Abstract: Objective To explore the reliability of applying AI assistant based on medical knowledge graph in pathological drawing scoring. Methods The study was conducted in February 2025. A total of 135 pathological drawings from students of the 2020 ″5+3″ integrated clinical medicine program at Tianjin Medical University were collected as data sources. AI assistant, Kimi, and 5 pathology teachers independently scored the drawings according to the scoring criteria. The scoring dimensions included professionalism, accuracy, logic, content integrity, knowledge application ability, learning attitude and standardization, and innovation and critical thinking. Wilcoxon rank-sum test was used to analyze the differences between the scoring results of AI assistant, Kimi and teachers' scores. Taking as reference standard the average score of 5 pathology teachers, the intraclass correlation coefficient (ICC) was used to compare the consistency between the scores of AI assistant, Kimi and teachers. Results The total scores of pathological drawing were 68.0 (10.0) for AI assistant, 82.0 (9.0) for Kimi, and 81.2 (7.3) for teachers. The total score of AI assistant was lower than that of the teachers, and the difference was statistically significant (P<0.001). There was no statistically significant difference between the total score of Kimi and that of teachers (P=0.112). The consistency between AI assistant and teachers' scores in each scoring dimension was higher than that of Kimi. AI assistant showed moderate consistency with teachers in the dimensions of professionalism (ICC=0.55) and accuracy (ICC=0.56), while Kimi had poor consistency with teachers in professionalism (ICC=0.24) and accuracy (ICC=0.20). Conclusions The reliability of AI assistant based on medical knowledge graph in pathological drawing scoring is better than that of general artificial intelligence model, and it can be used as auxiliary support for pathological drawing scoring. The score of the AI assistant is relatively strict, and the scoring settings of the AI assistant can be adjusted to align with the teachers' scoring range.