Ethics-related appraisal in AI mediating AI exposure and adoption willingness in medical PhD Students: cross-sectional study

Artificial intelligence (AI) has increasingly influenced medical education and clinical practice, yet significant variability exists in adoption willingness among healthcare professionals. While ethics-related appraisal was recognized as an important correlate of AI adoption willingness, its potential indirect role between AI exposure and adoption willingness has been underexplored, particularly among medical PhD students who represent future leaders in healthcare innovation. This cross-sectional study surveyed 202 medical PhD students to examine perceptions of AI in healthcare. Willingness to adopt AI was measured using three 5-point Likert items assessing recommendation intentions, participation willingness, and optimism about AI-driven outcomes. AI exposure was assessed through three items evaluating familiarity with AI concepts, clinical applications, and educational integration. Ethics-related appraisal was measured using four items reflecting perceptions of governance adequacy, application boundaries, international standards alignment, and legal-ethical awareness. Data were analyzed using SPSS 30.0 and SPSS Amos 30.0. AI exposure was positively associated with willingness to adopt AI, with a standardized total association of 0.537 [95% CI: 0.352 to 0.696]. The direct association was not statistically significant (95% CI: -0.161 to 0.184) when ethics-related appraisal was included in the model. The indirect association of AI exposure on willingness to adopt AI through ethics-related appraisal was 0.509 [95% CI: 0.341 to 0.727], accounting for 94.79% of the total association. In this cross-sectional sample, AI exposure was statistically associated with adoption willingness through its indirect association with ethics-related appraisal. These findings suggest that ethics-related appraisals is closely related to AI adoption attitudes among medical PhD students. Enhancing real-world AI exposure alongside structured ethics education may support more informed engagement with AI in healthcare.