Whose Voice is it Anyway? Artificial Intelligence and the New Crisis of Authenticity in Medical Education

Generative artificial intelligence (AI) has entered the spaces of reflection and narrative learning in medical education, spaces once defined by authenticity, introspection, and human voice. This Eye Opener examines tensions identified through a recent survey of undergraduate medical students and their ePortfolio physician coaches at the University of Ottawa regarding the use of AI in reflective writing. While the student response rate was notably lower (9.6%) than that of coaches (52.9%), this asymmetry prompted consideration of how the evaluative context of reflective writing may influence disclosure of AI use in voluntary surveys. Students who did respond described AI as a scaffold for idea generation and writing support, whereas coaches expressed unease, perceiving even limited AI use as a potential threat to authenticity. The resulting tension between pragmatism and preservation mirrors broader questions in medical education regarding reflective authorship and independent critical thinking. This moment invites reconsideration of reflection not solely as a written product but as a developmental process. Educators may need to move beyond detection toward dialogue that supports psychological safety, transparency, and shared understanding of authorship in the age of digitally assisted writing. Reflection has long been understood as a means of engaging with professional identity formation. The challenge now is determining how this process can remain meaningful as generative tools become increasingly embedded in learners' academic work.