Evaluating GPT-4's visual interpretation and clinical reasoning on emergency settings: A 5-year analysis.

Background: The use of generative AI, particularly large language models such as GPT-4, is expanding in medical education. This study evaluated GPT-4's ability to interpret emergency medicine board exam questions, both text- and image-based, to assess its cognitive and decision-making performance in emergency settings.

Methods: An observational study was conducted using Taiwan Emergency Medicine Board Exam questions (2018-2022). GPT-4's performance was assessed in terms of accuracy and reasoning across question types. Statistical analyses examined factors influencing performance, including knowledge dimension, cognitive level, clinical vignette presence, and question polarity.

Results: GPT-4 achieved an overall accuracy of 60.1%, with similar results on text-based (60.2%) and image-based questions (59.3%). It showed perfect accuracy in identifying image types (100%) and high proficiency in interpreting findings (86.4%). However, accuracy declined in diagnostic reasoning (83.1%) and further dropped in final decision-making (59.3%). This stepwise decrease highlights GPT-4's difficulty integrating image analysis into clinical conclusions. No significant associations were found between question characteristics and AI performance.

Conclusion: GPT-4 demonstrates strong image recognition and moderate diagnostic reasoning but limited decision-making capabilities, especially when synthesizing visual and clinical data. Although promising as a training tool, its reliance on pattern recognition over clinical understanding restricts real-world applicability. Further refinement is needed before AI can reliably support emergency medical decisions.