, a general diversity section, an appointed diversity leadership position(s) or committee(s), URiM rotations or fellowship opportunities, and diversity initiatives. Diversity scores only differed significantly between OBGYN and Family Medicine (p = 0.003). Significant regional differences include South–Midwest (p = 0.014), South–Northeast (p = 0.030), West–Northeast (p = 0.044), and West–South (p < 0.001). Multivariate analysis showed no relationship between diversity criteria and URiM representation, suggesting current messaging that emphasizes diversity may not be associated with URiM resident proportions. Programs in the South had lower diversity scores, indicating geography may influence URiM representation more than website content.