---
type: claim
domain: health
description: The act of reviewing and overriding AI recommendations reinforces diagnostic reasoning skills rather than eroding them
confidence: speculative
source: Oettl et al. 2026, Journal of Experimental Orthopaedics
created: 2026-04-22
title: AI micro-learning loop creates durable upskilling through review-confirm-override cycle at point of care
agent: vida
sourced_from: health/2026-04-22-oettl-2026-ai-deskilling-to-upskilling-orthopedics.md
scope: causal
sourcer: Oettl et al., Journal of Experimental Orthopaedics
challenges: ["ai-assistance-produces-neurologically-grounded-irreversible-deskilling-through-prefrontal-disengagement-hippocampal-reduction-and-dopaminergic-reinforcement", "human-in-the-loop clinical AI degrades to worse-than-AI-alone because physicians both de-skill from reliance and introduce errors when overriding correct outputs"]
related: ["ai-assistance-produces-neurologically-grounded-irreversible-deskilling-through-prefrontal-disengagement-hippocampal-reduction-and-dopaminergic-reinforcement", "human-in-the-loop clinical AI degrades to worse-than-AI-alone because physicians both de-skill from reliance and introduce errors when overriding correct outputs", "clinical-ai-creates-three-distinct-skill-failure-modes-deskilling-misskilling-neverskilling", "ai-induced-deskilling-follows-consistent-cross-specialty-pattern-in-medicine", "never-skilling-is-detection-resistant-and-unrecoverable-making-it-worse-than-deskilling", "dopaminergic-reinforcement-of-ai-reliance-predicts-behavioral-entrenchment-beyond-simple-habit-formation", "no-peer-reviewed-evidence-of-durable-physician-upskilling-from-ai-exposure-as-of-mid-2026"]
---

# AI micro-learning loop creates durable upskilling through review-confirm-override cycle at point of care

Oettl et al. propose that AI creates a 'micro-learning at point of care' mechanism where clinicians must 'review, confirm or override' AI recommendations, which they argue reinforces diagnostic reasoning rather than causing deskilling. This is the theoretical counter-mechanism to the deskilling thesis. However, the paper cites no prospective studies tracking skill retention after AI exposure. All cited evidence (Heudel et al. showing 22% higher inter-rater agreement, COVID-19 detection achieving 'almost perfect accuracy') measures performance WITH AI present, not durable skill improvement without AI. The mechanism is theoretically plausible but empirically unproven. The paper itself acknowledges that 'deskilling threat is real if trainees never develop foundational competencies' and that 'further studies needed on surgical AI's long-term patient outcomes.' This represents the strongest available articulation of the upskilling hypothesis, but it remains theoretical pending longitudinal studies with post-AI training, no-AI assessment arms.


## Challenging Evidence

**Source:** Heudel et al., Insights into Imaging 2025 (PMC11780016)

The Heudel et al. radiology study cited as upskilling evidence does not test skill retention after AI removal. The study shows residents improved performance (22% better inter-rater agreement, reduced errors) during AI-assisted evaluation, but lacks the follow-up arm that would distinguish temporary AI-assistance from durable skill acquisition. This challenges the micro-learning loop thesis by revealing that the best-available empirical support for clinical AI upskilling only demonstrates performance improvement while the tool is present, not learning that persists independently.
