{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:05:09Z","timestamp":1785146709314,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic accuracy and clinical reasoning of three frontier large language models (LLMs) across standardized pediatric gastroenterology, hepatology, and nutrition (PGHN) clinical vignettes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this cross\u2010sectional study, 25 fictional PGHN vignettes were developed by one board\u2010certified pediatric gastroenterologist and evaluated using three LLMs: Gemini 3.1 Pro, ChatGPT 5.4 Thinking, and Claude Sonnet 4.6 Extended. A conditional two\u2010step prompting protocol was applied. Three blinded, PGHN\u2010certified co\u2010authors independently scored responses using a structured instrument covering four domains (diagnostic accuracy, management, patient safety, reference quality; 0\u20132 each) and a global quality of clinical reasoning (QCR) score (1\u20135 Likert scale). Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). Group differences were analyzed using the Kruskal\u2013Wallis\n                      <jats:italic>H<\/jats:italic>\n                      test with Dunn post\u2010hoc correction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Interobserver reliability was excellent (ICC: 0.98 for domains; 0.87 for QCR). All three models achieved perfect diagnostic accuracy (median 2.00, interquartile range: 2.00\u20132.00). Statistically significant intermodel differences were identified in reference quality (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) and QCR (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049). Claude achieved significantly higher QCR scores than ChatGPT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043) and demonstrated the highest overall reference quality. Qualitative analysis revealed critical pharmacological dosing errors, contextual blindness, temporal obsolescence, and a high frequency of fabricated citations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While current LLMs demonstrate good diagnostic pattern recognition in PGHN, reproducible and potentially life\u2010threatening failures in pharmacological reasoning and reference accuracy create a dangerous illusion of competence. These findings suggest that LLMs may support differential diagnosis brainstorming in PGHN but do not establish their safety in real\u2010world clinical scenarios.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70502","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T10:32:43Z","timestamp":1784197963000},"source":"Crossref","is-referenced-by-count":0,"title":["The illusion of competence: Evaluating the clinical reasoning of large language models in pediatric gastroenterology"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3689-6852","authenticated-orcid":false,"given":"Yasin Maruf","family":"Ergen","sequence":"first","affiliation":[{"name":"Department of Pediatrics\/Division of Pediatric Gastroenterology G\u00fclhane Training and Research Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1885-6611","authenticated-orcid":false,"given":"Sel\u00e7uk","family":"Teke","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Division of Pediatric Gastroenterology G\u00fclhane Training and Research Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3165-3234","authenticated-orcid":false,"given":"Edibe G\u00f6zde","family":"Ba\u015faran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Division of Pediatric Gastroenterology G\u00fclhane Training and Research Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-5611","authenticated-orcid":false,"given":"Necati","family":"Balamtekin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Division of Pediatric Gastroenterology G\u00fclhane Training and Research Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000198"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03097-1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00873-0"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2196\/66648"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2023.5750"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.05.011"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32771"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.70096"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pdi3.42"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1514445"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.70097"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003877"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003207"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12314"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2196\/59823"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.2196\/46885"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-025-01021-3"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2023.115334"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpn3.70502","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpn3.70502","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpn3.70502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:16:01Z","timestamp":1785143761000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jpn3.70502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":19,"alternative-id":["10.1002\/jpn3.70502"],"URL":"https:\/\/doi.org\/10.1002\/jpn3.70502","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"article-number":"jpn3.70502"}}