The integration of Artificial Intelligence (AI) in healthcare is reshaping clinical practice, offering both opportunities for enhanced decision-making and risks of skill degradation among medical professionals. This growing impact calls for a comprehensive evaluation of its effects on medical expertise. This study presents a mixed-method literature review, combining systematic analysis with narrative synthesis to examine AI-induced deskilling and upskilling inhibition-the erosion of medical expertise and the reduction of opportunities for skill acquisition due to AI-driven decision support systems. Anchoring the discussion in the core medical competencies outlined by the Federation of Royal Colleges of Physicians of the UK-Practical Assessment of Clinical Examination Skills (PACES-MRCPUK), the systematic review identifies key vulnerabilities in physical examination, differential diagnosis, clinical judgment, and physician-patient communication. The narrative review explores broader themes related to Human–AI Interaction and the Impact of AI on Human Skills in Organizations. In response to concerns about the Second Singularity -a scenario in which decision-making autonomy is increasingly ceded to AI, weakening human oversight-this review advocates for a research agenda that prioritizes longitudinal studies, real-time monitoring of AI’s impact, and the development of frameworks to mitigate skill erosion, ensuring the preservation of professional autonomy and the safeguarding of the irreplaceable elements of human judgment in medicine and beyond.

In this article, we propose a conceptual and methodological framework for measuring the impact of the introduction of AI systems in decision settings, based on the concept of technological dominance, i.e. the influence that an AI system can exert on human judgment and decisions. We distinguish between a negative component of dominance (automation bias) and a positive one (algorithm appreciation) by focusing on and systematizing the patterns of interaction between human judgment and AI support, or reliance patterns, and their associated cognitive effects. We then define statistical approaches for measuring these dimensions of dominance, as well as corresponding qualitative visualizations. By reporting about four medical case studies, we illustrate how the proposed methods can be used to inform assessments of dominance and of related cognitive biases in real-world settings. Our study lays the groundwork for future investigations into the effects of introducing AI support into naturalistic and collaborative decision-making.

The emergence of black-box, subsymbolic, and statistical AI systems has motivated a rapid increase in the interest regarding explainable AI (XAI), which encompasses both inherently explainable techniques, as well as approaches to make black-box AI systems explainable to human decision makers. Rather than always making black boxes transparent, these approaches are at risk of painting the black boxes white, thus failing to provide a level of transparency that would increase the system’s usability and comprehensibility, or even at risk of generating new errors (i.e., white-box paradox). To address these usability-related issues, in this work we focus on the cognitive dimension of users’ perception of explanations and XAI systems. We investigated these perceptions in light of their relationship with users’ characteristics (e.g., expertise) through a questionnaire-based user study involved 44 cardiology residents and specialists in an AI-supported ECG reading task. Our results point to the relevance and correlation of the dimensions of trust, perceived quality of explanations, and tendency to defer the decision process to automation (i.e., technology dominance). This contribution calls for the evaluation of AI-based support systems from a human–AI interaction-oriented perspective, laying the ground for further investigation of XAI and its effects on decision making and user experience.

In this paper, we present an exploratory study on the potential impact of holographic heart models and mixed reality technology on medical training, and in particular in teaching complex Congenital Heart Diseases (CHD) to medical students. Fifty-nine medical students were randomly allocated into three groups. Each participant in each group received a 30-minute lecture on a CHD condition interpretation and transcatheter treatment with different instructional tools. The participants of the first group attended a lecture in which traditional slides were projected onto a flat screen (group “regular slideware”, RS). The second group was shown slides incorporating videos of holographic anatomical models (group “holographic videos”, HV). Finally, those in the third group wore immersive, head-mounted devices (HMD) to interact directly with holographic anatomical models (group “mixed reality”, MR). At the end of the lecture, the members of each group were asked to fill in a multiple-choice questionnaire aimed at evaluating their topic proficiency, as a proxy to evaluate the effectiveness of the training session (in terms of acquired notions); participants from group MR were also asked to fill in a questionnaire regarding the recommendability and usability of the MS Hololens HMDs, as a proxy of satisfaction regarding its use experience (UX). The findings show promising results for usability and user acceptance.