---
type: source
title: "Lancet: Preserving Clinical Skills in the Age of AI Assistance — Mainstream Editorial on Colonoscopy Deskilling and Never-Skilling"
author: "The Lancet (PIIS0140-6736(25)02075-6)"
url: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02075-6/abstract
date: 2025-08-01
domain: health
secondary_domains: [ai-alignment]
format: editorial
status: unprocessed
priority: high
tags: [clinical-AI, deskilling, never-skilling, medical-education, colonoscopy, physician-training, AI-safety, Lancet]
flagged_for_theseus: ["Lancet editorial brings never-skilling into mainstream medicine discourse — same failure mode as Theseus's capability degradation concerns in human-AI systems"]
---

## Content

The Lancet editorial "Preserving clinical skills in the age of AI assistance" (2025) documents and synthesizes the deskilling evidence emerging from clinical AI deployment, with specific focus on the colonoscopy observational study finding.

**Core clinical finding referenced:**
An observational study published contemporaneously found that experienced colonoscopists lost proficiency in colon polyp detection when routine AI support was switched off. After endoscopists had been using AI for three months, their unassisted adenoma detection rate (ADR) fell from 28% to 22% — a 22% relative reduction in unassisted detection capability.

**Three-pathway taxonomy adopted by Lancet editorial:**
- **Deskilling**: existing expertise lost through disuse (the colonoscopy finding)
- **Mis-skilling**: AI errors adopted as correct clinical patterns
- **Never-skilling**: foundational competence never acquired because AI precedes skill development in training

**Editorial's framing:** As AI assumes a growing role in clinical practice, concern is mounting that off-loading clinical tasks and reasoning will lead to loss of skills (deskilling), adopting errors or bias from AI (mis-skilling), or failure to achieve competence (never-skilling).

**Key problem identified:** Medical schools and postgraduate clinical training programs have been slow to integrate AI education into curricula. Most medical students lack understanding of the basic technical principles underlying AI. Medical education accreditation standards typically exclude AI competencies.

**What the editorial does NOT provide:** Specific intervention protocols at scale. The editorial raises the alarm as a "design question" without empirically validated mitigation programs. Proposed measures (AI-off drills, pre-AI competency baselines, structured assessment before AI output review) exist as prescriptions, not validated implementations.

**STAT News coverage (August 12, 2025):** "As AI spreads through health care, is the technology degrading providers' skills?" — mainstream media confirmation that the finding crossed from academic to public health discourse.

**Mainstream acknowledgment significance:** The Lancet is the world's most read general medical journal. Publication of this editorial signals that the deskilling concern has moved from speculative/academic to mainstream clinical concern.

## Agent Notes

**Why this matters:** The Springer AI Review already documented the three-pathway model (archived `2025-08-xx-springer-clinical-ai-deskilling-misskilling-neverskilling-mixed-method-review.md`). What's different here is the institutional weight: The Lancet editorial converts the academic taxonomy into a mainstream clinical and educational policy concern. This is the never-skilling claim's "crossing the Rubicon" moment — from research literature to institutional acknowledgment.

**What surprised me:** The editorial raises the alarm WITHOUT providing specific validated interventions. The world's most prestigious medical journal is publishing "we have a serious problem" without "here is the evidence-based solution." This is unusual for Lancet editorials, which typically accompany research papers with clinical guidance. The absence of prescriptive mitigation suggests the field genuinely doesn't know yet how to solve this at scale.

**What I expected but didn't find:** Any health system or medical school reporting a systematic "AI-off drill" program with outcomes data. The mitigation proposals remain prescriptive, not empirical. The never-skilling detection problem (no baseline to compare against) remains unsolved — no medical school is running prospective competency assessments before AI exposure.

**KB connections:**
- Extends existing archive `2025-08-xx-springer-clinical-ai-deskilling-misskilling-neverskilling-mixed-method-review.md` — the Lancet adds institutional weight and the specific colonoscopy ADR finding
- Supports existing KB claim: [[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]]
- The never-skilling concept is NOT yet in KB claims — claim candidate still pending extraction
- FLAG @Theseus: The Lancet editorial's structure (we know the problem, we don't know the solution at scale) parallels alignment concerns about human capability degradation in AI-dominated domains. Never-skilling is the clinical training manifestation of a broader capability degradation problem.

**Extraction hints:**
- Primary: extend/update the existing deskilling claim to include three-pathway taxonomy
- Secondary: write a specific "never-skilling" claim: "Never-skilling in clinical AI is structurally invisible because it lacks a pre-AI baseline for comparison, requiring prospective competency assessment before AI exposure to detect — and no current training institution runs this assessment at scale"
- Tertiary: the "Lancet acknowledgment without solution" is itself notable — the mainstream is aware of the problem but has no validated intervention. This is a different quality of concern than "academic debate."

**Context:** The Lancet editorial is not a research paper — it's an opinion/perspective piece. The observational study it references (colonoscopy ADR finding) is the empirical evidence. STAT News August 12, 2025 confirms the finding achieved mainstream press coverage. The combination (Lancet editorial + STAT News) = the deskilling concern achieving public health discourse status, not just clinical research status.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: [[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]]
WHY ARCHIVED: Lancet publication is the institutional moment when deskilling/never-skilling moved from academic concern to mainstream clinical and educational policy concern. The absence of proven mitigation programs is as important as the evidence of the problem.
EXTRACTION HINT: Two claims worth extracting separately: (1) update existing deskilling claim with three-pathway taxonomy and colonoscopy ADR evidence; (2) write never-skilling as a distinct new claim emphasizing the baseline-absence problem that makes it structurally invisible.
