Purpose/Significance To explore feasible paths for generative artificial intelligence (GenAI) to empower medical library knowledge services, in order to enhance service efficiency, optimize user experience, and support medical education and scientific research innovation.Method/Process The current research and application status of GenAI in knowledge services of libraries and medical libraries is systematically sorted out. The mutual promotion effect between GenAI and knowledge services in medical libraries is analyzed, and a framework for knowledge services in medical libraries is built. Result/Conclusion A five-layer path framework centered on “demand-resource-technology-service-feedback” is formed, and four guarantee strategies in terms of data security, technology adaptation, personnel capability and institutional norms are proposed, providing references for the intelligent development of knowledge services in medical libraries.