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.

This critical review explores two interrelated trends: the rapid increase in studies on machine learning (ML) applications within health informatics and the growing concerns about the reproducibility of these applications across different healthcare settings. Addressing these concerns necessitates acknowledging the uncertainty inherent in evaluating medical decision support systems. Therefore, we emphasize the importance of external validation and robustness assessment of the underlying ML models to better estimate their performance across diverse real-world scenarios. To raise awareness among health practitioners and ML researchers, we advocate for the widespread adoption of external validation practices and uncertainty quantification techniques. Our survey of specialized literature reveals that fewer than 4% of studies published in high-impact medical informatics journals over the past 13 years have validated their systems using data from settings different from those that provided the training data. This low percentage is incompatible with responsible research, given the potential risks posed by unreliable ML models in healthcare. Raising the standards for medical AI evaluation is crucial to improving practitioners' understanding of the potential and limitations of decision support systems in real-world settings. It is essential that uncertainty is not hidden in studies aimed at advancing knowledge in this field.

Conversational agents are transforming digital interactions across various domains, including healthcare, education, and customer service, thanks to advances in large language models (LLMs). As these systems become more autonomous and ubiquitous, understanding what constitutes high-quality interaction from a user perspective is increasingly critical. Despite growing empirical research, the field lacks a unified framework for defining, measuring, and designing user-perceived interaction quality in human–artificial intelligence (AI) dialogue. Here, we present an integrative review of 125 empirical studies published between 2017 and 2025, spanning text-, voice-, and LLM-powered systems. Our synthesis identifies three consistent layers of user judgment: a pragmatic core (usability, task effectiveness, and conversational competence), a social–affective layer (social presence, warmth, and synchronicity), and an accountability and inclusion layer (transparency, accessibility, and fairness). These insights are formalised into a four-layer interpretive framework—Capacity, Alignment, Levers, and Outcomes—operationalised via a Capacity × Alignment matrix that maps distinct success and failure regimes. It also identifies design levers such as anthropomorphism, role framing, and onboarding strategies. The framework consolidates constructs, positions inclusion and accountability as central to quality, and offers actionable guidance for evaluation and design. This research redefines interaction quality as a dialogic construct, shifting the focus from system performance to co-orchestrated, user-centred dialogue quality.