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The use of generative artificial intelligence–based dictation in a neurosurgical practice: a pilot study
In a pilot comparative study Hopkins et al. from the Keck School of Medicine, USC, Los Angeles (Neurosurgery; Endocrinology) published in Neurosurgical Focus to evaluate whether a modified OpenAI Generative artificial intelligence model can match or improve upon the accuracy of a commercial dictation tool (Nuance Dragon Medical One) in neurosurgical operative report generation. Whisper‑based model demonstrated non‑inferior overall word error rate (WER) versus Dragon (1.75% vs 1.54%, p=0.08). Excluding linguistic errors, Whisper outperformed Dragon (0.50% vs 1.34%, p<0.001; total errors 6.1 vs 9.7, p=0.002). Whisper’s performance was robust to faster speech and longer recordings, unlike Dragon 1).
Critical Review
* Strengths:
- Direct comparison of a cutting-edge generative AI (Whisper) to an established clinical tool in a real-world neurosurgical workflow.
- Objective metrics (WER) with appropriate statistical analysis.
- Mixed-case operative reports cover cranial and spinal procedures, enhancing generalizability.
* Weaknesses & Limitations:
- Small sample size (n=10 reports, 3 physicians) limits statistical power.
- Lack of real-time clinical integration assessments—only offline comparisons.
- No analysis of downstream impact on report quality, clinician satisfaction, or patient safety.
- Commercial Dragon may not represent the latest version or fully optimized settings.
* Methodological concerns:
- Manual WER calculation introduces potential reviewer bias; no inter‑rater reliability reported.
- Recording conditions and audio quality not standardized across sessions.
- Exclusion of “linguistic errors” may bias interpretation toward AI advantage.
* Clinical relevance:
- Whisper’s stability with faster dictation may support efficiency gains in high-volume clinical settings.
- Noninferiority demonstrated, but real-world deployment needs integration, EHR compatibility, user training, and error recovery workflow.
Verdict: 6.5 / 10
| Criteria | Score | Comments |
| Innovation | 8 | Novel application of transformer-based AI to dictation |
| Methodology | 6 | Solid but limited by small sample and manual error assessment |
| Clinical Applicability | 6 | Promising, yet lacks prospective implementation data |
| Statistical Rigor | 6 | Basic significance testing performed; confidence intervals absent |
Key Takeaway for Neurosurgeons: Modified Whisper offers comparable, or potentially better, transcription accuracy than Dragon in neurosurgical dictation, especially under faster speech rates—but further large-scale, workflow-integrated trials are essential before clinical adoption.
Bottom Line: This pilot suggests generative AI could reduce documentation burden, but robustness and clinical utility must be validated in real-world settings.
Title: The use of generative artificial intelligence–based dictation in a neurosurgical practice: a pilot study Full Citation: Hopkins BS, Dallas J, Yu J, Briggs RG, Chung LK, Cote DJ, Gomez D, Shah I, Carmichael JD, Liu JC, Mack WJ, Zada G. *Neurosurg Focus*. 2025 Jul 1;59(1):E8. doi:10.3171/2025.4.FOCUS24834 Publication Date: July 1, 2025 Corresponding Author Email: Not explicitly listed; likely accessible via USC Keck directory (e.g. [email protected])
Categories: Research, AI in Neurosurgery, Clinical Workflow, Pilot Studies Tags: generative AI, transcription, Whisper model, Dragon Medical One, neurosurgery documentation, word error rate