Deep Dive · Two Desks: Should AI Write the Fellow's Notes?

A 60-page referral, nine years of creatinine, and an AI summary waiting on two desks: the attending's and the first-year fellow's. A Kidney360 perspective says to hand drafting, summarizing and paperwork to AI first, because a clinician checks the draft. A CJASN perspective says that same drafting is how fellows learn judgment, and warns of "never-skilling". We look at what the evidence actually shows: an ambient-scribe trial in which the better of two tools saved about 20 seconds per note, trainees who accepted roughly three of every four wrong AI answers, and endoscopists who detected fewer adenomas on their own after AI arrived in their units. Then a Fight Night verdict. The takeaway: AI can take the paperwork off a nephrologist's desk, but the safety net is still a human who knows enough to catch its mistakes, so fellows need to build that skill before they hand anything over. Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Several of the dialysis AI tools discussed come from Fresenius. He also directs quality improvement and research for nephrology fellows. Chapters 00:00 Cold open, welcome and disclosure 01:22 The attending's desk: hand AI the paperwork first? The ambient-scribe trial and the dialysis AI tools 07:27 The fellow's desk: never-skilling, a hallucination-spotting test, colonoscopy deskilling, and AI practice patients 12:36 Who checks the checker: the ASN statement, authors' ties, and a pre-visit medication-reconciliation idea 15:10 Fight Night verdict and the Monday-morning change Papers discussed Aiumtrakul N, Thongprayoon C, Cheungpasitporn W. Artificial Intelligence in Nephrology Practice: Practical Pathways to Improve Efficiency. Kidney360 2026 (ahead of print, open access). https://journals.lww.com/kidney360/fulltext/10.34067/kid.0000001424~artificial-intelligence-in-nephrology-practice-practical Fong JMN, Wang AYM. Equipping Nephrology Fellows with the Knowledge, Skills, and Attitudes for the Artificial Intelligence Era. CJASN 2026 (ahead of print). https://doi.org/10.2215/CJN.0000001239 Lukac PJ, et al. Ambient AI Scribes in Clinical Practice: A Randomized Trial. NEJM AI 2025;2(12). https://doi.org/10.1056/AIoa2501000 Zhou J, et al. General practice trainees' ability to tell AI hallucinations from correct answers. BMC Med Educ 2025;25:406. https://doi.org/10.1186/s12909-025-06916-2 Garbelli M, et al. Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis. Biomedicines 2024;12:2219. https://doi.org/10.3390/biomedicines12102219 Chaudhuri, et al. Machine-learning-directed interventions for hemodialysis patients at imminent risk of hospitalization. NEJM Catalyst 2026;7(3) (abstract only). https://doi.org/10.1056/CAT.25.0212 Budzyń K, et al. Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study. Lancet Gastroenterol Hepatol 2025;10:896-903 (abstract only). https://doi.org/10.1016/S2468-1253(25)00133-5 Ke Y, et al. AI-induced never-skilling in medical education. Nat Med 2026;32:1997-2006 (abstract only). https://doi.org/10.1038/s41591-026-04438-y Tangri N, et al. Responsible Use of Artificial Intelligence to Improve Kidney Care (ASN statement). JASN 2026;37:881-890. https://doi.org/10.1681/ASN.0000000929 Lavigne E, et al. AI-Standardized Clinical Examination Training on OSCE Performance. NEJM AI 2025;2(8) (abstract only). https://doi.org/10.1056/AIoa2500066 Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words; read the original before changing practice. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors. nephspace.com · [email protected]