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The impact of artificial intelligence on critical thinking and clinical reasoning in health professions education: A systematic review and meta-analysis.

Yan Ni Tay·Nicholas Wee Siong Neo·Chiew Jiat Rosalind Siah
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Abstract

BACKGROUND: Critical thinking and clinical reasoning underpin healthcare professionals' ability to navigate uncertainties and deliver safe and effective care. With artificial intelligence (AI) advancement and growing adoption, AI-based educational tools are increasingly used to support these cognitive competencies' development. OBJECTIVE: To synthesize randomised and controlled clinical trials on AI-based educational tools in health professions education and examine their effects on critical thinking and clinical reasoning among health professions students. METHODS: Six electronic databases were searched from January 1, 2014 to July 28, 2025 was reviewed: PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Embase and Web of Science. Two independent reviewers performed data extraction and quality assessment using standardized JBI checklists. The GRADE approach was used to assess the certainty of evidence. Studies were pooled via random-effects meta-analyses or narrative syntheses. RESULTS: Fourteen randomised controlled trials and seven controlled clinical trials were included (n = 21). Meta-analyses revealed small to medium effect sizes for the surrogate clinical reasoning outcomes of performance-based assessment scores (SMD 0.68; 95% CI [0.38, 0.98], p-value = 0.00; I2 = 38%) and knowledge test scores (SMD 0.39; 95% CI [0.09, 0.69], p-value = 0.01; I2 = 79%). Critical thinking and clinical reasoning skills and dispositions were narratively synthesized, with majority of included studies favouring AI-based interventions but the evidence had low to very low certainty. CONCLUSION: AI-based educational interventions may improve critical thinking and clinical reasoning among health profession students, but the evidence is very uncertain. This review offers preliminary insights but does not allow identification of optimal interventions or discipline-specific recommendations due to small sample sizes and substantial intervention heterogeneity. Further research is required to draw definitive conclusions. PROTOCOL REGISTRATION: CRD42025634074.

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HumansThinkingClinical ReasoningArtificial IntelligenceHealth OccupationsClinical CompetenceJournal ArticleSystematic ReviewMeta-AnalysisReview

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Yan Ni Tay, Nicholas Wee Siong Neo, Chiew Jiat Rosalind Siah. 2026-08-04. The impact of artificial intelligence on critical thinking and clinical reasoning in health professions education: A systematic review and meta-analysis.. https://doi.org/10.1016/j.nedt.2026.107322

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Artificial Intelligence subjectClinical Competence subjectClinical Reasoning subjectHealth Occupations subjectHumans subjectJournal Article subjectJournal Article; Systematic Review; Meta-Analysis; Review resourceMeta-Analysis subjectSystematic reviews study

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