Agreement Between Reasoning-Oriented Generative AI Models and Clinical Educators in Evaluating Japanese Objective Structured Clinical Examination Transcripts: Preliminary Comparative Study.

Background: Medical interview training faces limitations in both implementation and evaluation. While generative artificial intelligence (GenAI) offers a potential solution, it remains unclear whether reasoning-oriented models improve evaluation, particularly for the Japanese language. Objective: We assessed scoring patterns to evaluate the agreement between reasoning-oriented GenAI model scores and clinical educator consensus ratings in Japanese medical interview training. Methods: This study was conducted at a medical university in Japan using original Japanese-language text data derived from medical interview training. Postgraduate year 1 and 2 residents were involved. Two blinded human clinical educators independently evaluated the transcripts and reached consensus through discussion. These consensus ratings were used as a practical reference standard, while preconsensus agreement was also assessed to characterize interhuman variability. Two GenAI models, GPT-5.2 Thinking (OpenAI) and Gemini 3.0 Pro (Google LLC), independently evaluated the same transcripts directly. Each GenAI model generated a single zero-shot evaluation per transcript using default settings. All evaluations used a standardized 6-domain Objective Structured Clinical Examination rubric (patient care, history taking, physical examination, accuracy and organization of clinical information, clinical reasoning, and management) scored on a 1-6 Likert scale, where 1 indicates inferior, and 6 indicates excellent. We compared mean evaluation scores using the Wilcoxon signed-rank test and assessed interrater reliability using intraclass correlation coefficients between the GenAI models and the clinical educators. Results: Clinical educators and both GenAI models rated the entire dataset of 40 transcripts by 20 included residents. Clinical educator consensus ratings yielded the highest overall mean scores (5.18, 95% CI 5.06 to 5.30). Comparatively, both GenAI models demonstrated significantly lower scores: GPT-5.2 Thinking assigned the lowest overall score (3.68, 95% CI 3.62 to 3.72; P<.001), followed by Gemini 3.0 Pro (4.09, 95% CI 3.97 to 4.21; P<.001). This discrepancy was most pronounced in the management domain, where GPT-5.2 Thinking assigned 2.93 (95% CI 2.79 to 3.06) compared with the clinical educator consensus mean score of 5.20 (95% CI 4.91 to 5.49). Agreement between the GenAI models and the clinical educator consensus ratings was poor across all domains, with overall intraclass correlation coefficients of 0.04 (95% CI 0.00 to 0.09) for GPT-5.2 Thinking and 0.22 (95% CI 0.10 to 0.35) for Gemini 3.0 Pro. Conclusions: In this preliminary, single-center, transcript-based Japanese-language study, single-run zero-shot evaluations by GPT-5.2 Thinking and Gemini 3.0 Pro showed lower scores and poor agreement with the clinical educator consensus ratings. These findings should be interpreted cautiously because multiple outputs, prompt-sensitivity analyses, local validation, and model-parameter comparisons were not performed. Under the specific conditions tested, these models should not be used as standalone evaluators for Japanese Objective Structured Clinical Examination medical interview transcripts. Whether these models can provide useful formative feedback remains a hypothesis.