Evidence-Based Medicine

Research Appraisals

Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.

Showing 16 appraisals

Systematic ReviewEvidence: Weak
25CEBM

Artificial intelligence in medicine

Green artificial intelligence in health applications

As the healthcare sector increasingly integrates Artificial Intelligence (AI) technologies to improve operational effectiveness, diagnosis, and therapy, the environmental footprint of these innovations has become a growing concern. High energy consumption, electronic waste, and carbon emissions associated with the deployment and training of AI models pose sustainability challenges that must be addressed. This paper investigates the concept and application of Green AI in healthcare, aiming to balance technological advancement with environmental responsibility. This systematic review explores key themes, including green computing practices, the adoption of energy-efficient AI models, and the use of renewable energy sources within healthcare settings. It identifies a range of healthcare applications employing Green AI, highlights emerging trends, and emphasizes the growing importance of environmental awareness in AI development. Furthermore, the study examines enabling tools and techniques, outlines barriers to adoption, and highlights how Green AI can help streamline processes, reduce resource waste, and promote environmentally friendly medical procedures like telemedicine. The review also discusses the significance of policy frameworks, international initiatives, and cross-sector collaboration in promoting environmentally responsible AI deployment. Finally, the paper presents practical implications and outlines future research directions to guide the sustainable evolution of AI in healthcare.

1 Aug 2026

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Randomised Controlled TrialEvidence: Weak
50CEBM

PloS one

Evaluating the cultural alignment of multilingual LLMs in typical Japanese workplace scenarios

While current evaluations of LLM cultural alignment predominantly rely on static benchmarks in Western contexts, their ability to navigate generative, high-context socio-pragmatic demands in non-Western environments remains critically underexplored. This study investigates how multilingual LLMs adapt to the Japanese workplace-a stringent stress-test environment characterized by strong high-context communication norms and rigid honorific conventions-using Hofstede's six cultural dimensions as a heuristic framework. We evaluated five state-of-the-art LLMs (LLM-jp, Phi, Llama, Qwen, and GLM) through a large-scale crowdsourced human evaluation. Based on 1,718 valid evaluator sessions, native Japanese raters assessed model outputs to generate a holistic Japanese Workplace Cultural Alignment Score (JWCAS). To dissect the underlying communicative strategies, we paired this with a three-layer diagnostic sub-score analysis (Linguistic Form, Socio-Cultural Values, and Social Action). Our results reveal that leading multilingual models (Phi and GLM) achieved overall JWCAS scores comparable to, or significantly higher than, the native Japanese model (LLM-jp). Crucially, our sub-score analysis demonstrates that holistic evaluation metrics can obscure deep pragmatic deficits: while LLM-jp overfits to surface-level linguistic politeness (Layer 1), it shows critical weaknesses in socio-cultural values (Layer 2) and context-aware social strategies (Layer 3). In contrast, leading multilingual models demonstrate balanced competence across all layers. These findings suggest that true cultural competence requires moving beyond native linguistic mastery, highlighting the necessity of multi-dimensional diagnostic frameworks for cross-cultural AI alignment.

29 July 2026

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otherEvidence: Weak
30CEBM

Proceedings of the National Academy of Sciences of the United States of America

Legal infrastructure for transformative AI governance

Most of our AI governance efforts focus on substance: What rules do we want in place? What limits or checks do we want to impose on AI development and deployment? But a key role for law is not only to establish substantive rules but also to establish legal and regulatory infrastructure to generate and implement rules. The transformative nature of AI calls especially for attention to building legal and regulatory frameworks. In this Perspective, I review three examples: the creation of registration regimes for frontier models; the creation of registration and identification regimes for autonomous agents; and the design of regulatory markets to facilitate a role for private companies to innovate and deliver AI regulatory services.

29 July 2026

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otherEvidence: Weak
40CEBM

MedEdPORTAL : the journal of teaching and learning resources

Artificial Intelligence and Large Language Models: A Case-Based, Peer-Teaching Workshop for Preclinical Medical Students

INTRODUCTION: Artificial intelligence tools have rapidly become integrated in health care settings and are quickly affecting medical student education. However, there remains limited formal teaching on such tools in student curricula. This project sought to introduce preclerkship medical students to the basics of large language models and allow them to practice ways to best use these tools to supplement their learning. METHODS: The authors designed, implemented, and evaluated a 60-minute lecture and 100-minute workshop for second-year medical students. The workshop included interactive cases covering various aspects of artificial intelligence use, and some groups were led entirely by student leaders, allowing for peer teaching. RESULTS: One hundred sixty-eight students from Harvard Medical School and Harvard School of Dental Medicine were enrolled in this session. Anonymous pre- and postsession surveys (N = 124 and N = 62, respectively) were collected and compared via unpaired t test assuming unequal variance and showed statistically significant increase in the mean ratings of six 5-point Likert scale questions assessing artificial intelligence-related knowledge/self-efficacy (P < .01) and mixed changes to 5 questions relating to attitudes/behavioral intent. DISCUSSION: Our artificial intelligence and large language model session provides a framework for teaching medical students, early in their educational journey, the basics of these tools. Our session provides interactive exercises to illustrate how best to leverage such tools while also discussing their potential risks. Such education will be important to incorporate into medical student curricula as artificial intelligence technologies grow increasingly common.

23 July 2026

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otherEvidence: Weak
20CEBM

Journal of medical Internet research

Digital Transformation in Health Care: Are We on the Right Track?

Health care digital transformation is gaining increasing attention, despite the observed challenges in its implementation. The envisioned benefits, together with the growing need for better health care, are motivating academia, organizations, regulatory agencies, and governments to develop more effective digital health care solutions. Through extensive debates among the authors, this paper discusses how digital transformation is being conducted in the health care sector. Our discussion relies on concepts from sociotechnical systems theory, categorizing it into 3 social (people, culture, and goals) and 3 technical (processes/procedures, infrastructure, and technology) dimensions. Drawing on both the literature discussed in this paper and our combined academic and practical experience-each author contributing over a decade of work in health care digital transformation-we examined current digitalization efforts from a sociotechnical standpoint. Overall, we argue that both social and technical dimensions present elements that have either encouraged or discouraged the progress of health care digital transformation. The identification of current trends on such (on- and off-track) elements allowed the formulation of 12 propositions across each sociotechnical dimension for future testing and validation. This approach can help establish better government policies, foster private initiatives, and shift regulatory guidelines to support a successful digital transformation in health systems. Finally, from a research perspective, we outline some opportunities for further interdisciplinary investigation in the field, promoting advances in the understanding of health care digital transformation.

22 July 2026

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otherEvidence: Weak
35CEBM

Computers, informatics, nursing : CIN

Bridging the Gap Between Potential and Practice: An Integrative Review of Generative Artificial Intelligence in Nursing

BACKGROUND: Generative artificial intelligence (GAI) has emerged as a transformative tool in health care, particularly with the integration of large language models (LLMs) into electronic health record (EHR) systems. These tools have the potential to enhance clinical decision-making, increase efficiencies, and decrease time in the EHR. However, despite expanding availability, adoption in nursing practice remains limited. This integrative review aimed to synthesize the literature and explore barriers related to the integration of GAI tools into nursing practice. METHODS: We conducted an integrative search of peer-reviewed literature published between November 2022 and July 2025 to examine the current evidence while assessing for methodological quality. The retrieved articles were screened for title, abstract, and full text eligibility. We synthesized themes related to GAI adoption by nurses, focusing on ethical, educational, and workflow-related factors that influence use. RESULTS: A total of 10 studies met criteria including 7 qualitative descriptive design, 2 case reports, and 1 experimental clinical trial. Four key barriers emerged: educational gaps, ethical concerns, data transparency issues, and workflow misalignment contributing to nurses' hesitancy to engage with GAI tools. Recommendations include involvement of nurses in the design, implementation, and evaluation of GAI tools and mandatory AI curricula in nursing education. CONCLUSIONS: Overcoming barriers requires nurse involvement in GAI design efforts, targeted education, and governance models that foster trust and usability. Nurse-centered integration of GAI tools has the potential to advance workforce efficiencies while preserving patient safety.

4 July 2026

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observationalEvidence: Weak
45CEBM

Medical education online

Exploring medical Artificial Intelligence Readiness among Korean medical students: a cross-sectional study

INTRODUCTION: Artificial intelligence (AI) is rapidly transforming healthcare systems and clinical practice, increasing the need to prepare future physicians to work effectively with AI technologies in clinical contexts. Despite growing interest in integrating AI into medical education, empirical evidence regarding medical students' readiness to use AI remains limited. This study aimed to assess medical AI readiness among Korean medical students and explore factors associated with their readiness. METHODS: A cross-sectional survey was conducted among medical students enrolled in a six-year medical program at a university in Korea. A total of 204 students participated in the study. Medical AI readiness was measured using the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), which assesses four domains: cognition, ability, vision, and ethics. Descriptive statistics, independent t-tests, and Pearson's correlation analyses were performed using SPSS version 27. RESULTS: The overall mean score of medical AI readiness was 4.19 on a 7-point Likert scale, indicating a moderate level of medical AI readiness. Among the subscales, ethics showed the highest mean score (4.69), followed by vision (4.44), ability (4.18), and cognition (3.92). The frequency of AI use was significantly associated with medical AI readiness, whereas the daily duration of AI use was not. No significant gender differences were observed. When students were divided into the low (pre-medical years 1-2) and high (medical years 1-4) groups, the high group showed significantly higher scores only in the ability subscale. CONCLUSIONS: The findings suggest that medical students are not yet sufficiently prepared to utilize AI technologies in clinical practice, particularly in terms of knowledge and practical competencies related to AI. These results highlight the need for structured and longitudinal AI education in medical curricula to better prepare future physicians for AI-integrated healthcare environments.

1 July 2026

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Randomised Controlled TrialEvidence: Insufficient
15CEBM

Journal of health organization and management

Cloud-based healthcare architecture for securing and monitoring healthcare data

PURPOSE: A new method known as Lionized Remora optimization based Recurrent Neural Network (LRObRNN) is recommended to enhance the safety of medical information stored on cloud servers to tackle these issues. DESIGN/METHODOLOGY/APPROACH: To safeguard patient data, healthcare organizations must thoughtfully choose reliable and compliant cloud service providers while implementing robust security measures. Storing patient information in cloud systems raises issues with illegal access and data breaches. FINDINGS: The LRObRNN generates a secret key using Lionized Remora optimization and employs cryptography to encrypt sensitive healthcare data. Continuous monitoring ensures the security of data transmission by identifying irregularities. ORIGINALITY/VALUE: Leveraging Recurrent Neural Networks the system analyzes sequential data, enabling the detection of patterns and potential security breaches during data transmission. The performance evaluation includes metrics such as encryption and decryption time, confidentiality rate, processing time, resource usage and efficiency, which are compared with other existing models.

27 June 2026

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Systematic ReviewEvidence: Weak
40CEBM

European journal of hospital pharmacy : science and practice

Unit dose drug dispensing systems in hospitals: a systematic review of medication error reduction and cost-effectiveness

BACKGROUND: Medical errors pose significant risks to patient safety and public health. Automated unit dose drug dispensing systems (UDDSs) have emerged as valuable tools to reduce medication errors while optimising economic and logistical resources. OBJECTIVES: This systematic review aims to evaluate studies specifically focused on the impact of automated UDDSs in reducing medication errors and streamlining processes. METHODS: A literature search was performed on PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2019 and 2024. The search, concluded on 24 September 2024, included studies conducted in inpatient hospital settings that assessed automated UDDS effects on medication errors, therapy management and inventory control. Outcomes examined included effects on patient safety, cost-effectiveness and inventory management. Results were synthesised qualitatively. RESULTS: From 3346 references, four studies met the inclusion criteria: a cost-effectiveness analysis, an uncontrolled before-and-after study, and two observational studies. UDDS improved medication processes, reducing drug-related problems, medication handling and dispensing time by 50% per patient per day. Integrated with barcode scanning, UDDS lowered medication administration errors (MAEs) from 19.5% to 15.8% and harmful MAEs from 3.0% to 0.3%. Overall, medication errors dropped by 45-70%, enhancing safety and reducing manual handling risks. UDDS demonstrated cost-effectiveness by significantly reducing MAEs. The study estimated a reduction in MAEs, with a cost-effectiveness ratio of €17.69 per avoided MAE. For potentially harmful MAEs, the cost-effectiveness ratio was estimated at €30.23 per avoided error. These findings suggest substantial long-term savings potential, though the exact magnitude may vary depending on hospital size and implementation specifics CONCLUSIONS: Automated UDDSs improve patient safety by significantly reducing medication errors and delivering cost savings through better inventory management. Challenges such as high initial costs and workflow adjustments can be mitigated through gradual implementation and staff training. Further integration with other healthcare technologies, such as barcoding, real-time tracking, artificial intelligence (AI)-driven error prevention tools and fully automated restocking systems could enhance UDDS benefits and further support hospital processes.

25 June 2026

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otherEvidence: Moderate
80CEBM

International journal of medical informatics

An AI-assisted framework for the ethical use of machine learning in healthcare

This study develops and evaluates ETHICS, a concise, clinician-facing ethical protocol for the routine use of machine learning (ML) in healthcare. Using ChatGPT for first-stage drafting, we generated six actionable principles - Equity and Fairness, Transparency and Patient-Centered Care, Human Oversight and Clinical Integrity, Information Privacy and Data Governance, Continuous Improvement and Sustainability, and Support and Education for Professionals - structured as a mnemonic to support uptake in time-constrained clinical settings. Outputs were treated as provisional and refined through mandatory human source verification, iterative readability optimization, multidisciplinary expert review, and scenario-based stress testing. Readability analysis showed substantial improvement from high complexity to clinician-accessible language. Expert ratings indicated strong endorsement with excellent inter-rater reliability. Implementation readiness was confirmed across five clinical scenarios, all passing predefined adequacy thresholds. The findings suggest generative AI can accelerate ethical protocol drafting, but validity and practicality depend on structured human oversight and real-world testing.

16 June 2026

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otherEvidence: Moderate
65CEBM

BMJ health & care informatics

Beyond the digital health tsunami: reaffirming biomedical and health informatics as the scientific foundation of digital healthcare transformation

Digital health (DH) has emerged as the dominant terminology for technology-enabled healthcare, reshaping institutional discourse, educational programmes and policy agendas. DH is often portrayed as a novel discipline that could supersede Biomedical and Health Informatics (BMHI), creating conceptual ambiguity and the risk of weakening scientific rigour in the design, evaluation and governance of digital interventions. This paper clarifies BMHI's disciplinary identity, characterises DH as a practice-oriented and implementation-oriented domain, and establishes the epistemic relationship between the two in order to inform academic strategy, curricula and professional identity. A comparative conceptual analysis examined scope, theoretical foundations, methodological approaches, educational frameworks, professional structures and stakeholder ecosystems in both domains, informed by recent debates on degree programmes and workforce training. We found that BMHI is a mature scientific discipline with explicit theoretical foundations encompassing data representation, knowledge modelling, clinical reasoning, decision support, interoperability, sociotechnical analysis, evaluation science, safety, ethics and governance. DH, by contrast, represents an implementation-oriented translational domain that operationalises BMHI through products, services and organisational transformation (eg, telehealth, mobile applications, artificial intelligence-enabled clinical services). While DH has amplified visibility and accelerated adoption, it lacks autonomous theoretical foundations and depends on BMHI for scientific validity, safety and sustainability. Three evolutionary scenarios are examined: DH absorbing BMHI (epistemically incoherent), convergence as parallel disciplines (conceptually flawed), and reintegration of DH within BMHI as its applied layer (scientifically coherent and strategically sustainable) but requiring disciplinary communication, curricular alignment and institutional leadership explicitly positioning DH as a translational layer of BMHI.

24 May 2026

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qualitativeEvidence: Moderate
85CEBM

JMIR medical education

A Competency Framework for Medical AI Education: Mixed Methods Study

BACKGROUND: Although artificial intelligence (AI) is increasingly adopted in health care, clinicians face barriers, including insufficient understanding, limited trust, and challenges in interpreting AI outputs. Existing frameworks, such as the United Nations Educational, Scientific and Cultural Organization (UNESCO) AI competency framework, lack clinical specificity. Additionally, there remains limited evidence on framework-based training programs for medical professionals. OBJECTIVE: This study aimed to (1) develop a medical AI competency framework and (2) apply the framework to design an AI training program and pilot 1 module. METHODS: We conducted a mixed methods study comprising 2 phases. In Study 1, we developed a medical AI competency framework by integrating the UNESCO AI framework with the Miller pyramid model. The framework was refined through expert input from 24 stakeholders (6 hospital administrators, 8 medical professionals, and 10 university instructors). Expert responses were analyzed using deductive content analysis based on predefined codebooks. In study 2, we designed an AI training program based on the framework, and evaluated it using a 2-round Delphi process. Nine educators with expertise in instructional design, medical education, and AI participated in the Delphi study. Consensus in round 1 was defined as an IQR≤1, agreement score proportion >75%, and full-score frequency >49.23%; in round 2, consensus was defined as agreement score proportion >80%. A pilot workshop with 28 participants and 4 instructors assessed the feasibility of 1 module using self-reported measures of satisfaction, engagement, and confidence. RESULTS: A 6D 4-level medical AI competency framework was developed. Among the 24 experts, 19 (79.17%) mentioned competencies related to AI foundations, and 23 (95.83%) mentioned competencies related to application skills. The framework was translated into a 5-module training program, covering patient-centered and ethical AI, privacy and security, medical AI applications, bias and health equity, and generative AI in health care. Each module included 5 elements: content, learning goals, teaching activities, learning resources, and assessment. The Delphi process achieved complete consensus across all 25 elements of the training program. The pilot workshop indicated high participant satisfaction (mean 4.00, SD 0.52), good engagement (mean 3.80, SD 0.71-mean 4.05, SD 0.51), and moderate self-reported confidence (mean 3.63, SD 0.53). These findings suggest that the module was feasible, although outcomes should be interpreted cautiously given the self-reported and short-term nature of the evaluation. CONCLUSIONS: The framework provides a structured reference for AI training program design in medical education. The workshop findings provide preliminary support for the feasibility of the program's technical module, while also highlighting the need for broader and longer-term evaluations. Future work should expand the framework and training program to new regions and delivery formats (eg, semester-long courses and continuing medical education) and evaluate their long-term impact.

21 May 2026

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Systematic ReviewEvidence: Weak
40CEBM

BMJ open

Implementation of safety management systems (SMS) in healthcare: a systematic review and international comparison

OBJECTIVES: Many industries where safety is a priority (eg, aviation) use safety management systems (SMSs), but evidence on their use in healthcare is needed to determine whether they could support patient safety improvement. We investigated the application of national-level SMSs to patient safety in terms of effectiveness, implementation and experience. DESIGN: Systematic review using a case study approach. DATA SOURCES: We identified patient safety organisations in each country and searched their websites. We also searched MEDLINE (in December 2023) and Embase (via Ovid), CINAHL (EBSCO) and Web of Science (in February 2024). ELIGIBILITY CRITERIA: Any evidence from five high-income countries that have publicly funded healthcare systems with universal coverage: Australia, Canada, Ireland, New Zealand and the Netherlands. We included publications on the effectiveness, implementation or experience of the patient safety approach in each country. DATA EXTRACTION AND SYNTHESIS: Included evidence was summarised and mapped onto an initial analytical framework based on analysis of SMSs in high-risk industries, enabling cross-country comparisons. Drafts were shared with experts from patient safety organisations in each country for comment. Formal quality appraisal was not possible as most evidence was non-evaluative. RESULTS: 53 publications were included, from Australia (5), Canada (7), Ireland (8), New Zealand (9) and the Netherlands (24). Only the Netherlands implemented a patient safety programme explicitly based on an SMS approach. Some aspects of patient safety in hospitals improved as a result, but there was significant variation in both the implementation of the programme and attributed outcomes.In the other four countries, the main components of an SMS were identified to some extent, along with evidence that their patient safety approaches had been influenced by concepts from high-risk industries and 'safety science' more widely. CONCLUSIONS: Emerging ideas from high-risk industries (beyond SMSs) and broader safety science have influenced all countries, reflecting increasing awareness of the need for initiatives to be context-specific to be successful. However, their implementation and impact need further evaluation. PROSPERO REGISTRATION NUMBER: CRD42023487512.

15 May 2026

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otherEvidence: Moderate
80CEBM

PloS one

An explainable multi-head attention network for healthcare IoT threat detection based on the MedDefender-MHAN framework

The rapid proliferation of Internet of Medical Things (IoMT) devices in healthcare environments has created critical cybersecurity vulnerabilities that demand both accurate and interpretable intrusion detection solutions. Existing deep learning-based intrusion detection systems (IDS) achieve high detection accuracy but lack inherent explainability, limiting their clinical adoption under regulatory frameworks such as GDPR and FDA guidelines. This paper presents MedDefender-MHAN, an explainable multi-head attention network specifically designed for healthcare IoT threat detection. The proposed framework introduces a novel dual-stream architecture that combines convolutional neural networks for local spatial feature extraction with transformer-based encoders for long-range temporal dependency modeling. Unlike existing approaches that apply explainability as a post-hoc process, MedDefender-MHAN embeds interpretability directly into the multi-head attention mechanism, enabling real-time gradient-weighted explanation generation without external XAI pipelines. Evaluated on CICIDS2017 and TON_IoT benchmark datasets, MedDefender-MHAN achieves detection accuracies of 99.47% and 98.92% respectively, with sub-3ms inference latency and a throughput of 435 samples per second. Explainability evaluation demonstrates 94.6% alignment with expert-annotated attack signatures and 91.9% temporal accuracy, outperforming post-hoc methods such as SHAP and Integrated Gradients. These results confirm that MedDefender-MHAN provides a clinically viable, regulatory-compliant security solution for real-world healthcare IoT infrastructure. The proposed framework addresses the dual imperatives of methodological transparency and clinical impact, directly responding to the growing need for trustworthy AI-driven security solutions in regulated healthcare IoMT environments.

20 Apr 2026

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otherEvidence: Weak
50CEBM

Journal of medical Internet research

Beyond GPT-4: The Rapidly Evolving Potential of Large Language Models for Clinical Guideline Improvement

This commentary reviews the study by Jones et al, which evaluated whether GPT-4 could improve the readability of injectable medication guidelines while preserving important safety information. The study found that GPT-4 produced modest readability gains comparable to manual revision, but also introduced omissions and meaning changes in a minority of sections. These findings highlight both the potential and limitations of early large language models (LLMs) in clinical contexts. However, this study reflects the capabilities of a specific model in a rapidly evolving domain. Since the release of GPT-4, advances in multistep reasoning, model-critique workflows, and structured validation have substantially improved the ability of newer systems to detect omissions, maintain factual fidelity, and support controlled editing. As a result, some documented limitations may stem from the constraints of a single-model, single-pass workflow rather than intrinsic flaws in LLM-assisted guideline revision. This commentary highlights the need for evaluation frameworks that can keep pace with LLM progress and emphasizes that clinical oversight and user-centered testing remain essential. Updated research using contemporary models is needed to determine how emerging architectures can more safely support clarity, consistency, and maintenance of clinical guidelines.

12 Apr 2026

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otherEvidence: Moderate
75CEBM

International journal of nursing studies

The use of large language models in clinical documentation: A scoping review

BACKGROUND: Clinical documentation is essential for safe, high-quality care but has become increasingly complex, contributing to clinician burnout. Large language models offer potential to ease documentation by generating summaries, structuring data, and ensuring compliance. However, concerns remain regarding accuracy, bias, privacy, and regulatory risks. OBJECTIVE: To map current literature on large language models applications in clinical documentation, evaluating their benefits, limitations, and ethical considerations. INFORMATION SOURCES: Five electronic databases (i.e., PubMed, Scopus, CINAHL, Cochrane Library, and IEEE Xplore) covering peer-reviewed literature published in English between January 2009 and August 2025. METHODS: This scoping review followed Arksey and OMalleys framework and was reported in accordance with PRISMA-ScR guidelines. Screening, data extraction, and quality appraisal were conducted independently by multiple reviewers using Joanna Briggs Institute tools. Findings were synthesized using descriptive and narrative approaches. RESULTS: Forty-one studies met inclusion criteria, most originating from the United States. Large language models were primarily applied to clinical note generation, discharge summaries, and provider-patient encounter documentation. Key evaluation metrics included content accuracy, linguistic quality, and summarization performance. Large language models demonstrated potential to improve documentation efficiency and readability, with some studies reporting up to 40 % time savings. However, concerns about factual inaccuracies, hallucinations, and reduced performance in complex cases were common. Clinician perceptions were mixed. Some found notes generated by large language models helpful and well-structured, while others raised concerns about reliability, liability, and loss of clinical nuance. Ethical challenges included data privacy, security, and algorithmic bias, with varying levels of compliance across settings. CONCLUSIONS: Large language models hold significant promise for enhancing clinical documentation by improving efficiency, standardization, and clarity. However, their safe and effective use requires rigorous attention to accuracy, ethical safeguards, and clinician trust. Integration must support, rather than supplant, clinical reasoning and patient-centered care. Co-design with clinicians, real-world evaluation, and artificial intelligence literacy are essential to ensure that these technologies augment, not erode, professional judgment and care quality. REGISTRATION: Open Science Framework Registries (https://osf.io/m4h3q).

2 Apr 2026

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