AI-Driven Objective Structured Clinical Examination Generation in Digital Health Education: Comparative Analysis of Three GPT-4o Configurations (Preprint)

Abstract

<sec> <title>BACKGROUND</title> Objective Structured Clinical Examinations (OSCEs) are used as an evaluation method in medical education, but require significant pedagogical expertise and investment, especially in emerging fields like digital health. Large language models (LLMs), such as ChatGPT (OpenAI), have shown potential in automating educational content generation. However, OSCE generation using LLMs remains underexplored. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate 3 GPT-4o configurations for generating OSCE stations in digital health: (1) standard GPT with a simple prompt and OSCE guidelines; (2) personalized GPT with a simple prompt, OSCE guidelines, and a reference book in digital health; and (3) simulated-agents GPT with a structured prompt simulating specialized OSCE agents and the digital health reference book. </sec> <sec> <title>METHODS</title> Overall, 24 OSCE stations were generated across 8 digital health topics with each GPT-4o configuration. Format compliance was evaluated by one expert, while educational content was assessed independently by 2 digital health experts, blind to GPT-4o configurations, using a comprehensive assessment grid. Statistical analyses were performed using Kruskal-Wallis tests. </sec> <sec> <title>RESULTS</title> Simulated-agents GPT performed best in format compliance and most content quality criteria, including accuracy (mean 4.47/5, SD 0.28; &lt;i&gt;P&lt;/i&gt;=.01) and clarity (mean 4.46/5, SD 0.52; &lt;i&gt;P&lt;/i&gt;=.004). It also had 88% (14/16) for usability without major revisions and first-place preference ranking, outperforming the other configurations. Personalized GPT showed the lowest format compliance, while standard GPT scored lowest for clarity and educational value. </sec> <sec> <title>CONCLUSIONS</title> Structured prompting strategies, particularly agents’ simulation, enhance the reliability and usability of LLM-generated OSCE content. These results support the use of artificial intelligence in medical education, while confirming the need for expert validation. </sec>

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