Utilization of ChatGPT-4 in Plastic and Reconstructive Surgery: A Narrative Review

Abstract

Background:

ChatGPT-4 (Chat Generative Pre-Trained Transformer) has demonstrated remarkable capabilities in natural language processing and understanding, making it a promising tool for various medical domains. This article presents a comprehensive overview of the potential applications of ChatGPT-4, a cutting-edge language model developed by OpenAI, in the field of plastic and reconstructive surgery.

Methods:

After conducting a thorough literature review, we discovered pertinent articles that explore the application of ChatGPT-4 in plastic surgery. By examining these findings and integrating the information with our personal experience using ChatGPT-4 in the field of plastic surgery, we have produced an all-encompassing narrative review.

Results:

The narrative review focuses on three main areas: clinical applications, research applications, and medical education. In the clinical realm, ChatGPT-4 has the potential to streamline documentation processes, improve communication, and enhance personalized patient care. It can assist in generating accurate and comprehensive progress notes, operative notes, surgical consent forms, on-call schedules, and consultation reports. However, it is important to note that ChatGPT-4 should be used as a supportive tool and should not replace human doctors.

Conclusions:

The potential applications of ChatGPT-4 in plastic and reconstructive surgery are vast and promising. This technology has the potential to revolutionize documentation, research, and medical education in the field. However, it is crucial to integrate this tool responsibly, considering its limitations and ensuring that human expertise remains paramount.

Takeaways

Question: What is the use of ChatGPT-4 in plastic and reconstructive surgery?

Findings: The narrative review focuses on three main areas: clinical applications, research applications, and medical education.

Meaning: ChatGPT-4 has a lot of exciting possibilities in plastic and reconstructive surgery. It could completely change how we document things, do research, and teach medicine in this field. However, we need to be careful and use it responsibly. We have to remember that human knowledge and skills are still very important.

INTRODUCTION

ChatGPT-4 (Chat Generative Pre-Trained Transformer) is a billions-parameter natural language processing model created by OpenAI that uses deep learning algorithms to produce human-like responses to text-based inquiries.¹ The language model has been used in educational platforms, chatbots, customer care, and other host applications.^2,3 The recent release of ChatGPT-4 has sparked heated conversations about its potential capabilities and drawbacks in the medical field, attracting medical researchers’ attention from diverse specialties.^1,4 ChatGPT-4 has potentially helped medical fields by providing a platform for medical professionals to access knowledge and information and enhance preoperative planning.⁵ In plastic surgery, ChatGPT-4 has the potential to become an essential tool in this field due to its contribution to reconstructive surgery.⁶ Recent research studies have suggested that ChatGPT-4 can be the game-changer among plastic surgeons due to its high outpatient consultation capacity,³ generation of new surgical ideas,⁷ and improvement of the reconstructive and plastic surgery research landscape.⁶ Besides, the AI language model can enhance the training of plastic surgeons by improving their Plastic Surgery In-Service Training Examination score,² enhancing their competency and efficiency during the surgical process. ChatGPT-4, the fourth iteration of the Generative Pre-trained Transformer series, marks an important milestone in the field of natural language processing and artificial intelligence.⁸ By automating the documentation process, ChatGPT-4 not only saves valuable time for physicians but also ensures that medical charts are detailed and precise.⁹ Clinical decision support is another domain where ChatGPT-4 has made significant contributions. By analyzing patient data, medical histories, and symptoms, ChatGPT-4 can offer valuable insights and recommendations to healthcare providers. This augmented intelligence helps physicians in making informed decisions about diagnosis and treatment, leading to improved patient care and outcomes.¹⁰ As the medical community continues to explore and refine the applications of ChatGPT-4, it is crucial to navigate the ethical considerations and ensure responsible and effective use of this powerful tool in healthcare settings.^11,12 The aim of this article is to explore the potential applications and benefits of ChatGPT-4, a natural language processing model developed by OpenAI, in the field of plastic surgery. It aims to discuss how ChatGPT-4 can contribute to reconstructive surgery, outpatient consultations, generation of new surgical ideas, research advancements, and the training of plastic surgeons. The article seeks to highlight the positive impact of ChatGPT-4 on the plastic surgery field and its potential to enhance patient care, surgical outcomes, and the overall efficiency of plastic surgeons.

METHODS

In this narrative review, we conducted a comprehensive search of various databases, including PubMed and Google Scholar, in May 2023. We used search terms such as “ChatGPT-4,” “artificial intelligence,” “machine learning,” “plastic surgery,” and “reconstructive surgery” to streamline our search. Following a meticulous examination by the authors, we selected 45 articles that addressed the study’s objectives. We evaluated the titles and abstracts of these articles and retrieved their full texts. Our review only included articles related to ChatGPT-4’s application in plastic and reconstructive surgery, also incorporating our own experience using ChatGPT-4 in this field. We limited our search to articles published in English and those involving human studies. The articles encompass various aspects of ChatGPT-4’s application in plastic and reconstructive surgery, such as medical education, patient education, and surgical planning. Table 1 provides a comprehensive list of prompts used for generating operative notes, surgical consent forms, and examination questions; acting as a virtual tutor; simulating procedures; creating presentation outlines; crafting personal statements; and providing patient education. These prompts were designed to focus specifically on plastic surgery topics and were used as inputs to the ChatGPT-4 model to generate the desired materials.

Table 1.

Prompts for Generating Plastic Surgery Materials Using ChatGPT-4

Material	Prompt
Operative notes	"Generate operative notes for a [specific plastic surgery procedure]."
Surgical consent form	"Create a surgical consent form for [specific plastic surgery procedure]."
Virtual tutor	"Utilize ChatGPT-4 as a virtual tutor for plastic surgery education."
Exam questions	"Generate exam questions related to plastic surgery topics."
Procedure simulation	"Simulate a plastic surgery procedure and provide step-by-step instructions."
Presentation outlines	"Generate presentation outlines on [specific plastic surgery topic]."
Personal statements	"Assist in crafting personalized personal statements for plastic surgery residency."
Patient education	"Create patient education materials for [specific plastic surgery procedure]."

Role of ChatGPT-4 in Plastic Surgery

I . Clinical Applications of ChatGPT-4

• Progress Notes and Discharge Summaries:

ChatGPT-4 can assist healthcare professionals in generating accurate and comprehensive medical notes, such as discharge summaries, patient letters, and progress notes. It can extract relevant information from the patient’s medical record and synthesize it into a coherent narrative, reducing the time and effort required for documentation.¹³ However, it is important to note that ChatGPT-4 is not a replacement for human doctors. ChatGPT-4 can be used to help doctors write progress notes, but it is important for doctors to review the notes and to make sure that they are accurate and complete.

• Writing Operative Notes:

We believe that ChatGPT-4 can be used to write operative notes in plastic surgery by generating personalized text that is accurate, complete, and consistent with the standards of care. This can be a valuable tool for doctors who are looking for a way to improve the quality of their operative notes. Here is an example of how ChatGPT-4 can be used to write an operative note for a patient who has undergone breast augmentation surgery. Such results can be generated by asking the question, “Can you provide an operative report for breast augmentation surgery?” See Figure 1 for a summarized operative note generated with the aid of ChatGPT-4.

Fig. 1.

Using ChatGPT-4 for generating operative notes.

• Writing Surgical Consent Forms:

ChatGPT-4 can be a valuable tool for creating surgical consent forms for plastic surgery, offering comprehensive content, simplified language, personalization, and multilingual support. However, it is vital to address potential limitations, such as accuracy and bias, to ensure the effective and responsible use of ChatGPT-4 in patient care. See Figure 2 for an example of how ChatGPT-4 can be used to write a consent form for a patient who has undergone bilateral reduction mammoplasty. Such results can be generated by asking the question, “Can you provide a consent form for bilateral reduction mammoplasty?”

Fig. 2.

Using ChatGPT-4 for generating a surgical consent form.

• Writing Consultation Reports:

The use of ChatGPT-4 in writing consultations for plastic surgery can streamline the process, improve communication between healthcare professionals, and create concise, informative, and personalized consultation reports. By leveraging ChatGPT-4’s capabilities, plastic surgeons can generate consultation documents that enhance collaboration and support decision-making while saving time and effort.⁹

1. Structured consultation reports: ChatGPT-4 can generate consultation reports that follow a consistent, structured format. This can include sections such as patient demographics, clinical history, physical examination findings, and the proposed surgical plan. A standardized structure allows for easier interpretation and communication among healthcare professionals involved in the patient’s care.⁹

2. Synthesizing complex information: The language model can process and synthesize complex medical information, including patient history, examination findings, and imaging results. By extracting the most relevant details, ChatGPT-4 can create a concise and informative consultation report that highlights the critical aspects of the patient’s case.¹³

3. Personalized recommendations: ChatGPT-4 can tailor the consultation report to the individual patient, taking into account their specific medical history, needs, and preferences. This personalization can lead to more targeted and effective surgical recommendations, ultimately improving patient outcomes.^9,13

4. Clear and concise language: The language model can present the information in a clear, concise, and easy-to-understand manner. This can facilitate improved communication between the plastic surgeon, the referring physician, and other healthcare professionals involved in the patient’s care.⁹

• Medical Consultation and Answering Patients’ Questions:

ChatGPT-4 can answer questions that the patient or medical professional may have about a particular condition or surgical procedure. In addition, ChatGPT-4 can assist in decision-making and diagnosis by providing healthcare professionals with relevant information and recommendations based on patient data. However, it is important to note that ChatGPT-4 is still a work in progress and has limitations, so it should not be relied upon as the sole source of information in medical consultations. One example is virtual health assistance, where ChatGPT-4 can be integrated into virtual health platforms to provide patients with immediate assistance in the perioperative period. This could potentially lead to reduced wait times and improved access to care.³

II. Use of ChatGPT-4 in Research

The use of ChatGPT-4 has been explored in the field of research and academic writing. Text generation was tested and published in the form of case reports, which were reasonably accurate and grammatically correct, as well as capable of generating incredibly fast documents containing hundreds of words. However, a limitation was emphasized that the software generated citations that were not truly present in the literature, raising concerns about its use in academic writing.¹⁴

The ability to generate abstracts from human abstracts was also used, and in one study, 32% of AI-generated texts were falsely graded by human viewers as human work.¹⁵ Another potential use for ChatGPT-4 in research is its ability to effectively search for novel systematic review ideas in plastic surgery. In one study, ChatGPT-4 was asked to generate ideas in different branches of plastic surgery and compared with human reviews in large databases. It was concluded that ChatGPT-4 can effectively generate novel ideas. However, it is primarily limited to generating ideas and cannot properly execute a full systematic review.¹⁶ Nonetheless, researchers’ expertise and data interpretation abilities should not be replaced by ChatGPT-4. Therefore, researchers must evaluate ChatGPT-4’s use and ensure that it aligns with best research practices.¹⁷

III. Use of GPT-4 in Medical Education

• Virtual Tutoring:

ChatGPT-4 can serve as a virtual tutor, answering questions and providing explanations on various plastic surgery topics, procedures, and techniques. This can help students gain a better understanding of the subject matter and clarify any doubts. Such results can be generated by asking the question, “What is the difference between a skin graft and a flap?” (Fig. 3).

Fig. 3.

Use of ChatGPT-4 as a virtual tutor.

• Case-based Learning:

ChatGPT-4 can generate detailed case scenarios and high-quality examination questions to help students apply their knowledge in a practical context. This involves analyzing a patient’s condition, selecting the appropriate procedure, and discussing potential complications and outcomes. Additionally, it can assist with preparation for USMLE and in-service examinations. Such results can be generated by asking the question, “Can you provide a practice question on the topic of reconstructive surgery in facial burns?”^1,2 (Fig. 4).

Fig. 4.

Use of ChatGPT-4 to generate examination questions.

• Procedure Simulations:

ChatGPT-4 can guide students through virtual simulations of plastic surgery procedures, outlining the surgical steps and explaining the rationale behind each action. This can help students familiarize themselves with the procedures before performing them in real-life situations. Such results can be generated by asking the question, “Can you give me a brief overview of the rhinoplasty procedure?” (Fig. 5).

Fig. 5.

Use of ChatGPT-4 to generate procedure simulation.

• Assessment and Feedback:

ChatGPT-4 can be used to create quizzes and assessments for students, testing their knowledge and understanding of plastic surgery concepts. It can also provide personalized feedback, helping students identify areas of improvement.

• Research Assistance:

As mentioned earlier, ChatGPT-4 can assist in finding relevant research articles, case studies, and resources related to plastic surgery. It can also help students stay up-to-date with the latest advancements in the field.¹⁸

• Creation of Presentations:

ChatGPT-4 can help plastic surgery residents prepare PowerPoint presentations by assisting with topic selection, creating structured outlines, developing content, suggesting visual aids, providing citation assistance, offering presentation tips, and serving as a practice audience for feedback. However, it is essential for residents to verify the information provided by ChatGPT-4 with trusted sources and consult with mentors and colleagues for guidance. Such results can be generated by asking the question, “Can you help me create an outline for a presentation on facial reconstruction after Mohs surgery?” (Fig. 6).

Fig. 6.

Use of ChatGPT-4 to generate an outline for presentation.

IV. Patient Education

ChatGPT-4 has the potential to develop a wide range of educational materials for patients undergoing plastic surgery. These resources may take various forms, such as text-based documents, interactive elements, customized content, or translations. Text-based documents could encompass informational brochures and leaflets, whereas interactive components might consist of quizzes and engaging activities.

By utilizing GPT-4, educational materials can become more captivating and interactive compared with conventional resources, helping patients to better comprehend the presented information. Moreover, GPT-4 can generate personalized materials tailored to each patient’s specific needs and preferences, which can make patients feel more involved in their care and enhance their understanding of available options (Fig. 7). Such results can be generated by asking the question, “I am considering breast augmentation surgery. Can you give me an overview of the procedure and options available?”

Fig. 7.

Use of ChatGPT-4 for patient education.

ETHICAL CONSIDERATIONS AND CHALLENGES IN THE USE OF CHATGPT-4 IN PLASTIC AND RECONSTRUCTIVE SURGERY

ChatGPT-4 has the potential to be used in plastic and reconstructive surgery in a variety of ways. However, there are also a number of ethical considerations and challenges that need to be addressed before ChatGPT-4 can be used in this way. These include the following:

• Accuracy and Reliability

Because GPT-4 is an evolving large language model, it is crucial to evaluate the precision and dependability of its output. GPT-4’s potential errors may lead to incorrect diagnoses or treatment strategies.

• Hallucinations

“Hallucinations” refer to incorrect or fabricated answers generated by ChatGPT-4 when it does not know the correct answer to a question. In other words, ChatGPT-4 may generate an answer that is not based on any factual information or knowledge, but rather is a product of its own programming. This can be a potential limitation of using AI chatbots like ChatGPT-4 in medical consultations, as it may provide inaccurate or misleading information if it generates a hallucination instead of admitting that it does not know the answer.^9,13

• Bias

ChatGPT-4’s training is based on an extensive dataset containing text and code, which may inherently carry biases. These biases may manifest in ChatGPT-4’s output. For instance, if there’s an overrepresentation of male-authored content in the training dataset, ChatGPT-4 could generate text with a male bias.^9,13

• Privacy

ChatGPT-4’s training dataset might include personal information that could be traced back to patients. It is essential to implement measures that protect patient privacy when using ChatGPT-4.^9,13

• Adoption

The speed at which plastic surgeons embrace ChatGPT-4 is uncertain. Some may hesitate to adopt new technology that has not been thoroughly assessed.

Despite these challenges, ChatGPT-4 holds considerable potential to transform plastic and reconstructive surgery. However, it is crucial to carefully weigh these ethical challenges before implementing ChatGPT-4 in clinical settings. By addressing these ethical implications, we can ensure that ChatGPT-4 is used safely and ethically within plastic and reconstructive surgery.

FUTURE DIRECTIONS AND IMPLICATIONS OF ARTIFICIAL INTELLIGENCE IN PLASTIC AND RECONSTRUCTIVE SURGERY

We conducted this narrative analysis to compile data on the use of a chatbot similar to ChatGPT-4, acknowledging that the data within the bot may not be updated beyond 2021. Our study focused on exploring the feasibility and potential utility of using a chatbot in the context of plastic surgery. Although the temporal limitations of the data used in ChatGPT-4 are important to consider, our objective was to investigate the effectiveness of the chatbot technology itself. Artificial intelligence, including ChatGPT-4, has the potential to significantly impact the field of plastic and reconstructive surgery in various ways. Key future directions and implications include virtual surgical consultations, machine learning-assisted surgical techniques, global collaboration in research and education, and patient-specific prosthetics and implants. In the context of the example provided, patient-specific prosthetics and implants refer to custom-designed and manufactured prosthetic devices or implants that are tailored to fit the unique anatomy and needs of individual patients. These patient-specific solutions are designed using advanced imaging techniques, like computed tomography scans or magnetic resonance imaging, to capture precise measurements and contours of the patient’s body. This information is then utilized in computer-aided design software to create a 3D model, which is subsequently used to manufacture the custom prosthetic or implant, often using 3D printing technology.¹⁹ It is important to acknowledge the limitation of limited access to ChatGPT-4 in many countries. The availability and use of AI models like ChatGPT-4 are influenced by factors such as internet connectivity, technological infrastructure, and regional restrictions. This restricted accessibility may hinder the widespread adoption and applicability of ChatGPT-4 in certain geographic locations, limiting its potential benefits and generalizability. Therefore, it is important to recognize that the findings and recommendations derived from our study, which relies on the utilization of ChatGPT-4, may not be directly applicable or accessible to specific regions or populations with limited access to the model. Future research and implementation efforts should take into account the challenges of accessibility and strive to ensure equitable access to advanced AI technologies across different locations.

In plastic and reconstructive surgery, patient-specific prosthetics and implants can offer numerous advantages, such as better fit and function, reduced surgical time, and improved aesthetic outcomes. However, it is crucial to address ethical considerations and limitations, such as patient privacy and data security, while ensuring ChatGPT-4 serves as a supportive tool rather than a replacement for the expertise of trained surgeons. By responsibly leveraging ChatGPT-4, we can work toward improving patient care and outcomes in this medical specialty.

CONCLUSIONS

ChatGPT-4 has the potential to transform the field of plastic and reconstructive surgery in several ways, from enhanced surgical planning to personalized patient education and expedited research. As we continue to develop and refine this technology, it is essential to remain mindful of its ethical implications and limitations. By harnessing the power of ChatGPT-4 responsibly, we can improve the quality of care and outcomes for patients undergoing plastic and reconstructive surgery procedures.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.