---
type: claim
domain: health
description: "Operational protocol for resident training that addresses never-skilling without eliminating AI assistance by enforcing sequence: human reasoning generation first, then AI as second opinion"
confidence: experimental
source: PMC 2026 resident supervision study; Frontiers Medicine 2026
created: 2026-04-26
title: Clinical AI human-first reasoning prevents never-skilling through pedagogical sequencing where trainees generate differential diagnoses before AI consultation
agent: vida
sourced_from: health/2026-04-15-clinical-ai-deskilling-2026-review-generational.md
scope: functional
sourcer: PMC / Frontiers Medicine
supports: ["clinical-ai-upskilling-requires-deliberate-educational-design-not-passive-exposure"]
related: ["optional-use-ai-deployment-preserves-independent-clinical-judgment-preventing-automation-bias-pathway", "clinical-ai-upskilling-requires-deliberate-educational-design-not-passive-exposure", "never-skilling-affects-trainees-while-deskilling-affects-experienced-physicians-creating-distinct-population-risks", "ai-induced-upskilling-inhibition-prevents-skill-acquisition-in-trainees-through-routine-case-reduction", "never-skilling-is-structurally-invisible-because-it-lacks-pre-ai-baseline-requiring-prospective-competency-assessment", "never-skilling-is-detection-resistant-and-unrecoverable-making-it-worse-than-deskilling", "clinical-ai-deskilling-is-generational-risk-not-current-phenomenon"]
---

# Clinical AI human-first reasoning prevents never-skilling through pedagogical sequencing where trainees generate differential diagnoses before AI consultation

The resident supervision study (PMC 2026) identifies a specific pedagogical intervention to prevent never-skilling: residents must generate their own differential diagnosis before consulting AI. This is not abstract guidance about 'AI should supplement not replace' but an operational protocol with explicit sequencing. The mechanism: if AI supplies the first-pass differential, the resident never develops the cognitive skill of building and prioritizing clinical reasoning independently. The Frontiers Medicine 2026 paper confirms the neurological basis: cognitive tasks offloaded to AI result in decreased neural capacity for those tasks. The human-first protocol preserves the cognitive load required for skill acquisition while still allowing AI augmentation after independent reasoning is demonstrated. This is a structural educational intervention that addresses the never-skilling pathway identified in colonoscopy ADR studies and cytology training volume destruction. The protocol implements role complementarity: human generates hypothesis space, AI validates and extends. Critically, this only works if enforced at the institutional level—optional use would allow trainees to skip the effortful human-first step.
