Endoscopist De-Skilling after Exposure to Artificial Intelligence in Colonoscopy: A Multicenter Observational Study

Does AI use contribute to de-skilling? Probably, according to this study of endoscopists.

This study compared >1.4k patient outcomes who underwent non-AI assisted colonoscopy before and after AI implementation.

Background:

· A recent meta-analysis of 20 randomised trials “showed an absolute 8.1 % increase in ADR [Adenoma detection rate] with the use of AI during colonoscopy.5 This AI-driven ADR increase is expected to improve colorectal cancer prevention effect”

· They note that “this excitement [of higher ADR detection via AI assistance] has diverted attention from another key clinical question: the impact of AI on human capability” and it “remains unclear how continuous exposure to AI affects endoscopists’ behavior and patient-relevant outcomes in standard, non-AI assisted procedures”

· “Psychological studies suggest that ongoing AI exposure may impact behavior in different ways: positively, by training clinicians, or negatively, through a “de-skilling” effect, where automation use leads to cognitive skill decay—patterns observed in non-medical fields”

Findings:

· “Our primary analysis showed the continuous exposure to AI reduced ADR of standard, non-AI assisted colonoscopy from 28.4% to 22.4% with a 6% absolute difference, suggesting a detrimental effect on endoscopist capability”

· “In conclusion, we observed that continuous exposure to AI in clinical practice reduced the ADR of standard, non-AI assisted colonoscopy”

· The observational design nevertheless requires a cautious interpretation because of selection bias and confounding, and limited ability to draw causal interferences

· On why de-skilling may occur, “We believe that continuous exposure to decision support systems like AI may lead to the natural human tendency to over-rely on their recommendations, leading to clinicians becoming less motivated, less focused, and less responsible when making cognitive decisions without AI assistance”

· In support, they refer to a recent study that showed “reduced visual eye-movements during colonoscopy when using AI for polyp detection, indicating a risk of overdependence on such systems”

Ref: Budzyń, K., Romańczyk, M., Kitala, D., Kołodziej, P., Bugajski, M., Adami, H. O., … & Mori, Y. Endoscopist De-Skilling after Exposure to Artificial Intelligence in Colonoscopy: A Multicenter Observational Study. The Lancet