From AI use to critical thinking among medical students: a moderated mediation perspective on cognitive load and self-regulated learning

Abstract

Background The increasing integration of artificial intelligence (AI) in medical education has raised important questions regarding its impact on higher-order cognitive processes, particularly critical thinking. Aim and Objectives This study examines the interplay of cognitive load and self-regulated learning in explaining how AI-based educational technology influences critical thinking among medical university students. Methods Using a cross-sectional research design, data were collected from 480 undergraduate medical students with prior experience using AI tools. Data were collected using standardized measures assessing AI usage, cognitive load, self-regulated learning, and critical thinking. Hayes' PROCESS Model 14 was employed to test mediation and moderated mediation effects. Results The findings revealed that AI-based technology use was positively associated with critical thinking and self-regulated learning, while cognitive load showed a negative association with both variables. Mediation analysis indicated that cognitive load partially mediated the relationship between AI use and critical thinking. Furthermore, the moderated mediation analysis demonstrated that self- regulated learning significantly moderated the indirect effect, such that the negative impact of cognitive load on critical thinking weakened at higher levels of self-regulation. Conclusion These findings highlight that the effectiveness of AI in enhancing critical thinking depends not only on its cognitive support but also on learners' ability to regulate their engagement. The study provides theoretical and practical implications for integrating AI in educational contexts.