ChatGPT-4 Surpasses Residents: A Study of Artificial Intelligence Competency in Plastic Surgery In-service Examinations and Its Advancements from ChatGPT-3.5.

Background: ChatGPT, launched in 2022 and updated to Generative Pre-trained Transformer 4 (GPT-4) in 2023, is a large language model trained on extensive data, including medical information. This study compares ChatGPT's performance on Plastic Surgery In-Service Examinations with medical residents nationally as well as its earlier version, ChatGPT-3.5. Methods: This study reviewed 1500 questions from the Plastic Surgery In-service Examinations from 2018 to 2023. After excluding image-based, unscored, and inconclusive questions, 1292 were analyzed. The question stem and each multiple-choice answer was inputted verbatim into ChatGPT-4. Results: ChatGPT-4 correctly answered 961 (74.4%) of the included questions. Best performance by section was in core surgical principles (79.1% correct) and lowest in craniomaxillofacial (69.1%). ChatGPT-4 ranked between the 61st and 97th percentiles compared with all residents. Comparatively, ChatGPT-4 significantly outperformed ChatGPT-3.5 in 2018-2022 examinations (P < 0.001). Although ChatGPT-3.5 averaged 55.5% correctness, ChatGPT-4 averaged 74%, a mean difference of 18.54%. In 2021, ChatGPT-3.5 ranked in the 23rd percentile of all residents, whereas ChatGPT-4 ranked in the 97th percentile. ChatGPT-4 outperformed 80.7% of residents on average and scored above the 97th percentile among first-year residents. Its performance was comparable with sixth-year integrated residents, ranking in the 55.7th percentile, on average. These results show significant improvements in ChatGPT-4's application of medical knowledge within six months of ChatGPT-3.5's release. Conclusion: This study reveals ChatGPT-4's rapid developments, advancing from a first-year medical resident's level to surpassing independent residents and matching a sixth-year resident's proficiency.

A 1-Day-Old Girl With Infantile Hemangioma and Sternal Cleft.

CASE PRESENTATION: A newborn girl presented to the hospital on the first day of life because of respiratory failure. She was born at home at 37 weeks' gestation with minimal prenatal care and was found to be small for gestational age. The patient was found to have partial sternal agenesis and sternal cleft, cutis aplasia, left facial hemangioma, micrognathia, wide-spaced nipples, and low-set ears. The mother's and baby's urine toxicology screening were positive for amphetamines. Chest radiographs on admission showed bilateral hazy opacities. CT scan of the chest showed an absent sternum with midline chest wall concavity. The patient was monitored preoperatively in the cardiac ICU for risks of arrythmia, respiratory failure, altered cardiac output, and acute cardiopulmonary decompensation.

Implant-associated anaplastic large cell lymphoma: beyond breast prostheses.

OBJECTIVE: Anaplastic large cell lymphoma (ALCL) is a rare form of non-Hodgkin T-cell lymphoma potentially associated with silicone-shelled breast implants. The low incidence of ALCL has prevented establishment of causality. Many implantable devices are constructed with biomaterials similar to those used in breast prostheses. The purpose of this paper is to identify reports of ALCL in association with other types of implantable devices. METHODS: A literature review was conducted using PubMed to identify reports of non-Hodgkin lymphoma in association with various implantable devices. RESULTS: One case of ALCL was identified in association with a stainless steel internal fixation plate. Diffuse large B-cell lymphoma was widely reported in association with various implantable biomaterials and chronic inflammation. CONCLUSION: The neoplastic response associated with breast prostheses appears substantively different from other implantable devices. Physicians caring for patients with silicone elastomer-containing implants should have increased suspicion for implant-associated ALCL and report all pertinent cases in the literature.