AI-induced deskilling in orthopedic surgery: Preserving judgment in the age of intelligent decision support

Artificial intelligence (AI) is rapidly entering orthopedic practice, offering efficiency gains while risking cognitive deskilling, particularly among trainees who may shift from generating clinical judgments to passively verifying algorithmic recommendations. Drawing on foundational automation-bias literature, cognitive-load theory, deliberate-practice principles, and Miller's pyramid of competence, this editorial argues that orthopedic education must explicitly cultivate "AI independence" alongside AI fluency. We propose periodic AI-off assessments, a structured competency framework aligned with entrustable professional activities, and calibrated reliance modeled on aviation safety practices, so that future surgeons retain the capacity to reason, override, and remain accountable when intelligent systems are unavailable or incorrect.