Accuracy Is Not Enough: Reasoning and Reference Reliability in Orthopaedic Large Language Model (LLM) Applications

GPT-5 appears to exceed previously reported LLM performance on the OITE and achieved accuracy higher than published mean scores for senior trainees, but demonstrated poor reference reliability, with one in three answers citing fabricated or misrepresented evidence. Even correct answers frequently relied on flawed or unverifiable sources. Evaluation of LLMs in medical education should incorporate systematic reasoning and evidence validation, not accuracy alone.