Abstract
Background Artificial intelligence (AI) tools have been rapidly adopted by medical researchers, yet whether medical trainees and professionals in low- and middle-income countries possess the awareness and habits needed to use these tools safely remains poorly documented. This study characterized AI adoption, hallucination awareness, and verification and disclosure practices among medical trainees and professionals in Pakistan. Methods A cross-sectional anonymous online survey was conducted among medical students, house officers, residents, physicians, and faculty involved in research or academic work across Pakistan (May 2026). Descriptive statistics and chi-square tests were applied to 373 eligible responses. Results AI use was near-universal (99.7%), with 60.3% using AI daily. The most commonly reported tool was Claude (Anthropic, San Francisco, CA) (40.5%), followed by ChatGPT (OpenAI, San Francisco, CA) (29.2%), and Perplexity (Perplexity AI, Inc., San Francisco, CA) (26.0%), though this ranking likely reflects sampling characteristics. Despite high adoption, 59.2% (95% CI: 54.2-64.1%) typically did not verify AI outputs before use, and 40.2% had never heard that AI can generate fabricated references. In behavioral vignettes, 36.5% assumed convincing AI-generated references were authentic, and 54.2% would continue using remaining AI content after discovering one fabricated reference. Formal research training was strongly associated with consistent disclosure (51.7% vs. 17.1%; χ²(1) = 48.43, p < 0.001, Cramer's V = 0.36). Role was significantly associated with both verification behavior (χ²(4) = 17.22, p = 0.0018, Cramer's V = 0.22) and hallucination awareness (χ²(4) = 13.44, p = 0.0093, Cramer's V = 0.19), with non-verification highest among medical students and unawareness highest among physicians. Daily use frequency, research training, and publication count showed no other significant associations. Conclusions Medical trainees and professionals in Pakistan demonstrate high AI adoption alongside incomplete hallucination awareness and infrequent verification - a pattern that may carry implications for research integrity. Formal training was the only factor significantly associated with consistent disclosure. Integration of AI literacy into medical curricula and institutional governance frameworks merits consideration.