Effects of Artificial Intelligence-Supported Education on Critical Thinking, Problem-Solving, Clinical Reasoning, and Decision-Making in Health Science Education: A Systematic Review of Interventional Studies.

BACKGROUND

Artificial intelligence (AI) is increasingly incorporated into health science education through diagnostic systems, intelligent tutoring systems, adaptive learning platforms, chatbots, virtual patients, and large language models. However, its effects on higher-order cognitive skills remain uncertain.

OBJECTIVE

To synthesize interventional evidence on the effects of AI-supported education on critical thinking, problem-solving, clinical reasoning, and decision-making among health science learners.

METHODS

This systematic review followed PRISMA 2020 and a prospectively registered protocol (PROSPERO CRD420251128495). PubMed, Scopus, the Cochrane Library, Google Scholar, and supplementary sources were searched for interventional studies evaluating AI-supported education and at least one of four predefined cognitive outcomes: critical thinking, problem-solving, clinical reasoning, or decision-making. Searches were updated through 24 August 2026. Randomized studies were assessed using RoB 2, non-randomized intervention studies using ROBINS-I, and quasi-experimental studies using JBI critical appraisal criteria. Findings were synthesized narratively and classified as positive, null, mixed, or negative.

RESULTS

Twenty-nine interventional studies involving 2138 participants met the eligibility criteria. The included studies evaluated conventional and generative AI technologies, including diagnostic AI systems, intelligent tutoring systems, AI-enabled chatbots, generative image systems, and large language models. Findings varied across the four cognitive outcomes. Structured AI-supported interventions frequently demonstrated favorable effects on selected clinical reasoning, decision-making, problem-solving, and critical-thinking outcomes; however, null, mixed, and negative findings were also reported, particularly when AI was compared with established educational resources or used without structured instructional guidance.

CONCLUSION

AI-supported education may enhance selected higher-order cognitive outcomes among health science learners, but the evidence is inconsistent across technologies, instructional designs, comparators, and cognitive constructs. Structured integration that preserves active learner engagement and independent reasoning appears important. Further rigorous studies using validated outcome measures and assessments of sustained, unaided performance are needed.