primary presentation script 2022

Prepare and Present the Perfect Primary Sacrament Meeting Presentation

This Annual Presentation Should Not Be a Performance

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What follows assumes that you know what the Primary program is and how it operates.

Once a year the Primary children present what they have learned in a special Sacrament Meeting known as the Children's Sacrament Meeting Presentation. Members often look forward to this event. There is always something sweet in hearing children speak basic gospel truths and sing their songs with the simple faith characteristic of the young and innocent.

If you serve in the Primary, then you will help the children and other leaders prepare and present this annual event. What follows below should help.

Guidelines for the Children's Sacrament Meeting Presentation

Obviously, the Handbook is the first place you should go for guidance. All Primary information is contained in Chapter 11 . The brief guidance that exists for the Sacrament presentation can be found in 11.5.4 .

The presentation should take place sometime in the fourth quarter of the year. It should showcase what the children have learned in Primary; so it makes sense to have it towards the end of the year.

After the Sacrament has been administered , the presentation can take up the remaining time in Sacrament meeting, but it does not have to. If you only have a small number of children in Primary, a shorter program may be just fine.

Try not to think of this event as a performance or a celebration. It should be an opportunity for the children to share and demonstrate what they have learned.

What You Should Do in the Presentation

The Presentation takes place under the general direction of the bishopric. One of the bishop's counselors should be assigned to oversee the Primary and work closely with Primary leaders. He should certainly be involved in planning and executing the presentation.

Preliminary meetings should be held with him to plan the presentation. Once finished, he must approve the final plan. He should always be involved in guiding the Primary program and especially the annual presentation.

Each year the Church issues a yearly Outline for Sharing Time . This Outline should be the foundation for the yearly Sacrament presentation as well. The Sharing Time themes should provide the content.

Singing should be a major part of the presentation. The Church provides all the songs and resources that should be used. Every child can participate in singing these songs and every Primary child ages 3-11 should.

Approved aspects of the presentation include children doing the following:

• Reciting scripture passages
• Singing in small groups
• Sharing testimonies
• Brief messages from Primary leaders and the counselor assigned oversight of the Primary.

What You Should Not Do in the Presentation

Images and visual aids are not approved for the presentation. This may take some getting used to. There are numerous images and visual aids provided in the Outline for Sharing Time. Although they can be used during regular Primary time and to teach the children throughout the year, they should not be used for the annual presentation.

In addition, costumes or any type of media presentation should not be used either. They are not consistent with the reverence or solemnity that should prevail in Sacrament meeting.

Music is a Key Focus of the Presentation

Primary music leaders and accompanists should plan for , teach and direct all the music for Sharing Time throughout the year, and during the presentation.

Besides following all the general music guidelines that exist, they must follow the additional guidelines for the Primary. Handbook guidance is found in Chapter 14 . Specific guidance and resources for Primary music leaders is online.

Some musical instruments, songs and teaching resources that are appropriate for teaching children are not appropriate in Sacrament meeting.

Tips to Make the Presentation Go Smoothly

• Time the songs, talks and everything else. Know how long it takes for children to get into position and so forth.
• Ask teachers to remain seated during the songs so that children can see and be seen.
• Involve parents and make certain they have enough time to help their children with their parts of the presentation.
• Make certain all  leaders, music people and teachers have a copy of the program.
• Have someone manage the podium, raising and lowering it and assisting the children with their speaking parts, especially if they take fright at the last moment.
• Rehearse the presentation in the chapel, so the children feel comfortable. However, this should not take up what should be classroom time.
• Use the disability resources the Church provides in order to accommodate all children to participate in the presentation.

When it is all over, praise the children for how well they did. Meet with others to determine what could be improved in the future.

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2023 LDS Primary Theme, Talks, and Songs – Primary Program Script & Outline Downloads

If you need help putting together and writing a 2023 Primary presentation script and outline, you have come to the right place!  Below is a simple format that follows Music for Singing Time 2023 Come Follow Me – New Testament that any Primary can implement for their sacrament meeting Primary presentation!

2022 Primary Presentation Script & Outline

If you need help putting together and writing a 2022 primary presentation script and outline, you have come to the right place!  Below is a

2021 Primary Program Outline

We are getting down to the nitty gritty of the primary program! If you need help putting together and writing a 2021 primary program outline,

Be prepared in singing time for the entire month – every month!  And all you have to do is print!

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Planning a Primary Program Tips & Ideas

Today, this post is all about helping with planning a primary program tips & ideas to help you navigate this HUGE task!

The biggest aspect of our calling as Primary Music Leader is planning for, coordinating for, and preparing the kids for the annual Primary Program Presentation in Sacrament Meeting.

The Primary Program is such a special program, and is a great opportunity for the kids, but there is so much that goes on behind the scenes to think about.

My hope is that this post can help you better prepare and plan for your own ward’s Primary Program.

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How to plan a primary program presentation, 1. pick your date early.

A lot of the stress that comes with the program is not feeling adequately prepared or not having enough time to teach the songs. When I’m doing my yearly planning in December and January I also take a good look at the calendar. One of the first things I want to be able to anticipate is how much time do I have.

My personal preference is to have the Primary Program early in the year, rather than later. We ended up having to hold the program in November one year because I had a bunch of travel planned in October. It was so late in the year and it made it really difficult to work on Christmas or other songs and the program songs felt like they dragged on all year long.

The next year, I was sure to set a date early that helped me to plan family trips around that schedule. Make sure you consider the following when planning your date:

• Look at the Stake and Ward calendars. Specifically, you’ll want to take note of Ward and Stake conference as well as General Conference. These are really helpful to add to your planning calendars early, anyways. Keep these dates in mind for what might work for your program including any necessary practices.
• Review School and Other Calendars. Pay attention to national holidays, school breaks, and even the start of school as all of these dates will be important in determining what will work best for the majority of your ward.
• Check Leadership Schedules. After I had a date (and backup date) in mind, I submitted my requested date to the Primary Presidency to review and consider. I simply told them I had reviewed the calendars and was hoping we can set a date for the Program that I would be able to work towards. I sent my suggested date with reasoning and asked them to discuss as a presidency and with the Bishopric / Ward Council as may be needed and let me know!

For my ward, our perfect date is September 15th. We have Stake Conference the following week so it will be really helpful to have the Program out of the way before Stake Conference. Our schools start August 26th so that gives us the option of practices on 9/25, 9/1, and 9/8.

We’ll likely do a full practice on 9/25 with all the kids, do a separate practice with JR and SR in their regular schedule on 9/1, and then come all together again on 9/8 to work out any last kinks! It’s also really important for our ward to have the program early in the Fall season as we are subject to hurricanes and cancellations especially in October!

2. Pick Your Program Songs

Along with picking my date as soon as possible, I also spend some time pouring over the suggested song list and seeking inspiration to find the right songs for us to work on for the year.

Having your songs picked at the beginning of the year takes away a lot of the extra stress and decision making on a weekly and monthly basis. I plan out all my song picks then make a rough outline of the songs for the month and even have my song list printed out for the whole year so my pianist has the time she needs to practice!

Also consider what verses you will teach. This will help you focus on just what needs to be taught and add extra verses simply if you have extra time or decide to!

The song list (and verses) are then shared with the Primary Presidency to go over any of their feedback and thoughts.

3. Create a Rough Program Outline

The last step I do for planning the program is to create a rough outline. After a very rough outline, such as a suggested song order, I turn over my planning to the Presidency and they take over the rest of the Primary Program content from there.

My efforts to make these plans early really is helpful to the Primary Presidency. Keep in mind, some Presidencies may choose to do their own thing. Still, you’ll be doing your best to provide what you can to the Presidency that can ultimate decide.

You can see my rough suggested outline based on my song picks, in case it’s helpful:

My 2019 New Testament Primary Program Suggested Rough Outline

• Tell Me the Stories of Jesus (or before Baptism)
• Primary President Introduction
• CTR 5/6 – “I can Follow the Savior by….”
• CTR 7/8 – “My baptism was special to me because…” 1-minute talk about Baptism?
• The Holy Ghost
• Sunbeams & CTR 4 – “I know the Savior loves be because…”
• CTR 10 – “The Atonement makes an impact on my life by…”
• I Know My Father Lives
• CTR 9 – “Studying the Savior’s life has taught me…”
• Closing remarks from Bishop
• Keep the Commandments (Hymn #303 – Closing Song)

Tips & Ideas for Planning a Primary Program

Group songs and/or classes.

With a shorter meeting block, there’s less time for those extra transitions between songs and between speaking parts. One way I plan to help speed up our Primary Program is by grouping the songs and singing 2 songs back-to-back, when it makes sense. You could also look for opportunities to pick a medley that combines two of your Program songs!

We’ll also group classes and have two classes come up together (or one after the other) to spend a little less time transitioning between songs and speaking parts.

Simplify Song Choices

A really easy way to cut back your overall time (and make the program much simpler!) is to decide to either cut back on the number of program songs or select just a certain verse per song, rather than trying to learn the entire song.

We’ve decided to do mostly 1st verses, with the exception of the Baptism Song (1st and 3rd verse) and Gethsemane.

When you have less overall songs / verses to teach, it also gives you a lot more flexibility to tie-in other songs or work on song that fit the weekly Come, Follow Me themes!

Let the Kids “Write” the Program

The Primary Program is a chance for the kids to share their testimonies and what they’ve learned throughout the year. One way to majorly simplify is to skip the more traditional written out scripts and instead let the kids take a part is determining the Program!

This is often something that has been done with the very youngest of classes, but can really be used with all the age groups. Give the class a prompt, such as “I can Follow the Savior by…” and let them speak their own words!

You can have their ideas written down, so teachers can help those with stage freight. But their own words will make the program much more meaningful (and funny!)

Have older kids participate in writing the program by helping give input. They can help decide what songs they want to learn, maybe even a special musical number for the Senior Primary! They can also write a short talk or share a favorite scripture story from the year. Most of the children will only have the time to speak a sentence or two, but you can certainly help make it their own words and thoughts!

Consider a Sunday Practice

With all the recent changes to the Sunday block, if you have an overlapping time and are not the last ward in the building, you might be able to utilize the building Sunday afternoon! I love the flexibility we now have to choose something like this, rather than a Saturday practice!

The wards in my building meet at 9, 10:30, and 12 which means the building is empty by 2pm. The chapel may be available even earlier! Since we are the middle ward, I think we’ll aim for 2 or 2:30 and have an hour and a half practice so we can work on seating arrangements and run through the program twice!

Primary Program Printables

I’ve created a series of printable sets with an invite, bulletin board cover, poster, and even a comment card to tie into the yearly Come Follow Me Primary Program themes. These files are an editable PDF to help you easily utilize them for your own Primary!

Just click on the image or link below to head over to the themed post to grab those printable Primary Program helps!

Old Testament Primary Program Printables

New Testament Primary Program Printables

What other tip or advice do you have for others planning their Primary Program?

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How to Write a Primary Sacrament Meeting Program

I don't know why, but sisters need to chill out. Every year, around the time to write the Primary Sacrament Meeting program aspirin sales go through the roof and nervous ticks develop at an alarming rate. The primary program is not a production. It's not something that needs to be cutesy perfect. But in all honesty, I don't think that's the main reason people stress out. I think/hope it's because we love Heavenly Father. We want the spirit to be felt. We want the children to have a good experience.

With that said... now what?

Come, Follow Me—For Primary: Old Testament 2022

I know my Savior Lives: Primary Program Script & Tips

Putting on a Primary Program is a HUGE task!  Especially if you are new to your calling- trust me I can relate!  When I first got called a few years ago it was in August, I was clueless to everything and had no idea that most primarys already had a date and possibly even a script for their programs.  When I realized that I went into a full blown panic attack.  Thank goodness for some kind-hearted soul who put their script online and I adapted that to our ward (which was really hard in itself since I didn’t even know the children yet!).  Anyhow, time for me to pay it forward.

This is my third primary program, and I FINALLY feel like I am getting the hang of it.  We sat down to write the script and I included a few things from the other scripts floating around out there (especially the opening from The Mormon Home  which I thought was beautifully written).  Here’s a few tips (some of them learned the very hard way) to help you have a successful and smooth rehearsal & program:

•  Have at least one extra part written in for each class, a part that is not necessary to the flow of the script, but something that you can throw at a kid that showed up out of the blue, or an overly confident visitor that wants to participate… (we have had that happen!  I can hardly get my kids to participate in OUR ward, I can’t imagine them wanting to go up in a ward they didn’t know!  But hey, more power to those that do.)
• Have the sunbeams say their names, then they know they can at least say part of their part perfectly! (UPDATE: so I was wrong, my son actually got up and said “my name is Jane…” which was the name of the little girl that went before him.  Yup.  Probably the best part of the program).
• Have some prompts, parts where the children need to fill in the blank or answer a question.  I would say about half of our program is made up of prompts, so that it adds some personalization & spunk!  You can send the prompts home to parents (maybe you’ll have better luck than us getting them back) or have them fill them out with their teachers during sunday school and collect at the end.
• We like to have a narrator who introduces each month’s topic and scripture, I feel like it adds cohesion and helps it flow.  Usually we pick a child who is about to graduate from Primary.
• We try our best to collect the talks from primary throughout the year so that come program time we can use their talks (in whole or in part) in the program.
• On program day have the children come early to sing prelude music.  The truth is most of them wont make it and you will probably be left with a small group singing the prelude music.  BUT, if you ask them to come EARLY then they will probably come ON TIME!! 🙂
• We like to have the children sit on the stage for the entire sacrament meeting.  I have seen wards that wait until after the sacrament and then have all the children come to the stand.  That can work too, I personally think its less disruptive to just have them all situated and up there from the get-go.  This does require help from teachers though to get through the first portion of the meeting before the program starts.  Just make your expectations to teachers clear.
• Print copies of the program AND THE SONGS and hand them out to all the teachers in folders.  Tell them to sing along!  And ask them to work with the kids in class to help them memorize their parts. The more they feel ownership over the program the more they will want to help ensure its success 🙂

Ok, ok…. enough jibber jabber, here is the script we are using (ya know, I made some changes before I passed it on to YOU), adapt it for you ward or just use bits and pieces… good luck!

Now the question is, how do we put the “PAR-TAY” into a primary program?  My Mom told me something about raffle tickets and dollar store prizes to help get through rehearsals.  I thought that was GENIUS!  The rehearsals are so long and tedious for those little munchkins…much akin to torture after sitting through sacrament meeting.  Head to the dollar store (of course) and pick yourself up raffle tickets ( or these are really cute with a star on them ) and an assortment of “prizes”.  Arm each teacher with raffle tickets and make your expectations VERY clear to both teachers & children.  I am going to explain that each child can earn up to 3 tickets per rehearsal.

• One ticket for good behavior.  If you are having your rehearsal in the chapel remind them that they need to be in top-notch reverent mode.
• One ticket for memorizing their part, or making progress towards memorizing their part.
• And the last ticket for singing all the songs (or putting genuine effort into singing all the songs even if they forget some words).

I am going to challenge the teachers to not just give out 3 tickets willy-nilly and have the kids really earn each one.  Then at the end of the rehearsal they can go into the primary room and trade their tickets for prizes.

I was going to put together an invitation for you to download (we like to hand out 2 invites to each child 2 weeks before the program and challenge them to invite their non member friends or family) but Sheena already did a fabulous job and I couldn’t imagine topping it.  So head over there to Little LDS Ideas and you are all set for a great program.  And remember, in the end all anyone cares about is seeing those cuties up on stage 😉  What are your tips for surviving the primary program?  What is your favorite part of watching them?

For more primary ideas check out my free baptism preview printable handouts  and my primary newsletter template .  And if you are getting ready for the new year check out my sharing time assignment cards with the 2016 theme!    Follow me on pinterest to keep up with all my primary ideas & free printables!

UPDATE: 2016 script now available here with even more tips 🙂

*All Amazon links are affiliate links- this means that if you purchase something through the link I earn a small commission.  Thanks for supporting my site!!

27 thoughts on “ I know my Savior Lives: Primary Program Script & Tips ”

I LOVE the raffle ticket idea, Alia! I am definitely sharing this great idea and will do it for our own Primary. 🙂 Thanks for sharing my invites. I also just posted Program covers as well. Thanks! Sheena Perron recently posted… {Primary} 2015 Primary Program Cover

Sheena how do you get all this done?! You amaze me!! Thanks for the comment 🙂

We have over 150 kids in our Primary and it feels like all the adults have a primary calling so it pretty much turns into a ward program! It’s always been my favorite Sunday of the year and I’m most excited for it this year since my daughter is a Sunbeam!!

150 kids Tia? Holy Moley!! Phew, extra blessings on that primary president’s head!! The first time you have a kid in the program is so fun 🙂

I love your ideas! I will totally use your ticket idea for our rehearsal. Thanks!!

Let me know how it goes Tracy! I love to learn from each other. How did people do their callings before the internet?!

Thanks for the ideas! We are a new presidency so any ideas for the program are appreciated! I love the raffle ticket ideas! With 100 kids it can get overwhelming for us and the teachers!

100 kids?? Wow! Good luck Natalie, fitting them on the stage will be probably be the hardest part!

These are all great tips! Writing the program seems overwhelming to me, but you make it sound doable! Amberly recently posted… Tips for Planning Your First Baby Free Vacation

Thanks for the supportive comment Amberly- and have a great weekend with your hubby 🙂

Great idea to have extra parts just in case. This year the Primary Presidency in our ward gave the assignment to each of the teachers so I have to figure out what my class is doing for the program. I have no idea yet since I don’t know how the rest of the program is going. I’m going to check out your script for ideas! Thanks.

Oh that’s really hard Camille! Did they assign you a month to cover or something??

Yeah, mine is the month about the Holy Ghost.

I did the raffle ticket thing (reverence tickets) as a general reverence program when I was Primary President. Then we did the prizes and a pizza party at the end of the year and it was a huge hit!

Thanks for writing a script, I always appreciated those who shared their hard work since it was one of the harder parts of my calling for me! Pinning this. Lara recently posted… What To Do When Decluttering Really Hurts

Did you do the pizza party on a sunday or a different day Lara?

We did it as a primary activity on a Saturday. Lara recently posted… What To Do When Decluttering Really Hurts

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Love these ideas!! Thanks for all the help. I love collaborating with all you wonderful ladies that are willing to share your ideas. Couldn’t do my job all by myself!!

I totally agree Jen! I could never do my calling without my amazing counselors and… THE INTERNET! 😉 Thanks for taking time to comment.

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We practice in the Chapel 2 weeks in a row… Would you do the raffle ticket two weeks in a row… getting prizes each week? Or see how many tickets they earn for 2 weeks? It just seems like kids need INSTANT rewards to keep them interested? Just wondering what you smart ladies would do?

Hi Sheri!! My plan is to to do prizes both weeks. They can earn up to 3 tickets each practice and every prize will be worth 1 ticket. So even if they only earn 1 ticket that day they can still pick out one prize. I am going to say they have to spend all their tickets and they can’t save them for the next week. Otherwise I think i’ll end up with kids in tears the second week “i lost my tickets” etc. So they can earn 6 prizes total in the end, 3 each week. Am I making any sense??

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I love all your ideas especially the raffle, grrat reward idea. I am a convert and when I first got assigned to write the program I was like what are you talking about. Never seen one before. I went to the Internet and found a ton of wonderful primary presidencies that posted their programs. The first one was a learning experience. The second one I was ready for. I started writing it at the beginning of the year so I wasn’t so slammed when the time came. The changes I made to make it run smooth were quite a few.

So I designed a seating chart of the stage in the chapel and assigned seats according to parts. We had about 60 kids and each one had their own part. I did each section according to the classes. The valiant 10 and 11 kids had to write a 1 minute talk, I gave them the topic and they wrote it and brought it to me so the Bishop could approve it. So at the end of each section one of the big kids would come give a talk.

I also made a filp chart that me and another counselor would hold in front of us to tell the kids what song we are singing next and which class would come up next. We also asked a volunteer to help the chorister to motion for the kids to stand and sit, so we had one person on each side so everyone could see. We had two sets of step stools for the kids because the small one was not big enough for the little sunbeams. I also put name tags on seats for rehearsal so it was less hectic.

And lastly we had the valiant classes sit on the stage for sacrament so the only ones that had to come up were the little kids. That worked out great and was very quick.

I just got called as president 2 months ago and I am actually looking forward to another program and getting to put my spin on it. This will be my 5th one in 6 years, not as president yet but as a counselor and secretary. Good luck everyone and thank you so much for making life easier by posting this stuff. Thank you

Those are some fantastic ideas! I like the idea of having one talk at the end of each section. Thanks for sharing Sabrina!

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The Lesson Helps available at Latterday Village for Primary 6 contain several activities and games to engage your class in the lesson as well as other materials prepared to assist you as you teach. 

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• a Jenga based puzzle and non Jenga option

Our helps for "Lesson 22: Israel and the Brass Serpent " include:

• Lesson title poster
• materials for the attention activity 
• an activity to use with an enrichment activity about the attributes of a humble person
• an activity to use with the enrichment activity that has the children act out scenarios where is a person is either humble or not humble. 
• participation type award for the humility skits

Our helps for "Lesson 21: The Ten Commandments " include:

• an activity to help the children understand the ten commandments 

These printables are included in this fun Sunbeam Lesson Packet:

Our helps for "Lesson 20: The Israelites Receive Food from Heaven " include:

• an activity themed after the lesson material - with board strips
• enrichment activity based visual activity

Our helps for "Lesson 19: Moses Delivers the Israelites from Bondage" include:

• A couple scripture memory games for the 5th article of faith
• board strip visuals for an enrichment activity
• related handout

Sunbeam Lesson 17 printables:

Our helps for "Lesson 18: The Birth and Calling of Moses" include:

• Moses Scrabble
• Primary Scripture Search
• Board Strips
• Quick Overview Story Script
• Title Poster
• Moses Worksheets

Our helps for "Lesson 17: Joseph Forgives His Brothers" include:

• an activity for memorizing a couple of scriptures from the lesson;
• an activity for an enrichment activity
• a handout based on an enrichment activity 

Our helps for "Lesson 16: Joseph in Egypt" include:

• an activity for reviewing a number of important scriptures from the lesson
• a game that covers several enrichment activities from the lesson and can be played when going over the discussion and application questions
• an activity for reviewing an important scripture from the lesson.  

Our helps for "Lesson 15: Joseph Was Sold into Egypt" include:

• a couple of games for memorizing scriptures related to the lesson
• a handout that relates to a couple of the enrichment activities

Activity and Coloring Page

Our helps for "Lesson 14: Jacob and His Family" include:

• games for a couple enrichment activities

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• a game based on the attention activity
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Super Cute Printables and a special audio file for Primary 1 Chapter 12!

Lesson helps for Sunbeams Primary 1

Our helps for "Lesson 12: Isaac and Rebekah" include:

• a couple of activities based on the Enrichment activities from the lesson 
• a quote poster from one of the quotes from the manual and smaller handouts

Our helps for "Lesson 45 - The Gift of the Atonement (Easter Lesson)" include:

• a PowerPoint presentation that covers the lesson subject, as well as related questions and scriptures

Our helps for "Lesson 11: Abraham and Isaac" include:

• a couple games for reviewing and memorizing a key scripture from the lesson;
• a game to go along with an Enrichment activity for the lesson

Our helps for "Lesson 10: Abraham and Lot" include:

• a handout made to go with an enrichment activity from the lesson
• materials to do another Enrichment activity from the lesson

LDS Primary Sunbeam lesson helps

Sunbeam Lesson Helps

Our helps for "Lesson 9: Jehovah Makes Covenants with Abraham" include:

• a game for covering each of the promises (covenants) made with Abraham
• a game for discussing ways each class member can prepare to share the gospel
• a game for discussing ways each class member can be a missionary now

Our helps for "Lesson 8: Noah and the Flood" include:

• a game for memorizing a key scripture from the lesson;
• a competitive game based on the lesson topic
• a handout to go with one of the enrichment activities 

Primary 1 Sunbeam's lesson 7 helps include

Our helps for "Lesson 7: Enoch and a Zion People" include:

• a game for memorizing and reviewing the tenth Article of Faith;
• an activity based on one of the enrichment activities 

• Open access
• Published: 15 May 2024

Expert assessment of ChatGPT’s ability to generate illness scripts: an evaluative study

• Yasutaka Yanagita 1 ,
• Daiki Yokokawa 1 ,
• Fumitoshi Fukuzawa 1 ,
• Shun Uchida 2 ,
• Takanori Uehara 1 &
• Masatomi Ikusaka 1  

BMC Medical Education volume  24 , Article number:  536 ( 2024 ) Cite this article

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An illness script is a specific script format geared to represent patient-oriented clinical knowledge organized around enabling conditions, faults (i.e., pathophysiological process), and consequences. Generative artificial intelligence (AI) stands out as an educational aid in continuing medical education. The effortless creation of a typical illness script by generative AI could help the comprehension of key features of diseases and increase diagnostic accuracy. No systematic summary of specific examples of illness scripts has been reported since illness scripts are unique to each physician.

This study investigated whether generative AI can generate illness scripts.

We utilized ChatGPT-4, a generative AI, to create illness scripts for 184 diseases based on the diseases and conditions integral to the National Model Core Curriculum in Japan for undergraduate medical education (2022 revised edition) and primary care specialist training in Japan. Three physicians applied a three-tier grading scale: “A” denotes that the content of each disease’s illness script proves sufficient for training medical students, “B” denotes that it is partially lacking but acceptable, and “C” denotes that it is deficient in multiple respects.

By leveraging ChatGPT-4, we successfully generated each component of the illness script for 184 diseases without any omission. The illness scripts received “A,” “B,” and “C” ratings of 56.0% (103/184), 28.3% (52/184), and 15.8% (29/184), respectively.

Useful illness scripts were seamlessly and instantaneously created using ChatGPT-4 by employing prompts appropriate for medical students. The technology-driven illness script is a valuable tool for introducing medical students to key features of diseases.

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Introduction

An illness script is defined as a specific script format geared to represent patient-oriented clinical knowledge organized around enabling conditions, faults (i.e., pathophysiological process), and consequences [ 1 ]. This script encompasses key elements of diseases. such as pathophysiology, epidemiology, time course, symptoms and signs, diagnosis, and treatment [ 2 ]. An illness script is the cognitive structure of a clinician's knowledge of a disease, which is formed based on personal experience, formal learning, and clinical practice. This allows physicians to efficiently organize and pull complex information from memory to aid in diagnosis [ 1 , 3 ].

Reports suggest that leveraging illness scripts can improve the instruction of clinical reasoning and serve as an effective method for refining the learner’s clinical reasoning skills [ 4 , 5 , 6 ]. Therefore, illness scripts increase diagnostic accuracy and are useful for continuing medical education [ 7 ].

Conversely, the clinical application of illness scripts is not straightforward. Clinicians iteratively enhance their illness scripts through their clinical practice and by encountering various cases, including those considered atypical. Illness scripts are not static, that is, they refine and develop as clinicians enhance their skills.

Therefore, no standardized illness scripts exist for any disease, and creating them for educational purposes is time-consuming. Hence, our focus on large language models (LLMs), is due to the notable progress achieved in natural language processing using generative pretrained transformers (GPT) [ 8 ]. Although generative AI, as typified by ChatGPT-4, was not explicitly designed for medical applications, previous research has showcased ChatGPT-4’s capability to successfully pass medical licensing examinations in the United States and Japan [ 9 , 10 ]. It has contributed to generating differential diagnosis lists from patient histories [ 11 ], clinical vignettes [ 12 ], and intervened in various aspects of medicine. Furthermore, the potential of AI models in specialized medical education and practice is acknowledged [ 13 ]. ChatGPT was utilized to generate initial drafts of United States Medical Licensing Examination-style, multiple-choice items [ 14 ].

With the rapid progress of AI technology, if a generative AI tool, such as ChatGPT-4, could be used to generate illness scripts that are beneficial in understanding the key features of diseases, this could be applied to medical education.

No research has delved into the automated generation of illness scripts tailored to individual diseases. Furthermore, the output’s accuracy becomes critical when integrating such technologies into the medical domain due to the implications for disease diagnosis and treatment. This study attempts to investigate that ChatGPT can create an illness script that contains sufficient information for medical students to learn about diseases. Since ChatGPT-4 is known to generate incorrect information, three board-certified physicians assessed whether ChatGPT-4 can adeptly generate an illness script containing adequate information.

Study design

Focusing on the illnesses and conditions integral to the Japanese National Model Core Curriculum for undergraduate medical education (2022 revised edition) [ 15 ] and primary care training program in Japan [ 16 ], the illness scripts for 184 diseases were systematically generated using ChatGPT-4. Subsequently, three board-certified general physicians (YY, SU, and FF) assessed if the generated output reached the level required for graduating medical students. Finally, each illness script was graded on a three-point scale, that is, “A” denotes that the content proved sufficient for medical students, “B” denoted that it exhibited partial inadequacy, and “C” denotes that it was deemed inadequate in multiple aspects.

Large language model environment

The illness scripts were generated on July 25, 2023, using the July 20 version of GPT-4 (OpenAI, San Francisco, California, USA). GPT is a large language model (LLM) developed by OpenAI for natural language processing. Its dynamic response generation is based on probabilities the neural network derives from learned syntactic and semantic relationships in the text [ 17 ].

Selecting diseases for illness scripts

Commonly and frequently encountered diseases were selected due to their importance for medical students. Considering that the diseases managed in primary care overlap with those that medical students should learn about, the diseases studied in primary care training in Japan [ 16 ] were used as a reference. Among the 205 disease and symptom items representing the 16 areas targeted for appropriate management in primary care [ 16 ], 184 were identified as sufficiently relevant for the creation of the illness script. These diseases are included in the National Model Core Curriculum in Japan for undergraduate medical education (2022 revised edition) [ 15 ].

Physicians YY, SU, and FF established the exclusion criteria through collaborative discussions and excluded 21 items with minimal diagnostic contribution or mere symptomatology. Seventeen items (e.g., those associated with palliative care or non-critical symptoms, such as lower back pain) were omitted because they lacked the specificity for script creation. Furthermore, four items related to community-acquired pneumonia, herpes encephalitis, herpes infections, and adrenal insufficiency were excluded because they were pertinent to the input examples in the prompt. The English names for the 184 selected items were entered into the prompt based on the International Classification of Diseases, 11th Revision (ICD-11) [ 18 ] registered disease names ( Supplementary Material ).

Content to be entered into ChatGPT-4, program code

The prompts for ChatGPT-4 were carefully engineered to ensure their interpretability by generative AI while succinctly defining the desired outputs [ 19 ]. The output items referencing the proposed elements of illness scripts [ 2 ] were determined after discussions facilitated by one board-certified physician (YY) and fellow of internal medicine (DY). The input-specified key elements of the illness scripts included pathophysiology, epidemiology, time course, signs and symptoms, diagnosis, and treatment. The character limit per item was set at less than 50 characters, based on findings from prior illness scripts [ 2 ] and the general requirement that an average of 20–30 words per English sentence could be generated. Three output examples (community-acquired pneumonia, herpes zoster, and primary adrenal insufficiency) were added after key elements. The structured prompt for ChatGPT-4 was: [Create an illness script for < disease name > . List the following items in less than 50 characters each: [pathophysiology][epidemiology][time course][Symptoms and Signs][Diagnostics][and treatment]. The following is a reference example of an illness script. Example1), Example2), Example3)] (Fig.  1 ). This prompt was entered into ChatGPT once, and the output information was evaluated. No additional prompts were entered to indicate modifications.

Screenshot of the prompt input

A broader evaluation was conducted by physicians YY, SU, and FF to assess the generated illness script’s utility for medical students.

Following a discussion among the three evaluators, the usefulness of the illness scripts in this study was defined as the level at which each item contained the minimum amount of required information and would not cause inconvenience to a medical student learning to use the illness scripts for the first time. Initially, screening was conducted by physician YY to ensure that the output included the essential elements of the illness script: pathophysiology, epidemiology, time course, symptoms and signs, diagnosis, and treatment. Subsequently, the three evaluators rated the illness scripts with all output items on a five-point scale. The evaluation was structured on a five-point scale, where 1 denotes “not at all useful, needs overall revision,” and 5 denotes “very useful, no additional modifications needed.” To achieve a structured assessment, each item was evaluated considering the age and mode of onset, typical symptoms, essential diagnostic examinations, standard treatment, and adequacy of the course of treatment. Failure to meet these items resulted in a point deduction. The rating of each evaluator was summed, and each illness script was scored on a 15-point scale. Composite scores were categorized into three levels: 15, 14, and 13 or less, corresponding to “A,” “B,” and “C,” respectively. Moreover, any identified deficiencies in the illness scripts were discussed during the evaluation. Consequently, an “A” rating signifies a script that proved sufficiently informative for medical students and required no further modification, “B” is a script that was partially sufficient or required minor revision but was acceptable. “C” represents a script that was inadequate in several respects and necessitated multiple revisions. Then, we discussed the reasons for discrepancies in the evaluations and identified the main aspects that were lacking in the creation of the illness scripts by ChatGPT, along with considerations for their educational application.

Ethical considerations

This study did not involve human or animal participants, thereby obviating the need for ethical approval.

The illness scripts for all 184 target diseases were successfully generated using ChatGPT-4. Each script incorporated the following specified elements: pathophysiology, epidemiology, time course, signs and symptoms, diagnosis, and treatment, strictly following the prompt instructions. The distribution of the ratings among the evaluated scripts revealed that 56.0% (103/184) were rated “A,” 28.3% (52/184) were “B,” and 15.8% (29/184) were “C”. Examples of the illness scripts with “A” and “C” ratings are presented in Figs.  2 and 3 , respectively. Table 1 lists the breakdown of evaluations across different categories. Cardiovascular and psychiatric systems had the highest number of “C” ratings.

Example of an A-rated illness script

Example of a C-rated illness script

Deficiencies in the output of ChatGPT-4’s illness scripts were identified during a comprehensive discussion among physicians YY, SU, and FF, focusing on the deduced points. The deficiencies identified within each component of the illness script are outlined as follows:

Pathophysiology:

Droplet transmission for varicella was incorrectly indicated as a route of infection.

Epidemiology:

The phrase “Risk: Age” was unclear regarding the specific age group to which it referred.

Genetic diseases, such as the von Willebrand disease, lacked the associated family history.

Phrases, such as “more common in certain ethnic groups”, were deemed too vague.

Time course:

The duration of a single attack for cluster headaches was not mentioned besides the symptomatic period.

Diagnostics:

Outputs were criticized for being too generic, such as “refer to guidelines” or “exclude similar conditions.”

In mitral valve insufficiency and aortic valve stenosis, “Heart murmur on auscultation” was described but the type of murmur was not specified.

A paper bag (no longer recommended, especially for adults) was generated for hyperventilation syndrome.

Inappropriate antibiotic treatment was generated for non-purulent mastitis.

The use of the abbreviation VNS was noted for treating epileptic encephalopathy.

The treatment for tension headaches is listed as NSAIDs or triptans, but only “use prophylaxis if the frequency is high.” Limited and contradictory data exist concerning the effectiveness of triptans in treating tension-type headaches.

In abdominal aortic aneurysms, the description is “monitor small aneurysms, surgical repair (open or endovascular) for large or rapidly growing aneurysms.” The definitions of small and large are unclear.

We utilized ChatGPT-4 to construct easily comprehensible illness scripts for 184 diseases based on the topics covered in the Japanese National Model Core Curriculum for undergraduate medical education (2022 revised edition) [ 15 ] and primary care residency programs in Japan [ 16 ]. The three physicians assigned an “A” rating to 56% of the developed illness scripts, signifying their adequacy. More than half of the generated illness scripts required no changes. Furthermore, 28.3% were rated “B,” indicating partial sufficiency with potential usability after minor revisions and additions. The “A” and “B” ratings (i.e., approximately 84% of the illness scripts) demonstrated relatively high accuracy.

The illness scripts rated as “B” exhibited specific characteristics, such as omitting family history as a crucial risk factor for genetic diseases. In the case of tension headache, the preventive treatment was only indicated if the frequency was high, suggesting the need for more specificity in the output. However, given that one reviewer found the content partially insufficient while the others deemed it sufficient, the overall content was arguably adequate for medical students. A potential solution to address this variability is by adjusting the content of prompts (e.g., character limit restrictions) [ 19 ].

The illness scripts receiving a "C" rating lacked critical information for diagnosis, such as missing essential symptoms or tests. The rater observed that the valvular disease illness script should describe the presence of a heart murmur and the type of murmur. This assessment indicates a potential influence from the learning material on which the generative AI was trained [ 20 ]. The information on the web on valvular disease is expected to be described only in the presence or absence of a heart murmur, leading to inadequate AI output. These errors can occur in a certain percentage of outputs when generating large volumes of content.

Notably, the prevalence of “A” and “B” ratings was observed on the 16 areas regarding the accuracy of illness scripts across different diseases. However, the cardiovascular and psychiatric scripts exhibited a higher proportion of “C” ratings. A more explicit description was required to treat abdominal aortic aneurysms because of variations in the treatment approaches, which is based on the aneurysm size. In the psychiatric system, outputs, such as “diagnosis based primarily on clinical interview and symptom criteria (DSM-5)”, were considered considerably general and lacking specificity. Constraints on the item’s character count may have contributed to the challenge of providing detailed information, particularly given the multifaceted nature of cardiovascular assessments and the wide variety of psychiatric symptoms. Analyzing the illness scripts’ outputs, we could observe that the compilation of symptoms and tests did not consider the frequency of symptoms or the sensitivity of the tests.

This study employed a straightforward input approach to ChatGPT-4, specifying three examples of illness scripts in the prompt to control the output standard. To ensure that each item was within 20–30 words, a pilot study was conducted for verification, and the prompt was set to input 50 Japanese characters. As a result, there was one item that had a maximum length of 22 words, while the other items were within 20 words. However, several illness scripts lacked essential details since the character limits were set for each item to minimize redundant information. Adjusting the character limits for prompts or prioritizing symptoms based on frequency could improve the output for specific diseases or conditions. Furthermore, modifying the character count may allow more accurate illness scripts to be created, especially for complex systems, such as the cardiovascular system, which have many “C” ratings. Moreover, several methods are employed for refining the scripts, including changing the number of characters for each item and specifying the data to be referenced in the interactive exchange between the script and ChatGPT [ 21 ].

Previous studies reported that various medical information generated using AI has been reported and is increasingly applied to the medical field [ 22 , 23 ]. Considering this, the illness scripts generated in this study can be used in the field of medical education in the future. A previous study reported that clinical vignettes created by ChatGPT are comparable to those created by human authors [ 24 ]. Although concerns persist regarding copyright issues and the medical accuracy of content generated by generative AI systems [ 25 ], careful consideration and appropriate use can significantly expand their utility. Medical educators can curate outputs, enabling generative AI to be utilized in delivering educational information to students [ 26 ]. This tool would reduce the burden on educators, who could focus on other educational content. In addition, students may be able to create content based on their own level of understanding by teaching them how to generate illness scripts. However, greatly relying on such convenience may lead to various issues. The biggest disadvantage of using such systems is that students may believe in all the output content without critically analyzing its accuracy [ 27 ].

Extending the illness script concept [ 28 ] to other potential applications across the healthcare field is presently being investigated. We expect that more accurate illness script generation will be achieved in the future, and the prompt of ChatGPT may be customized by the educators [ 29 ]. AI could play a pivotal role in providing valuable insights and information by generating these extended illness scripts.

This study has several limitations. First, the evaluation was conducted based on the GPT-4 version available from July 25, 2023. Given that further updates are anticipated, continuous evaluation is necessary.

Second, the absence of clear standards for evaluating illness scripts is noteworthy. This study relied on the subjective assessments of three physicians, and results might vary if evaluated by physicians from other specialties.

Third, the utility was evaluated based on the potential benefit of illness scripts to medical students. We did not verify the usefulness for educators or specialists in various fields, indicating an avenue for future research.

Generative AI enables the swift and seamless production of illness scripts. While the results must be carefully reviewed, the potential applications of this technology in medical education are evident. AI-generated illness scripts are useful for medical students and for developing and refining their own scripts.

Availability of data and materials

Data on the results of this study are available from the corresponding author (YY) upon reasonable request.

Abbreviations

Artificial intelligence

Large language models

Generative pretrained transformer

International classification of diseases 11th revision

Diagnostic and statistical manual of mental disorders-5

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Acknowledgements

We are greatly grateful to the Department of General Medicine members in the Chiba University Hospital for their support.

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Yasutaka Yanagita, Daiki Yokokawa, Fumitoshi Fukuzawa, Takanori Uehara & Masatomi Ikusaka

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YY, DY, and MI designed and coordinated the study. YY, DY, FF, and SU conducted the data analysis and interpretation. YY, DY, and MI drafted the manuscript. SU, FF, and UT revised it for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Yanagita, Y., Yokokawa, D., Fukuzawa, F. et al. Expert assessment of ChatGPT’s ability to generate illness scripts: an evaluative study. BMC Med Educ 24 , 536 (2024). https://doi.org/10.1186/s12909-024-05534-8

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