From principle to practice: Developing a digital-age clinical artificial intelligence ethics competence framework through early-career doctors' experiences.

Ethical competence for AI-mediated care requires integrated epistemic and relational capacities beyond technical literacy or traditional medical ethics. We propose the Digital-Age Clinical AI Ethics Competence (DCEC) framework, comprising four domains of epistemic awareness, relational integrity, reflexive accountability and adaptive professionalism, anchored by ethical digital literacy (EDL). Each domain is operationalised with specific learning activities and assessment strategies such as Objective Structured Clinical Examination (OSCE) stations, reflective portfolios and ethics viva. We discuss implications for curriculum design, faculty development and competency-based assessment.