Does routine AI assistance erode endoscopy skills?

While numerous trials have shown the use of AI to assist colonoscopies increases the detection of adenomas — generating much enthusiasm for the technology — in Poland, an observational study published in The Lancet Gastroenterology & Hepatology of more than 1400 colonoscopies has found that, several months after the routine introduction of AI, the rate at which experienced health professionals detect precancerous growths in the colon in non-AI assisted colonoscopies decreased by 20% (from 28.4% to 22.4%). This research raises questions about how continuous use of AI affects endoscopist skills.

“To our knowledge this is the first study to suggest a negative impact of regular AI use on healthcare professionals’ ability to complete a patient-relevant task in medicine of any kind,” author Dr Marcin Romańczyk of Academy of Silesia said. “Our results are concerning given the adoption of AI in medicine is rapidly spreading. We urgently need more research into the impact of AI on health professionals’ skills across different medical fields.

“We need to find out which factors may cause or contribute to problems when healthcare professionals and AI systems don’t work well together, and to develop ways to fix or improve these interactions.” Four colonoscopy centres in Poland between September 2021 and March 2022 were used for the study. At the end of 2021, regular AI use was introduced at the centres, after which colonoscopies were randomly done either with or without AI assistance.

Performed by 19 experienced endoscopists who had conducted over 2000 colonoscopies each, during the period of the study, 1443 colonoscopies were conducted without AI — 795 before regular introduction of AI use and 648 after AI implementation. The study observed that the average rate of adenoma detection at non-AI assisted colonoscopies significantly decreased from 28.4% (226/795) before AI exposure to 22.4% (145/648) after AI exposure — this corresponded to a 20% relative and 6% absolute reduction in adenoma detection rate. Meanwhile, in the AI-assisted colonoscopies, there was a 25.3% (186/734) adenoma detection rate.

“These results pose an interesting question about previous randomised controlled trials which found AI-assisted colonoscopy enabled a higher adenoma detection rate than non-AI assisted colonoscopy,” author Professor Yuichi Mori of University of Oslo said. “It could be the case that non-AI assisted colonoscopy assessed in these trials is different from standard non-AI assisted colonoscopy as the endoscopists in the trials may have been negatively affected by continuous AI exposure.”

Some limitations are acknowledged by the authors, including that the observational nature of the study means that factors other than the implementation of AI use may have influenced the findings. That the study was conducted with experienced endoscopists may also limit its generalisation to all endoscopists. Needed, the researchers said, are further studies with less experienced health professionals — to see if long-term AI tool use has a larger impact on their ability to detect of adenomas without AI.

“These findings temper the current enthusiasm for rapid adoption of AI based technologies,” Dr Omer Ahmad of University College London, who was not involved in the study, said in a comment published in the same journal, “[…] and highlight the importance of carefully considering possible unintended clinical consequences. Although previous experimental studies have alluded to negative modification of behaviour after AI exposure, the study by Budzyń and colleagues provides the first real-world clinical evidence for the phenomenon of deskilling, potentially affecting patient-related outcomes. [...] Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy.”

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