{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:02:27Z","timestamp":1789732947625,"version":"4.0.1"},"reference-count":28,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As artificial intelligence (AI) becomes increasingly integrated into medicine and surgery, its applications are expanding rapidly\u2014from aiding clinical documentation to providing patient information. However, its role in medical decision-making remains uncertain. This study evaluates an AI language model\u2019s alignment with clinical consensus statements in foot and ankle surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical consensus statements from the American College of Foot and Ankle Surgeons (ACFAS; 2015-2022) were collected and rated by ChatGPT-o1 as being inappropriate, neither appropriate nor inappropriate, and appropriate. Ten repetitions of the statements were entered into ChatGPT-o1 in a random order, and the model was prompted to assign a corresponding rating. The AI-generated scores were compared to the expert panel\u2019s ratings, and intra-rater analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis of 9 clinical consensus documents and 129 statements revealed an overall Cohen\u2019s kappa of 0.29 (95% CI: 0.12, 0.46), indicating fair alignment between expert panelists and ChatGPT. Overall, ankle arthritis and heel pain showed the highest concordance at 100%, while flatfoot exhibited the lowest agreement at 25%, reflecting variability between ChatGPT and expert panelists. Among the ChatGPT ratings, Cohen\u2019s kappa values ranged from 0.41 to 0.92, highlighting variability in internal reliability across topics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ChatGPT achieved overall fair agreement and demonstrated variable consistency when repetitively rating ACFAS expert panel clinical practice guidelines representing a variety of topics. These data reflect the need for further study of the causes, impacts, and solutions for this disparity between intelligence and human intelligence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV: Retrospective cohort study<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19386400251319567","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T07:48:56Z","timestamp":1740210536000},"page":"492-497","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["ChatGPT Achieves Only Fair Agreement with ACFAS Expert Panelist Clinical Consensus Statements"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6894-9605","authenticated-orcid":false,"given":"Dominick J.","family":"Casciato","sequence":"first","affiliation":[{"name":"Orlando VA Medical Center, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Calhoun","sequence":"additional","affiliation":[{"name":"Orlando VA Medical Center, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.12.016"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1305756"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci14030228"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2024.112131"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000002781"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2024.100923"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.57728"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2024.111957"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000001228"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.2196\/46924"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2024.06.009"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2024.05.014"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/19386400241249810"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/19386400241235834"},{"key":"e_1_3_2_16_2","unstructured":"American College of Foot and Ankle Surgeons (ACFAS). Clinical consensus documents. n.d. https:\/\/www.acfas.org\/research\/clinical-consensus-documents. 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