Generative artificial intelligence in medical education: from knowledge assessment to clinical reasoning and professional competence.

Generative artificial intelligence (GenAI), particularly large language models (LLMs), is poised to fundamentally transform medical education. Based on a structured literature search of PubMed, Scopus, Web of Science, and Google Scholar, this review synthesizes current evidence on the applications, capabilities, and limitations of GenAI across the medical training continuum. Advanced LLMs demonstrate a formidable command of medical knowledge, consistently achieving passing scores on standardized licensing examinations, with GPT-4 and domain-specific models like Ortho GPT showing particular proficiency. As versatile teaching tools, these models can generate high-quality assessment materials, provide personalized on-demand tutoring, and power interactive virtual patients for clinical reasoning practice. However, this potential is tempered by significant challenges, including a propensity for "hallucinations," embedded biases that can perpetuate health inequities, linguistic performance disparities, and a fundamental gap in flexible, adaptive clinical reasoning. Integration also raises critical concerns regarding academic integrity, potential over-reliance leading to deskilling, and data privacy. Responsible adoption requires a structured approach encompassing the development of tiered AI competency frameworks, blended curricular integration, dedicated faculty development, and a rigorous research agenda focused on longitudinal learning outcomes. Ultimately, GenAI should be viewed as a powerful augmentative tool, not a replacement for human educators. Its successful integration will depend on leveraging its strengths to enhance efficiency and scalability while preserving the essential humanistic elements of medical practice through expert oversight and validation.