DOI: 10.1111/ijd.70743 ISSN: 0011-9059

The Differential That Never Gets Generated

Apurv Khandelwal
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ABSTRACT

Residents increasingly ask large language models to name a lesion before diagnosing it themselves. The practice contributes a specific harm: never‐skilling, a phenomenon in which reasoning is never acquired, and is distinct from 'deskilling' or 'model error'. Forming a differential first is necessary but insufficient. Departments should require documented differentials, supervise disagreement, and examine unassisted reasoning.

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