Cultivating Student Agency in the AI Era

Traditionally, medical and health professions educators are often considered experts in their field, responsible for defining the competency needed for future practice and helping learners access information and develop competencies. Today, information is abundant, and AI can rapidly synthesize knowledge to support clinical decision-making and learning. While grappling with this change in the source of expertise, the AAMC has established Principles for the Responsible Use of Artificial Intelligence in and for Medical Education, which foregrounds a human-centered approach that prioritizes important human relationships. An addition to training students to determine when AI use is responsible for patient care, helping them discern how AI influences their learning and which human capabilities and skills will be needed in future practice. This challenge highlights the importance of student agency.

Student Agency

Student agency is the capacity to act intentionally and take ownership of one's learning and professional development. An agentic learner can recognize gaps in knowledge, formulate meaningful questions, seek appropriate resources, critically evaluate information, and adapt when circumstances change. As access to information expands, the need for discernment becomes even more important. The AAMC's call for a human-centered approach to AI ultimately depends on learners who can exercise sound judgment, think critically, adapt to changing circumstances, and take responsibility for their own development.  

Heutagogy: A Framework for Developing Agency

Heutagogy extends beyond pedagogy (teacher-directed learning) and andragogy (self-directed adult learning). In a heutagogical approach, learners are not only responsible for how they learn; they help determine what they learn, why they learn it, and how success is evaluated. The focus shifts from acquiring competency toward developing capability — the ability to apply knowledge in unfamiliar, complex, and changing situations. ​​The goal is not simply to develop competent learners, but also to develop adaptable professionals capable of continuously identifying new learning needs throughout their careers.

Double Loop Learning: How Heutagogy Works

Heutagogy leverages double-loop learning. One loop is experiential and includes learners considering the problem and the resulting action and outcomes. The other loop is metacognitive when they reflect on their problem-solving process and test their personal values and assumptions. The role of the educator in the heutagogy framework is similar to one that supports developing master adaptive learners. The role includes:  

1. Managing ambiguity by guiding learners through uncertain and dynamic situations to build skills and confidence
2. Adapting to new ideas by encouraging learners to drive critical thinking, challenge assumptions, and expand understanding
3. Fostering engagement by prompting reflection
4. Empowering others by providing resources, helping to develop effective learning habits, and being a sounding board for their ideas

What Might a Heutagogical Approach Look Like?

Many medical and health professions educators and learners are already incorporating elements of heutagogy without explicitly using the term. For example, DEFT-AI is a model designed for engaging with learners about their use of AI in a clinical setting. A first-year medical student might use AI-assisted learning tools to identify gaps in their understanding of cardiovascular physiology, develop a personalized learning plan, and seek resources beyond those assigned in the curriculum. Rather than passively consuming information, the learner actively shapes the learning process. Similarly, a resident investigating a complex clinical question might use AI and traditional evidence sources to explore possible answers. Rather than focusing solely on the outcome, the educational emphasis shifts toward examining how the learner approached the problem, what assumptions influenced their reasoning, how they evaluated information, and how their understanding evolved over time.

In each case, the goal extends beyond knowledge acquisition. The focus is on developing learners who can direct their own learning, critically evaluate information, reflect on their thinking, and adapt in response to changing circumstances.

Moving Beyond AI Literacy

Medical and health professions educators have done yeoman's work developing AI competency frameworks and guidance for responsible AI use. They have also discussed the impact of AI use in terms of gaining competence — deskilling and never skilling — as well as maintaining important human relationships. Ultimately, today’s learners will be responsible for knowing how to use AI and thrive in a future where technologies, evidence, and professional expectations continue to evolve. Heutagogy offers a compelling framework for addressing this challenge. By placing learner agency at the center of education, it shifts our attention from what learners know today to how they will continue learning tomorrow.

MedEdPearls are developed monthly by the health professions educator developers in educational affairs. Previous MedEdPearls explored Keeping the Human in the AI Loop with SPARC, AI Community of Practice and Learning Together, and Using AI for Pedagogical Excellence.