Global physician perspectives on artificial intelligence in healthcare across 50 countries and territories.

Despite rapid advances in artificial intelligence (AI) capabilities, clinical integration remains limited, partly due to an incomplete understanding of physicians' real-world engagement and determinants of adoption. We conducted an international cross-sectional survey between June and September 2024 using a 30-item questionnaire translated into 13 languages, analysing 1049 complete responses from 50 countries and territories. Most respondents reported fundamental to advanced understanding of AI (86.5%) and believed it would improve clinical practice (80.2%), particularly in efficiency (53.5%), timeliness (52.0%), and effectiveness (44.0%). However, only 27.8% had used AI in practice, and 17.7% had received formal training. Mann-Whitney analyses showed that positive attitudes and formal training were associated with greater AI understanding, familiarity and usage (all p ≤ 0.008). In multivariable regression, physicians with formal training were more than three times as likely to use AI (adjusted OR 3.40; 95% CI 2.31-5.01; p < 0.001), and those working in institutions with AI technologies were more than eight times as likely (adjusted OR 8.43; 95% CI 5.74-12.34; p < 0.001). These findings indicate a persistent gap between awareness and adoption driven primarily by structural factors, particularly the absence of formal AI training and limited institutional investment in AI technologies.