Abstract
<title>Abstract</title> <p>Background Generative artificial intelligence (GAI) has been extensively integrated into nursing and medical education, significantly transforming the academic practices of students. Nonetheless, the varying impacts of GAI on core competency development across educational stages remain ambiguous, with limited empirical evidence on hierarchical educational support needs. This study aimed to investigate the effects of GAI utilization on critical thinking, research competence, and academic integrity among Chinese nursing and medical students at undergraduate, master's, and doctoral levels, and to identify their specific needs for targeted GAI educational support. Methods This descriptive qualitative study analyzed semi‑structured interviews with 44 students (16 undergraduate, 16 master's, 12 doctoral) from a western Chinese medical university using inductive content analysis, with TAM and AI Literacy frameworks informing discussion. Results GAI usage patterns varied by academic level: undergraduates for coursework, versus postgraduates for literature reviews, experimental design, and data analysis. The dual academic impact featured enhanced critical thinking and knowledge acquisition, counterbalanced by risks of over-reliance, marginal clinical skill efficacy, and cognitive offloading—with research competency gains largely confined to postgraduates. A pronounced demand for systemic support, including teacher guidance and institutional training, pervaded all levels. Conclusion GAI differentially affects nursing/medical students' progression, warranting stage-specific support. We propose a three-stage TAM-extension model (PEOU‑driven, PU‑driven, critical‑reflective) to capture developmental trajectories, offering empirical grounds for tiered AI literacy curricula.</p>