Daily Papers

Large Language Models (LLMs) have demonstrated considerable potential in general practice. However, existing benchmarks and evaluation frameworks primarily depend on exam-style or simplified question-answer formats, lacking a competency-based structure aligned with the real-world clinical responsibilities encountered in general practice. Consequently, the extent to which LLMs can reliably fulfill the duties of general practitioners (GPs) remains uncertain. In this work, we propose a novel evaluation framework to assess the capability of LLMs to function as GPs. Based on this framework, we introduce a general practice benchmark (GPBench), whose data are meticulously annotated by domain experts in accordance with routine clinical practice standards. We evaluate ten state-of-the-art LLMs and analyze their competencies. Our findings indicate that current LLMs are not yet ready for deployment in such settings without human oversight, and further optimization specifically tailored to the daily responsibilities of GPs is essential.

Skin conditions affect an estimated 1.9 billion people worldwide. A shortage of dermatologists causes long wait times and leads patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in referral errors, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 skin conditions that represent roughly 80% of the volume of skin conditions seen in primary care. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively. For a random subset of the validation set (n=963 cases), 18 clinicians reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs. These results highlight the potential of the DLS to augment general practitioners to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

Integrating Large Language Models (LLMs) in healthcare diagnosis demands systematic frameworks that can handle complex medical scenarios while maintaining specialized expertise. We present KG4Diagnosis, a novel hierarchical multi-agent framework that combines LLMs with automated knowledge graph construction, encompassing 362 common diseases across medical specialties. Our framework mirrors real-world medical systems through a two-tier architecture: a general practitioner (GP) agent for initial assessment and triage, coordinating with specialized agents for in-depth diagnosis in specific domains. The core innovation lies in our end-to-end knowledge graph generation methodology, incorporating: (1) semantic-driven entity and relation extraction optimized for medical terminology, (2) multi-dimensional decision relationship reconstruction from unstructured medical texts, and (3) human-guided reasoning for knowledge expansion. KG4Diagnosis serves as an extensible foundation for specialized medical diagnosis systems, with capabilities to incorporate new diseases and medical knowledge. The framework's modular design enables seamless integration of domain-specific enhancements, making it valuable for developing targeted medical diagnosis systems. We provide architectural guidelines and protocols to facilitate adoption across medical contexts.

Deep neural networks are often applied to medical images to automate the problem of medical diagnosis. However, a more clinically relevant question that practitioners usually face is how to predict the future trajectory of a disease. Current methods for prognosis or disease trajectory forecasting often require domain knowledge and are complicated to apply. In this paper, we formulate the prognosis prediction problem as a one-to-many prediction problem. Inspired by a clinical decision-making process with two agents -- a radiologist and a general practitioner -- we predict prognosis with two transformer-based components that share information with each other. The first transformer in this framework aims to analyze the imaging data, and the second one leverages its internal states as inputs, also fusing them with auxiliary clinical data. The temporal nature of the problem is modeled within the transformer states, allowing us to treat the forecasting problem as a multi-task classification, for which we propose a novel loss. We show the effectiveness of our approach in predicting the development of structural knee osteoarthritis changes and forecasting Alzheimer's disease clinical status directly from raw multi-modal data. The proposed method outperforms multiple state-of-the-art baselines with respect to performance and calibration, both of which are needed for real-world applications. An open-source implementation of our method is made publicly available at https://github.com/Oulu-IMEDS/CLIMATv2.

In medical applications, deep learning methods are built to automate diagnostic tasks. However, a clinically relevant question that practitioners usually face, is how to predict the future trajectory of a disease (prognosis). Current methods for such a problem often require domain knowledge, and are complicated to apply. In this paper, we formulate the prognosis prediction problem as a one-to-many forecasting problem from multimodal data. Inspired by a clinical decision-making process with two agents -- a radiologist and a general practitioner, we model a prognosis prediction problem with two transformer-based components that share information between each other. The first block in this model aims to analyze the imaging data, and the second block leverages the internal representations of the first one as inputs, also fusing them with auxiliary patient data. We show the effectiveness of our method in predicting the development of structural knee osteoarthritis changes over time. Our results show that the proposed method outperforms the state-of-the-art baselines in terms of various performance metrics. In addition, we empirically show that the existence of the multi-agent transformers with depths of 2 is sufficient to achieve good performances. Our code is publicly available at https://github.com/MIPT-Oulu/CLIMAT.

We present Welzijn.AI as new digital solution for monitoring (mental) well-being in elderly populations, and illustrate how development of systems like Welzijn.AI can align with guidelines on responsible AI development. Three evaluations with different stakeholders were designed to disclose new perspectives on the strengths, weaknesses, design characteristics, and value requirements of Welzijn.AI. Evaluations concerned expert panels and involved patient federations, general practitioners, researchers, and the elderly themselves. Panels concerned interviews, a co-creation session, and feedback on a proof-of-concept implementation. Interview results were summarized in terms of Welzijn.AI's strengths, weaknesses, opportunities and threats. The co-creation session ranked a variety of value requirements of Welzijn.AI with the Hundred Dollar Method. User evaluation comprised analysing proportions of (dis)agreement on statements targeting Welzijn.AI's design characteristics, and ranking desired social characteristics. Experts in the panel interviews acknowledged Welzijn.AI's potential to combat loneliness and extract patterns from elderly behaviour. The proof-of-concept evaluation complemented the design characteristics most appealing to the elderly to potentially achieve this: empathetic and varying interactions. Stakeholders also link the technology to the implementation context: it could help activate an individual's social network, but support should also be available to empower users. Yet, non-elderly and elderly experts also disclose challenges in properly understanding the application; non-elderly experts also highlight issues concerning privacy. In sum, incorporating all stakeholder perspectives in system development remains challenging. Still, our results benefit researchers, policy makers, and health professionals that aim to improve elderly care with technology.

Medical Large Vision-Language Models (Med-LVLMs) have shown strong potential in multimodal diagnostic tasks. However, existing single-agent models struggle to generalize across diverse medical specialties, limiting their performance. Recent efforts introduce multi-agent collaboration frameworks inspired by clinical workflows, where general practitioners (GPs) and specialists interact in a fixed sequence. Despite improvements, these static pipelines lack flexibility and adaptability in reasoning. To address this, we propose MMedAgent-RL, a reinforcement learning (RL)-based multi-agent framework that enables dynamic, optimized collaboration among medical agents. Specifically, we train two GP agents based on Qwen2.5-VL via RL: the triage doctor learns to assign patients to appropriate specialties, while the attending physician integrates the judgments from multi-specialists and its own knowledge to make final decisions. To address the inconsistency in specialist outputs, we introduce a curriculum learning (CL)-guided RL strategy that progressively teaches the attending physician to balance between imitating specialists and correcting their mistakes. Experiments on five medical VQA benchmarks demonstrate that MMedAgent-RL not only outperforms both open-source and proprietary Med-LVLMs, but also exhibits human-like reasoning patterns. Notably, it achieves an average performance gain of 20.7% over supervised fine-tuning baselines.

With the growing utilization of large language models (LLMs) across domains, alignment towards human preferences has become one of the most critical aspects of training models. At the forefront of state-of-the-art human alignment methods are preference optimization methods (*PO). However, prior research has often concentrated on identifying the best-performing method, typically involving a grid search over hyperparameters, which can be impractical for general practitioners. In this paper, we aim to identify the algorithm that, while being performant, is simultaneously more robust to varying hyperparameters, thereby increasing the likelihood of achieving better results. We focus on a realistic out-of-distribution (OOD) scenario that mirrors real-world applications of human alignment, offering practical insights into the strengths and weaknesses of these methods. Furthermore, to better understand the shortcomings of generations from the different methods, we analyze the model generations through the lens of KL divergence of the SFT model and the response length statistics. Our analysis reveals that the widely adopted DPO method consistently produces lengthy responses of inferior quality that are very close to the SFT responses. Motivated by these findings, we propose an embarrassingly simple extension to the DPO algorithm, LN-DPO, resulting in more concise responses without sacrificing quality compared to the policy obtained by vanilla DPO.

Neuroimage processing tasks like segmentation, reconstruction, and registration are central to the study of neuroscience. Robust deep learning strategies and architectures used to solve these tasks are often similar. Yet, when presented with a new task or a dataset with different visual characteristics, practitioners most often need to train a new model, or fine-tune an existing one. This is a time-consuming process that poses a substantial barrier for the thousands of neuroscientists and clinical researchers who often lack the resources or machine-learning expertise to train deep learning models. In practice, this leads to a lack of adoption of deep learning, and neuroscience tools being dominated by classical frameworks. We introduce Neuralizer, a single model that generalizes to previously unseen neuroimaging tasks and modalities without the need for re-training or fine-tuning. Tasks do not have to be known a priori, and generalization happens in a single forward pass during inference. The model can solve processing tasks across multiple image modalities, acquisition methods, and datasets, and generalize to tasks and modalities it has not been trained on. Our experiments on coronal slices show that when few annotated subjects are available, our multi-task network outperforms task-specific baselines without training on the task.

The optimization of expensive-to-evaluate black-box functions is prevalent in various scientific disciplines. Bayesian optimization is an automatic, general and sample-efficient method to solve these problems with minimal knowledge of the underlying function dynamics. However, the ability of Bayesian optimization to incorporate prior knowledge or beliefs about the function at hand in order to accelerate the optimization is limited, which reduces its appeal for knowledgeable practitioners with tight budgets. To allow domain experts to customize the optimization routine, we propose ColaBO, the first Bayesian-principled framework for incorporating prior beliefs beyond the typical kernel structure, such as the likely location of the optimizer or the optimal value. The generality of ColaBO makes it applicable across different Monte Carlo acquisition functions and types of user beliefs. We empirically demonstrate ColaBO's ability to substantially accelerate optimization when the prior information is accurate, and to retain approximately default performance when it is misleading.

Segmenting text into fine-grained units of meaning is important to a wide range of NLP applications. The default approach of segmenting text into sentences is often insufficient, especially since sentences are usually complex enough to include multiple units of meaning that merit separate treatment in the downstream task. We focus on the task of abstractive proposition segmentation: transforming text into simple, self-contained, well-formed sentences. Several recent works have demonstrated the utility of proposition segmentation with few-shot prompted LLMs for downstream tasks such as retrieval-augmented grounding and fact verification. However, this approach does not scale to large amounts of text and may not always extract all the facts from the input text. In this paper, we first introduce evaluation metrics for the task to measure several dimensions of quality. We then propose a scalable, yet accurate, proposition segmentation model. We model proposition segmentation as a supervised task by training LLMs on existing annotated datasets and show that training yields significantly improved results. We further show that by using the fine-tuned LLMs as teachers for annotating large amounts of multi-domain synthetic distillation data, we can train smaller student models with results similar to the teacher LLMs. We then demonstrate that our technique leads to effective domain generalization, by annotating data in two domains outside the original training data and evaluating on them. Finally, as a key contribution of the paper, we share an easy-to-use API for NLP practitioners to use.

In software maintenance, bug reproduction is essential for effective fault localization and repair. Manually writing reproduction scripts is a time-consuming task with high requirements for developers. Hence, automation of bug reproduction has increasingly attracted attention from researchers and practitioners. However, the existing studies on bug reproduction are generally limited to specific bug types such as program crashes, and hard to be applied to general bug reproduction. In this paper, considering the superior performance of agent-based methods in code intelligence tasks, we focus on designing an agent-based framework for the task. Directly employing agents would lead to limited bug reproduction performance, due to entangled subtasks, lengthy retrieved context, and unregulated actions. To mitigate the challenges, we propose an Automated gEneral buG reproductIon Scripts generation framework, named AEGIS, which is the first agent-based framework for the task. AEGIS mainly contains two modules: (1) A concise context construction module, which aims to guide the code agent in extracting structured information from issue descriptions, identifying issue-related code with detailed explanations, and integrating these elements to construct the concise context; (2) A FSM-based multi-feedback optimization module to further regulate the behavior of the code agent within the finite state machine (FSM), ensuring a controlled and efficient script generation process based on multi-dimensional feedback. Extensive experiments on the public benchmark dataset show that AEGIS outperforms the state-of-the-art baseline by 23.0% in F->P metric. In addition, the bug reproduction scripts generated by AEGIS can improve the relative resolved rate of Agentless by 12.5%.

General-purpose pre-trained models ("foundation models") have enabled practitioners to produce generalizable solutions for individual machine learning problems with datasets that are significantly smaller than those required for learning from scratch. Such models are typically trained on large and diverse datasets with weak supervision, consuming much more training data than is available for any individual downstream application. In this paper, we describe the Visual Navigation Transformer (ViNT), a foundation model that aims to bring the success of general-purpose pre-trained models to vision-based robotic navigation. ViNT is trained with a general goal-reaching objective that can be used with any navigation dataset, and employs a flexible Transformer-based architecture to learn navigational affordances and enable efficient adaptation to a variety of downstream navigational tasks. ViNT is trained on a number of existing navigation datasets, comprising hundreds of hours of robotic navigation from a variety of different robotic platforms, and exhibits positive transfer, outperforming specialist models trained on singular datasets. ViNT can be augmented with diffusion-based subgoal proposals to explore novel environments, and can solve kilometer-scale navigation problems when equipped with long-range heuristics. ViNT can also be adapted to novel task specifications with a technique inspired by prompt-tuning, where the goal encoder is replaced by an encoding of another task modality (e.g., GPS waypoints or routing commands) embedded into the same space of goal tokens. This flexibility and ability to accommodate a variety of downstream problem domains establishes ViNT as an effective foundation model for mobile robotics. For videos, code, and model checkpoints, see our project page at https://visualnav-transformer.github.io.

Extending the context window of large language models (LLMs) is getting popular recently, while the solution of augmenting LLMs with retrieval has existed for years. The natural questions are: i) Retrieval-augmentation versus long context window, which one is better for downstream tasks? ii) Can both methods be combined to get the best of both worlds? In this work, we answer these questions by studying both solutions using two state-of-the-art pretrained LLMs, i.e., a proprietary 43B GPT and LLaMA2-70B. Perhaps surprisingly, we find that LLM with 4K context window using simple retrieval-augmentation at generation can achieve comparable performance to finetuned LLM with 16K context window via positional interpolation on long context tasks, while taking much less computation. More importantly, we demonstrate that retrieval can significantly improve the performance of LLMs regardless of their extended context window sizes. Our best model, retrieval-augmented LLaMA2-70B with 32K context window, outperforms GPT-3.5-turbo-16k and Davinci003 in terms of average score on seven long context tasks including question answering and query-based summarization. It also outperforms its non-retrieval LLaMA2-70B-32k baseline by a margin, while being much faster at generation. Our study provides general insights on the choice of retrieval-augmentation versus long context extension of LLM for practitioners.

Tokenization, the division of input text into input tokens, is an often overlooked aspect of the large language model (LLM) pipeline and could be the source of useful or harmful inductive biases. Historically, LLMs have relied on byte pair encoding, without care to specific input domains. With the increased use of LLMs for reasoning, various number-specific tokenization schemes have been adopted, with popular models like LLaMa and PaLM opting for single-digit tokenization while GPT-3.5 and GPT-4 have separate tokens for each 1-, 2-, and 3-digit numbers. In this work, we study the effect this choice has on numerical reasoning through the use of arithmetic tasks. We consider left-to-right and right-to-left tokenization for GPT-3.5 and -4, finding that right-to-left tokenization (enforced by comma separating numbers at inference time) leads to largely improved performance. Furthermore, we find that model errors when using standard left-to-right tokenization follow stereotyped error patterns, suggesting that model computations are systematic rather than approximate. We show that the model is able to convert between tokenizations easily, thus allowing chain-of-thought-inspired approaches to recover performance on left-to-right tokenized inputs. We also find the gap between tokenization directions decreases when models are scaled, possibly indicating that larger models are better able to override this tokenization-dependent inductive bias. In summary, our work performs the first study of how number tokenization choices lead to differences in model performance on arithmetic tasks, accompanied by a thorough analysis of error patterns. We hope this work inspires practitioners to more carefully ablate number tokenization-related choices when working towards general models of numerical reasoning.

Including code in the pre-training data mixture, even for models not specifically designed for code, has become a common practice in LLMs pre-training. While there has been anecdotal consensus among practitioners that code data plays a vital role in general LLMs' performance, there is only limited work analyzing the precise impact of code on non-code tasks. In this work, we systematically investigate the impact of code data on general performance. We ask "what is the impact of code data used in pre-training on a large variety of downstream tasks beyond code generation". We conduct extensive ablations and evaluate across a broad range of natural language reasoning tasks, world knowledge tasks, code benchmarks, and LLM-as-a-judge win-rates for models with sizes ranging from 470M to 2.8B parameters. Across settings, we find a consistent results that code is a critical building block for generalization far beyond coding tasks and improvements to code quality have an outsized impact across all tasks. In particular, compared to text-only pre-training, the addition of code results in up to relative increase of 8.2% in natural language (NL) reasoning, 4.2% in world knowledge, 6.6% improvement in generative win-rates, and a 12x boost in code performance respectively. Our work suggests investments in code quality and preserving code during pre-training have positive impacts.

Common law courts need to refer to similar precedents' judgments to inform their current decisions. Generating high-quality summaries of court judgment documents can facilitate legal practitioners to efficiently review previous cases and assist the general public in accessing how the courts operate and how the law is applied. Previous court judgment summarization research focuses on civil law or a particular jurisdiction's judgments. However, judges can refer to the judgments from all common law jurisdictions. Current summarization datasets are insufficient to satisfy the demands of summarizing precedents across multiple jurisdictions, especially when labeled data are scarce for many jurisdictions. To address the lack of datasets, we present CLSum, the first dataset for summarizing multi-jurisdictional common law court judgment documents. Besides, this is the first court judgment summarization work adopting large language models (LLMs) in data augmentation, summary generation, and evaluation. Specifically, we design an LLM-based data augmentation method incorporating legal knowledge. We also propose a legal knowledge enhanced evaluation metric based on LLM to assess the quality of generated judgment summaries. Our experimental results verify that the LLM-based summarization methods can perform well in the few-shot and zero-shot settings. Our LLM-based data augmentation method can mitigate the impact of low data resources. Furthermore, we carry out comprehensive comparative experiments to find essential model components and settings that are capable of enhancing summarization performance.

This paper explores the use of unstructured, multimodal data, namely text and images, in causal inference and treatment effect estimation. We propose a neural network architecture that is adapted to the double machine learning (DML) framework, specifically the partially linear model. An additional contribution of our paper is a new method to generate a semi-synthetic dataset which can be used to evaluate the performance of causal effect estimation in the presence of text and images as confounders. The proposed methods and architectures are evaluated on the semi-synthetic dataset and compared to standard approaches, highlighting the potential benefit of using text and images directly in causal studies. Our findings have implications for researchers and practitioners in economics, marketing, finance, medicine and data science in general who are interested in estimating causal quantities using non-traditional data.

Neural ranking models (NRMs) have attracted considerable attention in information retrieval. Unfortunately, NRMs may inherit the adversarial vulnerabilities of general neural networks, which might be leveraged by black-hat search engine optimization practitioners. Recently, adversarial attacks against NRMs have been explored in the paired attack setting, generating an adversarial perturbation to a target document for a specific query. In this paper, we focus on a more general type of perturbation and introduce the topic-oriented adversarial ranking attack task against NRMs, which aims to find an imperceptible perturbation that can promote a target document in ranking for a group of queries with the same topic. We define both static and dynamic settings for the task and focus on decision-based black-box attacks. We propose a novel framework to improve topic-oriented attack performance based on a surrogate ranking model. The attack problem is formalized as a Markov decision process (MDP) and addressed using reinforcement learning. Specifically, a topic-oriented reward function guides the policy to find a successful adversarial example that can be promoted in rankings to as many queries as possible in a group. Experimental results demonstrate that the proposed framework can significantly outperform existing attack strategies, and we conclude by re-iterating that there exist potential risks for applying NRMs in the real world.

Generative pre-trained transformer (GPT) models have revolutionized the field of natural language processing (NLP) with remarkable performance in various tasks and also extend their power to multimodal domains. Despite their success, large GPT models like GPT-4 face inherent limitations such as considerable size, high computational requirements, complex deployment processes, and closed development loops. These constraints restrict their widespread adoption and raise concerns regarding their responsible development and usage. The need for user-friendly, relatively small, and open-sourced alternative GPT models arises from the desire to overcome these limitations while retaining high performance. In this survey paper, we provide an examination of alternative open-sourced models of large GPTs, focusing on user-friendly and relatively small models that facilitate easier deployment and accessibility. Through this extensive survey, we aim to equip researchers, practitioners, and enthusiasts with a thorough understanding of user-friendly and relatively small open-sourced models of large GPTs, their current state, challenges, and future research directions, inspiring the development of more efficient, accessible, and versatile GPT models that cater to the broader scientific community and advance the field of general artificial intelligence. The source contents are continuously updating in https://github.com/GPT-Alternatives/gpt_alternatives.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

We present HealthGPT, a powerful Medical Large Vision-Language Model (Med-LVLM) that integrates medical visual comprehension and generation capabilities within a unified autoregressive paradigm. Our bootstrapping philosophy is to progressively adapt heterogeneous comprehension and generation knowledge to pre-trained large language models (LLMs). This is achieved through a novel heterogeneous low-rank adaptation (H-LoRA) technique, which is complemented by a tailored hierarchical visual perception approach and a three-stage learning strategy. To effectively learn the HealthGPT, we devise a comprehensive medical domain-specific comprehension and generation dataset called VL-Health. Experimental results demonstrate exceptional performance and scalability of HealthGPT in medical visual unified tasks. Our project can be accessed at https://github.com/DCDmllm/HealthGPT.

In recent years, there have been significant breakthroughs in the field of natural language processing, particularly with the development of large language models (LLMs). These LLMs have showcased remarkable capabilities on various benchmarks. In the healthcare field, the exact role LLMs and other future AI models will play remains unclear. There is a potential for these models in the future to be used as part of adaptive physician training, medical co-pilot applications, and digital patient interaction scenarios. The ability of AI models to participate in medical training and patient care will depend in part on their mastery of the knowledge content of specific medical fields. This study investigated the medical knowledge capability of LLMs, specifically in the context of internal medicine subspecialty multiple-choice test-taking ability. We compared the performance of several open-source LLMs (Koala 7B, Falcon 7B, Stable-Vicuna 13B, and Orca Mini 13B), to GPT-4 and Claude 2 on multiple-choice questions in the field of Nephrology. Nephrology was chosen as an example of a particularly conceptually complex subspecialty field within internal medicine. The study was conducted to evaluate the ability of LLM models to provide correct answers to nephSAP (Nephrology Self-Assessment Program) multiple-choice questions. The overall success of open-sourced LLMs in answering the 858 nephSAP multiple-choice questions correctly was 17.1% - 25.5%. In contrast, Claude 2 answered 54.4% of the questions correctly, whereas GPT-4 achieved a score of 73.3%. We show that current widely used open-sourced LLMs do poorly in their ability for zero-shot reasoning when compared to GPT-4 and Claude 2. The findings of this study potentially have significant implications for the future of subspecialty medical training and patient care.

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

Recent advancements in Large Language Models (LLMs) have demonstrated their potential in delivering accurate answers to questions about world knowledge. Despite this, existing benchmarks for evaluating LLMs in healthcare predominantly focus on medical doctors, leaving other critical healthcare professions underrepresented. To fill this research gap, we introduce the Examinations for Medical Personnel in Chinese (EMPEC), a pioneering large-scale healthcare knowledge benchmark in traditional Chinese. EMPEC consists of 157,803 exam questions across 124 subjects and 20 healthcare professions, including underrepresented occupations like Optometrists and Audiologists. Each question is tagged with its release time and source, ensuring relevance and authenticity. We conducted extensive experiments on 17 LLMs, including proprietary, open-source models, general domain models and medical specific models, evaluating their performance under various settings. Our findings reveal that while leading models like GPT-4 achieve over 75\% accuracy, they still struggle with specialized fields and alternative medicine. Surprisingly, general-purpose LLMs outperformed medical-specific models, and incorporating EMPEC's training data significantly enhanced performance. Additionally, the results on questions released after the models' training cutoff date were consistent with overall performance trends, suggesting that the models' performance on the test set can predict their effectiveness in addressing unseen healthcare-related queries. The transition from traditional to simplified Chinese characters had a negligible impact on model performance, indicating robust linguistic versatility. Our study underscores the importance of expanding benchmarks to cover a broader range of healthcare professions to better assess the applicability of LLMs in real-world healthcare scenarios.

Breast cancer is a major cause of cancer death among women, emphasising the importance of early detection for improved treatment outcomes and quality of life. Mammography, the primary diagnostic imaging test, poses challenges due to the high variability and patterns in mammograms. Double reading of mammograms is recommended in many screening programs to improve diagnostic accuracy but increases radiologists' workload. Researchers explore Machine Learning models to support expert decision-making. Stand-alone models have shown comparable or superior performance to radiologists, but some studies note decreased sensitivity with multiple datasets, indicating the need for high generalisation and robustness models. This work devises MammoDG, a novel deep-learning framework for generalisable and reliable analysis of cross-domain multi-center mammography data. MammoDG leverages multi-view mammograms and a novel contrastive mechanism to enhance generalisation capabilities. Extensive validation demonstrates MammoDG's superiority, highlighting the critical importance of domain generalisation for trustworthy mammography analysis in imaging protocol variations.