ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Evaluation of ChatGPT-4o as a text-based clinical decision support tool for junior otolaryngology residents: A randomized controlled trial.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAn increasing number of residents use Large Language Models (LLMs) as adjunctive tools in their medical practice. This preliminary randomized controlled trial evaluated the performance of ChatGPT-4o as a text-based clinical decision support tool for first-year residents (PGY1) and compared the structure and completeness of ChatGPT-4o outputs with those of a board-certified otolaryngologist.
methodsPGY1 resident consultation outputs were randomly assigned to either ChatGPT-4o or a board-certified otolaryngologist for assessing the resident consideration of medical history, clinical presentation, and examination findings in establishing primary and differential diagnoses, management plan, and treatments. Two blinded board-certified otolaryngologists independently assessed ChatGPT-4o and otolaryngologist recommendations using the Artificial Intelligence Performance Instrument (AIPI). The Intraclass Correlation Coefficient (ICC) was used to measure interrater agreement.
resultsPatient demographics were comparable between ChatGPT-4o (n = 40) and otolaryngologist groups (n = 40). Blinded assessment revealed comparable performance between the otolaryngologist and ChatGPT-4o for evaluating PGY1 resident consideration of medical history and clinical presentation for primary diagnosis, and management plan. ChatGPT-4o achieved higher AIPI scores for documenting differential diagnosis, completeness of additional examinations, and treatment explanations than the otolaryngologist. The mean AIPI score for ChatGPT-4o was significantly higher than the otolaryngologist score (14.20 ± 2.24 versus 12.34 ± 1.91; p = 0.001). Interrater reliability was adequate (ICC = 0.699). DISCUSSION: To our knowledge, this is the first study comparing LLM-generated text-based decision-support feedback and human review for PGY1 residents. Future studies are needed to determine the role of AI as an adjunctive tool under human oversight. IMPLICATIONS FOR PRACTICE: ChatGPT-4o demonstrated comparable performance to a board-certified otolaryngologist for providing structured, text-based decision-support feedback to PGY1 residents, achieving higher performance for documenting differential diagnoses and treatment explanations reflecting greater informational completeness rather than superior clinical judgment.
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