Evaluation of large language models in patient education and clinical decision support for rotator cuff injury: a two-phase benchmarking study.

Objective: This study evaluates the accuracy of ChatGPT-4o, ChatGPT-o1, Gemini, and ERNIE Bot in answering rotator cuff injury questions and responding to patients. Results show Gemini excels in accuracy, while ChatGPT-4o performs better in patient interactions.

Methods: Phase 1: Four LLM chatbots answered physician test questions on rotator cuff injuries, interacting with patients and students. Their performance was assessed for accuracy and clarity across 108 multiple-choice and 20 clinical questions. Phase 2: Twenty patients questioned the top two chatbots (ChatGPT-4o, Gemini), with responses rated for satisfaction and readability. Three physicians evaluated accuracy, usefulness, safety, and completeness using a 5-point Likert scale. Statistical analyses and plotting used IBM SPSS 29.0.1.0 and Prism 10; Friedman test compared evaluation and readability scores among chatbots with Bonferroni-corrected pairwise comparisons, Mann-Whitney U test compared ChatGPT-4o versus Gemini; statistical significance at p < 0.05.

Results: Gemini achieved the highest average accuracy. In the second part, Gemini showed the highest proficiency in answering rotator cuff injury-related queries (accuracy: 4.70; completeness: 4.72; readability: 4.70; usefulness: 4.61; safety: 4.70, post hoc Dunnett test, p < 0.05). Additionally, 20 rotator cuff injury patients questioned the top two models from Phase 1 (ChatGPT-4o and Gemini). ChatGPT-4o had the highest reading difficulty score (14.22, post hoc Dunnett test, p < 0.05), suggesting a middle school reading level or above. Statistical analysis showed significant differences in patient satisfaction (4.52 vs. 3.76, p < 0.001) and readability (4.35 vs. 4.23). Orthopedic surgeons rated ChatGPT-4o higher in accuracy, completeness, readability, usefulness, and safety (all p < 0.05), outperforming Gemini in all aspects.

Conclusion: The study found that LLMs, particularly ChatGPT-4o and Gemini, excelled in understanding rotator cuff injury-related knowledge and responding to patients, showing strong potential for further development.