Abstract
Generative artificial intelligence (GenAI) and large language models represent gains in educational efficiency and personalisation of learning. These are balanced against the considerations of the learning process, authentic assessment, and academic integrity. A pedagogical approach helps situate these concerns, and informs various types of governance and regulatory approaches. In this review we identify current and emerging issues regarding GenAI in medical education including pedagogical considerations, emerging roles, and trustworthiness. Potential measures to address specific regulatory concerns are explored.