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Artificial intelligence in the workplace is becoming increasingly common. These tools are sometimes used to aid users in performing their task, for example, when an artificial intelligence tool assists a radiologist in their search for abnormalities in radiographic images. The use of artificial intelligence brings a wealth of benefits, such as increasing the efficiency and efficacy of performance. However, little research has been conducted to determine how the use of artificial intelligence assistants might affect the user’s cognitive skills. In this theoretical perspective, we discuss how artificial intelligence assistants might accelerate skill decay among experts and hinder skill acquisition among learners. Further, we discuss how AI assistants might also prevent experts and learners from recognizing these deleterious effects. We then discuss the types of questions: use-inspired basic cognitive researchers, applied researchers, and computer science researchers should seek to answer. We conclude that multidisciplinary research from use-inspired basic cognitive research, domain-specific applied research, and technical research (e.g., human factors research, computer science research) is needed to (a) understand these potential consequences, (b) design artificial intelligence systems to mitigate these impacts, and (c) develop training and use protocols to prevent negative impacts on users’ cognitive skills. Only by answering these questions from multidisciplinary perspectives can we harness the benefits of artificial intelligence in the workplace while preventing negative impacts on users’ cognitive skills.

IntroductionInternal medicine residents perform paracentesis, but programs lack standard methods for assessing competence or maintenance of competence and instead rely on number of procedures completed. This study describes differences in resident competence in paracentesis over time.MethodsFrom 2016 to 2017, internal medicine residents (n = 118) underwent paracentesis simulation training. Competence was assessed using the Paracentesis Competency Assessment Tool (PCAT), which combines a checklist, global scale, and entrustment score. The PCAT also delineates two categorical cut-point scores: the Minimum Passing Standard (MPS) and the Unsupervised Practice Standard (UPS). Residents were randomized to return to the simulation lab at 3 and 6 months (group A, n = 60) or only 6 months (group B, n = 58). At each session, faculty raters assessed resident performance. Data were analyzed to compare resident performance at each session compared with initial training scores, and performance between groups at 6 months.ResultsAfter initial training, all residents met the MPS. The number achieving UPS did not differ between groups: group A = 24 (40%), group B = 20 (34.5%), p = 0.67. When group A was retested at 3 months, performance on each PCAT component significantly declined, as did the proportion of residents meeting the MPS and UPS. At the 6-month test, residents in group A performed significantly better than residents in group B, with 52 (89.7%) and 20 (34.5%) achieving the MPS and UPS, respectively, in group A compared with 25 (46.3%) and 2 (3.70%) in group B (p < .001 for both comparison).DiscussionSkill in paracentesis declines as early as 3 months after training. However, retraining may help interrupt skill decay. Only a small proportion of residents met the UPS 6 months after training. This suggests using the PCAT to objectively measure competence would reclassify residents from being permitted to perform paracentesis independently to needing further supervision.

Digital transformation is changing not only the demand for new digital skills, but also the value of skills that employees already possess. This study examines how perceived disruptive technological change is associated with digital skills decay and digital skills obsolescence and how these processes relate to employability anxiety, reskilling intention and workforce sustainability. A quantitative survey was conducted among 932 employees and business professionals from European Union countries between October 2025 and March 2026. The data were analyzed using PLS-SEM in SmartPLS, with Bayesian regression in JASP used as a complementary robustness check. The results supported the proposed model. Perceived disruptive technological change was positively associated with digital skills decay, while digital skills decay was positively related to digital skills obsolescence. Both digital skills decay and obsolescence were positively associated with employability anxiety. Employability anxiety was negatively associated with workforce sustainability, but it was positively associated with reskilling intention, which in turn supported workforce sustainability. Sustainable HRM practices and organizational learning culture were also positively associated with workforce sustainability. The findings suggest that workforce sustainability depends not only on training provision, but also on the early detection of skill devaluation and the development of organizational conditions that help employees remain employable, adaptable and included.

Anesthesia providers must be experts in advanced airway management techniques such as laryngeal mask airway and endotracheal tube insertion. However, practicing anesthesia providers may work in clinical settings where advanced airway management techniques are rarely required. Infrequent advanced airway skill performance in these clinical settings can lead to skill decay, which is the gradual loss of acquired skills through infrequent practice or extended periods of skill nonuse. This literature review synthesizes available evidence regarding advanced airway management skill decay. Themes emerging from the literature review include skill decay association with decreased endotracheal intubation success rates, a timeframe within which advanced airway management skill decay may begin to occur, and recommendations for preventing decay of advanced airway management skills. With infrequent use of advanced airway skills in clinical settings, routine practice is crucial for skill maintenance. Clinical simulation could play a role in mitigating skill decay among practicing anesthesia providers at risk for decay in advanced airway management skills resulting from skill nonpractice.

Determine the effectiveness of deliberate practice on improving handoff communication accuracy among prelicensure nursing students. Ineffective handoff contributes to preventable and costly medical errors, incorrect or delayed diagnosis and treatment and increased costs. Deliberate practice is recommended for skill development; however, little is known about the effectiveness of this teaching method with handoff. A one-group repeated measures quasi-experimental design was used. A convenience sample of prelicensure nursing students were recruited from four United States schools of nursing. Using simulation, participants independently completed four handoffs over three study visits, spaced three to four weeks apart. Each visit included deliberate practice of handoff communication to an incoming simulated participant nurse. Observational data on handoff accuracy were collected using the I-SBAR (Identification, Situation, Background, Assessment, Recommendation) tool. Total scores on the I-SBAR range from 0 to 10. Change in handoff scores over time were analyzed via a linear mixed-effects model. Covariates of age, grade point average, study site and healthcare work experience were investigated. Fifty-one students participated in the study. Mean handoff scores increased from 6.24 at T0 (baseline) to 8.34 at T1, declined to 6.96 at T2 and increased to 7.82 at T3 (final assessment). Statistically significant (p < 0.001) improvement was observed from baseline to final assessment. Findings support the deliberate practice method of handoff communication skills for increasing handoff accuracy in nursing students. Future research should consider skill decay and need for continued deliberate practice of handoff skills.

The infrequent use of skills relevant in non-routine situations in highly automated and high-risk industries is a major safety issue. The infrequent use of skills can lead to skill decay. Research on skill decay has a long history, but not much is known about the relevant factors and refresher interventions to attenuate skill decay in highly automated environments. In the present study, a scoping review was conducted to determine whether the well-known factors in skill decay research are also relevant for complex cognitive skill decay and to identify refresher interventions that are deemed effective for attenuating decay. A scoping review aims at identifying, summarizing, and mapping the body of literature on a given topic. Searches in electronic databases, including PsycArticles, PsyINFO, and Psyndex, via EBSCOhost and Web of Science and Google Scholar were conducted, and documents were analyzed regarding the research question, which resulted in n = 58 studies. The findings demonstrate the relevance of task characteristics and method-related (cognitive-based, behavioral-based training) and person-related factors (e.g., cognitive ability, experience, motivation) to mitigate decay. Additionally, the results demonstrate that minor refresher interventions are effective at attenuating complex cognitive skill decay. Implications for industry and training providers that aim to implement training and refresher interventions to attenuate skill decay in high-risk industries are provided. Researchers may use the information about the influences of person- and method-related factors, task characteristics, and refresher interventions presented in this scoping review as a starting point to conduct further empirical research by taking skill acquisition, retention, and transfer into account.

Background: This study aimed to objectively evaluate the impact of the gap in surgical practice caused by COVID-19 on surgical skill decay. Methods: This retrospective cohort study enrolled 148 cases of adult patients who were qualified for elective or urgent laparoscopic cholecystectomy. This study compared the period of nine months before the pandemic outbreak and nine months after the end of the pandemic. We analyzed the duration of surgery, the number of intraoperative adverse events (IAEs), postoperative complications (PCs), and differences between the surgeries performed by residents and those performed by specialists. Results: The number of IAEs did not differ significantly between groups (after COVID-19 (AC) and before COVID-19 (BC)). A difficult gallbladder (DGB) was associated with an increased risk of IAEs during surgery in both groups (BC:OR = 2.94, p = 0.049; AC:OR = 2.81, p = 0.35). The multivariate analyses showed no significant differences in IAEs or PCs when the residents performed surgeries compared to specialists. The average duration of surgery was significantly longer in the post-pandemic group (BC–102.4 min vs. AC–119.9 min, p = 0.024). Conclusions: Measurable determinants of surgical skills are the duration of surgery and the number of intraoperative adverse events. By defining this indicators, our study objectively shows that the reduction in the volume of surgeries during COVID-19 resulted in a phenomenon known as surgical skill decay.

Background Trainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay. Methods We designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers. Results The DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments. Conclusions The simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention. Trial Registration Not applicable, not a health care intervention.

Residents engaging in dedicated research experiences may return to clinical training with less surgical skill. The study aims were 1) to evaluate faculty perceptions of residents skills decay during dedicated research fellowships, and 2) to compare faculty and resident perceptions of residents skills decay. Faculty and residents were surveyed on resident research practices and perceptions of resident skills decay. Faculty thought residents returning from research demonstrate less technical skill (Median = 4; 5-point Likert scale, 1 = Strongly disagree, 5 = Strongly agree), demonstrate less confidence (Median = 4), and require more instruction (Median = 4). Both faculty and residents perceived the largest skill reduction in complex procedures, technical surgical skills, and knowledge of procedure steps (p < 0.05). While dedicated research experiences provide valuable academic experience, there is a cost to clinical skills retention and confidence specifically in the areas of complex operative procedures and technical surgical skills.

Skills decay is a known risk for surgical residents who have dedicated research time. We hypothesize that simulation-based assessments will reveal significant differences in perceived skill decay when assessing a variety of clinical scenarios in a longitudinal fashion. Residents (N = 46; Returning: n = 16, New: n = 30) completed four simulated procedures: urinary catheterization, central line, bowel anastomosis, and laparoscopic ventral hernia repair. Perception surveys were administered pre- and post-simulation. Perceptions of skill decay and task difficulty were similar for both groups across three procedures pre- and post-simulation. Due to a simulation modification, new residents were more confident in urinary catheterization than returning residents (F(1,4) = 11.44, p = 0.002). In addition, when assessing expectations for skill reduction, returning residents perceived greater skill reduction upon reassessment when compared to first time residents (t(35) = 2.37, p = 0.023). Research residents may benefit from longitudinal skills assessments and a wider variety of simulation scenarios during their research years. As part of a longitudinal study, we assessed research residents' confidence, perceptions of task difficulty and surgical skill reduction. Residents completed surveys pre- and post-experience with four simulated procedures: urinary catheterization, subclavian central line insertion, bowel anastomosis, and laparoscopic ventral hernia repair. Returning residents perceived greater skill reduction upon reassessment when compared to residents participating for the first time. In addition, modification of the clinical scenarios affected perceptions of skills decay.