Artificial intelligence literacy, attitudes, and use among surgical educators in China: a nation wide, cross-sectional study

Background: Artificial intelligence (AI) is increasingly integrated into medical education. However, levels of AI literacy, attitudes, and use among surgical educators remain unclear. In this study, we focused on Chinese surgical educators and aimed to investigate their AI literacy levels, attitudes towards AI (ATAI), actual usage of AI in teaching, as well as the interrelationship among them and their demographic characteristics.

Methods: We surveyed surgical educators from all 31 mainland Chinese provinces. Participants completed AI literacy and attitudes-toward-AI surveys and reported AI use in teaching as a percentage. Survey statistics and AI use percentage were analyzed against background characteristics. Weighted analyses were conducted using post-stratification weights based on national health statistics. Mediation models were used to evaluate interrelationship among literacy, attitude and usage.

Results: Within the study sample, significant disparities were found in AI literacy, a negative correlation between AI literacy and both ATAI and AI use was discovered. Structural equation modeling indicated that AI literacy had a statistically significant negative association on AI use (standardized β =−0.447; P=0.004) in total, 53.8% mediated by attitudes-toward-AI.

Conclusions: AI literacy among surgical educators does not necessarily promote AI use; instead, it likely fosters more balanced but cautious attitudes toward AI that reduces adoption. Despite the limitations in sampling methods, our findings still provide important insights into the AI literacy levels and attitudes toward AI among surgeons nationwide, and suggest potential benefits from promoting more equitable and accessible AI training programs.