Assessing the Potential of USMLE-Like Exam Questions Generated by GPT-4

Prior work has shown that large language models like GPT-4 and Med-PaLM 2 can answer sample questions from the USMLE Step 2 Clinical Knowledge (CK) exam with greater than 80% accuracy. But can these generative AI create USMLE-like exam questions? This capability could augment humans in writing or preparing for such exams. Here we assess the ability of GPT-4 to generate realistic exam questions by asking licensed physicians to (1) distinguish AI-generated questions from genuine USMLE Step 2 CK questions, and (2) assess the validity of AI-generated questions and answers. We find that GPT-4 can generate question/answer pairs that are largely indistinguishable from human-generated ones, with a majority (64%) deemed “valid” by a panel of licensed physicians. ### Competing Interest Statement Dr. Patel reports receiving equity compensation from Google LLC ### Funding Statement This work is supported by a National Science Foundation grant DMS-1916163; the Mark and Debra Leslie endowment for AI in Healthcare; the Stanford University Department of Medicine; Stanford Healthcare; the Stanford Medicine Program for AI in Healthcare; a NSF CAREER Grant (Emma Brunskill); and a Stanford Graduate Fellowship (Scott Fleming). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the funding bodies. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Stanford University waived ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the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 will be made available upon reasonable request to the authors