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This paper proposes a 3-tier competency framework designed to equip clinicians with essential AI skills for the effective and responsible integration of large language models in clinical practice. The framework spans foundational skills for safe use, intermediate skills for evaluation, and advanced skills for ethical governance and model lifecycle management. The authors argue that integrating this framework into medical education and job descriptions will standardize AI deployment, promote safer clinical practice, and ultimately improve patient outcomes.
A 3-tier competency framework offers a practical roadmap for clinicians to evolve from cautious AI users to responsible stewards, addressing the urgent need for AI skills in the rapidly changing landscape of clinical practice.
Large language models are rapidly transitioning from pilot schemes to routine clinical practice. This creates an urgent need for clinicians to develop the necessary skills to strike the right balance between seizing opportunities and taking accountability. We propose a 3-tier competency framework to support clinicians’ evolution from cautious users to responsible stewards of artificial intelligence (AI). Tier 1 (foundational skills) defines the minimum competencies for safe use, including prompt engineering, human–AI agent interaction, security and privacy awareness, and the clinician-patient interface (transparency and consent). Tier 2 (intermediate skills) emphasizes evaluative expertise, including bias detection and mitigation, interpretation of explainability outputs, and the effective clinical integration of AI-generated workflows. Tier 3 (advanced skills) establishes leadership capabilities, mandating competencies in ethical governance (delineating accountability and liability boundaries), regulatory strategy, and model life cycle management—specifically, the ability to govern algorithmic adaptation and change protocols. Integrating this framework into continuing medical education programs and role-specific job descriptions could enhance clinicians’ ability to use AI safely and responsibly. This could standardize deployment and support safer clinical practice, with the potential to improve patient outcomes.