Performance of ChatGPT Across Different Versions in Medical Licensing Examinations Worldwide: Systematic Review and Meta-Analysis
Authors: Liu Mingxin , Okuhara Tsuyoshi , Chang XinYi , Shirabe Ritsuko , Nishiie Yuriko , Okada Hiroko , Kiuchi Takahiro 
Published: June 2024

Background
Over the past 2 years, researchers have used various medical licensing examinations to test whether ChatGPT (OpenAI) possesses accurate medical knowledge. The performance of each version of ChatGPT on the medical licensing examination in multiple environments showed remarkable differences. At this stage, there is still a lack of a comprehensive understanding of the variability in ChatGPT’s performance on different medical licensing examinations.

Objective
In this study, we reviewed all studies on ChatGPT performance in medical licensing examinations up to March 2024. This review aims to contribute to the evolving discourse on artificial intelligence (AI) in medical education by providing a comprehensive analysis of the performance of ChatGPT in various environments. The insights gained from this systematic review will guide educators, policymakers, and technical experts to effectively and judiciously use AI in medical education.

Methods
We searched the literature published between January 1, 2022, and March 29, 2024, by searching query strings in Web of Science, PubMed, and Scopus. Two authors screened the literature according to the inclusion and exclusion criteria, extracted data, and independently assessed the quality of the literature concerning Quality Assessment of Diagnostic Accuracy Studies-2. We conducted both qualitative and quantitative analyses.

Results
A total of 45 studies on the performance of different versions of ChatGPT in medical licensing examinations were included in this study. GPT-4 achieved an overall accuracy rate of 81% (95% CI 78-84; P<.01), significantly surpassing the 58% (95% CI 53-63; P<.01) accuracy rate of GPT-3.5. GPT-4 passed the medical examinations in 26 of 29 cases, outperforming the average scores of medical students in 13 of 17 cases. Translating the examination questions into English improved GPT-3.5’s performance but did not affect GPT-4. GPT-3.5 showed no difference in performance between examinations from English-speaking and non–English-speaking countries (P=.72), but GPT-4 performed better on examinations from English-speaking countries significantly (P=.02). Any type of prompt could significantly improve GPT-3.5’s (P=.03) and GPT-4’s (P<.01) performance. GPT-3.5 performed better on short-text questions than on long-text questions. The difficulty of the questions affected the performance of GPT-3.5 and GPT-4. In image-based multiple-choice questions (MCQs), ChatGPT’s accuracy rate ranges from 13.1% to 100%. ChatGPT performed significantly worse on open-ended questions than on MCQs.

Conclusions
GPT-4 demonstrates considerable potential for future use in medical education. However, due to its insufficient accuracy, inconsistent performance, and the challenges posed by differing medical policies and knowledge across countries, GPT-4 is not yet suitable for use in medical education.

Trial Registration
PROSPERO CRD42024506687; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=506687