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Integrating AI Scribes into Medical Education: Guardrails for Preserving Clinical Reasoning.
Jane Abernethy1, Anna Shah2, Belinda Chen3
1Johns Hopkins Bayview Medical Center, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jaberne1@jhmi.edu.
Journal of General Internal Medicine
|February 2, 2026
Summary
Artificial intelligence (AI) scribes can aid physician training by supporting clinical reasoning. Educators should guide trainees to use AI tools as a scaffold for learning, not a replacement for critical thinking skills.
Area of Science:
- Medical Education
- Health Informatics
Background:
- Clinical documentation is crucial for physician training, fostering clinical reasoning and narrative synthesis.
- The rise of AI scribes automates note generation, posing potential challenges to medical education.
Purpose of the Study:
- To explore the impact of AI scribes on medical trainees' clinical reasoning and documentation skills.
- To propose best practices for integrating AI scribes into residency programs.
Main Methods:
- A 6-month pilot implementation of an AI scribe tool with 48 internal medicine residents.
- Generation of nearly 1000 AI-assisted clinical notes.
Main Results:
- AI scribes can support, rather than hinder, the development of reflective practice and diagnostic thinking.
- Seven best practices were developed, mapped to ACGME Core Competencies.
Conclusions:
- Educators must guide trainees to leverage AI as a tool to enhance reasoning, not as a substitute for it.
- Structured training and critical review are essential for effective AI scribe integration.
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