大型语言模型在医生推理任务上展现出超越人类的表现
Superhuman performance of a large language model on the reasoning tasks of a physician
AI总结：
本研究通过五项临床推理实验和急诊科真实世界对比，证明大型语言模型在医学诊断与管理推理上超越人类医生，实现了Ledley和Lusted的愿景，并呼吁开展前瞻性试验。
摘要：
Ledley和Lusted于1959年发表的一篇开创性论文将复杂的临床诊断推理病例确立为评估专家医疗计算系统的黄金标准，这一标准沿用至今。本文报告了由医生对大型语言模型（LLM）在具有挑战性的临床病例上进行评估的结果，并以数百名医生作为基线对照。我们开展了五项实验，分别测量鉴别诊断生成、诊断推理展示、分诊鉴别诊断、概率推理和管理推理方面的临床推理能力，所有实验均由具备经过验证的心理测量学资质的医生专家进行裁定。随后，我们报告了一项真实世界研究，在位于马萨诸塞州波士顿的一家大型三级学术医疗中心的急诊科中，对随机选择的患者比较人类专家与AI的第二诊疗意见。我们在三个预定义的诊断节点上对LLM和经委员会认证的医生进行了比较：急诊科分诊、医生初步评估以及入院或进入重症监护病房。在所有实验中——无论是病例情境还是急诊科第二诊疗意见——LLM均展现出超越人类的诊断和推理能力，并且相比前几代AI临床决策支持系统持续改进。我们的研究表明，LLM在通用医学诊断和管理推理方面已达到超越人类的表现，实现了Ledley和Lusted提出的愿景，并凸显了开展前瞻性试验的迫切需求。
英文摘要：
A seminal paper published by Ledley and Lusted in 1959 introduced complex clinical diagnostic reasoning cases as the gold standard for the evaluation of expert medical computing systems, a standard that has held ever since. Here, we report the results of a physician evaluation of a large language model (LLM) on challenging clinical cases against a baseline of hundreds of physicians. We conduct five experiments to measure clinical reasoning across differential diagnosis generation, display of diagnostic reasoning, triage differential diagnosis, probabilistic reasoning, and management reasoning, all adjudicated by physician experts with validated psychometrics. We then report a real-world study comparing human expert and AI second opinions in randomly-selected patients in the emergency room of a major tertiary academic medical center in Boston, MA. We compared LLMs and board-certified physicians at three predefined diagnostic touchpoints: triage in the emergency room, initial evaluation by a physician, and admission to the hospital or intensive care unit. In all experiments--both vignettes and emergency room second opinions--the LLM displayed superhuman diagnostic and reasoning abilities, as well as continued improvement from prior generations of AI clinical decision support. Our study suggests that LLMs have achieved superhuman performance on general medical diagnostic and management reasoning, fulfilling the vision put forth by Ledley and Lusted, and motivating the urgent need for prospective trials.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
