{"id":"https://openalex.org/W7213769965","doi":"https://doi.org/10.1186/s13018-026-07359-1","title":"Extended-reasoning mode and large language model accuracy on the Orthopaedic In-Training Examination: a paired comparison of two ChatGPT configurations","display_name":"Extended-reasoning mode and large language model accuracy on the Orthopaedic In-Training Examination: a paired comparison of two ChatGPT configurations","publication_year":2026,"publication_date":"2026-11-06","ids":{"openalex":"https://openalex.org/W7213769965","doi":"https://doi.org/10.1186/s13018-026-07359-1"},"language":"en","primary_location":{"id":"doi:10.1186/s13018-026-07359-1","doi":"https://doi.org/10.1186/s13018-026-07359-1","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07359-1","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s13018-026-07359-1","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5038725923","display_name":"Claire A. Donnelley","orcid":"https://orcid.org/0000-0001-7316-6368","observed_orcids":["https://orcid.org/0000-0001-7316-6368"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]},{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]},{"id":"https://openalex.org/I48633490","display_name":"Mass General Brigham","ror":"https://ror.org/04py2rh25","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Claire A. Donnelley","raw_affiliation_strings":["Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Mass General Brigham, Brigham and Women\u2019s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA"],"raw_orcid":"https://orcid.org/0000-0001-7316-6368","affiliations":[{"raw_affiliation_string":"Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Mass General Brigham, Brigham and Women\u2019s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA","institution_ids":["https://openalex.org/I1283280774","https://openalex.org/I136199984","https://openalex.org/I48633490"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5152310210","display_name":"Stephanie Kaszuba","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1340179700","display_name":"NewYork\u2013Presbyterian Hospital","ror":"https://ror.org/03gzbrs57","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1340179700"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Stephanie V. Kaszuba","raw_affiliation_strings":["Division of Arthroplasty Surgery, Department of Orthopaedic Surgery, New York Presbyterian Hospital, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Arthroplasty Surgery, Department of Orthopaedic Surgery, New York Presbyterian Hospital, New York, NY, USA","institution_ids":["https://openalex.org/I1340179700"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056261466","display_name":"Peter C. Noback","orcid":"https://orcid.org/0000-0002-1936-0490","observed_orcids":["https://orcid.org/0000-0002-1936-0490"]},"institutions":[{"id":"https://openalex.org/I57206974","display_name":"New York University","ror":"https://ror.org/0190ak572","country_code":"US","type":"education","lineage":["https://openalex.org/I57206974"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Peter Noback","raw_affiliation_strings":["Division of Hand Surgery, Department of Orthopaedic Surgery, New York University, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Hand Surgery, Department of Orthopaedic Surgery, New York University, New York, NY, USA","institution_ids":["https://openalex.org/I57206974"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5147504250","display_name":"Xuan Luo","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Xuan Luo","raw_affiliation_strings":["Department of Rehabilitation and Orthopaedics, Yale School of Medicine, New Haven, CT, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Rehabilitation and Orthopaedics, Yale School of Medicine, New Haven, CT, USA","institution_ids":["https://openalex.org/I32971472"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5038725923"],"corresponding_institution_ids":["https://openalex.org/I1283280774","https://openalex.org/I136199984","https://openalex.org/I48633490"],"apc_list":{"value":3090,"currency":"USD","value_usd":3090},"apc_paid":{"value":3090,"currency":"USD","value_usd":3090},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T14414","display_name":"Artificial Intelligence in Education","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/large-language-models","display_name":"large language models","score":0.8650000095367432},{"id":"https://openalex.org/keywords/chatgpt","display_name":"ChatGPT","score":0.9789999723434448},{"id":"https://openalex.org/keywords/orthopaedic-in-training-examination","display_name":"Orthopaedic In-Training Examination","score":0.9160000085830688},{"id":"https://openalex.org/keywords/orthopedic-residents","display_name":"orthopaedic residents","score":0.7020000219345093},{"id":"https://openalex.org/keywords/board-examination-preparation","display_name":"board examination preparation","score":0.7070000171661377},{"id":"https://openalex.org/keywords/llm-accuracy","display_name":"LLM accuracy","score":0.7639999985694885},{"id":"https://openalex.org/keywords/multimodal-large-language-models","display_name":"multimodal large language models","score":0.6259999871253967},{"id":"https://openalex.org/keywords/hand-surgery","display_name":"hand surgery","score":0.5339999794960022},{"id":"https://openalex.org/keywords/trauma-surgery","display_name":"trauma surgery","score":0.7789999842643738}],"concepts":[{"id":"https://openalex.org/C2780642338","wikidata":"https://www.wikidata.org/wiki/Q7632042","display_name":"Subspecialty","level":2,"score":0.7843000292778015},{"id":"https://openalex.org/C86251818","wikidata":"https://www.wikidata.org/wiki/Q816754","display_name":"Benchmarking","level":2,"score":0.6460000276565552},{"id":"https://openalex.org/C48677424","wikidata":"https://www.wikidata.org/wiki/Q6888088","display_name":"Mode (computer interface)","level":2,"score":0.5307000279426575},{"id":"https://openalex.org/C2776214188","wikidata":"https://www.wikidata.org/wiki/Q408386","display_name":"Inference","level":2,"score":0.5117999911308289},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4839000105857849},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.46720001101493835},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.4099999964237213},{"id":"https://openalex.org/C204321447","wikidata":"https://www.wikidata.org/wiki/Q30642","display_name":"Natural language processing","level":1,"score":0.3732999861240387},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.34279999136924744},{"id":"https://openalex.org/C178300618","wikidata":"https://www.wikidata.org/wiki/Q1898509","display_name":"Extant taxon","level":2,"score":0.33820000290870667},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.33730000257492065},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.3343999981880188},{"id":"https://openalex.org/C2778091340","wikidata":"https://www.wikidata.org/wiki/Q15749950","display_name":"Quality of Life Research","level":3,"score":0.3246000111103058},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.272599995136261},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.2524999976158142}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1186/s13018-026-07359-1","doi":"https://doi.org/10.1186/s13018-026-07359-1","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07359-1","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},{"id":"doi:10.21203/rs.3.rs-10788349/v1","doi":"https://doi.org/10.21203/rs.3.rs-10788349/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-10788349/v1","pdf_url":"https://www.researchsquare.com/article/rs-10788349/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.1186/s13018-026-07359-1","doi":"https://doi.org/10.1186/s13018-026-07359-1","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-026-07359-1","pdf_url":null,"source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.6240000128746033,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7213769965.pdf","grobid_xml":"https://content.openalex.org/works/W7213769965.grobid-xml"},"referenced_works_count":11,"referenced_works":["https://openalex.org/W3119050231","https://openalex.org/W4319460874","https://openalex.org/W4319662928","https://openalex.org/W4353015365","https://openalex.org/W4390521419","https://openalex.org/W4393297553","https://openalex.org/W4403032308","https://openalex.org/W4417097505","https://openalex.org/W7118190495","https://openalex.org/W7151824146","https://openalex.org/W7154598784"],"related_works":["https://openalex.org/W7151824146","https://openalex.org/W7214501069","https://openalex.org/W7118190495","https://openalex.org/W4408145305","https://openalex.org/W7203744429","https://openalex.org/W4406238710","https://openalex.org/W4417431044","https://openalex.org/W7213392544","https://openalex.org/W7154598784","https://openalex.org/W4409693306"],"abstract_inverted_index":{"Orthopaedic":[0,44,83],"surgery":[1],"residents":[2,60],"are":[3],"increasingly":[4],"using":[5,61],"large":[6],"language":[7],"models":[8],"(LLMs)":[9],"for":[10],"studying":[11],"and":[12,53,104,112,122,154,198],"board":[13],"preparation.":[14],"Extant":[15],"data":[16],"compare":[17],"LLM":[18,248],"vendors":[19],"rather":[20],"than":[21,48,244],"single-product":[22],"reasoning":[23,166,266],"settings":[24],"selected":[25],"by":[26],"users.":[27],"This":[28],"study":[29],"examines":[30],"whether":[31],"the":[32,43,55,74,92,109,115,127,143],"extended-reasoning":[33,116,158,236],"mode":[34,153],"of":[35,73,82],"ChatGPT":[36,93],"is":[37],"associated":[38,239],"with":[39,136,142,228,240],"higher":[40,242],"accuracy":[41,133,195,243],"on":[42],"In-Training":[45],"Examination":[46],"(OITE)":[47],"its":[49,245],"default":[50,110,246],"(standard)":[51,111],"configuration,":[52],"describes":[54],"failure":[56],"behavior":[57],"relevant":[58],"to":[59],"these":[62],"tools.":[63],"Cross-sectional":[64],"paired":[65],"benchmarking":[66],"study.":[67],"The":[68],"203":[69],"publicly":[70],"released":[71],"items":[72,200],"275-item":[75],"2024":[76],"OITE,":[77],"obtained":[78],"through":[79,91],"American":[80],"Academy":[81],"Surgeons":[84],"(AAOS)":[85],"ResStudy,":[86],"were":[87,120,124,182,220],"each":[88],"administered":[89],"twice":[90],"interface":[94],"(GPT-5":[95],"series;":[96],"OpenAI,":[97],"San":[98],"Francisco,":[99],"CA)":[100],"between":[101,196],"December":[102],"2025":[103],"January":[105],"2026,":[106],"once":[107,113],"in":[108,114,151,157,185,192,201,211],"(\u201cThinking\u201d)":[117],"configuration.":[118,187,247],"Prompts":[119],"identical,":[121],"responses":[123],"scored":[125],"against":[126],"official":[128],"AAOS":[129],"answer":[130],"key.":[131],"Paired":[132],"was":[134,148,189,238],"compared":[135],"McNemar\u2019s":[137],"exact":[138,145,168],"test;":[139],"subspecialty":[140],"differences":[141,181],"Fisher-Freeman-Halton":[144],"test.":[146],"Accuracy":[147],"79%":[149],"(161/203)":[150],"standard":[152],"93%":[155],"(189/203)":[156],"mode.":[159],"All":[160],"28":[161],"discordant":[162],"pairs":[163],"favored":[164],"extended":[165,255],"(McNemar\u2019s":[167],"p":[169,205],"<":[170],"0.001;":[171],"absolute":[172],"improvement":[173],"13.8":[174],"percentage":[175],"points,":[176],"95%":[177],"CI":[178],"9.0\u201318.5).":[179],"Between-subspecialty":[180],"not":[183],"significant":[184],"either":[186,202],"There":[188],"no":[190],"decline":[191],"observed":[193],"model":[194],"image-containing":[197],"text-only":[199],"configuration":[203,237],"(both":[204],"=":[206],"1.00).":[207],"Answer\u2013rationale":[208],"discordance":[209],"occurred":[210],"4/203":[212],"(2%)":[213],"items.":[214],"On":[215],"qualitative":[216],"review,":[217],"incorrect":[218],"answers":[219],"delivered":[221],"without":[222,250],"expressed":[223,251],"uncertainty,":[224],"at":[225],"times":[226],"even":[227],"citations.":[229],"In":[230],"this":[231],"single-pass":[232],"comparison,":[233],"ChatGPT\u2019s":[234],"user-selected":[235],"substantially":[241],"errors":[249],"uncertainty":[252],"persisted":[253],"under":[254],"reasoning.":[256],"LLMs":[257],"may":[258],"serve":[259],"as":[260],"supervised":[261],"adjuncts,":[262],"but":[263],"their":[264],"clinical":[265],"remains":[267],"untested.":[268]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-09-21T00:00:00"}