An audit of AI-related documents across U.S. medical schools: A framework-based qualitative content analysis

Medical schools would benefit from systematic guidance for developing comprehensive artificial intelligence (AI) policies, given generative AI's rapid integration into medical education. This study developed and applied an idealized AI policy framework to analyze AI-related documents at U.S. medical school institutions, providing reference points for the development and refinement of institutional policies.

AI-related documents from institutions with U.S. allopathic and osteopathic medical schools were systematically collected (from August to October 2024) and analyzed using a comprehensive framework containing 24 subthemes across six themes: Background/Context, Governance, AI Literacy, Tools/Usage, Ethical/Legal Considerations, and Technology Support and Infrastructure. Publicly available online documents were systematically coded to generate framework subtheme scores indicating breadth of coverage across framework themes.

AI-related documents retrieved from 73.7% (146/198) of U.S. medical school institutions covered an average of 8 of 24 subthemes, representing a mean framework coverage score of 32.3% ± 19.8 Rarely addressed subthemes included Audit and Compliance Mechanisms (6.8%, 10/146), Technical Infrastructure (6.2%, 9/146), and Environmental Stewardship (1.4%, 2/146). Academic Honesty and Plagiarism dominated AI-related documents (81.5%, 119/146), followed by Decision-Making Authority (54.1%, 79/146) and Critical Evaluation (52.1%, 76/146). Formal AI policies demonstrated significantly higher framework coverage than other AI document types (44.0% vs 30.4%, p = 0.003). Seven institutions with the highest coverage (≥13/24 subthemes) shared seven common distinguishing features, with six present universally.

AI-related documents currently emphasize academic integrity over strategic planning, with substantial gaps in infrastructure and review mechanisms. Institutions can enhance their AI policies by incorporating common features identified in well-designed policies and following frameworks that strike a balance between immediate concerns and long-term adaptability.