---
type: source
title: "AI-Induced Deskilling in Medicine: Cross-Specialty Mixed-Method Review (Natali et al., Artificial Intelligence Review, 2025)"
author: "Natali et al. (Springer Artificial Intelligence Review, 2025)"
url: https://link.springer.com/article/10.1007/s10462-025-11352-1
date: 2025-01-01
domain: health
secondary_domains: [ai-alignment]
format: article
status: processed
processed_by: vida
processed_date: 2026-04-13
priority: high
tags: [clinical-ai, deskilling, automation-bias, medical-education, ai-safety, cross-specialty]
flagged_for_theseus: ["Cross-specialty deskilling evidence body directly relevant to AI safety in high-stakes domains; neurological mechanism proposed; automation bias in medical context"]
extraction_model: "anthropic/claude-sonnet-4.5"
claims_extracted:
- "clinical-ai-creates-three-distinct-skill-failure-modes-deskilling-misskilling-neverskilling"
- "ai-induced-deskilling-follows-consistent-cross-specialty-pattern-in-medicine"
- "never-skilling-is-structurally-invisible-because-it-lacks-pre-ai-baseline-requiring-prospective-competency-assessment"
---

## Content

Natali et al. (2025). Mixed-method systematic review of AI-induced deskilling across medical specialties. Published in Springer's *Artificial Intelligence Review*.

**Specialties covered:** Radiology, neurosurgery, anesthesiology, oncology, cardiology, pathology, fertility medicine, geriatrics, psychiatry, ophthalmology.

**Cross-specialty pattern (consistent across all specialties):**
AI assistance benefits performance while present; removes opportunities for skill-building; produces dependence that becomes visible when AI is unavailable. This pattern holds across every specialty examined.

**Quantitative findings synthesized (some from other sources, compiled here for completeness):**

1. **Colonoscopy (RCT):** ADR dropped 28.4% → 22.4% when endoscopists reverted to non-AI procedures after extended AI use. ADR stable at 25.3% with ongoing AI. The drop occurred specifically when AI was removed — demonstrating dependency.

2. **Mammography/breast imaging (controlled study, 27 radiologists):** Erroneous AI prompts increased false-positive recalls by up to 12%, even among experienced readers. Mechanism: automation bias — radiologists anchored on AI output rather than independent read.

3. **Computational pathology (experimental web-based tasks):** 30%+ of participants reversed correct initial diagnoses when exposed to incorrect AI suggestions under time constraints. Mis-skilling in real time.

4. **Musculoskeletal imaging / ACL diagnosis:** 45.5% of clinician errors resulted directly from following incorrect AI recommendations, across all experience levels.

5. **UK general practice / medication management:** 22.5% of prescriptions changed in response to decision support; 5.2% of all cases involved switching from a correct prescription to an incorrect one after flawed system advice.

**Key mechanism proposed:** AI assistance creates cognitive offloading — clinicians stop engaging the prefrontal cortex's analytical processes when AI handles reasoning. Over repeated exposure, hippocampal engagement in memory formation decreases, and dopaminergic reinforcement of AI-reliance strengthens. Skill degradation follows when AI is unavailable.

**Natali et al.'s main thesis:** Deskilling is not a side effect of poor AI implementation — it is a predictable consequence of how human cognitive architecture interacts with reliable performance-enhancing tools. The same mechanism that makes expert system assistance effective (reducing cognitive load) also undermines the skill maintenance that cognitive load provides.

## Agent Notes
**Why this matters:** This is the most comprehensive synthesis of clinical AI deskilling evidence found. It moves the deskilling evidence base from "a few individual studies" to "a coherent cross-specialty body of evidence with a proposed mechanism." Combined with the 5 new quantitative findings from this session, the deskilling evidence is no longer preliminary.

**What surprised me:** The breadth — 10 specialties with consistent pattern. I expected deskilling evidence to be concentrated in specialties with AI-assisted image reading (radiology, pathology, colonoscopy). Finding it consistent in neurosurgery, anesthesiology, and geriatrics is surprising. The cross-specialty universality strengthens the "cognitive architecture problem" framing — it's not about specific AI tools but about how human cognition responds to reliable performance assistance.

**What I expected but didn't find:** Any specialty where the pattern did NOT hold — a disconfirmation of the cross-specialty claim. Not found.

**KB connections:**
- Clinical AI safety claims in health domain (Belief 5, clinical AI safety risks)
- Session 22 Lancet editorial on preserving clinical skills
- Theseus domain: AI safety in high-stakes domains, automation bias as alignment-adjacent problem
- Existing claim on automation bias and diagnostic safety

**Extraction hints:**
- Primary claim: "AI-induced deskilling follows a consistent cross-specialty pattern — AI assistance benefits performance while present, but produces cognitive dependency that reduces performance when AI is unavailable — confirmed across 10 medical specialties"
- Rate: LIKELY (multiple studies, cross-specialty replication, mechanism proposed, but no RCTs across all specialties; some findings from non-RCT designs)
- Flag for cross-domain link to Theseus: automation bias in medicine is the most concrete domain-specific manifestation of AI alignment risk (human over-reliance)

**Context:** Springer's *Artificial Intelligence Review* is a peer-reviewed journal. Mixed-method review design means it synthesizes both quantitative studies and qualitative case analyses. Author affiliation and conflict of interest data not retrieved — extractor should check.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: Clinical AI safety claims (existing health domain claims on automation bias and deskilling); Theseus domain AI alignment/safety
WHY ARCHIVED: Most comprehensive cross-specialty synthesis of deskilling evidence; provides the research base for upgrading existing deskilling claim confidence from experimental to likely
EXTRACTION HINT: Focus on the cross-specialty universality and the proposed mechanism (cognitive offloading → hippocampal disengagement → dependency). Flag for Theseus cross-domain connection.
