A Competency Framework for Medical AI Education: Mixed Methods Study

Abstract Background Although artificial intelligence (AI) is increasingly adopted in health care, clinicians face barriers, including insufficient understanding, limited trust, and challenges in interpreting AI outputs. Existing frameworks, such as the United Nations Educational, Scientific and Cultural Organization (UNESCO) AI competency framework, lack clinical specificity. Additionally, there remains limited evidence on framework-based training programs for medical professionals. Objective This study aimed to (1) develop a medical AI competency framework and (2) apply the framework to design an AI training program and pilot 1 module. Methods We conducted a mixed methods study comprising 2 phases. In Study 1, we developed a medical AI competency framework by integrating the UNESCO AI framework with the Miller pyramid model. The framework was refined through expert input from 24 stakeholders (6 hospital administrators, 8 medical professionals, and 10 university instructors). Expert responses were analyzed using deductive content analysis based on predefined codebooks. In study 2, we designed an AI training program based on the framework, and evaluated it using a 2-round Delphi process. Nine educators with expertise in instructional design, medical education, and AI participated in the Delphi study. Consensus in round 1 was defined as an IQR≤1, agreement score proportion >75%, and full-score frequency >49.23%; in round 2, consensus was defined as agreement score proportion >80%. A pilot workshop with 28 participants and 4 instructors assessed the feasibility of 1 module using self-reported measures of satisfaction, engagement, and confidence. Results A 6D 4-level medical AI competency framework was developed. Among the 24 experts, 19 (79.17%) mentioned competencies related to AI foundations, and 23 (95.83%) mentioned competencies related to application skills. The framework was translated into a 5-module training program, covering patient-centered and ethical AI, privacy and security, medical AI applications, bias and health equity, and generative AI in health care. Each module included 5 elements: content, learning goals, teaching activities, learning resources, and assessment. The Delphi process achieved complete consensus across all 25 elements of the training program. The pilot workshop indicated high participant satisfaction (mean 4.00, SD 0.52), good engagement (mean 3.80, SD 0.71‐mean 4.05, SD 0.51), and moderate self-reported confidence (mean 3.63, SD 0.53). These findings suggest that the module was feasible, although outcomes should be interpreted cautiously given the self-reported and short-term nature of the evaluation. Conclusions The framework provides a structured reference for AI training program design in medical education. The workshop findings provide preliminary support for the feasibility of the program’s technical module, while also highlighting the need for broader and longer-term evaluations. Future work should expand the framework and training program to new regions and delivery formats (eg, semester-long courses and continuing medical education) and evaluate their long-term impact.