---
type: source
title: "AI in Medicine: A Scoping Review of the Risk of Deskilling and Loss of Expertise Among Physicians"
author: "Heudel et al. (ScienceDirect 2026)"
url: https://www.sciencedirect.com/science/article/pii/S2949820126000123
date: 2026
domain: health
secondary_domains: []
format: scoping-review
status: unprocessed
priority: high
tags: [clinical-ai, deskilling, never-skilling, scoping-review, automation-bias, specialties, physician-training]
---

## Content

This 2026 scoping review is the most comprehensive systematic synthesis of AI-induced deskilling risk across medical specialties. Key findings from search results and related literature:

**Scope:**
- Covers multiple specialties including: radiology, neurosurgery, anesthesiology, oncology, cardiology, pathology, fertility medicine, geriatrics, psychiatry, ophthalmology, and rare disease diagnosis
- Identifies two distinct risk patterns: (1) deskilling — erosion of previously acquired skills through disuse; (2) "never-skilling" — trainees failing to acquire foundational proficiencies due to premature AI reliance

**Never-skilling concept (introduced/formalized):**
- "Never-skilling" occurs when trainees fail to develop foundational competencies due to premature reliance on automation — distinct from deskilling which affects experienced practitioners
- This is particularly acute in pathology/cytology, where AI automation of routine screening (cervical cytology) reduces the volume of routine cases trainees encounter

**Evidence types:**
- Quantitative evidence of decreased diagnostic accuracy when AI removed (colonoscopy ADR: 28.4%→22.4%; radiology false positives: +12%)
- Error propagation when AI introduces systematic biases
- Structural training environment changes reducing case exposure volume

**Key mechanisms identified:**
1. Automation bias — accepting AI output without sufficient critical evaluation
2. Reduced deliberate practice — AI handles routine cases that previously built skill
3. Training environment structural changes — fewer unassisted cases in AI-integrated settings
4. Confidence-competence decoupling — practitioners feel confident but perform worse

**Physician adoption context:** 81% of physicians now use some form of AI, with deskilling and automation bias emerging as top concerns.

## Agent Notes

**Why this matters:** This is the systematic backbone for Belief 5's deskilling evidence. With 11+ specialties covered, a defined mechanism (never-skilling), and quantitative performance outcome data, this is no longer a single-study concern. The cross-specialty scope means deskilling is a structural property of AI-integrated clinical environments, not an anomaly.

**What surprised me:** The "never-skilling" concept formalizes something Session 24 identified from the cytology training volume data. Confirming it has a name and a formal definition in a 2026 scoping review strengthens the claim candidate significantly. The KB has claims about deskilling in deployed AI but may lack a claim specifically about never-skilling in trainee populations.

**What I expected but didn't find:** I couldn't access the full paper (403 error) — so the above reflects search result summaries and related literature. The extractor should access the full paper for exact study counts, specialty breakdowns, and the formal definition of never-skilling.

**KB connections:**
- Core evidence for Belief 5 (Clinical AI creates novel safety risks)
- The two-mechanism framework (deskilling vs. never-skilling) suggests the KB may need two separate claims rather than one
- Connects to Session 24's proposed cytology never-skilling claim
- Relates to the divergence: the scoping review is the deskilling side's systematic evidence

**Extraction hints:**
- CLAIM: "Clinical AI creates distinct deskilling risks across at least 11 medical specialties, characterized by performance degradation when AI is removed"
- CLAIM (new): "AI-integrated training environments create 'never-skilling' — trainees fail to acquire foundational skills due to premature automation of routine cases" (distinct from deskilling in experienced practitioners)
- The two-mechanism distinction is the key intellectual contribution here — never-skilling vs. deskilling need separate claims with separate confidence levels (deskilling: likely to proven; never-skilling: experimental — less RCT-level evidence)

**Context:** Published in a medical AI journal in 2026. Full access blocked (403) during this session — extractor should retrieve full text. The paper is by Heudel et al., same first author as the radiology training study (PMC11780016), suggesting a coherent research program.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: Belief 5 (clinical AI deskilling) — existing claims in the KB
WHY ARCHIVED: Most comprehensive systematic evidence for deskilling across specialties. Introduces "never-skilling" as a formalized concept that may warrant a new claim in the KB.
EXTRACTION HINT: CRITICAL — access the full paper (currently 403). Extract: (1) exact specialty count and list, (2) formal never-skilling definition, (3) quantitative outcome data if any beyond what's available in search results, (4) mitigation strategies proposed, (5) confidence level for the 11-specialty claim.