Review Article

From Passive Tools to Autonomous Educators: The Transformative Role of Agentic Artificial Intelligence in Competency-Based Healthcare Education — A Review

Bikha Ram Devrajani
The University of Modern Sciences, Tando Muhammad Khan, Sindh, Pakistan,
Mudasar Latif Memon
The University of Modern Sciences, Tando Muhammad Khan, Sindh, Pakistan,

✉ Correspondence: Bikha Ram Devrajani Email: devrajani62@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i3.2636
Volume: 7, Issue 3 Pages: 182–190 Published: 21 Aug 2026
Received: 25 Mar 2026 Revised: 29 Jun 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

Abstract

The growth of intelligent systems in healthcare has increased the demand for future-ready clinical competencies in medical graduates. Current AI applications in medical education—rule-based intelligent tutoring systems, fixed e-learning platforms, and passive decision-support systems—lack the ability to provide personalized, adaptive learning in line with competency-based medical education (CBME). A substantive paradigm shift is agentic AI, characterized by goal-directedness, multi-step reasoning, and dynamic tool use. A structured narrative review was conducted. PubMed, Google Scholar, Scopus, and IEEE Xplore were searched systematically using terms such as agentic AI, autonomous AI in education, large language models in medical education, and LMIC medical education AI, and included publications published from January 2018 to March 2026. After applying pre-specified inclusion and exclusion criteria, 35 sources were included. We present a novel five-dimensional taxonomy of agentic AI in CBME that includes the level of autonomy, instructional role, specificity to clinical domain, assessment modality, and deployment context. Its applications in personalized curriculum design, clinical simulation, formative assessment, and faculty augmentation are examined. Prevalent issues such as algorithmic bias, the risk of hallucination, lack of data privacy, inadequate infrastructure, and regulatory uncertainty are discussed, with a particular focus on low- and middle-income countries (LMICs), specifically Pakistan.

Keywords
Agentic artificial intelligence competency-based medical education AI tutors healthcare education.

How to Cite This Article

Devrajani BR, Memon ML. From Passive Tools to Autonomous Educators: The Transformative Role of Agentic Artificial Intelligence in Competency-Based Healthcare Education — A Review. J Pak Soc Intern Med. 2026;7(3):182–190. doi:10.70302/jpsim.v7i3.2636

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

References

  1. . World Health Organization. Health workforce: working together for health. WHO Press; 2022.
  2. Abdullah Z, Ayub HS, Saleem S, Jabeen N, Gul N, Aman K. Competency-Based Medical Education: An Analysis of Implementation Challenges in Resource-Limited Settings. Pak J Health Sci. 2025;6(3):54–60.
  3. Schmidgall S. Agent AI: surveying the horizons of multimodal interaction. arXiv. 2024; arXiv:2401.03568.
  4. Kung TH, Cheatham M, Medenilla A, Sillos C, Leon LD, Elepaño C, et al. Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models. PLOS Digital Health. 2023;2(2): e0000198.
  5. Yousafzai AW, Khan FS, Naeem S. Integrating artificial intelligence into medical education in Pakistan: an urgent reform agenda. J Ayub Med Col Abbott. 2026;37(3):271–2.
  6. Frank JR, Mungroo R, Ahmad Y, Wang M, Rossi SD, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Medical Teacher. 2010;32(8):631–7.
  7. Ahmad N, Riaz S, Hussain I. Pakistan healthcare sector and AI-driven digital transformation. Pak J Med Sci. 2023;39(3):701–6.
  8. Clancey WJ. Knowledge-based tutoring: the GUIDON program [Internet]. CERN Document Server (European Organization for Nuclear Research). Eur Org Nuclear Res. 1987 ;URL: http://cds.cern.ch/record/110970
  9. Wang J, Shi E, Yu S, Wu Z, Ma C, Dai H, et al. Prompt Engineering for Healthcare: Methodologies and Applications. arXiv. 2023;URL:http://arxiv.org/abs/2304.14670
  10. Balasundaram S, Santosh KC. AI in healthcare education: evolution, applications and challenges. In: Proc Comput Sci. 2023. p. 814–28.
  11. Chen L, Chen P, Lin Z. Large language models in medical education. JMIR Med Educ. 2023;9.
  12. Williams A. Autonomous agents in education: a systematic review. Comput Educ Artif Intell. 2024;5(1):100143.
  13. Thirunavukarasu AJ, Ting DSJ, Elangovan K, Gutiérrez L, Tan TF, Ting DSW. Large language models in medicine. Nature Medicine. 2023];29(8):1930–40.
  14. Córdova‐Esparza D. AI-Powered Educational Agents: Opportunities, Innovations, and Ethical Challenges. Information. 2025;16(6):469.
  15. Zhang X, Zhang C, Sun J, Xiao J, Yang Y, Luo Y. EduPlanner: LLM-Based Multiagent Systems for Customized and Intelligent Instructional Design. IEEE Trans Learning Technol. 2025;18(2):416–27.
  16. Nori H, King N, McKinney SM, Carignan D, Horvitz E. Capabilities of GPT-4 on Medical Challenge Problems. arXiv. 2023; URL: http://arxiv.org/abs/2303.13375
  17. Bozkurt A, Xiao J, Lambert SI, Pazurek A, Crompton H, Koseoglu S, et al. Speculative futures on ChatGPT and generative artificial intelligence (AI): A collective reflection from the educational landscape. Dublin City University Open Access Institutional Repository (Dublin City University). 2023 Feb 13.
  18. Sallam M. ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns. Healthcare. 2023;11(6):887.
  19. Cascella M, Montomoli J, Bellini V, Bignami E. Evaluating the Feasibility of ChatGPT in Healthcare: An Analysis of Multiple Clinical and Research Scenarios. J Med Sys. 2023;47(1):3.
  20. Mok W, Mok A, Foo KC. Comparing AI responses to clinical scenarios. Med Teach. 2023;45(12):1395–401.
  21. Laverde N, Grévisse C, Jaramillo-Rincón SX, Manrique R. Integrating large language model-based agents into a virtual patient chatbot for clinical anamnesis training. Computational and Structural Biotechnol J. 2025;27:2481–91.
  22. Tu T, Schaekermann M, Palepu A, Saab K, Freyberg J, Tanno R, et al. Towards conversational diagnostic artificial intelligence. Nature. 2025;642(8067):442–50.
  23. Kaur H. Trustworthy AI in the healthcare domain. J Med Syst. 2022;46(10):70.
  24. Omiye JA, Gui H, Rezaei SJ, Zou J, Daneshjou R. Large language models in medicine: the potentials and pitfalls. arXiv (Cornell University). 2023; URL: http://arxiv.org/abs/2309.00087
  25. McCullum L, Agassi PA, Gallifant J, Ebner DK, Fernandes CO, Hicklen RS, et al. Performance Gains of LLMs With Humans in a World of LLMs Versus Humans. arXiv (Cornell University). 2025; URL: http://arxiv.org/abs/2505.08902
  26. Lee P, Bubeck S, Petro J. Benefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine. New Eng J Med. 2023;388(13):1233–9.
  27. Devrajani BR, Memon ML, Ahmed S. Digital health transformation in Sindh. J Pak Soc Intern Med. 2024;5(2):112–9.
  28. Paul M, Μαγλαράς Λ, Ferrag MA, Almomani I. Digitization of healthcare sector: A study on privacy and security concerns. Edinburgh Napier Research Repository (Edinburgh Napier University). 2023;9(4):571–88.
  29. Rehman A. Barriers to technology adoption in medical education in LMICs. Med Educ Online. 2021;26(1).
  30. Hasan S. Artificial intelligence in medical education. J Pak Med Assoc. 2022;72(5):1011–4.
  31. Flores-Cohaila J. AI-generated text in medical education. BMC Med Educ. 2023;23(1):845.
  32. Khan B, Fatima H, Qureshi A, Kumar S, Hanan A, Hussain J, et al. Drawbacks of Artificial Intelligence and Their Potential Solutions in the Healthcare Sector. Biomed Mat Dev. 2023;1(2):731–8.
  33. Bates D. Reporting recommendations for clinical AI research. NPJ Digit Med. 2021;4(1):54.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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