Diagnosis
Conditions
Keywords
Computer-assisted diagnosis, Large language models, clinical reasoning
Brief summary
This study will evaluate the effect of providing access to GPT-4, a large language model, compared to traditional diagnostic decision support tools on performance on case-based diagnostic reasoning tasks.
Detailed description
Artificial intelligence (AI) technologies, specifically advanced large language models like OpenAI's ChatGPT, have the potential to improve medical decision-making. Although ChatGPT-4 was not developed for its use in medical-specific applications, it has demonstrated promise in various healthcare contexts, including medical note-writing, addressing patient inquiries, and facilitating medical consultation. However, little is known about how ChatGPT augments the clinical reasoning abilities of clinicians. Clinical reasoning is a complex process involving pattern recognition, knowledge application, and probabilistic reasoning. Integrating AI tools like ChatGPT-4 into physician workflows could potentially help reduce clinician workload and decrease the likelihood of missed diagnoses. However, ChatGPT-4 was not developed for the purpose of clinical reasoning nor has it been validated for this purpose. Further, it may be subject to disinformation, including convincing confabulations that may mislead clinicians. If clinicians misuse this tool, it may not improve diagnostic reasoning and could even cause harm. Therefore, it is important to study how clinicians use large language models to augment clinical reasoning prior to routine incorporation into patient care. In this study, we will randomize participants to answer diagnostic cases with or without access to ChatGPT-4. The participants will be asked to give three differential diagnoses for each case, with supporting and opposing findings for each diagnosis. Additionally they will be asked to provide their top diagnosis along with next diagnostic steps. Answers will be graded by independent reviewers blinded to treatment assignment.
Interventions
OTHERGPT-4
OpenAI's GPT-4 large language model with chat interface.
Sponsors
Beth Israel Deaconess Medical Center
University of Minnesota
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Masking description
The grading of responses will be performed by assessors blinded to participant identity and treatment assignment.
Intervention model description
The trial will be designed as a randomized, two-arm, single-blind parallel group study.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Participants must be licensed physicians and have completed at least post-graduate year 2 (PGY2) of medical training. * Training in Internal medicine, family medicine, or emergency medicine.
Exclusion criteria
* Not currently practicing clinically.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic reasoning | During evaluation | The primary outcome will be the percent correct (range: 0 to 100) for each case. For each case, participants will be asked for three top diagnoses and findings from the case that support that diagnosis and oppose that diagnosis. Participants will receive 1 point for each plausible diagnosis. Findings supporting the diagnosis and findings opposing the diagnosis will also be graded based on correctness, with 1 point for partially correct and 2 points for completely correct responses. Participants will then be asked to name their top diagnosis, earning one point for a reasonable response and two points for the most correct response. Finally participants will be asked to name up to 3 next steps to further evaluate the patient with one point awarded for a partially correct response and two points for a completely correct response. The primary outcome will be compared on the case-level by the randomized groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time Spent on Diagnosis | During evaluation | We will compare how much time (in minutes) participants spend per case between the two study arms. |
Countries
United States
Outcome results
None listed