Journal of Educational Evaluation for Health Professions

Review

Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review: Xiaojun Xu, Yixiao Chen, Jing Miao; J Educ Eval Health Prof. 2024;21:6. Published online March 15, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.6

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Abstract PDF Supplementary Material: Background
ChatGPT is a large language model (LLM) based on artificial intelligence (AI) capable of responding in multiple languages and generating nuanced and highly complex responses. While ChatGPT holds promising applications in medical education, its limitations and potential risks cannot be ignored.
Methods
A scoping review was conducted for English articles discussing ChatGPT in the context of medical education published after 2022. A literature search was performed using PubMed/MEDLINE, Embase, and Web of Science databases, and information was extracted from the relevant studies that were ultimately included.
Results
ChatGPT exhibits various potential applications in medical education, such as providing personalized learning plans and materials, creating clinical practice simulation scenarios, and assisting in writing articles. However, challenges associated with academic integrity, data accuracy, and potential harm to learning were also highlighted in the literature. The paper emphasizes certain recommendations for using ChatGPT, including the establishment of guidelines. Based on the review, 3 key research areas were proposed: cultivating the ability of medical students to use ChatGPT correctly, integrating ChatGPT into teaching activities and processes, and proposing standards for the use of AI by medical students.
Conclusion
ChatGPT has the potential to transform medical education, but careful consideration is required for its full integration. To harness the full potential of ChatGPT in medical education, attention should not only be given to the capabilities of AI but also to its impact on students and teachers.

Research articles

ChatGPT (GPT-4) passed the Japanese National License Examination for Pharmacists in 2022, answering all items including those with diagrams: a descriptive study: Hiroyasu Sato, Katsuhiko Ogasawara; J Educ Eval Health Prof. 2024;21:4. Published online February 28, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.4

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Abstract PDF Supplementary Material: Purpose
The objective of this study was to assess the performance of ChatGPT (GPT-4) on all items, including those with diagrams, in the Japanese National License Examination for Pharmacists (JNLEP) and compare it with the previous GPT-3.5 model’s performance.
Methods
The 107th JNLEP, conducted in 2022, with 344 items input into the GPT-4 model, was targeted for this study. Separately, 284 items, excluding those with diagrams, were entered into the GPT-3.5 model. The answers were categorized and analyzed to determine accuracy rates based on categories, subjects, and presence or absence of diagrams. The accuracy rates were compared to the main passing criteria (overall accuracy rate ≥62.9%).
Results
The overall accuracy rate for all items in the 107th JNLEP in GPT-4 was 72.5%, successfully meeting all the passing criteria. For the set of items without diagrams, the accuracy rate was 80.0%, which was significantly higher than that of the GPT-3.5 model (43.5%). The GPT-4 model demonstrated an accuracy rate of 36.1% for items that included diagrams.
Conclusion
Advancements that allow GPT-4 to process images have made it possible for LLMs to answer all items in medical-related license examinations. This study’s findings confirm that ChatGPT (GPT-4) possesses sufficient knowledge to meet the passing criteria.

Information amount, accuracy, and relevance of generative artificial intelligence platforms’ answers regarding learning objectives of medical arthropodology evaluated in English and Korean queries in December 2023: a descriptive study: Hyunju Lee, Soobin Park; J Educ Eval Health Prof. 2023;20:39. Published online December 28, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.39

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Abstract PDF Supplementary Material

Purpose
This study assessed the performance of 6 generative artificial intelligence (AI) platforms on the learning objectives of medical arthropodology in a parasitology class in Korea. We examined the AI platforms’ performance by querying in Korean and English to determine their information amount, accuracy, and relevance in prompts in both languages.
Methods
From December 15 to 17, 2023, 6 generative AI platforms—Bard, Bing, Claude, Clova X, GPT-4, and Wrtn—were tested on 7 medical arthropodology learning objectives in English and Korean. Clova X and Wrtn are platforms from Korean companies. Responses were evaluated using specific criteria for the English and Korean queries.
Results
Bard had abundant information but was fourth in accuracy and relevance. GPT-4, with high information content, ranked first in accuracy and relevance. Clova X was 4th in amount but 2nd in accuracy and relevance. Bing provided less information, with moderate accuracy and relevance. Wrtn’s answers were short, with average accuracy and relevance. Claude AI had reasonable information, but lower accuracy and relevance. The responses in English were superior in all aspects. Clova X was notably optimized for Korean, leading in relevance.
Conclusion
In a study of 6 generative AI platforms applied to medical arthropodology, GPT-4 excelled overall, while Clova X, a Korea-based AI product, achieved 100% relevance in Korean queries, the highest among its peers. Utilizing these AI platforms in classrooms improved the authors’ self-efficacy and interest in the subject, offering a positive experience of interacting with generative AI platforms to question and receive information.

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Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review
Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef

Review

Application of artificial intelligence chatbots, including ChatGPT, in education, scholarly work, programming, and content generation and its prospects: a narrative review: Tae Won Kim; J Educ Eval Health Prof. 2023;20:38. Published online December 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.38

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Abstract PDF Supplementary Material

This study aims to explore ChatGPT’s (GPT-3.5 version) functionalities, including reinforcement learning, diverse applications, and limitations. ChatGPT is an artificial intelligence (AI) chatbot powered by OpenAI’s Generative Pre-trained Transformer (GPT) model. The chatbot’s applications span education, programming, content generation, and more, demonstrating its versatility. ChatGPT can improve education by creating assignments and offering personalized feedback, as shown by its notable performance in medical exams and the United States Medical Licensing Exam. However, concerns include plagiarism, reliability, and educational disparities. It aids in various research tasks, from design to writing, and has shown proficiency in summarizing and suggesting titles. Its use in scientific writing and language translation is promising, but professional oversight is needed for accuracy and originality. It assists in programming tasks like writing code, debugging, and guiding installation and updates. It offers diverse applications, from cheering up individuals to generating creative content like essays, news articles, and business plans. Unlike search engines, ChatGPT provides interactive, generative responses and understands context, making it more akin to human conversation, in contrast to conventional search engines’ keyword-based, non-interactive nature. ChatGPT has limitations, such as potential bias, dependence on outdated data, and revenue generation challenges. Nonetheless, ChatGPT is considered to be a transformative AI tool poised to redefine the future of generative technology. In conclusion, advancements in AI, such as ChatGPT, are altering how knowledge is acquired and applied, marking a shift from search engines to creativity engines. This transformation highlights the increasing importance of AI literacy and the ability to effectively utilize AI in various domains of life.

Citations

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Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review
Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef
Artificial Intelligence: Fundamentals and Breakthrough Applications in Epilepsy
Wesley Kerr, Sandra Acosta, Patrick Kwan, Gregory Worrell, Mohamad A. Mikati
Epilepsy Currents.2024;[Epub] CrossRef

Brief report

ChatGPT (GPT-3.5) as an assistant tool in microbial pathogenesis studies in Sweden: a cross-sectional comparative study: Catharina Hultgren, Annica Lindkvist, Volkan Özenci, Sophie Curbo; J Educ Eval Health Prof. 2023;20:32. Published online November 22, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.32

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Abstract PDF Supplementary Material

ChatGPT (GPT-3.5) has entered higher education and there is a need to determine how to use it effectively. This descriptive study compared the ability of GPT-3.5 and teachers to answer questions from dental students and construct detailed intended learning outcomes. When analyzed according to a Likert scale, we found that GPT-3.5 answered the questions from dental students in a similar or even more elaborate way compared to the answers that had previously been provided by a teacher. GPT-3.5 was also asked to construct detailed intended learning outcomes for a course in microbial pathogenesis, and when these were analyzed according to a Likert scale they were, to a large degree, found irrelevant. Since students are using GPT-3.5, it is important that instructors learn how to make the best use of it both to be able to advise students and to benefit from its potential.

Citations

Citations to this article as recorded by

Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review
Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef
Information amount, accuracy, and relevance of generative artificial intelligence platforms’ answers regarding learning objectives of medical arthropodology evaluated in English and Korean queries in December 2023: a descriptive study
Hyunju Lee, Soobin Park
Journal of Educational Evaluation for Health Professions.2023; 20: 39. CrossRef

Research articles

Performance of ChatGPT, Bard, Claude, and Bing on the Peruvian National Licensing Medical Examination: a cross-sectional study: Betzy Clariza Torres-Zegarra, Wagner Rios-Garcia, Alvaro Micael Ñaña-Cordova, Karen Fatima Arteaga-Cisneros, Xiomara Cristina Benavente Chalco, Marina Atena Bustamante Ordoñez, Carlos Jesus Gutierrez Rios, Carlos Alberto Ramos Godoy, Kristell Luisa Teresa Panta Quezada, Jesus Daniel Gutierrez-Arratia, Javier Alejandro Flores-Cohaila; J Educ Eval Health Prof. 2023;20:30. Published online November 20, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.30

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159 Download
4 Web of Science
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Abstract PDF Supplementary Material

Purpose
We aimed to describe the performance and evaluate the educational value of justifications provided by artificial intelligence chatbots, including GPT-3.5, GPT-4, Bard, Claude, and Bing, on the Peruvian National Medical Licensing Examination (P-NLME).
Methods
This was a cross-sectional analytical study. On July 25, 2023, each multiple-choice question (MCQ) from the P-NLME was entered into each chatbot (GPT-3, GPT-4, Bing, Bard, and Claude) 3 times. Then, 4 medical educators categorized the MCQs in terms of medical area, item type, and whether the MCQ required Peru-specific knowledge. They assessed the educational value of the justifications from the 2 top performers (GPT-4 and Bing).
Results
GPT-4 scored 86.7% and Bing scored 82.2%, followed by Bard and Claude, and the historical performance of Peruvian examinees was 55%. Among the factors associated with correct answers, only MCQs that required Peru-specific knowledge had lower odds (odds ratio, 0.23; 95% confidence interval, 0.09–0.61), whereas the remaining factors showed no associations. In assessing the educational value of justifications provided by GPT-4 and Bing, neither showed any significant differences in certainty, usefulness, or potential use in the classroom.
Conclusion
Among chatbots, GPT-4 and Bing were the top performers, with Bing performing better at Peru-specific MCQs. Moreover, the educational value of justifications provided by the GPT-4 and Bing could be deemed appropriate. However, it is essential to start addressing the educational value of these chatbots, rather than merely their performance on examinations.

Citations

Citations to this article as recorded by

Performance of GPT-4V in Answering the Japanese Otolaryngology Board Certification Examination Questions: Evaluation Study
Masao Noda, Takayoshi Ueno, Ryota Koshu, Yuji Takaso, Mari Dias Shimada, Chizu Saito, Hisashi Sugimoto, Hiroaki Fushiki, Makoto Ito, Akihiro Nomura, Tomokazu Yoshizaki
JMIR Medical Education.2024; 10: e57054. CrossRef
Response to Letter to the Editor re: “Artificial Intelligence Versus Expert Plastic Surgeon: Comparative Study Shows ChatGPT ‘Wins' Rhinoplasty Consultations: Should We Be Worried? [1]” by Durairaj et al.
Kay Durairaj, Omer Baker
Facial Plastic Surgery & Aesthetic Medicine.2024;[Epub] CrossRef
Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review
Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef
Information amount, accuracy, and relevance of generative artificial intelligence platforms’ answers regarding learning objectives of medical arthropodology evaluated in English and Korean queries in December 2023: a descriptive study
Hyunju Lee, Soobin Park
Journal of Educational Evaluation for Health Professions.2023; 20: 39. CrossRef

Medical students’ patterns of using ChatGPT as a feedback tool and perceptions of ChatGPT in a Leadership and Communication course in Korea: a cross-sectional study: Janghee Park; J Educ Eval Health Prof. 2023;20:29. Published online November 10, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.29

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136 Download
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Abstract PDF Supplementary Material

Purpose
This study aimed to analyze patterns of using ChatGPT before and after group activities and to explore medical students’ perceptions of ChatGPT as a feedback tool in the classroom.
Methods
The study included 99 2nd-year pre-medical students who participated in a “Leadership and Communication” course from March to June 2023. Students engaged in both individual and group activities related to negotiation strategies. ChatGPT was used to provide feedback on their solutions. A survey was administered to assess students’ perceptions of ChatGPT’s feedback, its use in the classroom, and the strengths and challenges of ChatGPT from May 17 to 19, 2023.
Results
The students responded by indicating that ChatGPT’s feedback was helpful, and revised and resubmitted their group answers in various ways after receiving feedback. The majority of respondents expressed agreement with the use of ChatGPT during class. The most common response concerning the appropriate context of using ChatGPT’s feedback was “after the first round of discussion, for revisions.” There was a significant difference in satisfaction with ChatGPT’s feedback, including correctness, usefulness, and ethics, depending on whether or not ChatGPT was used during class, but there was no significant difference according to gender or whether students had previous experience with ChatGPT. The strongest advantages were “providing answers to questions” and “summarizing information,” and the worst disadvantage was “producing information without supporting evidence.”
Conclusion
The students were aware of the advantages and disadvantages of ChatGPT, and they had a positive attitude toward using ChatGPT in the classroom.

Citations

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Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review
Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef
Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students
Yijun Wu, Yue Zheng, Baijie Feng, Yuqi Yang, Kai Kang, Ailin Zhao
JMIR Medical Education.2024; 10: e52483. CrossRef
ChatGPT and Clinical Training: Perception, Concerns, and Practice of Pharm-D Students
Mohammed Zawiah, Fahmi Al-Ashwal, Lobna Gharaibeh, Rana Abu Farha, Karem Alzoubi, Khawla Abu Hammour, Qutaiba A Qasim, Fahd Abrah
Journal of Multidisciplinary Healthcare.2023; Volume 16: 4099. CrossRef
Information amount, accuracy, and relevance of generative artificial intelligence platforms’ answers regarding learning objectives of medical arthropodology evaluated in English and Korean queries in December 2023: a descriptive study
Hyunju Lee, Soobin Park
Journal of Educational Evaluation for Health Professions.2023; 20: 39. CrossRef

Efficacy and limitations of ChatGPT as a biostatistical problem-solving tool in medical education in Serbia: a descriptive study: Aleksandra Ignjatović, Lazar Stevanović; J Educ Eval Health Prof. 2023;20:28. Published online October 16, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.28

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Abstract PDF Supplementary Material

Purpose
This study aimed to assess the performance of ChatGPT (GPT-3.5 and GPT-4) as a study tool in solving biostatistical problems and to identify any potential drawbacks that might arise from using ChatGPT in medical education, particularly in solving practical biostatistical problems.
Methods
ChatGPT was tested to evaluate its ability to solve biostatistical problems from the Handbook of Medical Statistics by Peacock and Peacock in this descriptive study. Tables from the problems were transformed into textual questions. Ten biostatistical problems were randomly chosen and used as text-based input for conversation with ChatGPT (versions 3.5 and 4).
Results
GPT-3.5 solved 5 practical problems in the first attempt, related to categorical data, cross-sectional study, measuring reliability, probability properties, and the t-test. GPT-3.5 failed to provide correct answers regarding analysis of variance, the chi-square test, and sample size within 3 attempts. GPT-4 also solved a task related to the confidence interval in the first attempt and solved all questions within 3 attempts, with precise guidance and monitoring.
Conclusion
The assessment of both versions of ChatGPT performance in 10 biostatistical problems revealed that GPT-3.5 and 4’s performance was below average, with correct response rates of 5 and 6 out of 10 on the first attempt. GPT-4 succeeded in providing all correct answers within 3 attempts. These findings indicate that students must be aware that this tool, even when providing and calculating different statistical analyses, can be wrong, and they should be aware of ChatGPT’s limitations and be careful when incorporating this model into medical education.

Citations

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Can Generative AI and ChatGPT Outperform Humans on Cognitive-Demanding Problem-Solving Tasks in Science?
Xiaoming Zhai, Matthew Nyaaba, Wenchao Ma
Science & Education.2024;[Epub] CrossRef

Brief report

Comparing ChatGPT’s ability to rate the degree of stereotypes and the consistency of stereotype attribution with those of medical students in New Zealand in developing a similarity rating test: a methodological study: Chao-Cheng Lin, Zaine Akuhata-Huntington, Che-Wei Hsu; J Educ Eval Health Prof. 2023;20:17. Published online June 12, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.17

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Abstract PDF Supplementary Material

Learning about one’s implicit bias is crucial for improving one’s cultural competency and thereby reducing health inequity. To evaluate bias among medical students following a previously developed cultural training program targeting New Zealand Māori, we developed a text-based, self-evaluation tool called the Similarity Rating Test (SRT). The development process of the SRT was resource-intensive, limiting its generalizability and applicability. Here, we explored the potential of ChatGPT, an automated chatbot, to assist in the development process of the SRT by comparing ChatGPT’s and students’ evaluations of the SRT. Despite results showing non-significant equivalence and difference between ChatGPT’s and students’ ratings, ChatGPT’s ratings were more consistent than students’ ratings. The consistency rate was higher for non-stereotypical than for stereotypical statements, regardless of rater type. Further studies are warranted to validate ChatGPT’s potential for assisting in SRT development for implementation in medical education and evaluation of ethnic stereotypes and related topics.

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Efficacy and limitations of ChatGPT as a biostatistical problem-solving tool in medical education in Serbia: a descriptive study
Aleksandra Ignjatović, Lazar Stevanović
Journal of Educational Evaluation for Health Professions.2023; 20: 28. CrossRef

Review

Can an artificial intelligence chatbot be the author of a scholarly article?: Ju Yoen Lee; J Educ Eval Health Prof. 2023;20:6. Published online February 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.6

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Abstract PDF Supplementary Material

At the end of 2022, the appearance of ChatGPT, an artificial intelligence (AI) chatbot with amazing writing ability, caused a great sensation in academia. The chatbot turned out to be very capable, but also capable of deception, and the news broke that several researchers had listed the chatbot (including its earlier version) as co-authors of their academic papers. In response, Nature and Science expressed their position that this chatbot cannot be listed as an author in the papers they publish. Since an AI chatbot is not a human being, in the current legal system, the text automatically generated by an AI chatbot cannot be a copyrighted work; thus, an AI chatbot cannot be an author of a copyrighted work. Current AI chatbots such as ChatGPT are much more advanced than search engines in that they produce original text, but they still remain at the level of a search engine in that they cannot take responsibility for their writing. For this reason, they also cannot be authors from the perspective of research ethics.

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Brief report

Are ChatGPT’s knowledge and interpretation ability comparable to those of medical students in Korea for taking a parasitology examination?: a descriptive study: Sun Huh; J Educ Eval Health Prof. 2023;20:1. Published online January 11, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.1

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Abstract PDF Supplementary Material

This study aimed to compare the knowledge and interpretation ability of ChatGPT, a language model of artificial general intelligence, with those of medical students in Korea by administering a parasitology examination to both ChatGPT and medical students. The examination consisted of 79 items and was administered to ChatGPT on January 1, 2023. The examination results were analyzed in terms of ChatGPT’s overall performance score, its correct answer rate by the items’ knowledge level, and the acceptability of its explanations of the items. ChatGPT’s performance was lower than that of the medical students, and ChatGPT’s correct answer rate was not related to the items’ knowledge level. However, there was a relationship between acceptable explanations and correct answers. In conclusion, ChatGPT’s knowledge and interpretation ability for this parasitology examination were not yet comparable to those of medical students in Korea.

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Review

What should medical students know about artificial intelligence in medicine?: Seong Ho Park, Kyung-Hyun Do, Sungwon Kim, Joo Hyun Park, Young-Suk Lim; J Educ Eval Health Prof. 2019;16:18. Published online July 3, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.18

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Abstract PDF Supplementary Material

Artificial intelligence (AI) is expected to affect various fields of medicine substantially and has the potential to improve many aspects of healthcare. However, AI has been creating much hype, too. In applying AI technology to patients, medical professionals should be able to resolve any anxiety, confusion, and questions that patients and the public may have. Also, they are responsible for ensuring that AI becomes a technology beneficial for patient care. These make the acquisition of sound knowledge and experience about AI a task of high importance for medical students. Preparing for AI does not merely mean learning information technology such as computer programming. One should acquire sufficient knowledge of basic and clinical medicines, data science, biostatistics, and evidence-based medicine. As a medical student, one should not passively accept stories related to AI in medicine in the media and on the Internet. Medical students should try to develop abilities to distinguish correct information from hype and spin and even capabilities to create thoroughly validated, trustworthy information for patients and the public.

Citations

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Research article

An expert-led and artificial intelligence system-assisted tutoring course to improve the confidence of Chinese medical interns in suturing and ligature skills: a prospective pilot study: Ying-Ying Yang, Boaz Shulruf; J Educ Eval Health Prof. 2019;16:7. Published online April 10, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.7

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12 Web of Science
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Abstract PDF Supplementary Material

Purpose
Lack of confidence in suturing/ligature skills due to insufficient practice and assessments is common among novice Chinese medical interns. This study aimed to improve the skill acquisition of medical interns through a new intervention program.
Methods
In addition to regular clinical training, expert-led or expert-led plus artificial intelligence (AI) system tutoring courses were implemented during the first 2 weeks of the surgical block. Interns could voluntarily join the regular (no additional tutoring), expert-led tutoring, or expert-led+AI tutoring groups freely. In the regular group, interns (n=25) did not receive additional tutoring. The expert-led group received 3-hour expert-led tutoring and in-training formative assessments after 2 practice sessions. After a similar expert-led course, the expert-led+AI group (n=23) practiced and assessed their skills on an AI system. Through a comparison with the internal standard, the system automatically recorded and evaluated every intern’s suturing/ligature skills. In the expert-led+AI group, performance and confidence were compared between interns who participated in 1, 2, or 3 AI practice sessions.
Results
The end-of-surgical block objective structured clinical examination (OSCE) performance and self-assessed confidence in suturing/ligature skills were highest in the expert-led+AI group. In comparison with the expert-led group, the expert-led+AI group showed similar performance in the in-training assessment and greater improvement in the end-of-surgical block OSCE. In the expert-led+AI group, the best performance and highest post-OSCE confidence were noted in those who engaged in 3 AI practice sessions.
Conclusion
This pilot study demonstrated the potential value of incorporating an additional expert-led+AI system–assisted tutoring course into the regular surgical curriculum.

Citations

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