Evolution of large language models and their applications in clinical medical education_West China Medical Journal

Authors：

WANG Yanan ^1,2,3 , JIANG Zhixuan ⁴ , HE Haoyang ^1,2,3 , LIU Ming ^1,2 ,  WU Simiao ^1,2,3

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Centre of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Institute of Brain Science and Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China;

Corresponding author：

WU Simiao, Email: simiao.wu@hotmail.com

Keywords：

Large language model; clinical medical education; artificial intelligence

DOI：

10.7507/1002-0179.202504061

Video：

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Large language models (LLMs), a key component of artificial intelligence (AI), represent a significant breakthrough in natural language processing. As the capabilities of LLMs continue to evolve, their potential applications and future implications in clinical medical education warrant considerable attention. This study systematically reviews the development of LLMs, explores their innovative applications within the context of current challenges in clinical medical education, and critically assesses both the advantages and limitations of their implementation. The objective is to provide a comprehensive reference for the continued integration of AI-driven LLMs into clinical medical education.

1.	王陇德. “健康中国 2030”的机遇与挑战. 科技导报, 2018, 36(22): 8-11.
2.	袁力, 张敬军, 刘林祥, 等. 改革传统医学教育模式提高医学生核心竞争力. 中华医学教育杂志, 2015, 35(1): 15-7, 107.
3.	Raiaan MAK, Mukta MSH, Fatema K, et al. A review on large language models: architectures, applications, taxonomies, open issues and challenges. IEEE Access, 2024, 82(2): 26839-26874.
4.	Omiye JA, Gui H, Rezaei SJ, et al. Large language models in medicine: the potentials and pitfalls : a narrative review. Ann Intern Med, 2024, 177(2): 210-220.
5.	Abd-Alrazaq A, AlSaad R, Alhuwail D, et al. Large language models in medical education: opportunities, challenges, and future directions. JMIR Med Educ, 2023, 9: e48291.
6.	邢永康, 马少平. 统计语言模型综述. 计算机科学, 2003(9): 22-26.
7.	林奕欧, 雷航, 李晓瑜, 等. 自然语言处理中的深度学习: 方法及应用. 电子科技大学学报, 2017, 46(6): 913-919.
8.	Gao C, Yan J, Zhou S, et al. Long short-term memory-based deep recurrent neural networks for target tracking. Inform Sci, 2019, 502(1): 279-296.
9.	Xu P, Zhu X, Clifton DA. Multimodal learning with transformers: a survey. IEEE Trans Pattern Anal Mach Intell, 2023, 45(10): 12113-12132.
10.	Elnaggar A, Heinzinger M, Dallago C, et al. ProtTrans: toward understanding the language of life through self-supervised learning. IEEE Trans Pattern Anal Mach Intell, 2022, 44(10): 7112-7127.
11.	Jowsey T, Stokes-Parish J, Singleton R, et al. Medical education empowered by generative artificial intelligence large language models. Trends Mol Med, 2023, 29(12): 971-973.
12.	任福继, 张彦如. 通用大模型演进路线. 科技导报, 2024, 42(12): 44-50.
13.	Lucas HC, Upperman JS, Robinson JR. A systematic review of large language models and their implications in medical education. Med Educ, 2024, 58(11): 1276-1285.
14.	罗姚, 谈在祥. ChatGPT 对循证医学发展的影响、挑战及其应对. 医学与哲学, 2024, 45(12): 16-21.
15.	商鲁翔, 薛茗月, 孙华鑫, 等. ChatGPT 作为医学教育工具的思考——以心血管内科主治医师资格考试为例. 医学与哲学, 2024, 45(14): 10-13.
16.	马应卓, 王俊, 刘彤, 等. 大语言模型在护理学领域应用的范围综述. 护理学杂志, 2024, 39(19): 124-129.
17.	马慧群. “ChatGPT+”时代皮肤专业规培教育面临的危机. 中国皮肤性病学杂志, 2023, 37(8): 973-975.
18.	罗妍, 刘宇炀, 李晓瑛, 等. 面向医学大模型的体系化人工智能框架构建与应用. 北京邮电大学学报, 2024, 47(4): 98-104.
19.	蔡睿, 葛军, 孙哲, 等. AI 预训练大模型发展综述. 小型微型计算机系统, 2024, 45(10): 2327-2337.
20.	马武仁, 弓孟春, 戴辉, 等. 以 ChatGPT 为代表的大语言模型在临床医学中的应用综述. 医学信息学杂志, 2023, 44(7): 9-17.
21.	Gan W, Ouyang J, Li H, et al. Integrating ChatGPT in orthopedic education for medical undergraduates: randomized controlled trial. J Med Internet Res, 2024, 26: e57037.
22.	Rao VM, Hla M, Moor M, et al. Multimodal generative AI for medical image interpretation. Nature, 2025, 639(8056): 888-896.
23.	Kung TH, Cheatham M, Medenilla A, et al. Performance of ChatGPT on USMLE: potential for AI-assisted medical education using large language models. PLOS Digit Health, 2023, 2(2): e0000198.
24.	张丽, 张雪, 周海燕, 等. ChatGPT 在中国临床执业医师资格模拟考试中的表现研究. 中国继续医学教育, 2024, 16(15): 157-162.
25.	Wang H, Wu W, Dou Z, et al. Performance and exploration of ChatGPT in medical examination, records and education in Chinese: pave the way for medical AI. Int J Med Inform, 2023, 177: 105173.
26.	Singhal K, Azizi S, Tu T, et al. Large language models encode clinical knowledge. Nature, 2023, 620(7972): 172-180.
27.	Tokuç B, Varol G. Medical education in the era of advancing technology. Balkan Med J, 2023, 40(6): 395-399.
28.	Dunn C, Hunter J, Steffes W, et al. Artificial intelligence-derived dermatology case reports are indistinguishable from those written by humans: a single-blinded observer study. J Am Acad Dermatol, 2023, 89(2): 388-390.
29.	Lu MY, Chen B, Williamson DFK, et al. A multimodal generative AI copilot for human pathology. Nature, 2024, 634(8033): 466-473.
30.	Brügge E, Ricchizzi S, Arenbeck M, et al. Large language models improve clinical decision making of medical students through patient simulation and structured feedback: a randomized controlled trial. BMC Med Educ, 2024, 24(1): 1391.
31.	刘大明, 李雅琦. 基于生成式大语言模型的教学设计研究. 中国科技论文在线精品论文, 2024, 17(4): 592-599.
32.	刘晖, 任曼, 寇丽圆, 等. ChatGPT 对医学临床实践教学的影响与思考. 中国医学教育技术, 2024, 38(4): 389-393,400.
33.	刘江峰, 张冉, 王东波, 等. 追溯科学融合的历史轨迹: AIGC 赋能交叉科学测度研究. 图书情报工作, 2024, 68(7): 137-150.
34.	Hswen Y, Abbasi J. AI will-and should-change medical school, says Harvard’s dean for medical education. JAMA, 2023, 330(19): 1820-1823.
35.	Xu X, Chen Y, Miao J. Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review. J Educ Eval Health Prof, 2024, 21: 6.
36.	Zhou Z, Qin P, Cheng X, et al. ChatGPT in oncology diagnosis and treatment: applications, legal and ethical challenges. Curr Oncol Rep, 2025, 27(4): 336-354.
37.	Huo B, Boyle A, Marfo N, et al. Large language models for chatbot health advice studies: a systematic review. JAMA Network Open, 2025, 8(2): e2457879.
38.	Li H, Moon JT, Purkayastha S, et al. Ethics of large language models in medicine and medical research. Lancet Digit Health, 2023, 5(6): e333-e335.
39.	全筱筱, 熊文举, 潘军杰, 等. 基于大语言模型的数据查询机器人在医学领域的应用. 医学新知, 2024, 34(9): 1057-1063.

1. 王陇德. “健康中国 2030”的机遇与挑战. 科技导报, 2018, 36(22): 8-11.
2. 袁力, 张敬军, 刘林祥, 等. 改革传统医学教育模式提高医学生核心竞争力. 中华医学教育杂志, 2015, 35(1): 15-7, 107.
3. Raiaan MAK, Mukta MSH, Fatema K, et al. A review on large language models: architectures, applications, taxonomies, open issues and challenges. IEEE Access, 2024, 82(2): 26839-26874.
4. Omiye JA, Gui H, Rezaei SJ, et al. Large language models in medicine: the potentials and pitfalls : a narrative review. Ann Intern Med, 2024, 177(2): 210-220.
5. Abd-Alrazaq A, AlSaad R, Alhuwail D, et al. Large language models in medical education: opportunities, challenges, and future directions. JMIR Med Educ, 2023, 9: e48291.
6. 邢永康, 马少平. 统计语言模型综述. 计算机科学, 2003(9): 22-26.
7. 林奕欧, 雷航, 李晓瑜, 等. 自然语言处理中的深度学习: 方法及应用. 电子科技大学学报, 2017, 46(6): 913-919.
8. Gao C, Yan J, Zhou S, et al. Long short-term memory-based deep recurrent neural networks for target tracking. Inform Sci, 2019, 502(1): 279-296.
9. Xu P, Zhu X, Clifton DA. Multimodal learning with transformers: a survey. IEEE Trans Pattern Anal Mach Intell, 2023, 45(10): 12113-12132.
10. Elnaggar A, Heinzinger M, Dallago C, et al. ProtTrans: toward understanding the language of life through self-supervised learning. IEEE Trans Pattern Anal Mach Intell, 2022, 44(10): 7112-7127.
11. Jowsey T, Stokes-Parish J, Singleton R, et al. Medical education empowered by generative artificial intelligence large language models. Trends Mol Med, 2023, 29(12): 971-973.
12. 任福继, 张彦如. 通用大模型演进路线. 科技导报, 2024, 42(12): 44-50.
13. Lucas HC, Upperman JS, Robinson JR. A systematic review of large language models and their implications in medical education. Med Educ, 2024, 58(11): 1276-1285.
14. 罗姚, 谈在祥. ChatGPT 对循证医学发展的影响、挑战及其应对. 医学与哲学, 2024, 45(12): 16-21.
15. 商鲁翔, 薛茗月, 孙华鑫, 等. ChatGPT 作为医学教育工具的思考——以心血管内科主治医师资格考试为例. 医学与哲学, 2024, 45(14): 10-13.
16. 马应卓, 王俊, 刘彤, 等. 大语言模型在护理学领域应用的范围综述. 护理学杂志, 2024, 39(19): 124-129.
17. 马慧群. “ChatGPT+”时代皮肤专业规培教育面临的危机. 中国皮肤性病学杂志, 2023, 37(8): 973-975.
18. 罗妍, 刘宇炀, 李晓瑛, 等. 面向医学大模型的体系化人工智能框架构建与应用. 北京邮电大学学报, 2024, 47(4): 98-104.
19. 蔡睿, 葛军, 孙哲, 等. AI 预训练大模型发展综述. 小型微型计算机系统, 2024, 45(10): 2327-2337.
20. 马武仁, 弓孟春, 戴辉, 等. 以 ChatGPT 为代表的大语言模型在临床医学中的应用综述. 医学信息学杂志, 2023, 44(7): 9-17.
21. Gan W, Ouyang J, Li H, et al. Integrating ChatGPT in orthopedic education for medical undergraduates: randomized controlled trial. J Med Internet Res, 2024, 26: e57037.
22. Rao VM, Hla M, Moor M, et al. Multimodal generative AI for medical image interpretation. Nature, 2025, 639(8056): 888-896.
23. Kung TH, Cheatham M, Medenilla A, et al. Performance of ChatGPT on USMLE: potential for AI-assisted medical education using large language models. PLOS Digit Health, 2023, 2(2): e0000198.
24. 张丽, 张雪, 周海燕, 等. ChatGPT 在中国临床执业医师资格模拟考试中的表现研究. 中国继续医学教育, 2024, 16(15): 157-162.
25. Wang H, Wu W, Dou Z, et al. Performance and exploration of ChatGPT in medical examination, records and education in Chinese: pave the way for medical AI. Int J Med Inform, 2023, 177: 105173.
26. Singhal K, Azizi S, Tu T, et al. Large language models encode clinical knowledge. Nature, 2023, 620(7972): 172-180.
27. Tokuç B, Varol G. Medical education in the era of advancing technology. Balkan Med J, 2023, 40(6): 395-399.
28. Dunn C, Hunter J, Steffes W, et al. Artificial intelligence-derived dermatology case reports are indistinguishable from those written by humans: a single-blinded observer study. J Am Acad Dermatol, 2023, 89(2): 388-390.
29. Lu MY, Chen B, Williamson DFK, et al. A multimodal generative AI copilot for human pathology. Nature, 2024, 634(8033): 466-473.
30. Brügge E, Ricchizzi S, Arenbeck M, et al. Large language models improve clinical decision making of medical students through patient simulation and structured feedback: a randomized controlled trial. BMC Med Educ, 2024, 24(1): 1391.
31. 刘大明, 李雅琦. 基于生成式大语言模型的教学设计研究. 中国科技论文在线精品论文, 2024, 17(4): 592-599.
32. 刘晖, 任曼, 寇丽圆, 等. ChatGPT 对医学临床实践教学的影响与思考. 中国医学教育技术, 2024, 38(4): 389-393,400.
33. 刘江峰, 张冉, 王东波, 等. 追溯科学融合的历史轨迹: AIGC 赋能交叉科学测度研究. 图书情报工作, 2024, 68(7): 137-150.
34. Hswen Y, Abbasi J. AI will-and should-change medical school, says Harvard’s dean for medical education. JAMA, 2023, 330(19): 1820-1823.
35. Xu X, Chen Y, Miao J. Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review. J Educ Eval Health Prof, 2024, 21: 6.
36. Zhou Z, Qin P, Cheng X, et al. ChatGPT in oncology diagnosis and treatment: applications, legal and ethical challenges. Curr Oncol Rep, 2025, 27(4): 336-354.
37. Huo B, Boyle A, Marfo N, et al. Large language models for chatbot health advice studies: a systematic review. JAMA Network Open, 2025, 8(2): e2457879.
38. Li H, Moon JT, Purkayastha S, et al. Ethics of large language models in medicine and medical research. Lancet Digit Health, 2023, 5(6): e333-e335.
39. 全筱筱, 熊文举, 潘军杰, 等. 基于大语言模型的数据查询机器人在医学领域的应用. 医学新知, 2024, 34(9): 1057-1063.

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