Comparative Performance Analysis of AI Engines in Answering American Board of Surgery In-Training Examination Questions: A Multi-Subspecialty Evaluation

Background The rapid advancement of artificial intelligence (AI) has led to its increasing application in the medical field, particularly in providing accurate and reliable information for complex medical queries. Purpose This study evaluates the performance of four AI engines—Perplexity, Chat GPT, DeepSeek, and Gemini in answering 100 multiple-choice questions derived from the American Board of Surgery In-Training Examination (ABSITE). A set of questions focused on five surgical subspecialties including colorectal surgery, acute care and trauma surgery (ACS), upper GI Surgery, breast and endocrine surgery, and hepatopancreatobiliary surgery (HPB). Data collection We evaluated these AI engines’ ability to provide accurate and focused medical knowledge as the main objective. The research study consisting of a two-month duration was conducted from January 1, 2025, to March 28, 2025. All AI engines received identical questions through then a comparison between correct and wrong responses was performed relative to the ABSITE key answers. Each question was entered manually into the chatbots, ensuring no memory retention bias. Statistical analysis The researchers conducted their statistical analysis with JASP software for performance evaluation between different subspecialties and AI engines through univariate and multivariate investigations. Results Among the available AI tools, DeepSeek produced the most accurate responses at 74% while Chat GPT delivered 70% accuracy Gemini achieved 69% and Perplexity attained 65%. Results showed that Chat GPT achieved 83.3% accuracy in colorectal surgery yet DeepSeek scored the best at 84.6% and 67.6% for HPB Surgery and ACS respectively. Perplexity achieved a 100% accuracy rate in breast and endocrine surgery which proved to be the highest score recorded throughout the study. The analysis showed that Chat GPT exhibited performance variability between different Surgical subspecialties since it registered significant variations ( P < .05), especially in acute care and trauma Surgery. The results of logistic regression indicated that Gemini along with Perplexity scored the most consistent answers among AI systems with a significant odds ratio of 2.5 ( P < .01). AI engines show different combinations of precision and reliability when solving medical questions about surgery yet DeepSeek stands out by remaining the most reliable overall. Conclusions Medical application AI models need additional development because performance results show major differences between medical specialties.