GPT-4's performance in supporting physician decision-making in nephrology multiple-choice questions

Generative Pre-trained Transformer (GPT)-4, a versatile conversational artificial intelligence, has potential applications in medicine, but its ability to support physicians' decision-making remains unclear. We evaluated GPT-4's performance in assisting physicians with nephrology questions. Forty-five single-answer multiple-choice questions were extracted from the Core Curriculum in Nephrology articles published in the American Journal of Kidney Diseases from October 2021 to June 2023. Eight junior physicians without board certification and ten senior physicians with board certification answered these questions twice: first unaided, then with the opportunity to revise their answers based on GPT-4's outputs. GPT-4 correctly answered 77.8% of the questions. Before using GPT-4, junior physicians had a median (interquartile range) proportion of correct answers of 53.3% (48.3-53.3), senior physicians 65.6% (60.6-66.7). After GPT-4 support, the median proportion of correct answers significantly increased to 72.2% (68.3-76.1) for juniors and 75.6% (73.3-80.0) for seniors (p = 0.008, p = 0.004). The improvement was significantly higher for junior physicians (p = 0.017). However, Senior physicians showed a decreased proportion of correct answers in one of the clinical categories. GPT-4 significantly improved physicians' accuracy in nephrology, especially among less experienced physicians, but may have negative impacts in specific subfields. Careful consideration is required when using GPT-4 to support physicians' decision-making.