From tool to teammate in a randomized controlled trial of clinician-AI collaborative workflows for diagnosis

Early studies of large language models (LLMs) in clinical settings have largely treated artificial intelligence (AI) as a tool rather than an active collaborator. As LLMs demonstrate expert-level diagnostic performance, the focus shifts from whether AI can offer valuable suggestions to how it integrates into physicians' diagnostic workflows. We conducted a randomized controlled trial (n = 70 clinicians) to assess a custom system designed for collaborative diagnostic reasoning. The design involved independent diagnostic assessments by the clinician and AI, followed by an AI-generated synthesis integrating both perspectives, highlighting agreements, disagreements, and offering commentary. We evaluated two collaborative workflows: AI as first opinion (preceding clinician) and AI as second opinion (following clinician). Both improved clinician diagnostic accuracy over conventional resources, (85% and 82% vs. 75%). Performance was comparable across workflows and not statistically different from AI-alone accuracy (90%), highlighting the potential of collaborative AI to complement clinician expertise. Qualitative analyses illustrate how workflow design shapes human-AI interaction. C: NCT06911645.