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Automation bias: a systematic review of frequency, effect mediators, and mitigators
Open accessAbstract
Automation bias (AB)--the tendency to over-rely on automation--has been studied in various academic fields. Clinical decision support systems (CDSS) aim to benefit the clinical decision-making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce. With a focus on healthcare, a systematic review of the literature from a variety of research fields has been carried out, assessing the frequency and severity of AB, the effect mediators, and interventions potentially mitigating this effect. This is discussed alongside automation-induced complacency, or insufficient monitoring of automation output. A mix of subject specific and freetext terms around the themes of automation, human-automation interaction, and task performance and error were used to search article databases. Of 13 821 retrieved papers, 74 met the inclusion criteria. User factors such as cognitive style, decision support systems (DSS), and task specific experience mediated AB, as did attitudinal driving factors such as trust and confidence. Environmental mediators included workload, task complexity, and time constraint, which pressurized cognitive resources. Mitigators of AB included implementation factors such as training and emphasizing user accountability, and DSS design factors such as the position of advice on the screen, updated confidence levels attached to DSS output, and the provision of information versus recommendation. By uncovering the mechanisms by which AB operates, this review aims to help optimize the clinical decision-making process for CDSS developers and healthcare practitioners.
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“The result is a cognitive moral hazard: epistemic responsibility is abdicated not because delegation is appropriate, but because the trainee cannot distinguish appropriate delegation from uncritical acceptance 29 .”
From AI-induced never-skilling in medical education (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Automation bias, well described in clinical decision support contexts, can lead individuals to privilege automated recommendations even when flawed, contributing to errors of commission or omission and reducing vigilance in information seeking [47].”
From Design and evaluation of a faculty development workshop series on integrating generative artificial intelligence in medical education: mixed methods pilot study (2026) · cites this paper as [47]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“For humans, post-hoc interaction with such outputs is opaque and coarse-grained: experts must reverseengineer the model's reasoning to correct errors, while novices risk automation bias and over-reliance on machine-generated authority [32, 44, 87].”
From Criticmate: Stagewise Human–AI Co-Critique in Single-Screen UI Evaluation (2026) · cites this paper as [32]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“These fi ndings relate to work on automation bias, algorithm aversion, and 'appropriate reliance' [5, 32, 44, 87].”
From Criticmate: Stagewise Human–AI Co-Critique in Single-Screen UI Evaluation (2026) · cites this paper as [32]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“HR professionals might utilize a system for decision support differently, as prior experience with personnel selection tasks is related to higher confidence in one’s own decisions, resulting in a lower reliance on the system and less automation bias (Goddard et al., 2012; Langer et al., 2021).”
From Check the box! How to deal with automation bias in AI-based personnel selection (2023) · cites this paper as Goddard et al., 2012
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“This way, the design of the system can support the attention of decision makers by varying reliability over time (Goddard et al., 2012; Zerilli et al., 2019).”
From Check the box! How to deal with automation bias in AI-based personnel selection (2023) · cites this paper as Goddard et al., 2012
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“Automation bias has been found to be a serious problem in contexts of AI-based decision support systems (Mosier and Skitka, 1999; Goddard et al., 2012; Lyell et al., 2018; Davis et al., 2020)”
From Check the box! How to deal with automation bias in AI-based personnel selection (2023) · cites this paper as Goddard et al., 2012
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“The core finding is broadly consistent: when humans receive an algorithmic recommendation, they defer to it at rates exceeding what would be warranted by the algorithm's demonstrated accuracy, even when available evidence contradicts the recommendation (Skitka, Mosier, and Burdick 1999;Goddard, Roudsari, and Wyatt 2012).”
From Limits of Interventions in AI-Assisted Decision Making (2026) · cites this paper as Goddard, Roudsari, and Wyatt 2012
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“These factors have also been deemed influential in a systematic review by Goddard et al. (2012).”
From Investigating appropriate reliance on AI-Based decision support systems: the role of expertise, trust, and self-confidence (2025) · cites this paper as Goddard et al., 2012
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“The risk of automation bias occurs in this process: a human being relies too heavily on the algorithm, even in the face of erroneous predictions (Goddard et al. 2011).”
From Legitimacy of Algorithmic Decision-Making: Six Threats and the Need for a Calibrated Institutional Response (2022) · cites this paper as Goddard et al. 2011
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“In the conclusion of their systematic review, Goddard et al. (2012) propose that expertise may act on primary drivers to influence reliance on DSS, with those primary drivers being trust and confidence, again emphasising that expertise likely plays an indirect role on reliance behaviour.”
From Investigating appropriate reliance on AI-Based decision support systems: the role of expertise, trust, and self-confidence (2025) · cites this paper as Goddard et al., 2012
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“Expertise, expected to be a predictor of both trust and reliance (Goddard et al., 2012), has been shown to reduce trust and reliance on AI, even when the user's judgement is incorrect (Küper et al., 2024).”
From Investigating appropriate reliance on AI-Based decision support systems: the role of expertise, trust, and self-confidence (2025) · cites this paper as Goddard et al., 2012
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“Goddard et al. (2012) propose that heightened confidence in one's own decisions generally diminishes reliance on external support, identifying confidence as a primary influence on reliance behaviour alongside trust.”
From Investigating appropriate reliance on AI-Based decision support systems: the role of expertise, trust, and self-confidence (2025) · cites this paper as Goddard et al., 2012
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“This risk is amplified by automation bias, the tendency to over-rely on algorithmic output, by leading clinicians to accept erroneous recommendations without adequate scrutiny.17-21”
From Automation Bias in Large Language Model Assisted Diagnostic Reasoning Among AI-Trained Physicians (2025) · cites this paper as [18]
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In the citing paper
“The principle of non-discrimination in algorithmic decision-making is the last to consider for completing the algorithmic legality fundamental requirements. This translates into a duty to avoid so-called automation biases 75 , preventing outcomes that might be discriminatory toward the addressee of administrative action.”
From Transparency Warranties for Algorithmic Decisions in Administrative Procedures. Synopsis between EU Law and the Italian Legal System (2026) · cites this paper as Goddard K, Roudsari A, Wyatt JC (2012)
The cited source says what the claim attributes to it.
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“Experimental lab studies have diagnosed this tendency across a number of research fields (Goddard, Roudsari, and Wyatt 2012).”
From Human–AI Interactions in Public Sector Decision Making: “Automation Bias” and “Selective Adherence” to Algorithmic Advice (2023) · cites this paper as Goddard, Roudsari, and Wyatt 2012
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In the citing paper
“However, systems to aid decision-making might especially be considered for novice HR professionals as these systems tend to improve the decision-making quality of less experienced decision makers (Goddard et al., 2012; Langer et al., 2021).”
From Check the box! How to deal with automation bias in AI-based personnel selection (2023) · cites this paper as Goddard et al., 2012
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In the citing paper
“Automation bias has been found to lead to adverse effects on decision outcomes in several other contexts before (e.g., Parasuraman and Manzey, 2010; Goddard et al., 2012).”
From Check the box! How to deal with automation bias in AI-based personnel selection (2023) · cites this paper as Goddard et al., 2012
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“Even when AI operates at the level of recommendation rather than direct action, the mere presence of an algorithmic suggestion can systematically shift human judgment toward the algorithm's conclusion, a phenomenon known as automation bias (Goddard, Roudsari, and Wyatt 2012;Alon-Barkat and Busuioc 2023).”
From Limits of Interventions in AI-Assisted Decision Making (2026) · cites this paper as Goddard, Roudsari, and Wyatt 2012
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In the citing paper
“Human involvement therefore does not necessarily guarantee effective control (Goddard et al. 2012).”
From When Recruiters Meet Algorithms: Advice Taking and Bias in AI‐Assisted Recruitment (2026) · cites this paper as Goddard et al. 2012
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“This tendency is consistent with automation bias, in which people overrely on automated recommendations and accept them without sufficient independent verification (Goddard et al., 2012).”
From Think Before You Accept: Can Written Justification Reduce Uncritical Uptake of AI Writing Suggestions? (2026) · cites this paper as Goddard et al., 2012
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“All had previously passed our standard psychological screener [30].”
From Progressive Disclosure: When, Why, and How Do Users Want Algorithmic Transparency Information? (2020) · cites this paper as [30]
Experimental — accuracy not yet measuredIn the citing paper
“Automation bias can occur in busy clinical settings where clinicians may feel pressure to make rapid decisions, leading them to rely on AI-generated results as a shortcut rather than engaging in thorough analysis.44”
From Bias in artificial intelligence for medical imaging: fundamentals, detection, avoidance, mitigation, challenges, ethics, and prospects (2024) · cites this paper as [44]
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“Such functions may support standardization and traceability, but pharmacists may also perceive automation as a source of risk if it reduces professional discretion, encourages over-reliance on system outputs, weakens direct clinical verification, or diffuses accountability when errors occur [13].”
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Clinical Artificial Intelligence as a Novice Nurse
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TRANSFORMATION OF EDUCATIONAL PRACTICES IN THE CONTEXT OF POST-INDUSTRIAL CHALLENGES
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The Future of Surgical Decision-Making in Critical Care
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Evaluating Generative AI in Benefits Administration: A Demonstration Project
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“If, for instance, adjudi-cators were too trusting of model outputs — even when they may be wrong – the “humans in the loop” that are often posited as a safeguard against model errors might amount to little more than mere functionaries, a concern termed automation bias [3, 17, 26].”
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“…a well-known human risk: automation bias, namely excessive reliance on automated suggestions and reduced vigilance or independent verifica - tion [ 27–29], as well as the possibility that the machine’s response is treated as the starting point rather than as a final check and a basis for…”
The Potential Expertise Paradox in AI-Assisted Radiology
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AI and Foundation Models in ART: A Medical Engineering Perspective
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Cognitive Load as a Lens for Understanding AI-Augmented Workflows in Agile Teams
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SAFE-GEM: Pre-Deployment Screening of GenAI Explanations in DAS Microseismic MonitoringPreprint
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Risk assessment of human-AI conflict
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“Collaborators often exhibit automation bias when presented with increased cognitive load, where they would accept automated recommendations without insufficient oversight, leading to erroneous model outputs that are treated as authoritative rather than as suggestion in an collaborative effort [6].”
Artificiell vapenautonomi och dess mänsklighetsunderskott
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Bias, Fairness, and Accountability in Forensic AI Systems
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“…operational implementation with postdeployment discordance monitoring and QSIR/PDSA learning, whereas the prostate MRI AI pathway represented an earlier-stage pathway evaluation with stronger emphasis on governance preparation, retrospective local validation planning, and pathway integration [5,7].”
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“Early studies of clinical decision-support systems demonstrated that clinicians may disproportionately rely on automated recommendations, even when those recommendations are incorrect [10,11].”
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“This phenomenon, referred to as automation bias, occurs when users favor suggestions from automated systems even when contradictory information is available or when AI recommendations lack transparency [ 62].”
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Metadata
- Authors
- Goddard, K., Roudsari, A., & Wyatt, J. C.
- Affiliations
- City, University of London (GB)
- University of Warwick (GB)
- Corresponding author
- Goddard, Kate
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01
- Volume
- 19
- Issue
- 1
- Pages
- 121-127
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC3240751
- OpenAlex
- W2281090488
- Cited by
- 1,162
- References
- 77
- Citations by year
- 2026: 513 · 2025: 180 · 2024: 111 · 2023: 88 · 2022: 78 · 2021: 61 · 2020: 39 · 2019: 29 · 2018: 23 · 2017: 8 · 2016: 7 · 2015: 4 · 2014: 6 · 2013: 11 · 2012: 4
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Engineering and Physical Sciences Research Council
- Topics
- Social Sciences › Human Factors and Ergonomics › Human-Automation Interaction and Safety
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- automation bias, clinical decision support systems, human-automation interaction, over-reliance on automation, trust in automation, cognitive style, workload, task complexity, time constraints, user accountability, DSS design, clinical decision-making
- MeSH terms
- Attitude to Computers, Automation, Aviation, Humans, Task Performance and Analysis, Decision Support Systems, Clinical
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