Critical Thinking, Human Judgment, and Artificial Intelligence in Combat Casualty Care: Implications for Military Medical Education and Practice.

Abstract

Artificial intelligence (AI) is rapidly transforming healthcare through advances in machine learning, predictive analytics, and large language models. These technologies offer substantial opportunities to improve diagnostic support, information management, and clinical decision support. Within military medicine, AI may afford a tactical advantage because future combat operations are expected to occur in contested environments characterized by prolonged evacuation timelines, degraded communications, limited resources, and increased casualty burdens. However, while AI can augment clinical performance, it cannot replace the critical-thinking capabilities required for combat casualty care. This commentary examines the relationship between AI and critical thinking in military medicine through the lens of problem complexity, learning environments, and John Boyd's Observe-Orient-Decide-Act (OODA) framework. Drawing upon the concepts of well-structured versus ill-structured problems, kind versus wicked learning environments, and the central role of orientation in decision-making, we argue that the value of AI varies with the nature of the problem being addressed. AI performs best in well-structured domains characterized by clear rules and reliable feedback, whereas combat casualty care frequently presents as ill-structured and wicked problems that require contextual understanding, judgment, adaptation, and future-oriented sensemaking. We propose that effective human-AI teaming should enhance rather than supplant clinical judgment. Accordingly, military medical education must deliberately cultivate critical-thinking skills, judgment, and AI literacy while exposing learners to uncertainty through realistic operational training. As AI capabilities continue to advance, preserving the cognitive skills required to make sound decisions under conditions of ambiguity and resource constraint will remain essential. Ultimately, human judgment remains the most important decision-support system in combat casualty care.