AI Literacy Among Chinese Medical Students: Cross-Sectional Examination of Individual and Environmental Factors.

Background: Artificial intelligence (AI) literacy is increasingly essential for medical students. However, without systematic characterization of the relevant components, designing targeted medical education interventions may be challenging. Objective: This study aimed to systematically describe the levels of and factors associated with multidimensional AI literacy among Chinese medical students. Methods: A cross-sectional, descriptive analysis was conducted using data from a nationwide survey of Chinese medical students (N=80,335) across 109 medical schools in 2024. AI literacy was assessed with a multidimensional instrument comprising three domains: knowledge, evaluating students' self-reported proficiency in core areas of medical AI applications; attitude, reflecting their self-perceived views on using AI for teaching and learning; and behavior, capturing the self-perceived usage frequency and application patterns. Multivariate linear regression was applied to examine the associations between individual factors (ie, demographic characteristics, family background, and enrollment motivation) and environmental factors (ie, educational phase, type of education program, and tier of education program) and AI literacy. Results: Respondents showed moderate to high levels of AI knowledge (mean 76.0, SD 26.9), followed by moderate AI attitude scores (mean 71.6, SD, 24.4). In contrast, AI behavior scores were much lower (mean 32.5, SD, 28.5), indicating little usage of AI tools. Of the individual factors, male students reported higher levels of AI attitude and behavior; both intrinsic and extrinsic motivation were positively associated with all three dimensions; advantaged family background was positively related to AI attitude and behavior, but not knowledge. Among the environmental factors, attending the prestigious Double First-Class universities was positively associated with higher AI usage. Enrollment in long-track medical education programs was associated with higher AI attitude and behavior, while being in the clinical phase was negatively associated with both AI knowledge and behavior. Environmental factors moderated the associations between individual characteristics and AI literacy, potentially attenuating disparities. Conclusions: Medical students reported moderate to high AI knowledge, moderate AI favorability, and low AI use. Individual characteristics and environmental factors were significantly associated with AI literacy, and environmental factors moderated the associations. The moderate AI literacy overall highlights the need for AI-related medical education, ideally with practical use and nuanced by socioeconomic factors.