ChatGPT (GPT-4) versus doctors on complex cases of the Swedish family medicine specialist examination: an observational comparative study

Abstract

BACKGROUND: Recent breakthroughs in artificial intelligence research include the development of generative pretrained transformers (GPT). ChatGPT has been shown to perform well when answering several sets of medical multiple-choice questions. However, it has not been tested for writing free-text assessments of complex cases in primary care. OBJECTIVES: To compare the performance of ChatGPT, version GPT-4, with that of real doctors. DESIGN AND SETTING: A blinded observational comparative study conducted in the Swedish primary care setting. Responses from GPT-4 and real doctors to cases from the Swedish family medicine specialist examination were scored by blinded reviewers, and the scores were compared. PARTICIPANTS: Anonymous responses from the Swedish family medicine specialist examination 2017-2022 were used. OUTCOME MEASURES: Primary: the mean difference in scores between GPT-4's responses and randomly selected responses by human doctors, as well as between GPT-4's responses and top-tier responses by human doctors. Secondary: the correlation between differences in response length and response score; the intraclass correlation coefficient between reviewers; and the percentage of maximum score achieved by each group in different subject categories. RESULTS: The mean scores were 6.0, 7.2 and 4.5 for randomly selected doctor responses, top-tier doctor responses and GPT-4 responses, respectively, on a 10-point scale. The scores for the random doctor responses were, on average, 1.6 points higher than those of GPT-4 (p<0.001, 95% CI 0.9 to 2.2) and the top-tier doctor scores were, on average, 2.7 points higher than those of GPT-4 (p<0.001, 95 % CI 2.2 to 3.3). Following the release of GPT-4o, the experiment was repeated, although this time with only a single reviewer scoring the answers. In this follow-up, random doctor responses were scored 0.7 points higher than those of GPT-4o (p=0.044). CONCLUSION: In complex primary care cases, GPT-4 performs worse than human doctors taking the family medicine specialist examination. Future GPT-based chatbots may perform better, but comprehensive evaluations are needed before implementing chatbots for medical decision support in primary care.

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