Which curriculum components do medical students find most helpful for evaluating AI outputs?

Recent breakthroughs in artificial intelligence (AI) research include advancements in natural language processing (NLP) achieved by large language models (LLMs), and; in particular, generative pre–trained transformer (GPT) architectures. The latest GPT developed by OpenAI, GPT–4, has shown remarkable intelligence across various domains and tasks. It exhibits capabilities in abstraction, comprehension, vision, computer coding, mathematics, and more, suggesting it to be a significant step towards artificial general intelligence (AGI), a level of AI that possesses capabilities similar to human intelligence. This paper explores this AGI, its knowledge diffusive and societal influences, and its governance. In addition to coverage of the major associated topics studied in the literature, and making up for their loopholes, we scrutinize how GPT-4 can facilitate the diffusion of knowledge across different areas of science by promoting their interpretability and explainability (IE) to inexperts. Where applicable, the topics are also accompanied by their specific potential implications on medical imaging.

Evaluating gpt-4 for zero-shot classification of bleeding and clotting events: Can large language models serve as second reviewers?

Problem definition: Large language models (LLMs) are being increasingly leveraged in business and consumer decision-making processes. Because LLMs learn from human data and feedback, which can be biased, determining whether LLMs exhibit human-like behavioral decision biases (e.g., base-rate neglect, risk aversion, confirmation bias, etc.) is crucial prior to implementing LLMs into decision-making contexts and workflows. To understand this, we examine 18 common human biases that are important in operations management (OM) using the dominant LLM, ChatGPT. Methodology/results: We perform experiments where GPT-3.5 and GPT-4 act as participants to test these biases using vignettes adapted from the literature (“standard context”) and variants reframed in inventory and general OM contexts. In almost half of the experiments, Generative Pre-trained Transformer (GPT) mirrors human biases, diverging from prototypical human responses in the remaining experiments. We also observe that GPT models have a notable level of consistency between the standard and OM-specific experiments as well as across temporal versions of the GPT-3.5 model. Our comparative analysis between GPT-3.5 and GPT-4 reveals a dual-edged progression of GPT’s decision making, wherein GPT-4 advances in decision-making accuracy for problems with well-defined mathematical solutions while simultaneously displaying increased behavioral biases for preference-based problems. Managerial implications: First, our results highlight that managers will obtain the greatest benefits from deploying GPT to workflows leveraging established formulas. Second, that GPT displayed a high level of response consistency across the standard, inventory, and non-inventory operational contexts provides optimism that LLMs can offer reliable support even when details of the decision and problem contexts change. Third, although selecting between models, like GPT-3.5 and GPT-4, represents a trade-off in cost and performance, our results suggest that managers should invest in higher-performing models, particularly for solving problems with objective solutions. Funding: This work was supported by the Social Sciences and Humanities Research Council of Canada [Grant SSHRC 430-2019-00505]. The authors also gratefully acknowledge the Smith School of Business at Queen’s University for providing funding to support Y. Chen’s postdoctoral appointment. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0279 .

BackgroundIn recent years, generative artificial intelligence and large language models (LLMs) have rapidly advanced, offering significant potential to transform medical education. Several studies have evaluated the performance of chatbots on multiple-choice medical examinations.ObjectiveThe study aims to assess the performance of two LLMs—GPT-4o and OpenAI o1—on the Médico Interno Residente (MIR) 2024 examination, the Spanish national medical test that determines eligibility for competitive medical specialist training positions.MethodsA total of 176 questions from the MIR 2024 examination were analyzed. Each question was presented individually to the chatbots to ensure independence and prevent memory retention bias. No additional prompts were introduced to minimize potential bias. For each LLM, response consistency under verification prompting was assessed by systematically asking, “Are you sure?” after each response. Accuracy was defined as the percentage of correct responses compared to the official answers provided by the Spanish Ministry of Health. It was assessed for GPT-4o, OpenAI o1, and, as a benchmark, for a consensus of medical specialists and for the average MIR candidate. Subanalyses included performance across different medical subjects, question difficulty (quintiles based on the percentage of examinees correctly answering each question), and question types (clinical cases vs theoretical questions; positive vs negative questions).ResultsOverall accuracy was 89.8% (158/176) for GPT-4o and 90% (160/176) after verification prompting, 92.6% (163/176) for OpenAI o1 and 93.2% (164/176) after verification prompting, 94.3% (166/176) for the consensus of medical specialists, and 56.6% (100/176) for the average MIR candidate. Both LLMs and the consensus of medical specialists outperformed the average MIR candidate across all 20 medical subjects analyzed, with ≥80% LLMs’ accuracy in most domains. A performance gradient was observed: LLMs’ accuracy gradually declined as question difficulty increased. Slightly higher accuracy was observed for clinical cases compared to theoretical questions, as well as for positive questions compared to negative ones. Both models demonstrated high response consistency, with near-perfect agreement between initial responses and those after the verification prompting.ConclusionsThese findings highlight the excellent performance of GPT-4o and OpenAI o1 on the MIR 2024 examination, demonstrating consistent accuracy across medical subjects and question types. The integration of LLMs into medical education presents promising opportunities and is likely to reshape how students prepare for licensing examinations and change our understanding of medical education. Further research should explore how the wording, language, prompting techniques, and image-based questions can influence LLMs’ accuracy, as well as evaluate the performance of emerging artificial intelligence models in similar assessments.

The introduction of large language models (LLMs), such as Generative Pre-trained Transformer 4 (GPT-4; OpenAI), has generated significant interest in health care, yet studies evaluating their performance in a clinical setting are lacking. Determination of clinical acuity, a measure of a patient's illness severity and level of required medical attention, is one of the foundational elements of medical reasoning in emergency medicine. To determine whether an LLM can accurately assess clinical acuity in the emergency department (ED). This cross-sectional study identified all adult ED visits from January 1, 2012, to January 17, 2023, at the University of California, San Francisco, with a documented Emergency Severity Index (ESI) acuity level (immediate, emergent, urgent, less urgent, or nonurgent) and with a corresponding ED physician note. A sample of 10 000 pairs of ED visits with nonequivalent ESI scores, balanced for each of the 10 possible pairs of 5 ESI scores, was selected at random. The potential of the LLM to classify acuity levels of patients in the ED based on the ESI across 10 000 patient pairs. Using deidentified clinical text, the LLM was queried to identify the patient with a higher-acuity presentation within each pair based on the patients' clinical history. An earlier LLM was queried to allow comparison with this model. Accuracy score was calculated to evaluate the performance of both LLMs across the 10 000-pair sample. A 500-pair subsample was manually classified by a physician reviewer to compare performance between the LLMs and human classification. From a total of 251 401 adult ED visits, a balanced sample of 10 000 patient pairs was created wherein each pair comprised patients with disparate ESI acuity scores. Across this sample, the LLM correctly inferred the patient with higher acuity for 8940 of 10 000 pairs (accuracy, 0.89 [95% CI, 0.89-0.90]). Performance of the comparator LLM (accuracy, 0.84 [95% CI, 0.83-0.84]) was below that of its successor. Among the 500-pair subsample that was also manually classified, LLM performance (accuracy, 0.88 [95% CI, 0.86-0.91]) was comparable with that of the physician reviewer (accuracy, 0.86 [95% CI, 0.83-0.89]). In this cross-sectional study of 10 000 pairs of ED visits, the LLM accurately identified the patient with higher acuity when given pairs of presenting histories extracted from patients' first ED documentation. These findings suggest that the integration of an LLM into ED workflows could enhance triage processes while maintaining triage quality and warrants further investigation.

e13630 Background: As many as 60% of prior authorization requests are denied, yet coverage approval occurs for more than 60% of appeals for some therapies. Appeal processes encumber providers and increase burnout, but large language models (LLMs) may aid providers by drafting appeal letters. We evaluated LLM performance at this task for radiotherapy denials. Methods: Three commercially accessible LLMs were evaluated: generative pre-trained transformer 3.5 (GPT3.5), GPT4, and GPT4+web with internet search capacity (OpenAI, Inc., San Francisco, CA). A fourth LLM, GPT3.5-FT, was developed by fine-tuning GPT3.5 in a HIPAA-complaint local environment. The fine-tuning training data comprised 53 insurance denial appeal letters prepared by radiation oncologists and paired prompts describing the clinical history and appeal intent. Training data were enriched in appeal letters for proton radiotherapy, stereotactic body radiotherapy, and image-guided radiotherapy for myriad clinical scenarios. Twenty prompts, each requesting a letter for a simulated patient history, were programmatically presented to the LLMs. Three radiation oncologists, who were blinded to the LLM source, scored letter outputs across four domains: language syntax and semantics, clinical detail inclusion, clinical reasoning validity, and overall readiness for insurer submission. Additionally, one radiation oncologist scored the authenticity and relevance of literature sources cited in output letters, which were requested by several test prompts. Interobserver agreement between radiation oncologist scores was determined by Cohen’s kappa coefficient. Scores were compared between LLMs with non-parametric statistical tests. Results: Agreement between radiation oncologists’ scores was moderate-to-excellent across all domains (median κ = 0.68, minimum κ = 0.41). GPT3.5, GPT4, and GPT4+web drafted letters that, by mode average, were semantically and syntactically clear, included all provided clinical history without confabulation, clinically reasoned with few necessary revisions, and overall were submissible to an insurer with minor revisions. GPT4 and GPT4+web clinically reasoned better than GPT3.5 (p values < 0.001). In contrast, GPT3.5-FT performance was inferior to other LLMs across all domains (p values < 0.001). LLMs were poor at identifying, citing, and summarizing relevant literature unless provided in the prompt. Conclusions: LLMs can draft insurance appeal letters for radiotherapy services that require few revisions yet are poor at referencing relevant literature. Contrary to our hypothesis, fine-tuning with data from our department compromised LLM performance.

BackgroundThe integration of artificial intelligence (AI) in medical education is evolving, offering new tools to enhance teaching and assessment. Among these, script concordance tests (SCTs) are well-suited to evaluate clinical reasoning in contexts of uncertainty. Traditionally, SCTs require expert panels for scoring and feedback, which can be resource-intensive. Recent advances in generative AI, particularly large language models (LLMs), suggest the possibility of replacing human experts with simulated ones, though this potential remains underexplored.ObjectiveThis study aimed to evaluate whether LLMs can effectively simulate expert judgment in SCTs by using generative AI to author, score, and provide feedback for SCTs in cardiology and pneumology. A secondary objective was to assess students’ perceptions of the test’s difficulty and the pedagogical value of AI-generated feedback.MethodsA cross-sectional, mixed methods study was conducted with 25 second-year medical students who completed a 32-item SCT authored by ChatGPT-4o (OpenAI). Six LLMs (3 trained on the course material and 3 untrained) served as simulated experts to generate scoring keys and feedback. Students answered SCT questions, rated perceived difficulty, and selected the most helpful feedback explanation for each item. Quantitative analysis included scoring, difficulty ratings, and correlations between student and AI responses. Qualitative comments were thematically analyzed.ResultsThe average student score was 22.8 out of 32 (SD 1.6), with scores ranging from 19.75 to 26.75. Trained AI systems showed significantly higher concordance with student responses (ρ=0.64) than untrained models (ρ=0.41). AI-generated feedback was rated as most helpful in 62.5% of cases, especially when provided by trained models. The SCT demonstrated good internal consistency (Cronbach α=0.76), and students reported moderate perceived difficulty (mean 3.7, SD 1.1). Qualitative feedback highlighted appreciation for SCTs as reflective tools, while recommending clearer guidance on Likert-scale use and more contextual detail in vignettes.ConclusionsThis is among the first studies to demonstrate that trained generative AI models can reliably simulate expert clinical reasoning within a script-concordance framework. The findings suggest that AI can both streamline SCT design and offer educationally valuable feedback without compromising authenticity. Future studies should explore longitudinal effects on learning and assess how hybrid models (human and AI) can optimize reasoning instruction in medical education.

PurposeLarge language models (LLMs) like Generative Pre-trained Transformer 4 (GPT-4) can assist in detecting errors in radiology reports, but privacy concerns limit their clinical applicability. This study compares closed-source and privacy-compliant open-source LLMs for detecting common errors in radiology reports.Materials and methodsA total of 120 radiology reports were compiled (30 each from X-ray, ultrasound, CT, and MRI). Subsequently, 397 errors from five categories (typographical, numerical, findings-impression discrepancies, omission/insertion, interpretation) were inserted into 100 of these reports; 20 reports were left unchanged. Two open-source models (Llama 3-70b, Mixtral 8x22b) and two commercial closed-source (GPT-4, GPT-4o) were tasked with error detection using identical prompts. The Kruskall–Wallis test and paired t-test were used for statistical analysis.ResultsOpen-source LLMs required less processing time per radiology report than closed-source LLMs (6 ± 2 s vs. 13 ± 4 s; p < 0.001). Closed-source LLMs achieved higher error detection rates than open-source LLMs (GPT-4o: 88% [348/397; 95% CI: 86, 92], GPT-4: 83% [328/397; 95% CI: 80, 87], Llama 3-70b: 79% [311/397; 95% CI: 76, 83], Mixtral 8x22b: 73% [288/397; 95% CI: 68, 77]; p < 0.001). Numerical errors (88% [67/76; 95% CI: 82, 93]) were detected significantly more often than typographical errors (75% [65/86; 95% CI: 68, 82]; p = 0.02), discrepancies between findings and impression (73% [73/101; 95% CI: 67, 80]; p < 0.01), and interpretation errors (70% [50/71; 95% CI: 62, 78]; p = 0.001).ConclusionOpen-source LLMs demonstrated effective error detection, albeit with comparatively lower accuracy than commercial closed-source models, and have potential for clinical applications when deployed via privacy-compliant local hosting solutions.Key PointsQuestionCan privacy-compliant open-source large language models (LLMs) match the error-detection performance of commercial non-privacy-compliant closed-source models in radiology reports?FindingsClosed-source LLMs achieved slightly higher accuracy in detecting radiology report errors than open-source models, with Llama 3-70b yielding the best results among the open-source models.Clinical relevanceOpen-source LLMs offer a privacy-compliant alternative for automated error detection in radiology reports, improving clinical workflow efficiency while ensuring patient data confidentiality. Further refinement could enhance their accuracy, contributing to better diagnosis and patient care.Graphical

Brief hospital course (BHC) summaries are clinical documents that summarize a patient's hospital stay. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as synthesizing BHCs from clinical notes have not been shown. We introduce a novel preprocessed dataset, the MIMIC-IV-BHC, encapsulating clinical note and BHC pairs to adapt LLMs for BHC synthesis. Furthermore, we introduce a benchmark of the summarization performance of 2 general-purpose LLMs and 3 healthcare-adapted LLMs. Using clinical notes as input, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to 3 open-source LLMs (Clinical-T5-Large, Llama2-13B, and FLAN-UL2) and 2 proprietary LLMs (Generative Pre-trained Transformer [GPT]-3.5 and GPT-4). We evaluate these LLMs across multiple context-length inputs using natural language similarity metrics. We further conduct a clinical study with 5 clinicians, comparing clinician-written and LLM-generated BHCs across 30 samples, focusing on their potential to enhance clinical decision-making through improved summary quality. We compare reader preferences for the original and LLM-generated summary using Wilcoxon signed-rank tests. We further request optional qualitative feedback from clinicians to gain deeper insights into their preferences, and we present the frequency of common themes arising from these comments. The Llama2-13B fine-tuned LLM outperforms other domain-adapted models given quantitative evaluation metrics of Bilingual Evaluation Understudy (BLEU) and Bidirectional Encoder Representations from Transformers (BERT)-Score. GPT-4 with in-context learning shows more robustness to increasing context lengths of clinical note inputs than fine-tuned Llama2-13B. Despite comparable quantitative metrics, the reader study depicts a significant preference for summaries generated by GPT-4 with in-context learning compared to both Llama2-13B fine-tuned summaries and the original summaries (P<.001), highlighting the need for qualitative clinical evaluation. We release a foundational clinically relevant dataset, the MIMIC-IV-BHC, and present an open-source benchmark of LLM performance in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. Our research effectively integrates elements from the data assimilation pipeline: our methods use (1) clinical data sources to integrate, (2) data translation, and (3) knowledge creation, while our evaluation strategy paves the way for (4) deployment.

Background: Generative Artificial Intelligence (AI), particularly large language models like ChatGPT, has rapidly entered medical education. In pharmacology instruction within MBBS programs, these AI tools offer novel educational benefitsfrom ondemand tutoring to personalized learningbut also pose risks due to "hallucinations, " i. e., AI -generated misinformation. Objective: This review explores how generative AI is being integrated into pharmacology education, the educational advantages it provides, the nature and causes of AI hallucinations, and the potential risks of relying on inaccurate AI -generated content in medical learning. Mitigation strategies, best practices, case examples, ethical considerations, and future directions are discussed to inform balanced and safe use. Methods: A literature review was conducted focusing on recent (2020-2025) peer -reviewed sources and authoritative reports on generative AI in medical and pharmacology education. Results: Generative AI can enhance pharmacology education through adaptive learning, rapid information access, and interactive simulations, which students have found useful for studying and clinical preparation. However, AI hallucinationsplausible -sounding yet incorrect answersare common, with studies reporting a substantial fraction of AI -generated medical responses containing errors. These inaccuracies can mislead learners and threaten patient safety if not recognized. Strategies such as careful validation of AI -provided information, AI literacy training, and technical approaches (e. g. retrieval -augmented generation) are identified to mitigate risks. Conclusions: Generative AI holds significant promise in medical pharmacology education by augmenting learning and engagement. Yet, educators and students must remain vigilant about AI hallucinations. A balanced approachleveraging AI's benefits while implementing safeguards and ethical guidelinesis essential to ensure that AI becomes a reliable adjunct in pharmacology education rather than a source of misinformation. Ongoing research, policy development, and training are needed to fully realize generative AI's potential in medical education while minimizing its risks.

BackgroundThe exponential growth of medical knowledge presents a paradox for modern medical education. While access to information is immediate, applying it in a clinically meaningful way remains a challenge. Large language models (LLMs), such as ChatGPT, are widely used for information retrieval, yet their role in dynamic, high-pressure clinical learning remains poorly understood.ObjectiveThis study aims to evaluate whether unstructured access to an LLM improves decision-making, teamwork, and confidence in trauma education for medical students.MethodsThis randomized controlled pilot study involved 41 final-year medical students participating in a trauma simulation session. Students self-selected into teams of 4 to 6 and were randomized to either an LLM-assisted group (ChatGPT-4o mini) or a control group without LLM access. All teams completed 18 video-based trauma scenarios requiring time-sensitive clinical decisions. Prompting was unrestricted. Confidence and trauma exposure were assessed using pre- or postquestionnaires. Facilitators rated teamwork (1-5), decision accuracy, and response times. Knowledge retention was measured 4 weeks later via an online quiz.ResultsConfidence in trauma management improved in both groups (P<.001), with larger gains in the non-LLM group (P=.02). LLM support did not enhance the decision accuracy or speed and was associated with longer response times in some complex cases. Teams without LLMs demonstrated more active discussion and scored higher in teamwork ratings (median 5.0 [IQR 5.0-5.0] vs median 3.5 [IQR 3.0-4.5]; P=.08). Students primarily used the LLM for fact-checking but reported vague or overly general responses. Knowledge retention was high across both groups and did not differ significantly (P=.33).ConclusionsWhile students appreciated the inclusion of artificial intelligence (AI), unstructured LLM use did not improve performance and may have disrupted the group reasoning. The use of non-English prompting likely contributed to lower AI performance, underscoring the importance of language alignment in LLM applications. This pilot study highlights the need for structured AI integration and targeted instruction in AI literacy. Simulation-based trauma education proved effective and well received, but optimizing the educational value of LLMs will require thoughtful curricular design. Further studies with more students are needed to define best practices for LLM use in clinical education.

As generative artificial intelligence (AI) tools and large language models (LLMs)-powered applications develop rapidly in the era of algorithms, it should be integrated thoughtfully to enhance English as a Foreign Language (EFL) teaching and learning without replacing learners’ critical thinking (CT). This study systematically analyzes the impact of generative AI tools and LLMs on language learners’ CT in EFL education using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to identify, evaluate, and synthesize relevant studies from 2022 to 2025. A thorough review of 15 selected studies focuses on generative AI tools and LLMs’ dual nature, research methods, main focuses, theory and models, limitations and challenges, and future directions in the field based on Web of Science (WoS), SCOPUS, ERIC, ProQuest, and Google Scholar. The findings identified generative AI tools and LLMs possessed both the potential to nurture and the risk of hindering CT in EFL education. 66.67% of studies reported generative AI tools and LLMs’ positive role in CT, while 33.33% of studies reported its negative role in CT. Furthermore, 3 types of research methods, 3 key themes of research focus, and 4 groups of theoretical perspectives were examined. However, 4 kinds of limitations in this field remain, including research scope, user dependency, generative AI reliability, and pedagogical integration. Future research can focus on assessing long-term effects, broadening research scope, promoting responsible AI use, and refining pedagogical strategies. Finally, Limitations, implications and future direction of this study were discussed.

The remarkable achievements of ChatGPT and Generative Pre-trained Transformer 4 (GPT-4) have sparked a wave of interest and research in the field of large language models (LLMs) for artificial general intelligence (AGI). These models provide intelligent solutions that are closer to human thinking, enabling us to use general artificial intelligence (AI) to solve problems in various applications. However, in the field of remote sensing (RS), the scientific literature on the implementation of AGI remains relatively scant. Existing AI-related research in RS focuses primarily on visual-understanding tasks while neglecting the semantic understanding of the objects and their relationships. This is where vision-LMs (VLMs) excel as they enable reasoning about images and their associated textual descriptions, allowing for a deeper understanding of the underlying semantics. VLMs can go beyond visual recognition of RS images and can model semantic relationships as well as generate natural language descriptions of the image. This makes them better suited for tasks that require both visual and textual understanding, such as image captioning and visual question answering (VQA). This article provides a comprehensive review of the research on VLMs in RS, summarizing the latest progress, highlighting current challenges, and identifying potential research opportunities. Specifically, we review the application of VLMs in mainstream RS tasks, including image captioning, text-based image generation, text-based image retrieval (TBIR), VQA, scene classification, semantic segmentation, and object detection. For each task, we analyze representative works and discuss research progress. Finally, we summarize the limitations of existing works and provide possible directions for future development. This review aims to provide a comprehensive overview of the current research progress of VLMs in RS (see Figure 1), and to inspire further research in this exciting and promising field.

Recent years have witnessed notable progress in Language Model (LM) technology, especially with the introduction of Large Language Models (LLMs). With the use of complex neural networks and enormous volumes of data, these models—like the GPT (Generative Pre-trained Transformer) series—have completely changed the field of natural language processing. This study offers a thorough analysis of LLMs, examining their uses as well as the difficulties and moral issues that come with implementing LLMs in practical settings. Moreover, it investigates the wide range of uses of LLMs in many fields, such as question answering, drug discovery, language translation, and text production. By means of this review, we hope to offer ideas on future directions in this quickly developing field as well as insights into the state-of-the-art in LLM research today. Key Words: Large Language Models, LangChain, Natural language processing, GPT, ChatGPT, AI chatbots, Indirect Prompt Injection

Large language models (LLMs) are advanced artificial intelligence (AI) tools capable of generating human-like text and are increasingly used in education, clinical care, and research. Little is known about their use within oral and maxillofacial surgery (OMFS) training. This study investigates LLM usage trends, perceived value, and educational integration among OMFS residents in the United States. A national, anonymous cross-sectional survey was distributed to OMFS residents via program directors. It gathered demographic data, LLM usage patterns, applications, perceived limitations, and attitudes toward incorporating LLMs into formal education. Eighty-one residents responded, 79.0% (64/81) reported having used an LLM, and of that group, 96.9% (62/64) use ChatGPT. 51.9% (42/81) of respondents used LLMs at least monthly in residency; however, 97.5% (79/81) reported having received no formal LLM education during residency. Residents used LLMs for clinical decision support, board preparation, research, and career planning. Free-text responses revealed a wide spectrum of views. Some advocated for curricular integration and patient education applications, while others questioned the need for formal instruction. Some respondents supported integrating LLMs into curriculums and patient education while others questioned the need for formal instruction. LLMs are used frequently by OMFS residents for a variety of purposes. As AI and LLMs become embedded in healthcare, understanding how OMFS residents interact with LLMs is vital. These findings may guide curriculum development, fostering responsible and effective use of LLMs in surgical training and practice.