ChatGPT versus human in generating medical graduate exam questions – An international prospective study

Introduction: This is a prospective study on the quality of multiple-choice questions (MCQs) generated by the language model ChatGPT for the use in medical graduate examination. Methods: 50 MCQs were generated by ChatGPT with reference to two standard undergraduate medical textbooks (Harrison's, and Bailey & Love's). Another 50 MCQs were drafted by two university professoriate staffs using the same medical textbooks. All 100 MCQ were individually numbered, randomized and sent to five independent international assessors for MCQ quality assessment using a standardized assessment score on five assessment domains; namely, appropriateness of the question, clarity and specificity, relevance, discriminative power of alternatives, and suitability for medical graduate examination. Results: The total time required for ChatGPT to create the 50 questions was 20 minutes 25 seconds while it took two human examiners a total of 211 minutes 33 seconds for drafting the 50 questions. When a comparison of the mean score was made between the questions constructed by AI with those drafted by human, only in the relevance domain that the AI was inferior to human (AI: 7.56 +/- 0.94 vs human: 7.88 +/- 0.52; p = 0.04). There was no significant difference in question quality between questions drafted by AI versus human, in the total assessment score as well as in other domains. Questions generated by AI yielded a wider range of scores while those created by human were consistent and within a narrower range. Conclusion: ChatGPT has the potential to generate comparable-quality MCQs for medical graduate examination within a significantly shorter time. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors All data produced in the present work are contained in the manuscript