Significant effort has been placed on developing decision support tools to improve patient care. However, drivers of real-world clinical decisions in complex medical scenarios are not yet well-understood, resulting in substantial gaps between these tools and practical applications. In light of this, we highlight that more attention on understanding clinical decision-making is required both to elucidate current clinical practices and to enable effective human-machine interactions. This is imperative in high-stakes scenarios with scarce available resources.

Recent advances in large language models (LLMs) have enabled general-purpose systems to perform increasingly complex domain-specific reasoning without extensive fine-tuning. In the medical domain, decision-making often requires integrating heterogeneous information sources, including patient narratives, structured data, and medical images. This study positions GPT-5 as a generalist multimodal reasoner for medical decision support and systematically evaluates its zero-shot chain-of-thought reasoning performance on both text-based question answering and visual question answering tasks under a unified protocol. We benchmark GPT-5, GPT-5-mini, GPT-5-nano, and GPT-4o-2024-11-20 against standardized splits of MedQA, MedXpertQA (text and multimodal), MMLU medical subsets, USMLE self-assessment exams, and VQA-RAD. Results show that GPT-5 consistently outperforms all baselines, achieving state-of-the-art accuracy across all QA benchmarks and delivering substantial gains in multimodal reasoning. On MedXpertQA MM, GPT-5 improves reasoning and understanding scores by +29.26% and +26.18% over GPT-4o, respectively, and surpasses pre-licensed human experts by +24.23% in reasoning and +29.40% in understanding. In contrast, GPT-4o remains below human expert performance in most dimensions. A representative case study demonstrates GPT-5's ability to integrate visual and textual cues into a coherent diagnostic reasoning chain, recommending appropriate high-stakes interventions. Our results show that, on these controlled multimodal reasoning benchmarks, GPT-5 moves from human-comparable to above human-expert performance. This improvement may substantially inform the design of future clinical decision-support systems.

Significant effort has been placed on developing decision support tools to improve patient care. However, drivers of real-world clinical decisions in complex medical scenarios are not yet well-understood, resulting in substantial gaps between these tools and practical applications. In light of this, we highlight that more attention on understanding clinical decision-making is required both to elucidate current clinical practices and to enable effective human-machine interactions. This is imperative in high-stakes scenarios with scarce available resources. We show that most existing machine learning methods are insufficient to meet these requirements and propose iTransplant, a novel data-driven framework to learn the factors affecting decisions on organ offers in an instance-wise fashion directly from clinical data, as a possible solution.

This course presents the main concepts of decision analysis, artificial intelligence, and predictive model construction and evaluation in the specific context of medical applications. The advantages and disadvantages of using these methods in real-world systems are emphasized, while students gain hands-on experience with application specific methods. The technical focus of the course includes decision analysis, knowledge-based systems (qualitative and quantitative), learning systems (including logistic regression, classification trees, neural networks), and techniques to evaluate the performance of such systems.