Performance of Artificial Intelligence Chatbot on the Canadian Otolaryngology in-Training Exam: Unlocking Insights on the Intersection of Technology and Education

ImportanceThe performance of large language models has been compared to that of physicians.ObjectiveTo evaluate the performance of ChatGPT-4 in the field of otolaryngology and head and neck surgery (OTOHNS) residency training.DesignObservational.SettingVirtual.ParticipantsChatGPT-4.InterventionsAll questions from the OTOHNS National In-Training Exam (NITE) for 2022 and 2023 were submitted to ChatGPT-4. Answers were graded by 2 reviewers using the official grading rubric, and the average score was used. Mean exam results from residents who have taken this exam were obtained from the lead faculty.Main Outcome Measures<i>Z</i>-tests were used to compare ChatGPT-4's performance to that of residents. The questions were categorized by type (image or text), task, subspecialty, taxonomic level and prompt length.ResultsChatGPT-4 scored 66% (350/529) and 65% (243/374) on the 2022 and 2023 exams, respectively. ChatGPT-4 outperformed the residents on both exams, among all training levels and within all sub-specialties except for the general/pediatrics section of the 2023 exam (<i>Z</i>-test -2.54). For the 2022 exam, ChatGPT-4 would rank in the 99th percentile among post-graduate year (PGY)-2 and 73rd percentile among PGY-4 classmates. For the 2023 exam, it would rank in the 99th percentile among PGY-2 and 71st percentile among PGY-4 classmates. ChatGPT-4 performed best on text-based questions (74%, <i>P</i> < .001) with an effect size of 1.27 (confidence interval (CI): 0.99-1.55), level 1 taxonomic questions (75%, <i>P</i> < .001) with an effect size of 0.084 (CI: 0.03-0.14) and guideline-based questions (70%, <i>P</i> = .048) with an effect size of 0.11 (CI: 0-0.23). It had no significant difference in performance based on subspecialty (<i>P</i> = .36) or prompt length (<i>P</i> = .39).ConclusionsChatGPT-4 not only achieved passing grades on 2 versions of the Canadian OTOHNS NITE, but it also significantly outperformed residents.RelevanceThis study underscores a critical need to redesign residency assessment methods.