The potential impact of generative AI across Miller’s pyramid of clinical competence: A systematic review

IF 4.5 3区医学 Q1 NURSING

Nurse Education in Practice Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI:10.1016/j.nepr.2026.104775

Yea Seul Yoon , Wonhee Baek , Hyemi Jo , Chaebin Hong , Yoonjung Ji

{"title":"The potential impact of generative AI across Miller’s pyramid of clinical competence: A systematic review","authors":"Yea Seul Yoon , Wonhee Baek , Hyemi Jo , Chaebin Hong , Yoonjung Ji","doi":"10.1016/j.nepr.2026.104775","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim</h3><div>This systematic review examines the effectiveness and limitations of generative artificial intelligence (GenAI) in supporting the development of clinical competence in nursing education across Miller’s pyramid, synthesizing evidence to inform the design of educator-guided, Expert-in-the-Loop hybrid educational frameworks.</div></div><div><h3>Background</h3><div>Nursing education faces challenges from ongoing pedagogical innovations linked to GenAI. This technology offers transformative potential for personalized learning; however, its rapid integration into curricula lacks a systematic evidence base.</div></div><div><h3>Design</h3><div>This systematic review used seven databases (CINAHL, PubMed, Scopus, Web of Science, Embase, PsycINFO and Cochrane) to find studies published from November 2022 to May 2025.</div></div><div><h3>Methods</h3><div>Studies were screened using predefined criteria. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A narrative synthesis was conducted, interpreting the findings based on Miller’s pyramid of clinical competence.</div></div><div><h3>Results</h3><div>Twelve studies met the inclusion criteria. GenAI applications were concentrated at the “Knows” (knowledge) and “Knows How” (application) levels of Miller’s pyramid, with no studies assessing real-world practice (“Does” level). While GenAI models passed licensure exams and improved cognitive and affective outcomes, they also had limitations, including factual inaccuracies, failures in clinical judgment and performance disparities.</div></div><div><h3>Conclusions</h3><div>GenAI is a powerful yet error-prone tool that necessitates systematic pedagogical redesign, not merely technological adoption. The Expert-in-the-Loop model, where educators validate generative AI outputs, may be key to transformations in nursing education. Embedding generative AI in educator-led frameworks can cultivate nursing professionals who leverage technology critically and ethically, ensuring care is both competent and human-centered.</div><div><strong>Registration</strong></div><div>This study was registered on PROSPERO (ID: CRD420251060512).</div></div>","PeriodicalId":48715,"journal":{"name":"Nurse Education in Practice","volume":"92 ","pages":"Article 104775"},"PeriodicalIF":4.5000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nurse Education in Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1471595326000776","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

This systematic review examines the effectiveness and limitations of generative artificial intelligence (GenAI) in supporting the development of clinical competence in nursing education across Miller’s pyramid, synthesizing evidence to inform the design of educator-guided, Expert-in-the-Loop hybrid educational frameworks.

Background

Nursing education faces challenges from ongoing pedagogical innovations linked to GenAI. This technology offers transformative potential for personalized learning; however, its rapid integration into curricula lacks a systematic evidence base.

Design

This systematic review used seven databases (CINAHL, PubMed, Scopus, Web of Science, Embase, PsycINFO and Cochrane) to find studies published from November 2022 to May 2025.

Methods

Studies were screened using predefined criteria. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A narrative synthesis was conducted, interpreting the findings based on Miller’s pyramid of clinical competence.

Results

Twelve studies met the inclusion criteria. GenAI applications were concentrated at the “Knows” (knowledge) and “Knows How” (application) levels of Miller’s pyramid, with no studies assessing real-world practice (“Does” level). While GenAI models passed licensure exams and improved cognitive and affective outcomes, they also had limitations, including factual inaccuracies, failures in clinical judgment and performance disparities.

Conclusions

GenAI is a powerful yet error-prone tool that necessitates systematic pedagogical redesign, not merely technological adoption. The Expert-in-the-Loop model, where educators validate generative AI outputs, may be key to transformations in nursing education. Embedding generative AI in educator-led frameworks can cultivate nursing professionals who leverage technology critically and ethically, ensuring care is both competent and human-centered.

Registration

This study was registered on PROSPERO (ID: CRD420251060512).

查看原文本刊更多论文

生成式人工智能对米勒临床能力金字塔的潜在影响：系统回顾。

目的：本系统综述探讨了生成式人工智能（GenAI）在支持米勒金字塔护理教育临床能力发展方面的有效性和局限性，综合证据，为教育者指导、专家在环混合教育框架的设计提供信息。背景：护理教育面临着与GenAI相关的持续教学创新的挑战。这项技术为个性化学习提供了变革性的潜力；然而，它与课程的快速整合缺乏系统的证据基础。设计：本系统综述使用了7个数据库（CINAHL、PubMed、Scopus、Web of Science、Embase、PsycINFO和Cochrane）来查找从2022年11月到2025年5月发表的研究。方法：采用预先确定的标准筛选研究。采用混合方法评价工具评价方法学质量。在Miller的临床能力金字塔的基础上，进行了叙事综合，解释了研究结果。结果：12项研究符合纳入标准。GenAI应用集中在Miller金字塔的“知道”（知识）和“知道如何”（应用）级别，没有研究评估现实世界的实践（“做”级别）。虽然GenAI模型通过了执照考试，改善了认知和情感结果，但它们也有局限性，包括事实不准确、临床判断失败和表现差异。结论：GenAI是一个强大但容易出错的工具，需要系统地重新设计教学方法，而不仅仅是采用技术。专家在循环模型中，教育工作者验证生成人工智能输出，可能是护理教育转型的关键。在教育工作者主导的框架中嵌入生成式人工智能，可以培养具有批判性和道德性的护理专业人员，确保护理既称职又以人为本。本研究在PROSPERO注册（ID: CRD420251060512）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Nurse Education in Practice NURSING-

CiteScore

5.40

自引率

9.40%

发文量

180

审稿时长

51 days

期刊介绍： Nurse Education in Practice enables lecturers and practitioners to both share and disseminate evidence that demonstrates the actual practice of education as it is experienced in the realities of their respective work environments. It is supportive of new authors and will be at the forefront in publishing individual and collaborative papers that demonstrate the link between education and practice.