<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.0 20040830//EN" "journalpublishing.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="2.0" xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="nlm-ta">JMIR Med Educ</journal-id><journal-id journal-id-type="publisher-id">mededu</journal-id><journal-id journal-id-type="index">20</journal-id><journal-title>JMIR Medical Education</journal-title><abbrev-journal-title>JMIR Med Educ</abbrev-journal-title><issn pub-type="epub">2369-3762</issn><publisher><publisher-name>JMIR Publications</publisher-name><publisher-loc>Toronto, Canada</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">v11i1e74947</article-id><article-id pub-id-type="doi">10.2196/74947</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Paper</subject></subj-group></article-categories><title-group><article-title>Paradox of AI in Higher Education: Qualitative Inquiry Into AI Dependency Among Educators in Palestine</article-title></title-group><contrib-group><contrib contrib-type="author"><name name-style="western"><surname>Alhur</surname><given-names>Anas Ali</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name name-style="western"><surname>Khlaif</surname><given-names>Zuheir N</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Hamamra</surname><given-names>Bilal</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name name-style="western"><surname>Hussein</surname><given-names>Elham</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff4">4</xref></contrib></contrib-group><aff id="aff1"><institution>Imam Abdulrahman Bin Faisal University</institution><addr-line>Damam</addr-line><country>Saudi Arabia</country></aff><aff id="aff2"><institution>Educational Sciences, An-Najah National University</institution><addr-line>Old Campus Street</addr-line><addr-line>Nablus</addr-line><addr-line>West Bank</addr-line><country>Palestinian Territory</country></aff><aff id="aff3"><institution>Education Language, An-Najah National University</institution><addr-line>Nablus</addr-line><addr-line>West Bank</addr-line><country>Palestinian Territory</country></aff><aff id="aff4"><institution>Al Ain University</institution><addr-line>Al Ain</addr-line><country>United Arab Emirates</country></aff><contrib-group><contrib contrib-type="editor"><name name-style="western"><surname>Lesselroth</surname><given-names>Blake</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="reviewer"><name name-style="western"><surname>Sivarajkumar</surname><given-names>Sonish</given-names></name></contrib><contrib contrib-type="reviewer"><name name-style="western"><surname>Kath</surname><given-names>Suraj</given-names></name></contrib><contrib contrib-type="reviewer"><name name-style="western"><surname>Elwi</surname><given-names>Taha A</given-names></name></contrib><contrib contrib-type="reviewer"><name name-style="western"><surname>Yu</surname><given-names>Zekai</given-names></name></contrib></contrib-group><author-notes><corresp>Correspondence to Zuheir N Khlaif, PhD, Educational Sciences, An-Najah National University, Old Campus Street, Nablus, West Bank, P358, Palestinian Territory, 970 0592754908; <email>zkhlaif@najah.edu</email></corresp></author-notes><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>15</day><month>9</month><year>2025</year></pub-date><volume>11</volume><elocation-id>e74947</elocation-id><history><date date-type="received"><day>25</day><month>03</month><year>2025</year></date><date date-type="rev-recd"><day>17</day><month>07</month><year>2025</year></date><date date-type="accepted"><day>15</day><month>08</month><year>2025</year></date></history><copyright-statement>&#x00A9; Anas Ali Alhur, Zuheir N Khlaif, Bilal Hamamra, Elham Hussein. Originally published in JMIR Medical Education (<ext-link ext-link-type="uri" xlink:href="https://mededu.jmir.org">https://mededu.jmir.org</ext-link>), 15.9.2025. </copyright-statement><copyright-year>2025</copyright-year><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on <ext-link ext-link-type="uri" xlink:href="https://mededu.jmir.org/">https://mededu.jmir.org/</ext-link>, as well as this copyright and license information must be included.</p></license><self-uri xlink:type="simple" xlink:href="https://mededu.jmir.org/2025/1/e74947"/><abstract><sec><title>Background</title><p>Artificial intelligence (AI) is increasingly embedded in medical education, providing benefits in instructional design, content creation, and administrative efficiency. Tools like ChatGPT are reshaping training and teaching practices in digital health. However, concerns about faculty overreliance highlight risks to pedagogical autonomy, cognitive engagement, and ethics. Despite global interest, there is limited empirical research on AI dependency among medical educators, particularly in underrepresented regions like the Global South.</p></sec><sec><title>Objective</title><p>This study focused on Palestine and aimed to (1) identify factors contributing to AI dependency among medical educators, (2) assess its impact on teaching autonomy, decision-making, and professional identity, and (3) propose strategies for sustainable and responsible AI integration in digital medical education.</p></sec><sec sec-type="methods"><title>Methods</title><p>A qualitative research design was used, using semistructured interviews (n=22) and focus group discussions (n=24) involving 46 medical educators from nursing, pharmacy, medicine, optometry, and dental sciences. Thematic analysis, supported by NVivo (QSR International), was conducted on 15.5 hours of transcribed data. Participants varied in their frequency of AI use: 45.7% (21/46) used AI daily, 30.4% (14/46) weekly, and 15.2% (7/46) monthly.</p></sec><sec sec-type="results"><title>Results</title><p>In total, 5 major themes were identified as drivers of AI dependency: institutional workload (reported by &#x003E;80% [37/46] of participants), low academic confidence (noted by 28/46, 60%), and perfectionism-related stress (23/46, 50%). The following 6 broad consequences of AI overreliance were identified: Skills Atrophy (reported by 89% [41/46]): educators reported reduced critical thinking, scientific writing, and decision-making abilities. Pedagogical erosion (35/46, 76%): decreased student interaction and reduced teaching innovation. Motivational decline (31/46, 67%): increased procrastination and reduced intrinsic motivation. Ethical risks (24/46, 52%): concerns about plagiarism and overuse of AI-generated content. Social fragmentation (22/46, 48%): diminished peer collaboration and mentorship. Creativity suppression (20/46, 43%): reliance on AI for content generation diluted instructional originality.</p><p>Strategies reported by participants to address these issues included establishing boundaries for AI use (n=41), fostering hybrid intelligence (n=37), and integrating AI literacy into teaching practices (n=39).</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>While AI tools can enhance digital health instruction, unchecked reliance risks eroding essential clinician competencies. This study identifies cognitive, pedagogical, and ethical consequences of AI overuse in medical education and highlights the need for AI literacy, professional development, and ethical frameworks to ensure responsible and balanced integration.</p></sec></abstract><kwd-group><kwd>AI dependency</kwd><kwd>generative AI</kwd><kwd>procrastination</kwd><kwd>AI reliance</kwd><kwd>hybrid intelligence</kwd></kwd-group></article-meta></front><body><sec id="s1" sec-type="intro"><title>Introduction</title><sec id="s1-1"><title>Background</title><p>The rapid incorporation of artificial intelligence in education (AIED) has significantly changed the educational landscape, providing unique chances for tailored teaching and learning experiences, instant feedback, and enhanced efficiency [<xref ref-type="bibr" rid="ref1">1</xref>]. Consequently, institutions across the globe are increasingly using AI-powered tools, including generative models like ChatGPT, to customize the educational process, streamline administrative duties, and reduce faculty workload [<xref ref-type="bibr" rid="ref2">2</xref>]. Despite important benefits, stakeholders have concerns regarding overdependence on AI, which is simply defined as students&#x2019; and instructors&#x2019; uncritical acceptance of AI-generated material [<xref ref-type="bibr" rid="ref3">3</xref>]. In addition, overreliance on AIED hinders cognitive involvement, productive critical thinking and decision making, and long-term skill growth [<xref ref-type="bibr" rid="ref4">4</xref>].</p><p>While literature on the topic of AIED is abundant, it primarily focuses on the gains of integrating AI in the educational setting [<xref ref-type="bibr" rid="ref5">5</xref>]. Ethical, cognitive, and professional challenges related to AIED, on the other hand, are far less explored [<xref ref-type="bibr" rid="ref6">6</xref>,<xref ref-type="bibr" rid="ref7">7</xref>]. Furthermore, most of the available research on overreliance on AIED is investigated in relation to students, exploring how excessive dependence on AI can negatively impact their ability to think critically and independently and to perform self-directed learning [<xref ref-type="bibr" rid="ref4">4</xref>,<xref ref-type="bibr" rid="ref8">8</xref>]. Other student-related studies have linked AI reliance to psychological factors such as perfectionism, impulsivity, and the need for immediate cognitive relief, drawing comparisons to internet and social media dependence [<xref ref-type="bibr" rid="ref9">9</xref>].</p><p>Empirical research investigating AI dependency among educators is still meager [<xref ref-type="bibr" rid="ref7">7</xref>], and most of the existing studies explore how AI enhances educators&#x2019; productivity and decision-making [<xref ref-type="bibr" rid="ref10">10</xref>]. Risks and challenges pertaining to AIED, on the other hand, are less explored. In addition, most research on AIED has been conducted in Western or Chinese contexts, with limited cross-cultural perspectives [<xref ref-type="bibr" rid="ref11">11</xref>]. This study has three aims: to examine the causes of educators&#x2019; overreliance on AI, to assess its impact on teaching autonomy and pedagogical identity, and to identify challenges and strategies for responsible AI use. Focusing on Palestinian higher education, the research offers insights to guide policy, faculty development, and ensure that AI enhances&#x2014;rather than replaces&#x2014;educators&#x2019; professional expertise.</p><p>This study conceptualizes the &#x201C;AI Paradox&#x201D; in higher education, where AI&#x2019;s benefits in streamlining academic work are offset by concerns over skill atrophy, ethics, and autonomy. It explores how faculty navigate these competing effects, highlighting the coexistence of innovation and emerging professional vulnerabilities.</p></sec><sec id="s1-2"><title>Research Questions</title><p>The research questions are as follows (1) What key factors contribute to AI dependency among educators in higher education? (2) How does AI dependency impact educators&#x2019; teaching autonomy, decision-making, and professional identity? (3) What strategies help educators maintain a balanced use of AI while maintaining pedagogical creativity and instructional effectiveness?</p></sec><sec id="s1-3"><title>Theoretical Foundation of the Study</title><p>The Interaction of Person-Affect-Cognition-Execution (I-PACE Model; <xref ref-type="fig" rid="figure1">Figure 1</xref>), developed by [<xref ref-type="bibr" rid="ref12">12</xref>], provides a comprehensive framework for understanding problematic technology use, including AI dependency. The I-PACE model explains how individual traits, emotional responses, cognitive processes, and behaviors interact to shape technology reliance. Its 4 components are: person-level predispositions (personality traits and cognitive styles), affect (emotional states like stress or anxiety), cognition (decision-making and impacts on autonomy), and execution (behavioral outcomes such as deskilling). This framework helps analyze how and why AI dependency develops among educators and its effects on autonomy and professional agency.</p><fig position="float" id="figure1"><label>Figure 1.</label><caption><p>I-PACE Model. I-PACE: Interaction of Person-Affect-Cognition-Execution.</p></caption><graphic alt-version="no" mimetype="image" position="float" xlink:type="simple" xlink:href="mededu_v11i1e74947_fig01.png"/></fig></sec><sec id="s1-4"><title>Previous Studies Using I-PACE</title><p>Research using I-PACE has demonstrated how individual predispositions, emotional states, and cognitive processes interact to influence excessive reliance on digital tools. For instance, studies on internet and social media addiction have found that individuals with high neuroticism<bold>,</bold> impulsivity, or perfectionism are more likely to develop problematic usage patterns, often as a coping mechanism for stress [<xref ref-type="bibr" rid="ref12">12</xref>]. Similarly, research on AI reliance in education suggests that educators and students with low self-efficacy in digital literacy or high performance expectations tend to offload cognitive tasks to AI, reducing engagement in critical thinking and problem-solving [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref13">13</xref>]. Studies show that institutional pressures and workload demands can drive educators to rely on AI for efficiency, often at the expense of pedagogical autonomy. Applying the I-PACE model, these studies highlight how occasional AI use can evolve into habitual dependence, shaped by psychological, cognitive, and behavioral factors.</p><p>Reliance on AI in education may lead to unhealthy dependence on AI tools that can reduce student autonomy, hinder skill acquisition, and elevate the risk of academic stress [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref14">14</xref>]. Although tactical application of AI is likely to improve teaching effectiveness and student engagement, students could still delegate crucial cognitive activities to technology rather than participating in reflective or creative thought [<xref ref-type="bibr" rid="ref9">9</xref>,<xref ref-type="bibr" rid="ref15">15</xref>,<xref ref-type="bibr" rid="ref16">16</xref>]. When consistently depending on AI for writing tasks, research projects, or making decisions, students jeopardize their chances of developing critical thinking, creativity, and self-directed learning techniques [<xref ref-type="bibr" rid="ref4">4</xref>,<xref ref-type="bibr" rid="ref16">16</xref>]. While AI can serve as a valuable complement to teaching strategies, instructors must ensure that embracing technology does not impede human-centered exploration [<xref ref-type="bibr" rid="ref17">17</xref>].</p><p>The psychological implications of reliance on AI are complex, involving personality characteristics, emotional control, and cognitive distortions [<xref ref-type="bibr" rid="ref8">8</xref>]. According to [<xref ref-type="bibr" rid="ref7">7</xref>] and [<xref ref-type="bibr" rid="ref8">8</xref>], neuroticism, self-critical perfectionism, and impulsivity elevate the chances of excessive dependence on AI-driven tools. Neuroticism, marked by increased responses to stress, frequently leads individuals to pursue immediate technological solutions for anxiety or performance apprehensions [<xref ref-type="bibr" rid="ref18">18</xref>]. Similarly, self-critical perfectionists might be drawn to the flawless results that AI is thought to produce, seeking to prevent errors and the unease linked to learning through trial and error [<xref ref-type="bibr" rid="ref19">19</xref>]. Instead of developing study habits, impulsive learners might resort to AI whenever they face challenges, perpetuating a pattern of dependence on external sources. This AI dependency diminishes creativity and independent thought [<xref ref-type="bibr" rid="ref8">8</xref>].</p><p>Scholars use the I-PACE model to explore how personal traits&#x2014;like perfectionism and impulsivity&#x2014;interact with emotional states and cognitive functions and sometimes result in maladaptive technology use [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref12">12</xref>]. This model illustrates how some individuals deal with academic pressure by consistently looking for digital shortcuts. Depending on digital shortcuts compromises an individual&#x2019;s need for autonomy, competence, and relatedness, which, according to the Basic Psychological Needs theory, are crucial for one&#x2019;s well-being and motivation [<xref ref-type="bibr" rid="ref20">20</xref>]. If AI reliably addresses unmet needs&#x2014;like providing quick responses that protect learners from the unease of ambiguity&#x2014;an excessive dependence might develop, reducing the intrinsic motivation essential for authentic learning and developmental progress [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref13">13</xref>]. Simultaneously, determining which aspects of AI design&#x2014;such as user interface, adaptive feedback, or customization features&#x2014;enhance or reduce dependency could assist developers in creating more ethically responsible platforms [<xref ref-type="bibr" rid="ref21">21</xref>].</p><p>Adverse academic emotions&#x2014;like anxiety and frustration&#x2014;can greatly heighten reliance on AI, hindering students&#x2019; motivation and their capacity to manage their own learning [<xref ref-type="bibr" rid="ref22">22</xref>]. As unaddressed psychological needs build up, students might seek emotional support or affirmation from AI [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref23">23</xref>]. Performance expectations further amplify this dependence: when students think AI significantly enhances their grades or educational results, they might overrate the technology&#x2019;s necessity [<xref ref-type="bibr" rid="ref24">24</xref>]. This corresponds with extensive research on performance expectancy, an element demonstrated to be essential in the adoption and ongoing usage of new technologies [<xref ref-type="bibr" rid="ref25">25</xref>]. Eventually, this persistent trend of pursuing immediate solutions or emotional comforts causes learners to neglect crucial cognitive activities like integrating information or contemplating mistakes [<xref ref-type="bibr" rid="ref8">8</xref>].</p></sec></sec><sec id="s2" sec-type="methods"><title>Methods</title><sec id="s2-1"><title>Overview</title><p>This study used a qualitative research approach to explore the factors influencing AI dependency and the consequences of AI dependency in medical education. A mixed approach of semistructured interviews and focus group sessions was used to gain insight into the experiences and perspectives of faculty members and to explore how using AI tools in their practice affects them as educators [<xref ref-type="bibr" rid="ref26">26</xref>].</p><p>To ensure participant anonymity while distinguishing between data sources, a consistent coding system was used. &#x201C;E&#x201D; refers to individual educators who participated in semistructured interviews, followed by a number identifying the participant (eg, E5=Educator 5). <bold>&#x201C;</bold>EFG&#x201D; refers to participants in focus group discussions (eg, EFG14). This system enabled pattern recognition across data types while maintaining confidentiality.</p></sec><sec id="s2-2"><title>Semistructured Interviews</title><p>Semistructured interviews were conducted with 22 faculty members to explore factors driving AI dependency and its consequences in medical education [<xref ref-type="bibr" rid="ref27">27</xref>]. Participants were purposively sampled from multiple universities and represented diverse disciplines (eg, nursing, pharmacy, optometry, medicine, and dental sciences). Variation in roles, teaching experience, and frequency of AI use was considered to ensure maximum variation and minimize overlap in perspectives due to shared institutional or disciplinary contexts. The interview protocol (<xref ref-type="supplementary-material" rid="app1">Multimedia Appendix 1</xref>) was informed by the study&#x2019;s theoretical framework. Each interview lasted 25&#x2010;35 minutes and was audio-recorded with consent. The interview guide (<xref ref-type="supplementary-material" rid="app1">Multimedia Appendix 1</xref>) was informed by the I-PACE framework and developed to explore individual, cognitive, and emotional dimensions of AI use. This guided the formulation of probes around motivation, attitudes, and usage patterns.</p></sec><sec id="s2-3"><title>Focus Group Sessions</title><p>To complement the interviews, 4 focus group sessions (n=24) were held with educators not involved in the interviews. This method enabled reflection and interaction, encouraging participants to build on shared experiences [<xref ref-type="bibr" rid="ref28">28</xref>-<xref ref-type="bibr" rid="ref31">31</xref>]. Purposive sampling ensured diversity across institutions, disciplines, and levels of AI engagement. All participants held teaching, research, or administrative roles. Focus group prompts (<xref ref-type="supplementary-material" rid="app2">Multimedia Appendix 2</xref>) were generated from preliminary interview analysis to deepen insight into shared institutional experiences. Sessions were audio-recorded and lasted approximately 1 hour. In total, the study involved 46 participants.</p></sec><sec id="s2-4"><title>Data Collection</title><p>In total, 22 semistructured interviews (25-35 min each) were audio-recorded with consent. Questions explored participants&#x2019; use of generative AI in teaching, research, and administration, including frequency, delegated tasks, and changing reliance. Follow-ups addressed motivations, benefits, and challenges in maintaining professional autonomy alongside AI integration.</p><p>Although the average duration of these interviews may appear relatively short for qualitative research, this was a deliberate methodological decision based on both logistical and conceptual considerations. Participants were full-time faculty members in medical and health sciences disciplines with heavy teaching, research, and clinical responsibilities. To respect their limited availability and ensure meaningful engagement, a focused and well-structured interview protocol was designed, aligned with the I-PACE model. This protocol was pilot-tested and refined to elicit conceptually rich responses within a concise time frame.</p><p>Despite the shorter duration, the interviews yielded dense, thematically robust narratives. To enrich data depth and validate emerging themes, 4 focus group discussions&#x2014;each approximately 1 hour&#x2014;were also conducted. These provided opportunities for reflection, triangulation, and deeper elaboration of core issues. Importantly, thematic saturation was achieved after 18 interviews, with subsequent interviews and focus groups confirming the stability of the thematic framework. Thus, while longer interviews might have allowed for further elaboration, the approach adopted ensured a balance between feasibility and qualitative rigor, without compromising the credibility or conceptual depth of the data.</p><p>To supplement these insights, four 1-hour focus groups (2 in person and 2 online) with 24 participants were held, facilitated by 2 researchers using prompts from interview analysis. Discussions explored AI usage patterns, reliance, and impacts on teaching and decision-making. All sessions were audio-recorded, providing broader perspectives that complemented the interview findings.</p><p>To ensure conceptual depth and data adequacy, recruitment and data collection continued until thematic saturation was achieved. Saturation was defined as the point at which no new themes or insights emerged during ongoing data analysis. This was observed after conducting 18 interviews, with subsequent interviews and focus group discussions confirming the stability and completeness of the thematic framework.</p><p>In this study, AI dependency is defined as overreliance on generative AI tools for academic tasks, leading to reduced cognitive engagement, professional autonomy, or pedagogical creativity. This contrasts with effective AI integration, which involves strategic, ethical use that maintains human oversight. Semistructured interviews probed these distinctions, exploring both the benefits and drawbacks of AI use and assessing impacts on teaching autonomy, motivation, and professional identity.</p></sec><sec id="s2-5"><title>Data Analysis</title><p>An inductive thematic analysis was conducted following Braun and Clarke&#x2019;s 6-phase framework (2006) to analyze data. The dataset comprised 12.25 hours of interview recordings and 3.25 hours of focus group sessions. All recordings were transcribed verbatim and verified through participant member checking to ensure accuracy.</p><p>Coding was performed using NVivo, with initial codes iteratively refined into subthemes and themes aligned with study objectives and relevant literature. Data collection and analysis were concurrent, and thematic saturation was reached after the 18th interview, confirmed by later focus groups.</p><p>To strengthen credibility, the study used methodological triangulation with interviews, focus groups, and artifacts such as anonymized AI-generated lesson plans and teaching notes. Analyzing these artifacts alongside participant reports provided contextual depth and validated emerging themes. Preserving cultural and linguistic nuances, coding and theme development were conducted in Arabic by bilingual researchers, with themes collaboratively translated into English. Backward translation ensured accuracy and contextual depth, while team discussions resolved discrepancies, maintaining conceptual equivalence and data integrity.</p><p>Participant responses were categorized using standardized terms: &#x201C;most&#x201D; (35/46, &#x003E;75%), &#x201C;many&#x201D; (50% [23/46,]&#x2010;75% [35/46]), and &#x201C;some&#x201D; (23/46, &#x003C;50%). Where participants expressed multiple perspectives, responses were coded under all relevant categories to reflect the complexity of AI integration in practice. This structured and multisource approach ensured the robustness, transparency, and trustworthiness of the findings.</p></sec><sec id="s2-6"><title>Trustworthiness</title><p>To ensure trustworthiness, the study systematically addressed the 4 key criteria of qualitative rigor: credibility, confirmability, dependability, and transferability. Credibility was strengthened through triangulation of data sources&#x2014;semistructured interviews, focus groups, and AI-generated teaching artifacts&#x2014;which provided multiple perspectives on the phenomenon. In addition, member checking was conducted by inviting participants to review selected transcripts and thematic summaries to validate interpretations.</p><p>The study used a hybrid coding approach, integrating both deductive and inductive strategies. A preliminary codebook based on the I-PACE model guided the initial round of coding, allowing the researchers to identify theoretically grounded patterns. Simultaneously, the analysis remained open to emergent inductive themes not captured by the model, thereby ensuring that the coding process was both conceptually informed and data-driven.</p><p>Confirmability was supported through independent coding by 2 researchers on a subset of transcripts (20/60, 30%), followed by peer debriefing and consensus-building sessions to refine code definitions and resolve discrepancies. While no formal interrater reliability statistic (eg, Cohen Kappa) was calculated, a shared audit trail was maintained to document analytic decisions, code evolution, and theme development. Final coding was conducted collaboratively using NVivo software.</p><p>Dependability was reinforced by clearly outlining data collection and analysis procedures, adhering to Braun and Clarke&#x2019;s 6-phase thematic analysis protocol, and using NVivo for systematic coding and data management. Transferability was supported through purposive sampling for maximum variation across discipline, institutional context, and AI use frequency, along with thick descriptions of participants&#x2019; backgrounds and contextual settings. Linguistic and cultural nuances were preserved through bilingual coding and backward translation, ensuring integrity across languages. Collectively, these procedures establish a rigorous foundation for the trustworthiness of the study&#x2019;s findings.</p></sec><sec id="s2-7"><title>Ethical Considerations</title><p>The study was conducted following approval (approval number Med. Dec. 2024/29) from the institutional review board at An Najah National University. All participants provided informed consent, receiving clear explanations of the study&#x2019;s purpose, voluntary participation, and confidentiality. Consent was indicated by participation, and participants were reminded of their right to withdraw at any time, ensuring ethical compliance and autonomy.</p></sec><sec id="s2-8"><title>Researchers' Background and Positionality</title><p>This study was conducted by an interdisciplinary research team composed of scholars from diverse academic backgrounds and institutions across different countries. The team includes experts in medical education, English language studies, educational technology, and qualitative research methodology, with shared experience in the integration of AI tools in teaching, learning, and research. Members of the team are affiliated with universities in the Middle East and North Africa region, providing a transnational perspective on the evolving role of AI in higher education. The team&#x2019;s varied disciplinary expertise and familiarity with a wide range of learner populations&#x2014;including undergraduate students, clinical educators, and faculty across Science, Technology, Engineering, and Mathematics (STEM) and humanities disciplines&#x2014;helped ensure a nuanced and contextually grounded interpretation of the data. This interdisciplinary orientation aligns with the study&#x2019;s broader aim to explore AI dependency as a multidimensional and cross-sectoral phenomenon.</p></sec></sec><sec id="s3" sec-type="results"><title>Results</title><sec id="s3-1"><title>Overview</title><p>To contextualize the qualitative findings, <xref ref-type="table" rid="table1">Table 1</xref> presents the demographic characteristics of the 46 participants who took part in the study, including faculty from diverse medical and health sciences disciplines such as nursing, pharmacy, optometry, medicine, and dental sciences. Participants varied in gender, age, teaching experience, frequency of AI use, and level of AI familiarity, ensuring a wide range of perspectives on the phenomenon of AI dependency in academic practice.</p><table-wrap id="t1" position="float"><label>Table 1.</label><caption><p>Demographic information about the participants in the semistructured interviews and focus group sessions.</p></caption><table id="table1" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Variable</td><td align="left" valign="bottom">Frequency (%)</td></tr></thead><tbody><tr><td align="left" valign="top" colspan="2">Sex</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Male</td><td align="left" valign="top">20 (43.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Female</td><td align="left" valign="top">26 (56.5)</td></tr><tr><td align="left" valign="top" colspan="2">Age (years)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>25&#x2010;35</td><td align="left" valign="top">5 (10.9)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>36&#x2010;45</td><td align="left" valign="top">15 (32.6)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>46&#x2010;55</td><td align="left" valign="top">18 (39.1)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>56+</td><td align="left" valign="top">8 (17.4)</td></tr><tr><td align="left" valign="top" colspan="2">Frequency of gen AI<sup><xref ref-type="table-fn" rid="table1fn1">a</xref></sup> use</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Daily</td><td align="left" valign="top">21 (45.7)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Weekly</td><td align="left" valign="top">14 (30.4)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Monthly</td><td align="left" valign="top">7 (15.2)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Occasionally</td><td align="left" valign="top">4 (8.7)</td></tr><tr><td align="left" valign="top">Teaching experience</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>1&#x2010;5 years</td><td align="left" valign="top">16 (34.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>6&#x2010;10 years</td><td align="left" valign="top">6 (13.0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>11&#x2010;15 years</td><td align="left" valign="top">15 (32.6)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>16+ years</td><td align="left" valign="top">9 (19.6)</td></tr><tr><td align="left" valign="top" colspan="2">AI familiarity level</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Low</td><td align="left" valign="top">19 (41.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Moderate</td><td align="left" valign="top">16 (34.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>High</td><td align="left" valign="top">11 (23.9)</td></tr><tr><td align="left" valign="top">Medical science discipline</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Nursing</td><td align="left" valign="top">8 (17.4)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Pharmacy</td><td align="left" valign="top">8 (17.4)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Optometry</td><td align="left" valign="top">9 (19.6)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Doctor of Medicine</td><td align="left" valign="top">7 (15.2)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Medical Laboratory Sciences</td><td align="left" valign="top">6 (13.0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Doctor of Dental</td><td align="left" valign="top">8 (17.4)</td></tr></tbody></table><table-wrap-foot><fn id="table1fn1"><p><sup>a</sup>AI: artificial intelligence.</p></fn></table-wrap-foot></table-wrap><p>Building on this diverse dataset, the findings are structured and interpreted through the lens of the I-PACE model. This framework enabled a systematic mapping of themes across 4 interrelated components: institutional and individual pressures were aligned with person variables; anxiety and motivation reflected the affect dimension; cognitive offloading and creativity suppression were linked to cognition; and habitual overuse of AI tools corresponded to execution functions. Together, these findings illustrate how psychological, cognitive, and behavioral mechanisms interact to shape educators&#x2019; dependency on AI technologies in higher education.</p><p>Research question #1<italic>:</italic> What key factors contribute to AI dependency among educators in higher education?</p><p>The first research question aimed to explore the factors influencing AI dependency among educators. The analysis revealed that AI dependency is shaped by institutional, psychological, cognitive, technological, and individual factors. <xref ref-type="table" rid="table2">Table 2</xref> presents the coding book for the first research question.</p><table-wrap id="t2" position="float"><label>Table 2.</label><caption><p>Coding book for the reasons for AI dependency research question.</p></caption><table id="table2" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Theme and subtheme</td><td align="left" valign="bottom">Quotation</td></tr></thead><tbody><tr><td align="left" valign="top">Institutional factors</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Heavy workload and time constraints</td><td align="left" valign="top"><italic>Without AI, I would spend hours grading assignments and drafting course materials. Now, I can do it in minutes</italic>. [E5]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Institutional expectation of using AI<sup><xref ref-type="table-fn" rid="table2fn1">a</xref></sup></td><td align="left" valign="top"><italic>Our university expects us to use AI, but there&#x2019;s little guidance on how to do it effectively</italic>. [E21]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Lack of institutional guidance</td><td align="left" valign="top"><italic>There are no clear policies on how much AI use is appropriate, so I just use it however I think best</italic>. [E8]</td></tr><tr><td align="left" valign="top">Psychological factors</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Anxiety and performance pressure</td><td align="left" valign="top"><italic>Everyone around me is using AI, and I don&#x2019;t want to be left behind.</italic> [E2]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Perfectionism and fear of errors</td><td align="left" valign="top"><italic>I feel like I&#x2019;ve lost my ability to draft a paper from scratch. I always turn to AI first</italic>. [E6]</td></tr><tr><td align="left" valign="top">Cognitive factors</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cognitive offloading</td><td align="left" valign="top"><italic>I used to brainstorm lesson plans myself. Now, I ask AI, and it gives me something within seconds</italic>. [E15]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Loss of pedagogical creativity</td><td align="left" valign="top"><italic>I used to create my own case studies and interactive activities. Now, I just modify what AI generates</italic>. [E17]</td></tr><tr><td align="left" valign="top">Technological factors</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Ease of access and automation</td><td align="left" valign="top"><italic>Why spend hours writing something when AI can give me a great draft in seconds?</italic> [E21]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Lack of AI literacy</td><td align="left" valign="top"><italic>I know AI isn&#x2019;t perfect, but I don&#x2019;t always know how to verify the accuracy of what it generates</italic>. [E18]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Feeling powerful and capable</td><td align="left" valign="top"><italic>With AI, I can complete tasks that would have taken me hours in just a few minutes</italic>. [E3]</td></tr><tr><td align="left" valign="top">Individual factors</td><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Academic self-efficacy</td><td align="left" valign="top"><italic>AI helps me refine my ideas, making my work more professional and well-structured</italic>. [E6]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Academic reputation</td><td align="left" valign="top"><italic>I rely on AI in writing research papers due to my reputation and publication pressure</italic>. [E9]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>High performance expectations</td><td align="left" valign="top"><italic>There&#x2019;s a lot of pressure to produce high-quality work, so I use AI to meet expectations</italic>. [E11]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Low academic confidence</td><td align="left" valign="top"><italic>I don&#x2019;t always trust my writing skills, so AI gives me the reassurance I need to finalize my work</italic>. [E4]</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Lack of scientific research engagement</td><td align="left" valign="top"><italic>I rarely engage in deep scientific research anymore because AI provides quick summaries</italic>. [E13]</td></tr></tbody></table><table-wrap-foot><fn id="table2fn1"><p><sup>a</sup>AI: artificial intelligence.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-2"><title>Institutional Factors</title><sec id="s3-2-1"><title>Heavy Workload and Time Constraints</title><p>Many participants viewed AI as essential for managing academic workloads, highlighting its role in reducing time spent on repetitive tasks like grading, report writing, and content creation.</p><disp-quote><p>Without AI, I would spend hours grading assignments and drafting course materials. Now, I can do it in minutes, which helps me keep up with my workload.</p><attrib>E5</attrib></disp-quote><p>Participants noted that institutional pressure to publish and show teaching effectiveness drives greater AI adoption. However, some&#x2014;especially in the social sciences&#x2014;found that unfamiliarity with AI increased their workload and added stress.</p><disp-quote><p>It&#x2019;s a double-edged sword&#x2014;AI helps me finish tasks faster, but I sometimes feel I need more time to understand it, which increases the time I need to finish writing the tasks.</p><attrib>E19</attrib></disp-quote></sec><sec id="s3-2-2"><title>Lack of Institutional Guidance</title><p>A recurring concern was the absence of institutional policies, support, or structured training for integrating AI responsibly. This lack of formal guidance often left participants unsure of how to use AI tools effectively and ethically.</p><disp-quote><p>There are no clear policies on how much AI use is appropriate, so I just use it however I think best.</p><attrib>E8</attrib></disp-quote><p>A few also expressed concern that future policy changes might disrupt their current dependency on AI.</p><disp-quote><p>I depend on AI now, but if my university decides to impose restrictions, I might struggle to adjust back to traditional methods.</p><attrib>E5</attrib></disp-quote></sec></sec><sec id="s3-3"><title>Psychological Factors</title><sec id="s3-3-1"><title>Anxiety and Performance Pressure</title><p>Several participants pointed out that AI helps them manage anxiety related to teaching and research expectations. Some also reported feeling pressured to stay updated with AI advancements and integrating AI tools in order to be adequately tech-savvy.</p><disp-quote><p>Everyone around me is using AI, and I don&#x2019;t want to be left behind. I feel like I need to use it to stay relevant.</p><attrib>E2</attrib></disp-quote><p>Nevertheless, a few participants argued that AI dependency sometimes increases stress, particularly when the accuracy of AI is uncertain.</p><disp-quote><p>I depend on AI, but at times, I worry that I might be using incorrect or biased information without realizing it.</p><attrib>E9</attrib></disp-quote></sec><sec id="s3-3-2"><title>Perfectionism and Fear of Errors</title><p>Some participants described themselves as perfectionists, adding that AI helps them ensure accuracy in research, lesson planning, and assessment design. In addition, AI increases their confidence as it helps them refine content and eliminate errors.</p><disp-quote><p>I use AI to check everything. I don&#x2019;t want to submit anything that isn&#x2019;t polished and error-free.</p></disp-quote><p>Conversely, a few expressed concern over the way AI dependency negatively impacts their academic and scholarly confidence.</p><disp-quote><p>I feel like I&#x2019;ve lost my ability to draft a paper from scratch. I always turn to AI first.</p><attrib>E 6</attrib></disp-quote></sec></sec><sec id="s3-4"><title>Cognitive Factors</title><sec id="s3-4-1"><title>Cognitive Offloading</title><p>Most participants acknowledged that AI has become their default tool for information retrieval and content creation, reducing the effort required for critical thinking and problem-solving.</p><disp-quote><p>I used to brainstorm lesson plans myself. Now, I ask AI, and it gives me something within seconds.</p><attrib>E15</attrib></disp-quote><p>However, some educators worried that relying on AI too frequently might weaken their cognitive engagement with their work.</p><disp-quote><p>I wonder if I&#x2019;m losing my ability to think critically because AI does the thinking for me.</p><attrib>E 10</attrib></disp-quote></sec><sec id="s3-4-2"><title>Loss of Pedagogical Creativity</title><p>A few pointed out that AI-generated content makes teaching more convenient but limits their creativity in designing course materials.</p><disp-quote><p>I used to create my own case studies and interactive activities. Now, I just modify what AI generates.</p><attrib>E17</attrib></disp-quote><p>On the other hand, some educators mentioned that AI enhances their creativity by providing new perspectives and ideas they would not have considered otherwise.</p><disp-quote><p>AI gives me different angles to approach a topic, which actually improves my lesson planning.</p><attrib>E22</attrib></disp-quote></sec></sec><sec id="s3-5"><title>Technological Factors</title><sec id="s3-5-1"><title>Ease of Access and Automation</title><p>Many participants indicated that AI tools are readily available and easy to use, making them convenient for performing academic tasks. According to these participants, AI helps them save time, generate ideas, and organize content efficiently.</p><disp-quote><p>Why spend hours writing something when AI can give me a great draft in seconds?</p><attrib>E21</attrib></disp-quote><p>However, a few pointed out that the ease of access makes it tempting to rely on AI for everything, leading to unintentional dependency.</p><disp-quote><p>The more I use AI, the harder it becomes to work without it. It&#x2019;s like having a calculator for everything.</p><attrib>E20</attrib></disp-quote></sec><sec id="s3-5-2"><title>Lack of AI Literacy</title><p>Some participants admitted that they lack a deep understanding of AI&#x2019;s inner workings<bold>,</bold> leading them to unquestioningly trust its outputs.</p><disp-quote><p>I know AI isn&#x2019;t perfect, but I don&#x2019;t always know how to verify the accuracy of what it generates.</p><attrib>E18</attrib></disp-quote><p>A few educators expressed concern that inadequate AI literacy might make them overly dependent on AI-generated insights.</p><disp-quote><p>I sometimes use AI without thinking critically because I assume it knows better than I do.</p><attrib>E1</attrib></disp-quote></sec><sec id="s3-5-3"><title>Feeling Powerful and Capable</title><p>Some educators pointed out that AI empowers them and allows them to produce high-quality content more efficiently.</p><disp-quote><p>With AI, I can complete tasks that would have taken me hours in just a few minutes. It makes me feel more capable.</p><attrib>E3</attrib></disp-quote><p>Moreover, a few were concerned that this sense of control is misleading, as they might be overestimating AI&#x2019;s reliability.</p><disp-quote><p>AI makes me feel smarter, but I sometimes wonder if I&#x2019;m just relying on it too much without questioning its accuracy.</p><attrib>E 3</attrib></disp-quote></sec><sec id="s3-5-4"><title>Individual Factors</title><p>Based on the coding book (<xref ref-type="table" rid="table2">Table 2</xref>), individual factors include academic reputation, high performance expectation, low academic self-efficacy, and lack of scientific research engagement.</p></sec></sec><sec id="s3-6"><title>Academic Reputation</title><p>Most participants reported that academic reputation is a key driver of their reliance on AI, particularly for scientific research. One prominent researcher shared that, because of his demanding teaching and research schedule, he relies on AI to assist with writing.</p></sec><sec id="s3-7"><title>Academic Self-Efficacy</title><p>Some participants mentioned that using AI enhances their confidence in their academic abilities.</p><disp-quote><p>AI helps me refine my ideas, making my work more professional and well-structured.</p><attrib>E6</attrib></disp-quote><p>Other participants expressed concerns that relying on AI might affect their academic reputation, as AI-generated content could be perceived as lacking originality.</p><disp-quote><p>I worry that using AI too much might make others question the authenticity of my work.</p><attrib>E7</attrib></disp-quote><sec id="s3-7-1"><title>Low Academic Confidence</title><p>A few participants admitted that AI serves as a tool for procrastination, allowing them to delay tasks while still producing quick results when needed.</p><disp-quote><p>&#x201C;I put off writing papers because I know AI can help me generate content at the last minute.&#x201D;</p></disp-quote><p>On the other hand, some educators maintained that AI use compensates for their low academic confidence, making them feel more capable in completing their work.</p><disp-quote><p>&#x201C;I don&#x2019;t always trust my writing skills, so AI gives me the reassurance I need to finalize my work.&#x201D;</p></disp-quote><p>Research question #2: How does AI dependency impact educators&#x2019; teaching autonomy, decision-making, and professional identity?</p><p>Findings from the second research question revealed that AI dependency has complex and varied consequences for educators. While participants acknowledged AI&#x2019;s efficiency and convenience, they also raised concerns about its negative effects. More than 30 subthemes emerged, categorized into 6 main themes: skills atrophy, pedagogical erosion, motivation decline, ethical and integrity risk, social fragmentation, and creativity suppression. <xref ref-type="table" rid="table3">Table 3</xref> details these subthemes, which are outlined in the following sections.</p><table-wrap id="t3" position="float"><label>Table 3.</label><caption><p>Consequences of AI dependency.</p></caption><table id="table3" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom">Main theme</td><td align="left" valign="bottom">Subtheme</td></tr></thead><tbody><tr><td align="left" valign="top">Skills atrophy</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Loss of critical thinking</p></list-item><list-item><p>Weakened problem-solving abilities</p></list-item><list-item><p>Diminished writing and research skills</p></list-item><list-item><p>Reduced analytical skills</p></list-item><list-item><p>Loss of decision-making abilities</p></list-item><list-item><p>Reduced ability to synthesize independently</p></list-item><list-item><p>Weakened judgment</p></list-item></list></td></tr><tr><td align="left" valign="top">Motivational decline</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Over-reliance on AI<sup><xref ref-type="table-fn" rid="table3fn1">a</xref></sup> for simple tasks</p></list-item><list-item><p>Procrastination</p></list-item><list-item><p>Reduced motivation</p></list-item><list-item><p>Increased laziness</p></list-item><list-item><p>Reduced individual initiatives</p></list-item></list></td></tr><tr><td align="left" valign="top">Pedagogical erosion</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Erosion of pedagogical autonomy</p></list-item><list-item><p>Reduced active engagement with students</p></list-item><list-item><p>Weakened academic mentorship</p></list-item><list-item><p>Reduced self-confidence</p></list-item><list-item><p>Perceived professional inadequacy</p></list-item></list></td></tr><tr><td align="left" valign="top">Ethical and integrity risks</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Increased plagiarism rate</p></list-item><list-item><p>Increased copyright infringement</p></list-item><list-item><p>Increased academic misconduct</p></list-item><list-item><p>Diminished human responsibility</p></list-item><list-item><p>Increased misleading information</p></list-item></list></td></tr><tr><td align="left" valign="top">Social fragmentation</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Affects students&#x2019; emotional state negatively</p></list-item><list-item><p>Diminished social development</p></list-item><list-item><p>Reduced human interaction</p></list-item><list-item><p>Decreased collaboration among humans</p></list-item></list></td></tr><tr><td align="left" valign="top">Creativity suppression</td><td align="left" valign="top"><list list-type="bullet"><list-item><p>Homogenization of knowledge production</p></list-item><list-item><p>Restrict creativity</p></list-item><list-item><p>Restrict information seeking</p></list-item></list></td></tr></tbody></table><table-wrap-foot><fn id="table3fn1"><p><sup>a</sup>AI: artificial intelligence.</p></fn></table-wrap-foot></table-wrap></sec></sec><sec id="s3-8"><title>Skills Atrophy</title><p>In this study, skills atrophy refers to the gradual decline of previously acquired skills and competencies due to lack of use or engagement. Related subthemes include weakened thinking skills, reduced problem-solving abilities, and diminished analytical synthesis.</p><p>All participants in the interviews and a few of the participants in the focus group discussions reported a decline in their skills in writing scientific research due to their frequent use of AI in scientific research. In addition, most participants reported that frequent reliance on AI has reduced their engagement in deep critical thinking.</p><disp-quote><p>I used to spend time reading multiple sources and forming my own analysis. Now, I just ask AI to summarize everything for me, and I take that as my starting point.</p><attrib>EFG18</attrib></disp-quote><p>Several participants in the interviews admitted that instead of independently evaluating and synthesizing information, they now trust AI-generated summaries and responses.</p><disp-quote><p>I don&#x2019;t challenge myself as much anymore. If AI gives me a structured answer, I don&#x2019;t always question it, I just go with it.</p><attrib>EFG26</attrib></disp-quote><p>In addition, several participants stated that using AI applications negatively affects their decision-making abilities, making them more reliant on automated solutions.</p><disp-quote><p>When I come across a difficult question in my field, my first instinct is to ask AI instead of thinking through possible solutions myself.</p><attrib>EFG36</attrib></disp-quote><p>A few participants pointed out that while AI speeds up the problem-solving process, it sometimes limits their ability to engage with complex academic challenges.</p><disp-quote><p>AI gives great answers quickly, but I worry that I&#x2019;m losing my ability to navigate difficult academic discussions without its help.</p><attrib>EFG13</attrib></disp-quote><p>Most participants reported that AI dependence has weakened their academic writing and research skills. Some found it difficult to start writing without AI-generated drafts after extended use, while others rarely conduct extensive literature reviews themselves.</p><disp-quote><p>I used to write everything from scratch, but now I start with an AI-generated outline. I wonder if I&#x2019;m losing my ability to structure my thoughts clearly on my own.</p><attrib>EFG25</attrib></disp-quote><p>A few participants mentioned that AI-generated summaries are convenient but may lead to a superficial understanding of academic topics.</p><disp-quote><p>Instead of reading full papers, I rely on AI to summarize them. I get the key points, but I feel like I&#x2019;m missing the depth of the discussion.</p><attrib>E17</attrib></disp-quote></sec><sec id="s3-9"><title>Motivational Decline</title><p>In the context of this study, motivation decline refers to the gradual reduction in an individual&#x2019;s drive, enthusiasm, or willingness to engage in various academic activities. Subthemes include procrastination, weaker intrinsic motivation, reduced individual initiatives, and overreliance on AI.</p><p>Several participants mentioned that AI has encouraged procrastination, as they know they can complete tasks quickly with AI assistance.</p><disp-quote><p>Before AI, I would start preparing my lectures well in advance. Now, I just rely on AI to generate material the night before.</p><attrib>EFG28</attrib></disp-quote><p>A few educators pointed out that while AI helps them meet deadlines, it sometimes leads to rushed and poor-quality work.</p><disp-quote><p>I meet my deadlines, but sometimes I feel like my work isn&#x2019;t as thoughtful as it used to be because I rely on AI to speed things up.</p><attrib>E15</attrib></disp-quote><p>A few educators mentioned that AI has made them more efficient but acknowledged that it can be tempting to take shortcuts.</p><disp-quote><p>I&#x2019;m more productive with AI, but I also recognize that I use it to avoid thinking through certain problems myself.</p><attrib>EFG13</attrib></disp-quote></sec><sec id="s3-10"><title>Pedagogical Erosion</title><p>In this study, pedagogical erosion refers to the gradual decline in the effectiveness, relevance, and innovation of teaching practices over time. Subthemes categorized under this theme include perceived professional inadequacy, erosion of pedagogy autonomy, reduced engagement with students, weakened academic mentorship, and reduced self-confidence.</p><p>Some participants pointed out that AI efficiently helps them improve the quality of their teaching material.</p><disp-quote><p>&#x201C;AI gives me a strong starting point for my lessons. I still personalize them, but it definitely saves me time.&#x201D;</p></disp-quote><p>According to a few participants, interactions with students became less personal since integrating AI into their workflow.</p><disp-quote><p>I used to spend more time giving individualized feedback. Now, I use AI-generated comments, and I feel like I&#x2019;m not engaging with my students as much.</p><attrib>E11</attrib></disp-quote><p>On the other hand, some educators argued that AI allows them to focus on more meaningful discussions instead of wasting time on repetitive tasks.</p><disp-quote><p>AI handles the routine work, so I can dedicate more time to having deeper discussions with my students.</p><attrib>E20</attrib></disp-quote><p>Many participants admitted that AI has made them doubt their own expertise, as they often feel that AI-generated content is superior to their own in structure and insight.</p><disp-quote><p>Sometimes I feel like AI writes better than I do. It&#x2019;s unsettling to think that I might not be as good as I used to be.</p><attrib>EFG35</attrib></disp-quote><p>Similarly, some mentioned that they feel they must use AI particularly when completing research or complex writing tasks.</p><disp-quote><p>&#x201C;<italic>If AI was suddenly unavailable, I don&#x2019;t know how I&#x2019;d manage my workload. I&#x2019;ve started to rely on it too much</italic>.&#x201D;</p></disp-quote><p>However, a few pointed out that AI boosts their confidence by helping them refine their work.</p><disp-quote><p>AI isn&#x2019;t replacing my skills&#x2014;it&#x2019;s just giving me an extra layer of support to make my work better.</p><attrib>EFG14</attrib></disp-quote><p>A few educators stressed that AI can and should be used wisely without hindering professional competence.</p><disp-quote><p>AI is a tool, not a replacement. As long as we use it strategically, we can avoid becoming too dependent.</p><attrib>E16</attrib></disp-quote></sec><sec id="s3-11"><title>Ethical and Integrity Risks</title><p>Ethical and integrity risks in this study refer to the challenges that arise when AI influences academic practices. Subthemes that emerged under this category include increased plagiarism rate and copyright infringement, increased academic misconduct, decreased human responsibility, and increased misleading information.</p><p>Some participants expressed concerns that AI facilitates plagiarism and reduces students&#x2019; accountability for their work.</p><disp-quote><p>It&#x2019;s so easy for students to copy-paste AI-generated responses without truly engaging with the material.</p><attrib>E7</attrib></disp-quote><p>Others pointed out that AI tools blur the lines of originality and authorship, making it difficult to differentiate between human and machine-generated work.</p><disp-quote><p>I worry that students are submitting AI-generated essays without understanding the concepts themselves.</p><attrib>E12</attrib></disp-quote><p>A few highlighted the fact that AI-generated content sometimes lacks accountability, as it can produce misleading or biased information.</p><disp-quote><p>AI sometimes generates convincing but factually incorrect statements, and students don&#x2019;t always verify them.</p><attrib>EFG21</attrib></disp-quote><p>On the other hand, some faculty members believe AI can be ethically leveraged if students are taught responsible AI use.</p><disp-quote><p>We should integrate AI literacy into our curriculum so students learn how to use these tools without compromising integrity.</p><attrib>E26</attrib></disp-quote></sec><sec id="s3-12"><title>Social Fragmentation</title><p>Social fragmentation in this research refers to the weakening of human connections and interactions due to AIED. Subthemes include negatively impacting students&#x2019; emotional state, diminishing social development, reducing human interaction, and decreasing collaboration among humans.</p><p>Many participants noted that students are becoming more isolated as AI tools replace traditional peer interactions in collaborative assignments.</p><disp-quote><p>Group discussions are not as engaging anymore because students rely on AI instead of exchanging ideas with their peers.</p><attrib>E9</attrib></disp-quote><p>However, some suggested that AI could be used to enhance social learning if implemented thoughtfully.</p><disp-quote><p>If we integrate AI strategically&#x2014;such as using it to facilitate discussions rather than replace them&#x2014;it can actually strengthen collaboration.</p><attrib>E30</attrib></disp-quote></sec><sec id="s3-13"><title>Creativity Suppression</title><p>Creativity suppression refers to the risk that AI may homogenize knowledge production, restrict creativity, and limit students&#x2019; ability to seek information. Subthemes include homogenizing knowledge production, restricting creativity, and limiting search for information from diverse sources.</p><p>Many participants reported that AI-generated content tends to produce generic, standardized responses, leading to a decline in original thought.</p><disp-quote><p>Students&#x2019; assignments are starting to look the same because they rely on AI-generated structures.</p><attrib>EFG15</attrib></disp-quote><p>Some educators emphasized that AI discourages thorough research, as students may settle for AI-generated summaries instead of exploring diverse sources.</p><disp-quote><p>Before AI, students would read multiple papers. Now, they just use AI to summarize, and I feel like they&#x2019;re missing out on critical engagement.</p><attrib>E14</attrib></disp-quote><p>Research question # 3: What strategies can help educators balance AI use while maintaining pedagogical creativity and instructional effectiveness?</p><p>The third research question explored strategies educators use to balance AI integration with traditional teaching while maintaining effectiveness and autonomy. Findings show that most view AI as a valuable tool but use strategies to prevent overreliance and preserve human-centered teaching, with some embracing its efficiency and others expressing concerns about its effects on critical thinking, creativity, and student-teacher interactions. Key themes are summarized below.</p></sec><sec id="s3-14"><title>Establishing Clear Boundaries for AI Use: Selective Use of AI for Instructional Tasks</title><p>Most participants said they use AI selectively, viewing it as a support tool rather than a replacement for their instructional role. They emphasized that core teaching activities&#x2014;mentoring, leading discussions, and assessing student progress&#x2014;should remain human-led.</p><disp-quote><p>AI helps with structuring lesson plans and summarizing content, but I make sure that my role as an educator remains central in guiding discussions and engaging with students.</p><attrib>E4</attrib></disp-quote><p>Some participants pointed out that AI is particularly useful for administrative tasks and content organization but should not dictate teaching methods.</p><disp-quote><p>I let AI handle routine tasks like scheduling and summarizing, but when it comes to interactive teaching, I rely on my own expertise and instincts.</p><attrib>EFG33</attrib></disp-quote><p>A few participants expressed concerns that without defined limits, educators might unconsciously begin to depend too much on AI-generated content.</p><disp-quote><p>I initially used AI just for support, but over time, I found myself relying on it more than I intended. Now, I consciously limit my AI use to avoid dependency.</p><attrib>EFG28</attrib></disp-quote></sec><sec id="s3-15"><title>Encouraging Critical Engagement With AI: Verifying AI-Generated Content</title><p>Many participants stated that they actively verify and refine AI-generated outputs before using them in teaching, noting that AI can produce misleading, biased, or overly simplified content. This requires educators to serve as content curators rather than passive users.</p><disp-quote><p>I never use AI-generated content without reviewing it first. It can be a great starting point, but I always fact-check and refine the materials to align with my course objectives.</p><attrib>EFG31</attrib></disp-quote><p>Some educators pointed out that they encourage students to critically analyze AI-generated responses rather than accepting them at face value.</p><disp-quote><p>I tell my students that AI is a tool, not an authority. They need to critique what it produces, question its assumptions, and think beyond the outputs.</p><attrib>EFG32</attrib></disp-quote><p>On the other hand, a few participants expressed concern that not all educators take the time to evaluate AI content carefully, which could lead to inaccuracies in teaching.</p><disp-quote><p>One of my worries is that some educators might blindly trust AI-generated materials, which could introduce errors or outdated information into their lessons.</p><attrib>EFG17</attrib></disp-quote></sec><sec id="s3-16"><title>Balancing AI With Human-Centered Teaching</title><sec id="s3-16-1"><title>Hybrid Intelligence</title><p>Most participants stressed that hybrid intelligence&#x2014;integrating human and machine intelligence&#x2014;is vital to prevent overreliance on AI. They defined it as critically assessing AI outputs, promoting deeper reflection and independent analysis rather than passive acceptance.</p></sec><sec id="s3-16-2"><title>Prioritizing Interactive and Discussion-Based Learning</title><p>Most participants reported intentionally designing courses to prioritize live discussions, debates, and student-driven learning to counterbalance AI-generated content, emphasizing that human interaction is essential for deep understanding and critical thinking.</p><disp-quote><p>AI is great for providing structured information, but meaningful learning happens when students engage in discussions, challenge ideas, and interact with their peers and instructors.</p><attrib>E15</attrib></disp-quote><p>Some participants mentioned that they use AI to supplement discussions by generating diverse perspectives, but they ensure that students analyze and debate those perspectives rather than passively accepting them.</p><disp-quote><p>I sometimes use AI to provide multiple viewpoints on a topic, but I make sure my students critically evaluate and compare them rather than just absorbing the information.</p><attrib>EFG25</attrib></disp-quote><p>However, a few participants pointed out that some educators struggle to balance AI integration with traditional teaching, leading to a more passive learning environment.</p><disp-quote><p>I've seen cases where AI-generated lectures replace interactive teaching, and I worry that students might become passive learners rather than active thinkers.</p><attrib>EFG32</attrib></disp-quote></sec></sec><sec id="s3-17"><title>Maintaining Pedagogical Creativity: Using AI as a Spark for Innovation, Not a Substitute for Creativity</title><p>Many participants reported that they leverage AI to generate new ideas for lesson planning but ensure that their personal creativity remains the driving force. They view AI as a brainstorming partner rather than a content creator.</p><disp-quote><p>I use AI to generate multiple lesson ideas, but I always customize them to fit my teaching style and my students' needs.</p><attrib>E3</attrib></disp-quote><p>Some educators pointed out that AI helps them explore innovative approaches to teaching but emphasized that human creativity is irreplaceable.</p><disp-quote><p>AI can suggest engaging activities, but it&#x2019;s my job to refine them and add the human element that makes learning meaningful.</p><attrib>E22</attrib></disp-quote><p>On the other hand, a few participants expressed concerns that excessive AI use might lead to a decline in originality if educators become overly reliant on AI-generated content.</p><disp-quote><p>I fear that if we depend too much on AI, we might lose the uniqueness of our teaching styles. That&#x2019;s why I try to balance AI use with my own creative input.</p><attrib>EFG26</attrib></disp-quote></sec><sec id="s3-18"><title>Fostering Student AI Literacy and Ethical Use: Teaching Students to Use AI Responsibly</title><p>Some participants expressed that they incorporate AI literacy into their courses to help students use AI effectively while avoiding over-reliance. They believe that educators should guide students in understanding AI&#x2019;s strengths and limitations.</p><disp-quote><p>I teach my students how to use AI as a research tool but also emphasize that they must engage critically with the results rather than just accepting AI-generated answers.</p><attrib>EFG32</attrib></disp-quote><p>Most participants reported that they actively discourage students from using AI for academic shortcuts, instead encouraging them to use AI as a means of enhancing learning.</p><disp-quote><p>AI can help students brainstorm ideas, but they need to put in the effort to analyze and expand on those ideas instead of just submitting AI-generated content.</p><p>[EFG34]</p></disp-quote><p>However, a few participants pointed out that some students misuse AI for assignments, and educators must establish clear guidelines on ethical AI use.</p><disp-quote><p>We need to teach students that AI is a tool to assist learning, not a way to bypass intellectual effort.</p><p>[EFG11]</p></disp-quote></sec><sec id="s3-19"><title>Continuous Professional Development and Peer Collaboration: Engaging in AI Training and Professional Learning Communities</title><p>Several participants mentioned that they actively seek professional development opportunities to improve their AI literacy and refine their AI integration strategies. They believe that educators must continuously learn to ensure that AI is used responsibly and effectively.</p><disp-quote><p>I regularly attend AI workshops to stay updated on best practices. The more I understand AI, the better I can integrate it into my teaching without becoming dependent on it.</p><attrib>E5</attrib></disp-quote><p>Some educators pointed out that they collaborate with colleagues to share AI integration strategies, discuss ethical concerns, and develop guidelines for responsible AI use.</p><disp-quote><p>We have faculty discussions on AI use where we exchange ideas on how to integrate AI without compromising teaching quality. These discussions help us find the right balance.</p><attrib>EFG36</attrib></disp-quote><p>On the other hand, a few participants expressed that some institutions lack adequate AI training programs, leaving educators to navigate AI integration on their own.</p><disp-quote><p>I wish there were more structured AI training for educators. Right now, we mostly figure it out through trial and error.</p><attrib>EFG35</attrib></disp-quote></sec></sec><sec id="s4" sec-type="discussion"><title>Discussion</title><sec id="s4-1"><title>Overview</title><p>The recent study examines the drivers and consequences of AI dependency among medical and health sciences faculty in Palestinian higher education, offering critical insights into over-reliance on generative AI and strategies for sustainable integration. This study contributes to the growing body of literature on digital transformation in medical education by identifying multidimensional factors that influence educators&#x2019; reliance on AI tools and their implications for pedagogical integrity and professional agency.</p></sec><sec id="s4-2"><title>Principal Findings</title><p>Institutional pressures&#x2014;particularly workload intensity and a lack of clear AI governance&#x2014;were identified as primary catalysts for increased AI reliance. These findings mirror previous studies [<xref ref-type="bibr" rid="ref4">4</xref>,<xref ref-type="bibr" rid="ref10">10</xref>] highlighting how time-saving AI applications appeal to overburdened faculty. Participants described using AI to manage grading, feedback, and administrative documentation, often without structured support or guidance. The absence of institutional frameworks creates ambiguity, allowing overuse and reinforcing dependency&#x2014;a concern consistent with the findings of [<xref ref-type="bibr" rid="ref7">7</xref>].</p><p>Psychological and individual factors also emerged as significant influences. Echoing previous research [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref9">9</xref>,<xref ref-type="bibr" rid="ref32">32</xref>], educators reported that anxiety, performance pressure, and perfectionism motivated AI use as a coping mechanism. High expectations for output quality and academic reputation intensified AI reliance, particularly in competitive or high-stakes disciplines. While some participants viewed AI as a confidence booster, others reported reduced academic self-efficacy and increased procrastination, reflecting problematic patterns of technology use.</p><p>At the cognitive level, many educators admitted to cognitive offloading, allowing AI to complete tasks once handled through personal reflection or pedagogical creativity. These practices align with concerns from [<xref ref-type="bibr" rid="ref33">33</xref>,<xref ref-type="bibr" rid="ref34">34</xref>] about diminished analytical and innovative capacity when AI is used uncritically. Participants noted that AI-generated lesson plans increased efficiency but limited deep thinking and originality, a paradox especially concerning in health education where critical reasoning and ethical judgment are essential.</p><p>Technological factors, especially ease of access and automation, facilitated habitual AI use, often unconsciously. Similar to findings on digital tool overuse [<xref ref-type="bibr" rid="ref25">25</xref>], educators recognized both the benefits and risks of AI ubiquity. Lack of AI literacy compounded the issue: while participants used GenAI tools regularly, many admitted limited understanding of how algorithms operate or how to evaluate their outputs critically [<xref ref-type="bibr" rid="ref17">17</xref>]. This blind trust not only undermines informed decision-making but also amplifies the risk of propagating misinformation or algorithmic bias in academic work.</p></sec><sec id="s4-3"><title>Consequences of AI Dependency</title><p>This study identified 6 major consequences of AI overreliance: skills atrophy, motivational decline, pedagogical erosion, ethical risks, social fragmentation, and creativity suppression. Faculty reported declining engagement in original writing, idea generation, and academic rigor&#x2014;findings echoed by [<xref ref-type="bibr" rid="ref8">8</xref>,<xref ref-type="bibr" rid="ref34">34</xref>,<xref ref-type="bibr" rid="ref35">35</xref>]. In some cases, AI was used as a substitute for personal initiative, weakening academic identity and self-reliance.</p><p>Social fragmentation was also discussed as educators expressed concern about diminished student-teacher interaction and reduced peer collaboration. This is consistent with [<xref ref-type="bibr" rid="ref36">36</xref>] noting how digital tools can isolate learners. Our findings suggest AI can support collaborative learning by matching students for group work and distributing roles equitably, potentially countering its fragmenting effects.</p><p>Participants frequently cited ethical risks such as plagiarism, misinformation, and authorship concerns, expressing uncertainty about acceptable boundaries for AI use in assessment and publication. These concerns align with calls for regular AI audits [<xref ref-type="bibr" rid="ref34">34</xref>], ensuring educational technologies are ethically vetted and contextually appropriate.</p></sec><sec id="s4-4"><title>Comparison to Prior Work</title><p>The findings reinforce and expand on theoretical models such as the I-PACE framework [<xref ref-type="bibr" rid="ref12">12</xref>], which links personality traits, affective responses, and cognitive control to problematic technology use. This study shows that in Palestinian higher education, AI dependency is a systemic issue shaped by resource constraints and institutional pressures, not just individual behavior. It highlights the interplay between personal motivations and structural limitations in AI use.</p></sec><sec id="s4-5"><title>Limitations and Future Research</title><p>This study&#x2019;s findings are limited by its focus on Palestinian higher education, which may affect transferability to other contexts. Variations in resources, policies, and academic cultures could lead to different experiences with AI dependency. Future research should explore these issues in diverse settings to broaden understanding.</p><p>Second, the use of self-reported data from 46 faculty members may introduce social desirability bias, with participants potentially misrepresenting their AI use. Conducting and translating interviews from Arabic to English may also have affected the preservation of linguistic and cultural nuances. Future studies should consider bilingual coding teams and cultural consultants for greater interpretive accuracy.</p><p>Third, this study focused solely on educators&#x2019; perspectives, excluding student voices. Future research should examine AI dependency among students to understand its effects on motivation, learning outcomes, and academic integrity.</p><p>Furthermore, while this study examined AI dependency broadly, it did not address disciplinary differences. Faculty in humanities, social sciences, and STEM may experience unique challenges and opportunities with AI. Future research should compare disciplines to uncover domain-specific dynamics of AI dependency.</p><p>Finally, this study provides a snapshot of current practices but does not assess the long-term effects of AI dependency on faculty roles, creativity, or knowledge production. Longitudinal and mixed methods research is needed to track changes over time and evaluate the impact of institutional interventions on pedagogical autonomy and professional integrity.</p></sec><sec id="s4-6"><title>Theoretical and Practical Implications</title><p>This study contributes to theoretical discourse on technology adoption in higher education by framing AI dependency as a multidimensional construct shaped by institutional, psychological, cognitive, and technological factors. Building on the I-PACE model, the findings demonstrate how overreliance on generative AI aligns with patterns of problematic technology use, particularly among faculty navigating high academic demands and limited institutional support. The study reinforces and extends the I-PACE framework by showing how its four components&#x2014;Person, Affect, Cognition, and Execution&#x2014;interact dynamically within educational environments to shape AI dependency.</p><p>Under the Person component, both individual (eg, academic self-efficacy, perfectionism, low confidence) and institutional drivers (eg, workload pressures, unclear policies) were identified as predisposing factors for AI overuse. These findings extend I-PACE by highlighting that external academic structures&#x2014;not just personal traits&#x2014;can significantly shape technology dependency. The Affect domain was reflected in emotional responses such as anxiety, fear of inadequacy, and pressure to meet performance expectations. Rather than being purely internal, these emotions were often shaped by systemic academic stressors, suggesting that affective triggers in the I-PACE model must be understood within broader socio-institutional contexts.</p><p>In the Cognition domain, participants frequently described cognitive offloading and declining engagement in creative and reflective tasks. Notably, this study introduces &#x201C;creativity suppression&#x201D; as a cognitive outcome not emphasized in the original model, pointing to the need for an update to account for AI&#x2019;s influence on ideation and pedagogical originality. The Execution component was evident in behavioral outcomes such as diminished teaching autonomy, motivational decline, and habitual reliance on AI. These confirm I-PACE&#x2019;s focus on maladaptive behavior patterns but also reveal participants&#x2019; active strategies&#x2014;like hybrid intelligence and critical engagement&#x2014;to retain pedagogical agency.</p><p>Overall, the study affirms the I-PACE model&#x2019;s value while proposing a broader interpretation that incorporates institutional, technological, and cultural factors specific to under-resourced higher education systems. By doing so, it deepens our understanding of how AI transforms academic identity, decision-making, and autonomy in the evolving landscape of digital education.</p><p>On a practical level, the study offers several actionable recommendations:</p></sec><sec id="s4-7"><title>Faculty Development</title><p>Higher education institutions should invest in personalized professional development to enhance AI literacy, ethical awareness, and pedagogical resilience. Training should include modules on AI ethics, data privacy, and algorithmic bias, tailored to each discipline&#x2019;s needs. Institutions can also use AI to personalize learning pathways for educators based on their backgrounds and evolving instructional needs.</p></sec><sec id="s4-8"><title>Institutional Policy Design</title><p>Institutions must establish clear and adaptive AI governance frameworks to guide responsible AI use among faculty and students. These frameworks should define acceptable use policies, clarify the boundaries of AI-generated content, and promote transparency in AI-supported academic work. To uphold ethical standards&#x2014;especially in high-stakes fields like medical education&#x2014;regular audits of AI tools should be implemented to assess potential biases, misinformation, and integrity risks. Moreover, developing such policies should be a collaborative effort involving faculty members, administrators, IT professionals, and ethicists to ensure both institutional trust and community-wide compliance.</p></sec><sec id="s4-9"><title>Student&#x2013;Teacher Interaction in AI Contexts</title><p>To reduce risks of pedagogical erosion and social fragmentation, institutions should set guidelines that preserve student&#x2013;teacher engagement in AI-rich environments. Human&#x2013;AI collaboration, reflective use of AI, and AI-facilitated group work can enhance accountability and peer interaction. Prioritizing feedback, mentorship, and dialogic teaching ensures AI remains a supplement, supporting balanced integration and safeguarding academic integrity.</p></sec><sec id="s4-10"><title>Conclusion</title><p>This study provides a comprehensive exploration of AI dependency among educators, highlighting the institutional, psychological, and cognitive factors that contribute to reliance on AI in academic practices. While AI offers significant benefits in terms of efficiency, knowledge management, and academic productivity, unchecked dependence can pose risks to pedagogical autonomy, critical thinking, and professional identity. The findings emphasize the importance of hybrid intelligence as a strategy to balance AI use, ensuring that technology enhances rather than replaces human intellectual engagement. The study&#x2019;s contributions to the theoretical discourse on AI adoption extend existing models by integrating the concept of AI dependency within a broader framework of professional agency and academic integrity. From a practical standpoint, these findings underscore the need for institutional policies, faculty training, and AI literacy initiatives that foster responsible AI use. Ultimately, this study advocates for a balanced approach where AI serves as a tool to augment human intelligence rather than replace it. Future research should continue to explore AI&#x2019;s evolving role in higher education, examining its long-term impact on faculty development, student learning, and knowledge creation in an increasingly AI-driven academic landscape.</p></sec></sec></body><back><notes><sec><title>Disclaimer</title><p>The authors use ChatGPT for proofreading of the introduction and organizing ideas in the literature review, all the authors take the responsibility of the accuracy of the content after proofreading and organizing the ideas of the introduction and literature review.</p></sec><sec><title>Data Availability</title><p>The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.</p></sec></notes><fn-group><fn fn-type="con"><p>The authors are responsible for all aspects of the research, including conceptualization, design, data collection, data analysis, and manuscript preparation. The authors have read and approved the final version of the manuscript.</p></fn><fn fn-type="conflict"><p>The authors declared there is no conflict of interest</p></fn></fn-group><glossary><title>Abbreviations</title><def-list><def-item><term id="abb1">AI</term><def><p>Artificial Intelligence</p></def></def-item><def-item><term id="abb2">AIED</term><def><p>Artificial Intelligence in Education</p></def></def-item><def-item><term id="abb3">Gen AI</term><def><p>Generative Artificial Intelligence</p></def></def-item><def-item><term id="abb4">IPACE</term><def><p>Interaction of Person-Affect-Cognition-Execution</p></def></def-item><def-item><term id="abb5">STEM</term><def><p>Science, Technology, Engineering, and Mathematics</p></def></def-item></def-list></glossary><ref-list><title>References</title><ref id="ref1"><label>1</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Singhal</surname><given-names>K</given-names> </name><name name-style="western"><surname>Azizi</surname><given-names>S</given-names> </name><name name-style="western"><surname>Tu</surname><given-names>T</given-names> </name><etal/></person-group><article-title>Large language models encode clinical knowledge</article-title><source>Nature New Biol</source><year>2023</year><month>08</month><volume>620</volume><issue>7972</issue><fpage>172</fpage><lpage>180</lpage><pub-id pub-id-type="doi">10.1038/s41586-023-06291-2</pub-id><pub-id pub-id-type="medline">37438534</pub-id></nlm-citation></ref><ref id="ref2"><label>2</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ansari</surname><given-names>AN</given-names> </name><name name-style="western"><surname>Ahmad</surname><given-names>S</given-names> </name><name name-style="western"><surname>Bhutta</surname><given-names>SM</given-names> </name></person-group><article-title>Mapping the global evidence around the use of ChatGPT in higher education: a systematic scoping review</article-title><source>Educ Inf Technol</source><year>2024</year><month>06</month><volume>29</volume><issue>9</issue><fpage>11281</fpage><lpage>11321</lpage><pub-id pub-id-type="doi">10.1007/s10639-023-12223-4</pub-id></nlm-citation></ref><ref id="ref3"><label>3</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Zhai</surname><given-names>C</given-names> </name><name name-style="western"><surname>Wibowo</surname><given-names>S</given-names> </name><name name-style="western"><surname>Li</surname><given-names>LD</given-names> </name></person-group><article-title>The effects of over-reliance on AI dialogue systems on students&#x2019; cognitive abilities: a systematic review</article-title><source>Smart Learn Environ</source><year>2024</year><volume>11</volume><issue>1</issue><fpage>28</fpage><pub-id pub-id-type="doi">10.1186/s40561-024-00316-7</pub-id></nlm-citation></ref><ref id="ref4"><label>4</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hess</surname><given-names>BJ</given-names> </name><name name-style="western"><surname>Cupido</surname><given-names>N</given-names> </name><name name-style="western"><surname>Ross</surname><given-names>S</given-names> </name><name name-style="western"><surname>Kvern</surname><given-names>B</given-names> </name></person-group><article-title>Becoming adaptive experts in an era of rapid advances in generative artificial intelligence</article-title><source>Med Teach</source><year>2024</year><month>03</month><volume>46</volume><issue>3</issue><fpage>300</fpage><lpage>303</lpage><pub-id pub-id-type="doi">10.1080/0142159X.2023.2289844</pub-id><pub-id pub-id-type="medline">38092006</pub-id></nlm-citation></ref><ref id="ref5"><label>5</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Creely</surname><given-names>E</given-names> </name><name name-style="western"><surname>Blannin</surname><given-names>J</given-names> </name></person-group><article-title>Creative partnerships with generative AI. Possibilities for education and beyond</article-title><source>Think Skills Creat</source><year>2025</year><month>06</month><volume>56</volume><fpage>101727</fpage><pub-id pub-id-type="doi">10.1016/j.tsc.2024.101727</pub-id></nlm-citation></ref><ref id="ref6"><label>6</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>AlAli</surname><given-names>R</given-names> </name><name name-style="western"><surname>Wardat</surname><given-names>Y</given-names> </name></person-group><article-title>Enhancing classroom learning: ChatGPT&#x2019;s integration and educational challenges</article-title><source>Intl J Rel</source><year>2024</year><volume>5</volume><issue>6</issue><fpage>971</fpage><lpage>985</lpage><pub-id pub-id-type="doi">10.61707/znwnxd43</pub-id></nlm-citation></ref><ref id="ref7"><label>7</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Al-Zahrani</surname><given-names>AM</given-names> </name><name name-style="western"><surname>Alasmari</surname><given-names>TM</given-names> </name></person-group><article-title>Exploring the impact of artificial intelligence on higher education: the dynamics of ethical, social, and educational implications</article-title><source>Humanit Soc Sci Commun</source><year>2024</year><volume>11</volume><issue>1</issue><fpage>1</fpage><lpage>12</lpage><pub-id pub-id-type="doi">10.1057/s41599-024-03432-4</pub-id></nlm-citation></ref><ref id="ref8"><label>8</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Zhong</surname><given-names>W</given-names> </name><name name-style="western"><surname>Luo</surname><given-names>J</given-names> </name><name name-style="western"><surname>Lyu</surname><given-names>Y</given-names> </name></person-group><article-title>How do personal attributes shape ai dependency in Chinese higher education context? Insights from needs frustration perspective</article-title><source>PLOS ONE</source><year>2024</year><volume>19</volume><issue>11</issue><fpage>e0313314</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0313314</pub-id><pub-id pub-id-type="medline">39485818</pub-id></nlm-citation></ref><ref id="ref9"><label>9</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Marciano</surname><given-names>L</given-names> </name><name name-style="western"><surname>Camerini</surname><given-names>AL</given-names> </name><name name-style="western"><surname>Schulz</surname><given-names>PJ</given-names> </name></person-group><article-title>Neuroticism and internet addiction: what is next? A systematic conceptual review</article-title><source>Pers Individ Dif</source><year>2022</year><month>02</month><volume>185</volume><fpage>111260</fpage><pub-id pub-id-type="doi">10.1016/j.paid.2021.111260</pub-id></nlm-citation></ref><ref id="ref10"><label>10</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Zawacki-Richter</surname><given-names>O</given-names> </name><name name-style="western"><surname>Mar&#x00ED;n</surname><given-names>VI</given-names> </name><name name-style="western"><surname>Bond</surname><given-names>M</given-names> </name><name name-style="western"><surname>Gouverneur</surname><given-names>F</given-names> </name></person-group><article-title>Systematic review of research on artificial intelligence applications in higher education &#x2013; where are the educators?</article-title><source>Int J Educ Technol High Educ</source><year>2019</year><month>12</month><volume>16</volume><issue>1</issue><fpage>1</fpage><lpage>27</lpage><pub-id pub-id-type="doi">10.1186/s41239-019-0171-0</pub-id></nlm-citation></ref><ref id="ref11"><label>11</label><nlm-citation citation-type="confproc"><person-group person-group-type="author"><name name-style="western"><surname>Huang Lecturer</surname><given-names>W</given-names> </name><name name-style="western"><surname>Zhang</surname><given-names>Z</given-names> </name><name name-style="western"><surname>Zeng</surname><given-names>Y</given-names> </name></person-group><article-title>Research on university students&#x2019; intention to use AI assistance in cross-cultural learning</article-title><conf-name>Proceedings of The International Conference on Electronic Business, ICEB&#x2019;24</conf-name><conf-date>Oct 24-28, 2024</conf-date><conf-loc>Zhuhai, Guangdong</conf-loc></nlm-citation></ref><ref id="ref12"><label>12</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Brand</surname><given-names>M</given-names> </name><name name-style="western"><surname>Young</surname><given-names>KS</given-names> </name><name name-style="western"><surname>Laier</surname><given-names>C</given-names> </name><name name-style="western"><surname>W&#x00F6;lfling</surname><given-names>K</given-names> </name><name name-style="western"><surname>Potenza</surname><given-names>MN</given-names> </name></person-group><article-title>Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: an interaction of person-affect-cognition-execution (I-PACE) model</article-title><source>Neuroscience &#x0026; Biobehavioral Reviews</source><year>2016</year><month>12</month><volume>71</volume><fpage>252</fpage><lpage>266</lpage><pub-id pub-id-type="doi">10.1016/j.neubiorev.2016.08.033</pub-id></nlm-citation></ref><ref id="ref13"><label>13</label><nlm-citation citation-type="confproc"><person-group person-group-type="author"><name name-style="western"><surname>Yu</surname><given-names>Q</given-names> </name><name name-style="western"><surname>Xu</surname><given-names>Y</given-names> </name></person-group><article-title>Awareness of responsibility and internet gaming addiction: the mediating role of cognitive emotion regulation strategies</article-title><conf-name>In 2024 9th International Conference on Modern Management, Education and Social Sciences (MMET 2024)</conf-name><conf-date>Sep 20-22, 2024</conf-date><conf-loc>Xiamen, China</conf-loc><fpage>61</fpage><lpage>70</lpage><pub-id pub-id-type="doi">10.2991/978-2-38476-309-2_8</pub-id></nlm-citation></ref><ref id="ref14"><label>14</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Zhang</surname><given-names>S</given-names> </name><name name-style="western"><surname>Zhao</surname><given-names>X</given-names> </name><name name-style="western"><surname>Zhou</surname><given-names>T</given-names> </name><name name-style="western"><surname>Kim</surname><given-names>JH</given-names> </name></person-group><article-title>Do you have AI dependency? The roles of academic self-efficacy, academic stress, and performance expectations on problematic AI usage behavior</article-title><source>Int J Educ Technol High Educ</source><year>2024</year><volume>21</volume><issue>1</issue><fpage>34</fpage><pub-id pub-id-type="doi">10.1186/s41239-024-00467-0</pub-id></nlm-citation></ref><ref id="ref15"><label>15</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hamamra</surname><given-names>B</given-names> </name><name name-style="western"><surname>Mayaleh</surname><given-names>A</given-names> </name><name name-style="western"><surname>Khlaif</surname><given-names>ZN</given-names> </name></person-group><article-title>Between tech and text: the use of generative AI in Palestinian universities - a ChatGPT case study</article-title><source>Cogent Education</source><year>2024</year><month>12</month><day>31</day><volume>11</volume><issue>1</issue><fpage>2380622</fpage><pub-id pub-id-type="doi">10.1080/2331186X.2024.2380622</pub-id></nlm-citation></ref><ref id="ref16"><label>16</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Omar</surname><given-names>A</given-names> </name><name name-style="western"><surname>Shaqour</surname><given-names>AZ</given-names> </name><name name-style="western"><surname>Khlaif</surname><given-names>ZN</given-names> </name></person-group><article-title>Attitudes of faculty members in Palestinian universities toward employing artificial intelligence applications in higher education: opportunities and challenges</article-title><source>Front Educ</source><year>2024</year><volume>9</volume><pub-id pub-id-type="doi">10.3389/feduc.2024.1414606</pub-id></nlm-citation></ref><ref id="ref17"><label>17</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Krou</surname><given-names>MR</given-names> </name><name name-style="western"><surname>Fong</surname><given-names>CJ</given-names> </name><name name-style="western"><surname>Hoff</surname><given-names>MA</given-names> </name></person-group><article-title>Achievement motivation and academic dishonesty: a meta-analytic investigation</article-title><source>Educ Psychol Rev</source><year>2021</year><month>06</month><volume>33</volume><issue>2</issue><fpage>427</fpage><lpage>458</lpage><pub-id pub-id-type="doi">10.1007/s10648-020-09557-7</pub-id></nlm-citation></ref><ref id="ref18"><label>18</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Stein</surname><given-names>DJ</given-names> </name><name name-style="western"><surname>Craske</surname><given-names>MG</given-names> </name><name name-style="western"><surname>Rothbaum</surname><given-names>BO</given-names> </name><etal/></person-group><article-title>The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management</article-title><source>World Psychiatry</source><year>2021</year><month>10</month><volume>20</volume><issue>3</issue><fpage>336</fpage><lpage>356</lpage><pub-id pub-id-type="doi">10.1002/wps.20919</pub-id><pub-id pub-id-type="medline">34505377</pub-id></nlm-citation></ref><ref id="ref19"><label>19</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Feher</surname><given-names>A</given-names> </name><name name-style="western"><surname>Smith</surname><given-names>MM</given-names> </name><name name-style="western"><surname>Saklofske</surname><given-names>DH</given-names> </name><name name-style="western"><surname>Plouffe</surname><given-names>RA</given-names> </name><name name-style="western"><surname>Wilson</surname><given-names>CA</given-names> </name><name name-style="western"><surname>Sherry</surname><given-names>SB</given-names> </name></person-group><article-title>The big three perfectionism scale&#x2013;short form (BTPS-SF): development of a brief self-report measure of multidimensional perfectionism</article-title><source>J Psychoeduc Assess</source><year>2020</year><month>02</month><volume>38</volume><issue>1</issue><fpage>37</fpage><lpage>52</lpage><pub-id pub-id-type="doi">10.1177/0734282919878553</pub-id></nlm-citation></ref><ref id="ref20"><label>20</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ryan</surname><given-names>RM</given-names> </name><name name-style="western"><surname>Deci</surname><given-names>EL</given-names> </name><name name-style="western"><surname>Vansteenkiste</surname><given-names>M</given-names> </name><name name-style="western"><surname>Soenens</surname><given-names>B</given-names> </name></person-group><article-title>Building a science of motivated persons: Self-determination theory&#x2019;s empirical approach to human experience and the regulation of behavior</article-title><source>Motiv Sci</source><year>2021</year><volume>7</volume><issue>2</issue><fpage>97</fpage><lpage>110</lpage><pub-id pub-id-type="doi">10.1037/mot0000194</pub-id></nlm-citation></ref><ref id="ref21"><label>21</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Jia</surname><given-names>J</given-names> </name><name name-style="western"><surname>Chen</surname><given-names>L</given-names> </name><name name-style="western"><surname>Zhang</surname><given-names>L</given-names> </name><name name-style="western"><surname>Xiao</surname><given-names>M</given-names> </name><name name-style="western"><surname>Wu</surname><given-names>C</given-names> </name></person-group><article-title>A study on the factors that influence consumers&#x2019; continuance intention to use artificial intelligence chatbots in a pharmaceutical e-commerce context</article-title><source>The Electronic Library</source><year>2025</year><month>05</month><day>22</day><volume>43</volume><issue>3</issue><fpage>303</fpage><lpage>321</lpage><pub-id pub-id-type="doi">10.1108/EL-09-2024-0275</pub-id></nlm-citation></ref><ref id="ref22"><label>22</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Caporusso</surname><given-names>N</given-names> </name></person-group><article-title>Generative artificial intelligence and the emergence of creative displacement anxiety</article-title><source>RDPB</source><year>2023</year><volume>3</volume><issue>1</issue><pub-id pub-id-type="doi">10.53520/rdpb2023.10795</pub-id></nlm-citation></ref><ref id="ref23"><label>23</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Meng</surname><given-names>J</given-names> </name><name name-style="western"><surname>Rheu</surname><given-names>M (MJ</given-names> </name><name name-style="western"><surname>Zhang</surname><given-names>Y</given-names> </name><name name-style="western"><surname>Dai</surname><given-names>Y</given-names> </name><name name-style="western"><surname>Peng</surname><given-names>W</given-names> </name></person-group><article-title>Mediated social support for distress reduction: AI chatbots vs. human</article-title><source>Proc ACM Hum-Comput Interact</source><year>2023</year><month>04</month><day>14</day><volume>7</volume><issue>CSCW1</issue><fpage>1</fpage><lpage>25</lpage><pub-id pub-id-type="doi">10.1145/3579505</pub-id></nlm-citation></ref><ref id="ref24"><label>24</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Lepp</surname><given-names>M</given-names> </name><name name-style="western"><surname>Kaimre</surname><given-names>J</given-names> </name></person-group><article-title>Does generative AI help in learning programming: Students&#x2019; perceptions, reported use and relation to performance</article-title><source>Computers in Human Behavior Reports</source><year>2025</year><month>05</month><volume>18</volume><fpage>100642</fpage><pub-id pub-id-type="doi">10.1016/j.chbr.2025.100642</pub-id></nlm-citation></ref><ref id="ref25"><label>25</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Casale</surname><given-names>S</given-names> </name><name name-style="western"><surname>Caplan</surname><given-names>SE</given-names> </name><name name-style="western"><surname>Fioravanti</surname><given-names>G</given-names> </name></person-group><article-title>Positive metacognitions about internet use: A new, specific form of metacognitions related to problematic internet use</article-title><source>Comput Human Behav</source><year>2016</year><volume>59</volume><fpage>1</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.1016/j.addbeh.2016.03.014</pub-id></nlm-citation></ref><ref id="ref26"><label>26</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>T&#x00FC;men Akyildiz</surname><given-names>S</given-names> </name><name name-style="western"><surname>Ahmed</surname><given-names>KH</given-names> </name></person-group><article-title>An overview of qualitative research and focus group discussion</article-title><source>International Journal of Academic Research in Education</source><year>2021</year><volume>7</volume><issue>1</issue><fpage>1</fpage><lpage>15</lpage><pub-id pub-id-type="doi">10.17985/ijare.866762</pub-id></nlm-citation></ref><ref id="ref27"><label>27</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Yin</surname><given-names>RK</given-names> </name></person-group><article-title>Validity and generalization in future case study evaluations</article-title><source>Evaluation (Lond)</source><year>2013</year><month>07</month><volume>19</volume><issue>3</issue><fpage>321</fpage><lpage>332</lpage><pub-id pub-id-type="doi">10.1177/1356389013497081</pub-id></nlm-citation></ref><ref id="ref28"><label>28</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Lambert</surname><given-names>SD</given-names> </name><name name-style="western"><surname>Loiselle</surname><given-names>CG</given-names> </name></person-group><article-title>Combining individual interviews and focus groups to enhance data richness</article-title><source>J Adv Nurs</source><year>2008</year><month>04</month><volume>62</volume><issue>2</issue><fpage>228</fpage><lpage>237</lpage><pub-id pub-id-type="doi">10.1111/j.1365-2648.2007.04559.x</pub-id><pub-id pub-id-type="medline">18394035</pub-id></nlm-citation></ref><ref id="ref29"><label>29</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Geampana</surname><given-names>A</given-names> </name><name name-style="western"><surname>Perrotta</surname><given-names>M</given-names> </name></person-group><article-title>Using interview excerpts to facilitate focus group discussion</article-title><source>Qual Res</source><year>2025</year><month>02</month><volume>25</volume><issue>1</issue><fpage>130</fpage><lpage>146</lpage><pub-id pub-id-type="doi">10.1177/14687941241234283</pub-id><pub-id pub-id-type="medline">40028392</pub-id></nlm-citation></ref><ref id="ref30"><label>30</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Khlaif</surname><given-names>ZN</given-names> </name><name name-style="western"><surname>Alkouk</surname><given-names>WA</given-names> </name><name name-style="western"><surname>Salama</surname><given-names>N</given-names> </name><name name-style="western"><surname>Abu Eideh</surname><given-names>B</given-names> </name></person-group><article-title>Redesigning assessments for AI-enhanced learning: a framework for educators in the generative AI era</article-title><source>Education Sciences</source><year>2025</year><volume>15</volume><issue>2</issue><fpage>174</fpage><pub-id pub-id-type="doi">10.3390/educsci15020174</pub-id></nlm-citation></ref><ref id="ref31"><label>31</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Poliandri</surname><given-names>D</given-names> </name><name name-style="western"><surname>Perazzolo</surname><given-names>M</given-names> </name><name name-style="western"><surname>Pillera</surname><given-names>GC</given-names> </name><name name-style="western"><surname>Giampietro</surname><given-names>L</given-names> </name></person-group><article-title>Dematerialized participation challenges: Methods and practices for online focus groups</article-title><source>Front Sociol</source><year>2023</year><volume>8</volume><fpage>1145264</fpage><pub-id pub-id-type="doi">10.3389/fsoc.2023.1145264</pub-id><pub-id pub-id-type="medline">37091722</pub-id></nlm-citation></ref><ref id="ref32"><label>32</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Fontana</surname><given-names>A</given-names> </name><name name-style="western"><surname>Benzi</surname><given-names>IMA</given-names> </name><name name-style="western"><surname>Cipresso</surname><given-names>P</given-names> </name></person-group><article-title>Problematic internet use as a moderator between personality dimensions and internalizing and externalizing symptoms in adolescence</article-title><source>Curr Psychol</source><year>2023</year><month>08</month><volume>42</volume><issue>22</issue><fpage>19419</fpage><lpage>19428</lpage><pub-id pub-id-type="doi">10.1007/s12144-021-02409-9</pub-id></nlm-citation></ref><ref id="ref33"><label>33</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Brand</surname><given-names>M</given-names> </name><name name-style="western"><surname>Wegmann</surname><given-names>E</given-names> </name><name name-style="western"><surname>Stark</surname><given-names>R</given-names> </name><etal/></person-group><article-title>The interaction of person-affect-cognition-execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors</article-title><source>Neuroscience &#x0026; Biobehavioral Reviews</source><year>2019</year><month>09</month><volume>104</volume><fpage>1</fpage><lpage>10</lpage><pub-id pub-id-type="doi">10.1016/j.neubiorev.2019.06.032</pub-id></nlm-citation></ref><ref id="ref34"><label>34</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Chaudhry</surname><given-names>IS</given-names> </name><name name-style="western"><surname>Sarwary</surname><given-names>SAM</given-names> </name><name name-style="western"><surname>El Refae</surname><given-names>GA</given-names> </name><name name-style="western"><surname>Chabchoub</surname><given-names>H</given-names> </name></person-group><article-title>Time to Revisit Existing Student&#x2019;s Performance Evaluation Approach in Higher Education Sector in a New Era of ChatGPT &#x2014; a case study</article-title><source>Cogent Education</source><year>2023</year><month>12</month><day>31</day><volume>10</volume><issue>1</issue><fpage>2210461</fpage><pub-id pub-id-type="doi">10.1080/2331186X.2023.2210461</pub-id></nlm-citation></ref><ref id="ref35"><label>35</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Baumeister</surname><given-names>RF</given-names> </name><name name-style="western"><surname>Vohs</surname><given-names>KD</given-names> </name></person-group><article-title>Self&#x2010;regulation, ego depletion, and motivation</article-title><source>Social &#x0026; Personality Psych</source><year>2007</year><month>11</month><volume>1</volume><issue>1</issue><fpage>115</fpage><lpage>128</lpage><pub-id pub-id-type="doi">10.1111/j.1751-9004.2007.00001.x</pub-id></nlm-citation></ref><ref id="ref36"><label>36</label><nlm-citation citation-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Simon&#x00FF;</surname><given-names>C</given-names> </name><name name-style="western"><surname>Damsgaard</surname><given-names>JB</given-names> </name><name name-style="western"><surname>Johansen</surname><given-names>K</given-names> </name><etal/></person-group><article-title>The power of a ricoeur-inspired phenomenological-hermeneutic approach to focus group interviews</article-title><source>J Adv Nurs</source><year>2025</year><month>08</month><day>13</day><pub-id pub-id-type="doi">10.1111/jan.70133</pub-id><pub-id pub-id-type="medline">40801446</pub-id></nlm-citation></ref></ref-list><app-group><supplementary-material id="app1"><label>Multimedia Appendix 1</label><p>Semistructured protocol.</p><media xlink:href="mededu_v11i1e74947_app1.docx" xlink:title="DOCX File, 16 KB"/></supplementary-material><supplementary-material id="app2"><label>Multimedia Appendix 2</label><p>Focus group discussion guide.</p><media xlink:href="mededu_v11i1e74947_app2.docx" xlink:title="DOCX File, 16 KB"/></supplementary-material></app-group></back></article>