AI as Teammate: Rethinking Task Distribution in Medical Training

Abstract

Integrating Artificial Intelligence (AI), particularly generative AI, into medical training has prompted concerns about learner over-reliance, misuse, and erosion of foundational clinical competencies. We propose a conceptual reframing at the decision level: the problem is not misuse but misclassification - a mechanistic failure of real-time metacognitive evaluation in selecting a subzone-inappropriate AI interaction mode. Drawing on "SCAN" (Substitute, Complement, Aid, Non-Negotiable), a human-centric decision-making framework for generative AI task allocation grounded in Vygotsky's Zone of Proximal Development and metacognition, we advance the emerging social-constructivist conversation around AI in medical education by offering a testable account of AI's role in clinical reasoning development. This framework yields testable predictions for how misclassification can be detected, mitigated, and, more importantly, prevented in the clinical learning environment. Regarding clinical reasoning development, we show how trajectories of skill acquisition (upskilling) and failure (the triad of skill failure: de-skilling, never-skilling, and mis-skilling) operate at the individual task level in ways that fixed-phase, cohort-wide treatments fail to capture. We further identify passive engagement within correctly classified AI-scaffolded tasks as a particularly insidious, detection-resistant pathway to mis-skilling - one requiring subzone re-identification from AI assistance to expert assistance, with human experts serving as epistemic auditors. The paper operationalizes SCAN for clinical curriculum design, supervision, and assessment, and opens an empirical research agenda grounded in cognitive science. This paradigm shift from misuse to misclassification is not semantic: it offers educators a clear perspective on what to look for, what to assess, and what to intervene on.