Meaningful oversight of medical AI beyond human in the loop

Human oversight of medical AI is increasingly required, but clinician presence alone does not make oversight meaningful. We propose four interlocking conditions—epistemic capacity, cognitive space, decisional authority, and intervention effectiveness—that determine whether human judgment can function as a safety mechanism. Embedding these conditions across procurement, deployment, monitoring, and decommissioning can turn oversight into an operational patient-safety capability across predictive, generative, semi-autonomous, and agentic systems.