The new JAMA paper on OpenEvidence puts a number on the trainee worry. Physicians within a decade of graduation sent 2.54x their workforce share of physician queries, residents and fellows 1.84x. That's the stage where clinical reasoning is still being built. The study counts queries, not answer quality or patient outcomes, so it shows who leans on the tool. It can't show whether anyone's skills have slipped.
Johns Hopkins just partnered with OpenEvidence, which reports 1.12 million license-verified US clinicians using it as of September. The line I noticed was not the headline. It was Hopkins’ vice dean for education raising “cognitive offloading”: trainees may lack skills expected of them when they practice unsupervised.
I’m a practicing oncologist, and this is the version of the problem I think about in clinic.
A fellow (and even me) can now get a guideline-concordant answer in seconds. What is harder to see is whether they could have built that answer themselves (I am worried about this skill; this is no joke), and whether they would catch it being wrong on a rare case.
Hopkins is floating a move from time-based to competency-based training (the evaluate doctors based on what they can do, not how much they spent in the hospital). That seems right to me, but competency has to be measured with the tool turned off at least some of the time.
The other issue is hospitals are not incentivized to graduate fellows earlier even if they met the competencies because they are cheap labor, so this competency thing I am not buying it, and I might be wrong.
Financial terms were not disclosed, and use cases are still being defined, so this is early.
Should board exams and fellowship evaluations assume AI access, or deliberately test without it?