How do Japanese medical trainees view artificial intelligence in medicine?

Artificial intelligence (AI) is rapidly transforming healthcare and medical education. From improving diagnostic accuracy and clinical decision-making to enabling virtual simulations and personalized learning, AI technologies are being integrated into the daily practice of clinicians and residents. Despite these benefits, concerns remain regarding ethical liability, data privacy, loss of human autonomy, and potential job displacement. As AI continues to expand into healthcare systems around the world, it is increasingly important to understand how future physicians will perceive and utilize these technologies.

Attitudes toward AI play a key role in determining whether AI tools are accepted, trusted, and effectively integrated into clinical practice and education. Positive attitudes promote openness and responsible use, while negative perceptions can lead to skepticism and underutilization. Therefore, accurately measuring medical students’ and residents’ attitudes toward AI is essential to identifying barriers to adoption and designing effective educational interventions. In 2024, Stein et al. introduced the 12-item Attitudes Toward Artificial Intelligence (ATTARI-12) scale, a brief and reliable measure that covers affective, cognitive, and behavioral aspects. However, the lack of a validated Japanese version has limited its application in Japan, where cultural factors such as uncertainty avoidance and social norms can influence responses to emerging technologies.

To address this gap, a research team led by Project Assistant Professor Hirohisa Fujikawa of Juntendo University in Japan and his colleagues Dr. Hirotake Mori, Dr. Yuji Nishizaki, Dr. Yuichiro Yano, and Dr. Toshio Naito collaborated with Dr. Kayo Kondo of Durham University, UK. Together, they developed and validated a Japanese version of the scale (J-ATTARI-12) for use among medical students and residents. Dr. Fujikawa explained the motivation behind the study:We observed large variations in how learners responded to AI, but no validated tools existed in Japan to measure these differences. This scale helps educators understand learner attitudes and better prepare future physicians for AI-powered practice” Their findings were published in the journal Volume 12, Issue e81986. JMIR Medical Education January 14, 2026.

This study was conducted in accordance with internationally recognized guidelines for translation and cross-cultural adaptation to ensure linguistic accuracy and cultural relevance. The nationwide online survey was conducted from June to July 2025 among medical students and residents at multiple universities and hospitals across Japan. A total of 326 participants were included in the analysis. A split-half validation approach was adopted for the psychometric evaluation. Briefly, exploratory factor analysis (EFA) was performed on half of the sample to identify the underlying factor structure, and confirmatory factor analysis (CFA) was performed on the other half to assess model fit. Convergent validity was tested by correlating J-ATTARI-12 scores and attitudes toward robots (related constructs), and internal consistency reliability was assessed using Cronbach’s α.

The analysis yielded several important findings. EFA identified a two-factor structure reflecting “AI anxiety and aversion” and “AI optimism and acceptance.” CFA demonstrated that this two-factor model showed good model fit and performed better than the one-factor model. Convergent validity was supported by a moderate positive correlation between J-ATTARI-12 scores and attitudes toward robots, and internal consistency reliability was also high, indicating that this scale reliably measures Japanese residents’ attitudes toward AI.

This study has important implications for education and research. Dr. Fujikawa said:Educators can use this scale to evaluate AI-related training and identify learners who are anxious or hesitant about using AI. Researchers can also track how attitudes evolve as AI is further integrated into healthcare.” J-ATTARI-12 supports data-driven curriculum development and informed decision-making in medical education by providing culturally adaptive and psychometrically appropriate instruments.

Reflecting on its broader significance, Dr. Fujikawa emphasized:The successful implementation of AI in healthcare will depend as much on clinician acceptance as on technical performance. Making these attitudes visible allows for better education and more responsible implementation.” He added that the scale will be used in the “Medicine and AI” program to be launched at Juntendo University in 2026, and is expected to facilitate future cross-border research.

In conclusion, this study successfully developed and validated the J-ATTARI-12, the first tool in Japan to assess medical students’ and residents’ attitudes toward AI. By providing a reliable and valid measure, we build a strong foundation for advancing AI education, research, and integration within Japan’s medical training system.

reference

DOI: https://doi.org/10.2196/81986

Author: Hirohisa Fujikawa^{1, 2, 3}Hirotake Mori¹Kayo Kondo⁴Yuji Nishizaki^1,5Yuichiro Yano¹Toshio Naito¹

Affiliation:

¹ Juntendo University School of Medicine, Department of General Medicine

² Department of Medical Education, International Medical Education Research Center, Graduate School of Medicine, The University of Tokyo

³ Center for Comprehensive Medical Education, Faculty of Medicine, Keio University

⁴ Department of Modern Languages ​​and Cultures, Durham University (UK)

⁵ Department of Medical Education, Juntendo University School of Medicine

About Hirohisa Fujikawa, Specially Appointed Assistant Professor

Hirohisa Fujikawa is a specially appointed assistant professor at the Department of General Medicine, Juntendo University School of Medicine. He holds an M.D. and a Ph.D. He holds a PhD from the University of Tokyo (2023) and is an expert in health professional education. With over 10 years of academic and clinical experience, Dr. Fujikawa has published over 90 peer-reviewed papers in international journals. His research focuses on ambiguity tolerance, physician work hour constraints, ownership of patient care, workplace social capital, and psychometric evaluation of educational instruments. He has served as corresponding author on multiple multicenter collaborative studies and has received competitive research funding and academic recognition for his contributions to the field of health professions education research.

History of Juntendo University

Juntendo was founded in 1838 as a medical school in the Netherlands, at a time when Western medical education had not yet generally penetrated Japanese society. In establishing Juntendo, the founders wanted to create a place where people could come together with the common goal of contributing to society through the power of medical education and practice. Their aspirations led to the establishment of Juntendo Hospital, Japan’s first private hospital. For many years, Juntendo University has played an important role in shaping medical education and practice in Japan, with its experience and perspective as an institution of higher education and a place of clinical practice. In the process, the university’s focus has also expanded and now consists of nine undergraduate programs and six graduate programs, with the university specializing not only in medicine but also in the fields of health sciences, health and sports sciences, nursing medicine and sciences, and international liberal arts. Juntendo University continues to innovatively pursue education and research at an international level, and aims to apply the results to society.

mission statement

Juntendo University’s mission is to strive for the advancement of society through education, research, and medical care, based on the school motto of “Jin – As you are, so am I.” and the philosophy of “Continuous progress.” The spirit of “Jin”, which is the ideal of all people who gather at Juntendo University, is kindness and consideration for others. The philosophy of “Constant Goodwill” embodies the founder’s belief that education and research activities can only develop in a free competitive environment. Our academic environment allows us to educate talented students who will become medical professionals whom patients can trust, scientists who can make innovative discoveries and inventions, and global citizens ready to serve society.