Large Language Models and Artificial Intelligence: A Primer for Plastic Surgeons on the Demonstrated and Potential Applications, Promises, and Limitations of ChatGPT

Abstract

Background The rapidly evolving field of artificial intelligence (AI) holds great potential for plastic surgeons. ChatGPT, a recently released AI large language model (LLM), promises application across many disciplines, including healthcare. Objectives The aim of this article is to provide a plastic surgeon’s primer on AI, LLM, and ChatGPT, including an analysis of current demonstrated and proposed clinical applications. Methods A systematic review was performed identifying medical and surgical literature on ChatGPT’s proposed clinical applications. Variables assessed included applications investigated, command tasks provided, user input information, AI-emulated human skills, output validation, and reported limitations. Results The analysis included 175 articles reporting on 13 plastic surgery applications and 116 additional clinical applications, categorized by field and purpose. Thirty-four plastic surgery applications were varied in their target audience, including attending plastic surgeons (n=17, 50%), trainees/educators (n=8, 24.0%), researchers/scholars (n=7, 21%), and patients (n=2, 6%). The 15 identified limitations of ChatGPT were categorized by training data, algorithm, and ethical considerations. Conclusions Widespread use of ChatGPT in plastic surgery will depend on rigorous research of proposed applications to validate performance and address limitations. This systemic review aims to guide research, development, and regulation to safely adopt AI in plastic surgery.

AI in Hand Surgery: Assessing Large Language Models in the Classification and Management of Hand Injuries

“…The speed at which an LLM can respond to queries becomes irrelevant if it offers incorrect and potentially harmful recommendations. Misinformation can lead to adverse patient outcomes and the erosion of trust in technology and healthcare providers [9,57,60]. As previously mentioned, we acknowledge that neither ChatGPT nor Gemini was designed specifically with medical applications in mind.…”

“…Two publicly available LLMs that have garnered recent interest are Google's Gemini [7] (built upon its predecessor Bard) and OpenAI's ChatGPT [8]. Although not designed specifically for medical purposes, these LLMs have demonstrated potential in medical decision making [9]. For example, ChatGPT achieved passing scores for both the United States Medical Licensing Examination [10] and American Society for Surgery of the Hand self-assessment exam [11], demonstrating a basic level of competence in medical 2 of 14 reasoning.…”

“…For example, ChatGPT achieved passing scores for both the United States Medical Licensing Examination [10] and American Society for Surgery of the Hand self-assessment exam [11], demonstrating a basic level of competence in medical 2 of 14 reasoning. With the potential to enhance diagnostic accuracy, informed decision making, and patient outcomes, LLMs like ChatGPT and Gemini show promise in augmenting healthcare delivery [9,12].…”

Both Patients and Plastic Surgeons Prefer Artificial Intelligence–Generated Microsurgical Information

“…A systematic review in 2023 found 13 articles reporting plastic-surgery-related applications of ChatGPT, demonstrating the emerging interest in the field of implementing this novel technology. 16 One study assessed the accuracy of ChatGPT in answering diverse medical queries. 17 Similar to our study, the generated responses were graded by physicians in terms of accuracy and comprehensiveness and found to be nearly completely correct in both categories, even in complex topics.…”

Artificial Intelligence as a Triage Tool during the Perioperative Period: Pilot Study of Accuracy and Accessibility for Clinical Application

“…[18][19][20][21] There remain appropriate concerns over the limitations of AI programs, including imperfect accuracy of generated outputs and the potential of AI programs working with out-ofdate information. [22][23][24] Although no plastic-surgery-specific AI tool has been developed, various companies have produced generative AI tools that are readily accessible by the general public. The long-term aim of this research is to determine the functionality and reliability of incorporating AI as a clinical tool to help manage patient questions and clinical concerns in the perioperative period.…”