Model Evolution and System Roles Influence the Performance of ChatGPT on Chinese Medical Licensing Exams: A Comparative Study (Preprint)

Abstract

<sec> <title>BACKGROUND</title> With the increasing application of Large Language Models (LLMs) like ChatGPT in various industries, its potential in the medical domain, especially in standardized examinations, has become a focal point of research. </sec> <sec> <title>OBJECTIVE</title> To assess the clinical performance of ChatGPT, focusing on its accuracy and reliability in the Chinese National Medical Licensing Examination (CNMLE). </sec> <sec> <title>METHODS</title> The CNMLE 2022 question set, consisting of 500 single-answer multiple choices questions, were reclassified into 15 medical sub-specialties. Each question was tested 8 to 12 times in Chinese on the OpenAI platform from April 24 to May 15, 2023. Three key factors were considered: the version of GPT-3.5 and 4.0, the prompts designation of system roles tailored to medical sub-specialties, and repetition for coherence. A passing accuracy threshold was established as 60%. The χ2 tests and Kappa values were employed to evaluate the model's accuracy and consistency. </sec> <sec> <title>RESULTS</title> GPT-4.0 achieved passing accuracy of (71.0% - 74.7%), significantly higher than that of GPT-3.5 (50.3% - 54.8%, P &lt; 0.001). Both models showed relatively high coherence between initial and 2nd response, with Kappa values of 0.778 and 0.610. System roles boosted accuracy for both GPT-4.0 (0.3% - 3.7%) and GPT-3.5 (1.3% - 4.5%), and increased the Kappa by 0.023 and 0.035 respectively. In multi-specialty analysis, GPT-4.0 passed the threshold in 14 of 15 sub-specialties, while GPT-3.5 did so in 7 of 15 on the first response. </sec> <sec> <title>CONCLUSIONS</title> GPT-4.0 passed the CNMLE and outperformed GPT-3.5 in key areas such as accuracy, consistency, and medical sub-specialty expertise. Adding a system role enhanced the model's reliability and answer coherence. GPT-4.0 showed promising potential in medical education and clinical practice, meriting further study. </sec>

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