The rise of advanced transformer-based generative artificial intelligence models represents one of the most profound changes to the medical landscape of the past century. Given the potential to impact everything from medical education to surgical decision-making, it is important to appreciate fundamental aspects of how these systems work and understand the ways in which they can be used responsibly to improve patient care. Prompt engineering provides the most obvious opportunity for clinicians to tailor these systems to their needs, but appreciating possible risks, including direct and indirect effects, is of profound importance for the clinician, educator, and researcher.