JMIR Publications

ABSTRACT

Large language models (LLMs) are rapidly transitioning from pilot schemes to routine clinical practice. This creates an urgent need for clinicians to develop the right skills to strike the right balance between seizing opportunities and taking accountability. We propose a three-tier competency framework to support clinicians’ transition from cautious users to responsible stewards of artificial intelligence (AI). Tier 1 (foundational skills) focuses on safe, basic proficiency, encompassing prompt engineering, agentic interaction (supervision, interruption, and manual rollback capability), and core security/privacy awareness. Tier 2 (intermediate skills) emphasizes evaluative expertise, including the critical assessment of bias detection, explainability, trust evaluation, and the effective clinical integration of AI-generated insights. Tier 3 (advanced skills) establishes leadership and governance capabilities, mandating competencies in ethical and regulatory governance, model customization oversight, and advanced model operations, specifically incorporating literacy in predetermined change control plans (PCCP). Integrating this framework into continuing medical education (CME) programmes and job descriptions could enhance clinicians' ability to use AI safely and responsibly. This would help to standardize deployment, improve clinical practice, and ultimately, patient outcomes.