AI Integration in Spanish Undergraduate Medical Education: National Cross-Sectional Study.

BACKGROUND: Artificial intelligence (AI) is reshaping clinical practice and redefining the competencies future physicians will need. International bodies, such as the Association of American Medical Colleges, have called for structured AI training in medical curricula. Despite growing international consensus, no systematic nationwide evaluation had been conducted in Spain prior to this study. OBJECTIVE: This study aimed to characterize the presence, type, and curricular features of AI-related training across all Spanish universities offering an official medical degree and to assess differences by institutional ownership and geographic region. METHODS: This cross-sectional study was conducted from July to September 2025. Universities were the unit of analysis. A census of all institutions offering an officially recognized medical degree was obtained from the Register of Universities, Centers and Degrees; all 52 eligible institutions were included. Publicly available curricula and course guides for the 2025-2026 academic year were reviewed by 2 independent researchers and validated by an external evaluator. Courses were classified as (1) a specific AI course (AI as primary topic, accounting for >50% of syllabus), (2) an AI-similar course (a digital health or biomedical informatics course referencing AI as secondary content), or (3) not AI-related training. Course-level variables included ownership (public or private), region, status (compulsory or elective), European Credit Transfer and Accumulation System (ECTS) credits, academic year, and department. All analyses were descriptive. Potential sources of bias were addressed through predefined classification criteria, duplicate independent extraction, and external dataset verification. RESULTS: Of 52 universities, 36 (69.2%) were public and 16 (30.8%) were private. A total of 10 (19.2%) institutions offered at least one specific AI course; 6 (11.5%) included an AI-similar course. Overall, 16 (30.8%) universities had incorporated AI in some form; 36 (69.2%) institutions had not incorporated AI. Rates were similar for public (7/36, 19.4%) and private institutions (3/16, 18.8%). Identified courses ranged from 3 to 6 ECTS credits, representing an average of 1.17% of the 360-credit degree; most were elective. Only the University of Jaén offered a compulsory course with AI content. Marked regional disparities were observed: Andalusia led with 5 of 9 (55.6%) universities offering a specific AI course, while 10 autonomous communities had no universities with any AI-related training. CONCLUSIONS: This study delivers the first census-based, reproducible, national assessment of AI integration in Spanish undergraduate medical education. Unlike prior work focused on individual programs or nonstandardized definitions, we applied a consistent taxonomic framework reusable for longitudinal monitoring and international benchmarking. Findings reveal a heterogeneous, predominantly elective, and low-weight curricular landscape with striking interregional inequities. These results inform curriculum reform, accreditation standards, and faculty development priorities and support the establishment of minimum national competency standards and systematic monitoring to ensure equitable AI literacy among future physicians in Spain.