Abstract
Concerns that AI tools may erode diagnostic reasoning contrast with claims that AI can foster higher-order thinking. This longitudinal study followed 372 medical students across 12 months of supervised rotations using an AI-assisted diagnosis system. AI-assisted diagnosis participation, AI literacy and medical critical thinking were assessed at baseline, 6 months and 12 months. Cross-lagged panel models examined prospective associations, statistical mediation by AI literacy and moderation by prior technological experience and learning goal orientation. Higher participation was associated with increases in AI literacy and critical thinking, and AI literacy statistically mediated the participation-to-critical thinking association. Indirect effects were stronger among students with greater technological experience and mastery-oriented goals and weaker among performance-oriented peers. Findings indicate that, within supervised clinical training, engagement with AI systems is associated with critical thinking development partly through enhanced AI literacy, supporting AI tools as educational resources under faculty guidance.