Does AI-supported clinical reasoning training enhance learning transfer in nursing students? A systematic review and...

To systematically review evidence on whether AI-supported clinical reasoning training promotes learning transfer among prelicensure nursing students.

Clinical reasoning is essential for safe nursing practice, yet gains in tests or familiar simulations may not transfer to novel or authentic clinical contexts. AI may support transfer through scalable deliberate practice, case variability and immediate feedback, but evidence remains fragmented.

A systematic review with narrative synthesis.

Eight databases were searched from inception to November 6, 2025. Eligible studies compared AI-supported clinical reasoning interventions with non-AI interventions or routine instruction. The outcomes focused on transfer-related metrics. We assessed risk of bias using RoB 2 for randomized trials and ROBINS-I for nonrandomized studies, followed by a narrative synthesis.

Five studies were included. AI-supported interventions generally improved knowledge and supported near transfer to structurally similar assessment contexts. Evidence regarding transfer to early clinical practice tasks was limited, with one RCT providing preliminary evidence of benefits in real-patient assessments and additional hypothesis-generating signals from a high-risk NRSI; however, evidence was insufficient regarding far transfer and long-term retention. Affective outcomes were mixed.

When AI-supported clinical reasoning training is well aligned with clinical reasoning frameworks and assessment requirements, it can effectively support near transfer. However, existing evidence provides limited support for its effectiveness in promoting far transfer or developing the interpersonal dimension of clinical reasoning. It is recommended that such training be strategically integrated into blended learning curricula, combined with guided reflection and social learning activities, to maximize educational outcomes.